Testimony of Assistant Administrator Nancy E. Lindborg to the House Foreign Affairs Subcommittee on the Middle East & North Africa

Thursday, September 19, 2013

Chairman Ros-Lehtinen, Ranking Member Deutch, and Members of the Committee, thank you for inviting me to testify on the ongoing U.S. response to Syria’s humanitarian crisis and the great challenges we still face.  Thank you also for your continued support for our humanitarian programs around the world, which make a positive difference every day in the lives of millions.   And I am pleased to be here today with an important colleague, partner, and friend in this effort, Assistant Secretary Anne Richard.       


The one constant in the Syrian crisis is the continued toll on the people of Syria—the children who haven't been to school for two years; the women who have endured rape and violence; and the millions of families who have been displaced from one village to the next as they flee the shifting lines of conflict.

The pace of escalation is staggering. In just one year, the number of reported deaths has more than tripled, from 26,000 to more than 100,000.  The number in need inside Syria jumped from 2.5 million people to more than 6.8 million. This is roughly the equivalent of the combined populations of Vermont, New Hampshire, Maine, and Connecticut all in need of humanitarian assistance.

Almost one-third of the population of Syria has now been forcibly displaced, many of them multiple times. One year ago, there were approximately 1.2 million people in Syria displaced from their homes and 238,000 registered refugees in neighboring countries. There are now approximately 5 million people displaced inside Syria and over 2 million refugees.  More Syrians are now forcibly displaced than people from any other country in the world.

As the crisis has escalated, the United States has accelerated our response. Since this time last year, USAID has scaled up our partners inside Syria from 12 to 26 and—to cope with a conflict with shifting lines—shored up systems and supply lines to increase our ability to reach people in need throughout the country.  With President Obama’s Eid announcement in August of an additional $195 million in humanitarian assistance, the United States is now contributing more than $1 billion in humanitarian assistance inside Syria and regionally.

I traveled last month to Jordan and Lebanon to highlight the continued commitment of the United States to help alleviate the extraordinary suffering of the Syrian people.  I also focused on confirming our support for the communities in Jordan and Lebanon that now host a staggering number of refugees, and where basic infrastructure—including water, electricity, schools and hospitals—is stretched to the limit.

Today, I would like to update you on three critical areas: the current status of our humanitarian response, the primary challenges faced by the humanitarian community, and the effort underway to address the significant impact of growing refugee populations on host communities.

The U.S. Humanitarian Response 

U.S. humanitarian assistance in Syria is reaching 3.5 million people across all 14 governorates. Working through all possible channels—the United Nations, international and non-governmental organizations (NGOs), and local Syrian organizations—to reach those in need, our humanitarian programs are providing life-saving supplies and services.

We coordinate closely with other donors and the humanitarian community to ensure our collective response effort is effective and efficient.  We have also worked to build the capacity of the Syrian Coalition’s Assistance Coordination Unit (ACU), which has proven an essential partner in reaching Syrians in need in opposition-held and contested areas.

At USAID, our humanitarian assistance is focused on three key areas: emergency medical care, food assistance, and the provision of much-needed relief supplies.  All of our programs seek to provide a special focus on reaching the most vulnerable populations—including women, children, persons with disabilities, and the elderly—who often face extraordinary levels of violence and abuse.

Medical Care

For almost two years, USAID has provided emergency medical care to those caught in the crossfire. We started with a small-scale operation focused on urgent response. But as the conflict persisted, we saw the need for a sustained infrastructure to meet ongoing needs. Today, we support 260 medical facilities across Syria. These field hospitals and makeshift clinics have treated more than 460,000 patients and performed more than 113,000 surgeries. We saw the need for more medical staff capable of saving lives, so we trained 1,280 Syrian volunteers to provide emergency first aid care.

Last spring, with the onset of warmer weather, dysfunctional systems and communicable diseases on the rise, USAID worked with partners to establish an early warning system for communicable diseases that require early detection and fast response to prevent devastating consequences.

Sadly, women and children often fare the worst in war.  In Syria, gender-based violence (GBV) is a serious concern in the growing crisis. USAID medical support includes services for GBV survivors through women’s health centers, mobile clinics, and outreach teams that provide health and psychosocial services to women who desperately need it. Home-based support is provided to vulnerable women and children living on the front lines and unable to travel for care.  And we work with our partners to find often simple but life-changing solutions, such as supporting all-purpose women’s washing and gathering spaces in camps for the internally displaced.

I also want to make a special note of the humanitarian heroes working on the front lines of this effort, especially the health workers who continue their efforts despite health facilities being targeted.  Doctors, nurses, and volunteer health workers risk their lives daily to save others. Just last week, we heard reports of a health facility near Aleppo that was bombed, killing 11 health workers and patients. Unfortunately, these reports are all too common in this brutal crisis.  We continue to provide support that ensures stipends, bandages, gauze, medicines, and training, but the Syrian health workers are providing the constant supply of courage.

Food Assistance

The United States is the largest donor of emergency food assistance to those affected by the Syrian crisis, including those who have fled to neighboring countries. Through the U.N. World Food Program (WFP) and NGOs, U.S. food assistance currently helps feed three million people inside Syria and more than one million refugees in Jordan, Lebanon, Turkey, Iraq and Egypt each month. Inside Syria, this emergency assistance provides a lifeline for the most vulnerable in areas where access is most constrained by insecurity.  And through our Emergency Food Security Program, USAID is able to deliver food assistance rapidly through a variety of flexible mechanisms—including local and regional purchase and voucher programs—that allow us to efficiently and effectively meet the food needs of Syrian refugees in the neighboring countries.

As civil war disrupts everyday life, USAID is working to address daily needs and to stay flexible. Since January, USAID has supported delivery of approximately 18,000 metric tons of food by NGOs to conflict-affected Syrian families not reached by WFP in Aleppo governorate, feeding over a quarter of a million people on a daily basis.  In late August, as more than 44,000 Syrian refugees crossed into the Kurdish region of northern Iraq in a single week, 15 metric tons of special nutritional bars from USAID were airlifted in on the first WFP-chartered relief flight.

Relief Supplies

Many Syrian families left home with nothing but the clothes on their backs. On my recent trip to Beirut, I met with a group of women who had terrible stories of grabbing what little they could as bombs tore apart their homes and villages.  Many of them spent weeks or months in different villages and cities before finally crossing the border.

Our assistance provides basic supplies especially critical for those who are displaced and seeking refuge, often in abandoned buildings and schools. Clothing, kitchen sets, blankets, mattresses, and bedding provide a lifeline.  Last spring, as summer approached and temperatures rose, we focused on providing clean water, improving sanitation, and stepping up hygiene education and supplies to thwart the spread of waterborne disease. Last winter, we provided blankets, heaters, and warm clothes to the displaced as well as host families.  With many more now in need, we—along with the international community—are now designing winterization kits and coordinating distribution plans to quickly deliver supplies to families in need before winter sets in.

Key Challenges

Humanitarian assistance faces three substantial challenges: lack of access, rising insecurity, and the mounting need for more resources.


The single-greatest factor limiting humanitarian aid remains the ongoing, intensifying conflict, which continues to prevent safe and secure access for aid workers and aid organizations. With the international community, we are working to reach all those in need in Syria, but there are areas we are unable to access or access consistently.  At every opportunity, we continue to push for greater humanitarian access, including access across borders to reach the most vulnerable groups of Syrians. 

In recent months, we have seen breakthroughs in the delivery of assistance across battle lines. Through delicate negotiations with the Syrian Government and opposition factions, and with the critical partnership of the Syrian Coalition, approximately 30 U.N.-sponsored convoys have reached displaced Syrians through cross-line operations. These efforts must continue, but they are logistically complicated and increasingly dangerous, with multiple checkpoints, rising criminality, and increasing numbers of armed militias. In July, the U.N. documented a cross-line trip from Damascus to Aleppo that would normally take three hours and instead took three days to pass through the 50 or so checkpoints now along the route.

As a result, less aid is reaching hard-hit areas, and for the first time, we are starting to see an increased number of children displaying signs of acute malnutrition. This further underscores the need for direct, cross-border delivery if we are to reach those in need more quickly.


Security remains a constant concern, and humanitarian aid workers continue to be targeted for detainments and killing. Our top priority is providing life-saving aid, so we must provide it in a way that protects both recipients and the courageous aid workers who provide it. Further endangering aid workers would mean undermining the international humanitarian effort itself.

Threats and attacks on medical workers and clinics remain especially prevalent, and some medical facilities have been destroyed completely. A recently released report by the U.N. Commission of Inquiry on Syria also cites a string of systematic attacks on hospitals and medical staff.  In the last year, on one of our NGO partner’s medical teams alone, 37 medical staff have been killed, 21 have been injured, and 13 have been arrested or are missing. Despite these risks, aid workers continue their heroic, life-saving work every day.

The profound security concerns in Syria mean that most of our assistance is provided without branding. We brand U.S. assistance when and where possible and continue to work to find ways that we can safely inform the Syrian people that the United States is responding as the leading donor and the largest, most proactive provider of humanitarian assistance. In April 2013, USAID began providing heavy-duty plastic sheeting branded with the USAID logo to internally displaced persons in spontaneous camps in northern Syria. To date, USAID-branded sheeting has been distributed in Atmeh, Bab Al Hawa, Karama, and Qah camps. 

Meanwhile, we are amplifying our message of solidarity and support through official visits to the region with intense media engagement targeting Syrians inside Syria, as well as neighboring populations affected by the crisis.


The current U.N. humanitarian appeals for Syria total the largest ever in the history of U.N. appeals and comprise nearly half of all the U.N.’s current global appeal.  Neighboring countries are already staggering under the rising costs of hosting more than two millions refugees, and traditional donors have all given generously, led by the United States.  Never before has it been so important for all countries to step forward in support of the people of Syria. As we look at a protracted regional crisis, it is imperative to see this as truly an international crisis with help required from all quarters. A recent U.N. report estimates that Syria’s development indices have been rolled back 35 years because of this crisis.  Even if the conflict were to end tomorrow, all expectations are of a recovery that will take a decade or longer.

This week, the United States joined fellow donors in Stockholm to discuss the staggering costs of this crisis, chart a clear and coordinated path to meet a rapidly growing set of needs, and determine how to ensure the rest of the world’s humanitarian crises are not forgotten.  An important development is the idea of a comprehensive platform to more effectively coordinate development funds with humanitarian resources in supporting neighboring countries.  With strong support from the host governments, efforts are underway to map where shared investment in critically stressed infrastructure can benefit refugee populations as well as hosting communities.  Consolidating and coordinating our resources will ensure our efforts are more sustainable and serve to benefit long-term stability and economic development in these countries.

Host Communities

The United States has already moved to direct key contingency and development programs in support of stressed host communities.  These efforts were a key focus of my recent travel to Jordan and Lebanon, where in some cases Syrian refugees now outnumber the Jordanian or Lebanese people in villages, and vital resources like water are already scarce. In both countries, we see that the poorest communities clearly overlap with the greatest concentration of refugees.  Tensions between locals and refugees over resources is a real threat to stability in both countries, so we are paying close attention to key infrastructure, health, and education programming and ramping up efforts to help ensure delivery of essential services at the local level so host communities directly benefit from our assistance.

While in Jordan, I visited Mafraq, an area in the north where many refugees are now living outside Za’atri camp. I met with leaders of community-based organizations running water management programs made possible by USAID’s Complex Crises Fund (CCF). These programs not only help families to access clean water themselves but also to improve water use efficiency, meaning they can provide water for their livestock and sustain their livelihoods. Domestic water supply in Jordan is among the lowest in the world, barely meeting basic household needs for sanitation, cooking, and cleaning. The CCF program supports community-based organizations in 12 governorates throughout Jordan in efforts to enhance water catchment, preservation, and infrastructure. It is helping the country to cope.

More recently, USAID launched a $21 million Community Engagement Project in Jordan that works closely with communities to identify their most pressing challenges and shape meaningful solutions. The program just issued its first set of 29 grants to address growing community needs and basic services: school infrastructure, public parks preservation, lighting, medical equipment, and youth clubs.

In Lebanon, where an estimated one fifth of the population is now Syrian refugees and the spillover effects of the crisis may be the most acute, USAID is similarly focused on water and education as well as a value-chain development program to advance agriculture in heavily affected areas like the Bekaa Valley in Lebanon’s northeast.  With approximately 250,000 Syrian refugees of school age currently in Lebanon and the United Nations Children’s Fund (UNICEF) predicting this number could climb to 550,000 by the end of the year, USAID’s $75 million education program is essential to help meet growing needs of the most vulnerable.


Humanitarian assistance will not end the bloodshed in Syria. Yet it is saving lives and helping alleviate the very real pressures this protracted conflict has put on the lives of everyday people. As we continue to work with the international community toward a political solution, the United States remains fully committed to a strong and flexible humanitarian response—and to coordinating closely with our international development partners—to help the Syrian people and Syria’s neighbors endure this crisis. And, we must continue to press for greater access and security for aid workers. We continue to be deeply appreciative of Congressional support to provide the resources that makes our humanitarian assistance work possible in the region.

Thank you for your time, and I look forward to your questions.

Examining the Syrian Refugee Crisis
House Foreign Affairs Committee, Subcommittee on the Middle East & North Africa

Last updated: September 20, 2013

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