by Bill Frist

Wall Street Journal

Droughts happen. Famines ensue. Families are destroyed. You can't control Mother Nature. On a fact-finding mission to the border of Kenya and Somalia this month, I learned otherwise.

Traveling with Jill Biden, wife of Vice President Joe Biden, I knew going in that 12 million people in the Horn of Africa are at risk of starvation and death because of the worst drought in 60 years. Five regions in war-torn Somalia are experiencing famine, and 29,000 children in the region have died in the past three months. There is much Americans can do—immediately and inexpensively—to save lives and quickly reverse the current trajectory of catastrophe.

Mrs. Biden and I spent most of our time engaging refugees who emotionally recounted their painful, weeks-long treks through parched lands with little food and water, having no choice but to leave their husbands in war-torn Somalia, often losing a child or two along the way to dehydration or lung infection.

The extreme drought has destroyed crops and caused the death of 80% of the livestock. For most Somalis who live a pastoral lifestyle, these conditions amount to an American losing their home, job and all worldly possessions, with no food or water available to beg for or borrow.

At the Dadaab camp along the Kenya-Somalia border, more than 1,600 refugees arrived on the day of our visit, bringing the total past 50,000 for the past month. Designed for 90,000 people, the camp is swollen beyond capacity with 430,000. Another 45,000, typically malnourished with crippled immune systems, wait outside the camp with little water, no sanitation, minimal health care and only makeshift shelter.

The world community has increasingly responded to the crisis in the past few weeks, but the demand continues to outstrip what is provided. The central challenge is access: The famine is centered in lawless Somalia, which is dominated by the al Qaeda-affiliated terrorist group al Shabaab. Nongovernmental organizations find it dangerous to operate there, as 47 aid workers have been killed over the past two years and many others kidnapped.

Mrs. Biden and I witnessed an ongoing outbreak of measles in the Dadaab camp, including a new wave among refugees in their 20s. This observation suggests an unanticipated need to vaccinate older age groups. Few Somalis have been vaccinated before coming to the camps (al Shabaab discourages vaccinations, considering them a Western intervention to be shunned). In a crowded camp of almost half a million, a small measles outbreak can explode and lead to mass casualties. Vaccinations can stop this—and each costs only a dollar.

Then there's water. Its absence causes famine, and its unclean varieties cause diarrhea that is dehydrating and can be fatal. That and acute malnutrition are the big killers. But nutrient-supplied oral fluids can bring young, malnourished children back from the brink of death within a few hours.

All these health interventions are cheap and easy to administer. A dollar goes a long way toward saving lives in Africa.

Outside of immediate crisis relief, our past investments clearly are paying off. U.S.-supported early-warning networks identified the famine threat a year ago, allowing Kenya and Ethiopia to begin stockpiling food reserves and planning regional responses. The U.S. is working with the World Food Program and the United Nations to initiate innovative programs like food vouchers that reduce corruption and better distribute food. These programs encourage regional and private-sector solutions to shortages, with smoother flow of foodstuffs from more plentiful areas to drought-stricken ones.

In times of budget cuts, we must remember that, according to Oxfam International, emergency food relief during a famine costs seven times more than preventing a disaster to begin with. Hence U.S. efforts such as the multi-year, multi-agency Feed the Future program to stimulate research into making plants more nutritious and crops more drought-resistant.

With the chaotic economy dominating the news, it's easy to focus on ourselves rather than others so far away. But when we remember that we spend only a tiny fraction of one percent of our budget on developmental aid, that recent assistance is smarter and more targeted than in the past, and that our investments in the Horn of Africa alone have saved millions of lives, each of us can be proud of our past investments and supportive of their growth in the future.

What can we do as individuals who care? A good place to start is the list of aid organizations on the website of the U.S. Agency for International Development,

Dr. Frist, a physician and former majority leader of the U.S. Senate, is chairman of Hope Though Healing Hands.

The Rugged Altruists

Aug 24 2011

by David Brooks

NYT Op-ed

Nairobi, Kenya

Many Americans go to the developing world to serve others. A smaller percentage actually end up being useful. Those that do have often climbed a moral ladder. They start out with certain virtues but then develop more tenacious ones.

The first virtue they possess is courage, the willingness to go off to a strange place. For example, Blair Miller was a student at the University of Virginia who decided she wanted to teach abroad. She Googled “teach abroad” and found a woman who had been teaching English in a remote town in South Korea and was looking for a replacement.

Miller soon found herself on a plane and eventually at a small airport in southern South Korea. There was no one there to greet her. Eventually, the airport closed and no one came to pick her up. A monk was the only other person around and eventually he, too, left and Miller was alone.

Finally, a van with two men rolled in and scooped her up. After a few months of struggle, she had a fantastic year at a Korean fishing village, the only Westerner for miles and miles. Now she travels around Kenya, Pakistan and India for the Acumen Fund, a sort of venture capital fund that invests in socially productive enterprises, like affordable housing and ambulance services.

The second virtue they develop is deference, the willingness to listen and learn from the moral and intellectual storehouses of the people you are trying to help.

Rye Barcott was a student at the University of North Carolina who spent a summer sharing a 10-by-10 shack in Kibera, the largest slum in Nairobi, Kenya. One night he awoke with diarrhea and stumbled to the public outhouse. He slid onto the cement floor and vomited as his bare body hit puddles of human waste.

He left his soiled pants outside the hut, but when he went to find them later they were gone. He was directed to another hut where a stick-thin girl, with missing clumps of hair, had the pants, scrubbed and folded, in her lap. Barcott said softly, “I’m grateful,” and asked her why she had cleaned them. “Because I can,” she replied. A week later, she died of AIDS and her body was taken in a wheelbarrow to a communal grave.

Over the next several years, Barcott served as an officer in the Marines in places like Iraq and created an inspiring organization called Carolina for Kibera, which offers health services and serves as a sort of boys and girls club for children in the slum.

The greatest and most essential virtue is thanklessness, the ability to keep serving even when there are no evident rewards — no fame, no admiration, no gratitude.

Stephen Letchford is a doctor working in Kijabe, Kenya. One night, years ago, when he was working at a hospital in Zambia, a man stole a colleague’s computer. Letchford drove the police down the single road leading from town. The police found the man carrying the computer and, in the course of the arrest, shot him in the abdomen.

They put the man in the back of the car and rushed him back to the hospital to save his life. Letchford pressed his wounds to stem the bleeding, using tattered garbage bags as surgical gloves. He had scraped his hands gardening that day and was now covered by the man’s blood.

They saved the thief’s life and discovered he was infected with H.I.V. For several days, Letchford and his family were not sure whether he had been infected by the man who robbed them. Their faith was tested. (They later learned that he was not infected.) When the man recovered, he showed no remorse, no gratitude; he just folded in on himself, cold and uncommunicative.

This final virtue is what makes service in the developing world not just an adventure, a spiritual experience or a cinematic moment. It represents a noncontingent commitment to a specific place and purpose.

As you talk to people involved in the foreign aid business — on the giving and the receiving ends — you are struck by how much disillusionment there is.

Very few nongovernmental organizations or multilateral efforts do good, many Kenyans say. They come and go, spending largely on themselves, creating dependency not growth. The government-to-government aid workers spend time at summit meetings negotiating protocols with each other.

But in odd places, away from the fashionableness, one does find people willing to embrace the perspectives and do the jobs the locals define — in businesses, where Westerners are providing advice about boring things like accounting; in hospitals where doctors, among many aggravations, try to listen to the symptoms the patients describe.

Susan Albright, a nurse working with disabled children in Kijabe, says, “Everything I’ve ever learned I put to use here.” Her husband, Leland Albright, a prominent neurosurgeon, says simply, “This is where God wants us to be.”

omo 2

Today started as usual with ward rounds, visiting my patients: Stephen, baba with DM and Mr. SO whom we operated on for appendicitis. I really feel sorry for Stephen’s dad.

Then we went to the OR where we had one scheduled surgery and one emergent ex-lap. The scheduled surgery was removal of a breast mass; turned out to be a chocolate cyst (grossly). I really enjoyed having scrubbed in. I started the IV line and first-assisted; also got to close the skin. I really do enjoy surgery especially on days like this when I feel competent; when the operation went well, when I closed skin properly, when I feel I helped the team help a patient. 

The second case was interesting. A man in his 60s/70s presented to the hospital after a road traffic accident in which he obtained rib fractures and perineal laceration. He also had an acute-appearing abdomen with left quadrant tenderness, hypoactive bowel sounds and free air on x-ray. We were concerned about stomach/small intestine perforation or splenic laceration. The interesting part of the story is that upon entering his abdomen, what we found was indeed a perforated viscus (small intestine) but there were surrounding adherent exudates to suggest bacterial perforation such as typhoid perforation, not due to trauma. His spleen and other internal organs were fine. We wonder if he was ill preceding his accident; I’d find out from him on rounds tomorrow

After the OR, went to physician conference where Dr. Aremu talked about the responsibilities of family physicians to their patients. There was a post-presentation announcement about ensuring patients pay their bills up-front especially in non-emergent cases. The thing is that this is a small town where many of our patients cannot afford the hospital bills; many go into debt as a result, but the hospital needs funds to run to be able to keep helping patients; there really is a need for a national/state-wide health insurance system.

Overall, I’ve had an excellent experience here in Ogbomoso. The physicians here do so much with very little. I admire the tradition of praying before every surgery and before every clinical encounter. There is obviously room for improvement, need for specialists such as pathologists, cardiologists and ICU physicians, and need for better diagnostic and monitoring equipment such as ECG monitors (there isn’t one even in the ICU) and CT scanners (especially given the volume of patients that present with head injuries). I think though that beyond the hospital and immediate control of hospital personnel, general road safety urgently needs to be addressed. Too many patients present with and die from otherwise preventable injuries secondary to road traffic accidents. Also urgent, is the need for a health insurance system as too many patients end up being turned away or under-treated due to inability to afford medical services.


Bill Frist: NPR Interview with Melissa Block

To listen, CLICK HERE.

Former Senator Bill Frist just came back from a fact finding-finding mission to the border of Kenya and Somalia. He and Jill Biden, the vice president's wife, visited the Dadaab camp, which was designed for 90,000 but its population of Somalian refugees has swollen to 430,000.

In an interview with NPR's Melissa Block, Frist threw out numbers. Lots of them that put the situation in the Horn of Africa in some perspective. He said: This is the worst drought in 60 years; 29,000 children under the age of five have died in the past 90 days; tens of thousands are dead; 12 million people are at risk of death; 42 percent of them die from starvation.

All of that is hard to visualize, but then Frist talks about the people he talked to at the camp.

"A family might be typically a woman who has four children, who has walked for 15, as many as 20 days to leave the area of famine and lawlessness and lack of aid... and walk across a desert, arriving many times missing one child, a child who died along the way," he said.

The children arrive at the camp malnourished or starving and what's amazing, he said, is that an inexpensive mix of water, sugar and nutrients will bring a child back to life.

Frist has seen human tragedy. He's been to Rwanda during the genocide and saw the 1980 famine in the horn of Africa. He's been to Chad, Darfur and Sudan but he says what strikes him about this particular crisis is that "the world is responding to the need itself but the need is increasing faster than the response."

"The simplicity with which this can be addressed... is not keeping up with increased demand," he said. "They're all human tragedies, but this one we can nip in the bud if we're more aggressive."

Melissa also asked some tough questions of Frist, the chairman of the non-profit Hope Though Healing Hands. She brought up the AP report that detailed that thousands of sacks of food aid were being stolen and asked what he would tell Americans, struggling through a bad economy.

"We spend less than half a percent of our budget on all of developmental aid. Not just responding to crisis but in all of developmental aid. So we don't spend nearly as much as people think," he said.

Frist admitted that this famine is a man-made crisis. The drought is bad but the political situation on the ground, the fact that Islamist militant group al Shabaab has not let aid flow in has made things worse.

"But it doesn't mean we give up," he said. "It means we stay on it. We do the best we can as the oneness of humanity gets translated by [non governmental organizations], by partnerships, by governments, by individuals who focus on it."

To read more, CLICK HERE.

By Jill Biden and Bill Frist

USA Today

WHF and Biden 8.8.11

This week, we traveled to Dagahaley refugee camp in Dadaab, Kenya, where hundreds of thousands of people have fled Somalia seeking to escape the worst famine in 60 years.

We met women and children who walked for weeks, often barefoot and with nothing but the clothes on their backs, desperate to find food and medical care. We heard the story of one mother who was too weak to carry both of her children, and made the wrenching choice to leave one behind on the road in hopes of saving the other. We learned of families who had arrived too late whose children became part of a devastating statistic: In the past three months alone, 29,000 children younger than 5 have died of starvation.

Fortunately, the international community has mobilized. Last year, the U.S. realized this potential for famine and worked with other countries to stockpile food and medical supplies in the region. We are now helping more than 4.6 million people.

Amid the devastation, we saw the impact of this aid. We saw inexpensive oral rehydration packs bring listless babies back to life. We saw children getting vitamins and vaccines that will stop the spread of deadly diseases throughout the camps.

Still, the scope of this crisis threatens to overwhelm the international response. Without lifesaving assistance, hundreds of thousands of people, most of them children, could die.

As governments and international organizations do their part, the rest of us can do ours. Just a few dollars can literally save a life. (Go to to see how you can help.)

Yet we must also confront the broader challenge of food insecurity that leaves so many people vulnerable to droughts like this one. That's why America has been helping nations such as Ethiopia and Kenya develop innovative and improved crops and irrigation methods, and new ways for farmers to market and transport their products. The goal of our aid is simple: to help create the conditions where such aid is no longer needed.

That, ultimately, is how we can help prevent the kind of suffering we see in Somalia today.

As we left one of the camps, a mother looked us in the eyes, surrounded by her four malnourished children, and asked us to please help save her family.

We all have the power to answer her plea.

Jill Biden is the wife of Vice President Biden. Bill Frist is a former Republican senator from Tennessee.


CRISIS IN THE HORN OF AFRICA - Dr. Bill Frist, former Senate majority leader, telephoned Playbook after returning from a trip with Dr. Jill Biden to a famine refugee camp on the Kenya-Somalia border: "The Horn of Africa is undergoing the most acute food-security emergency in the last 25 years - 29,000 kids have died in the last 90 days. The response to the crisis is improving globally, but the magnitude is outstripped the supplies. ... Two issues that I'm stressing: Number one, lives can be saved by both individual Americans, and taxpayers through our government responding and investing. And, number two, our long-term investments over the last 10 years, through the USAID, in the Horn of Africa, have paid off. ... "Dr. Biden is very effective in listening, observing, listening, asking questions, and representing the United States in terms of concern and commitment of support. Because she's not in the political hotbed, for me, who's out of politics, she was a perfect leader for the delegation. ... I have visited refugee camps in Chad and Darfur ... The striking difference here is the lack of access in Somalia, because of a dysfunctional government. There's no access to the millions of people in Somalia, where the famine is worst. Therefore, the refugees all have to go to Ethiopia and Kenya, where there is economic stress and environmental stress. ... The crowding in the refugee camps has resulted in pneumonia and a very rare skin disorder, ictchyosis. The kids are dying of pneumonia and diarrheal diseases. ... Individuals who do want to invest, the easiest place to go is, which has a list of nongovernment organizations."

kijabe hospital

Photo: Kijabe Hospital

I have been in Kijabe for almost three weeks and today is the first day I received a hard and fast sign that I am in a developing country. No power. No explanation. On one minute then off the next.  It happened in the OR  – just a blink – but serves as a reminder that as much as there is available here in Kijabe, more than in many other hospitals in Kenya, it is still a tenuous resource. One that is dependent on the hard work of so many to keep things running as smoothly as possible so that the lights stay on, the available suture will be strong enough to hold a knot, and blood will be available for the patient with anemia who needs to have his spleen out. 

My first night here I was summoned to “Casualty”, Kijabe’s version of an Emergency Room. There had been an “RTA” (a Road Traffic Accident) and all the victims had been brought to Kijabe. There were 11 total, easily filling the small room that is Casualty. Not quite knowing where to start – which patients had been seen, which had not, I glanced around the room quickly triaging patients. Doing so, I noticed some family members gathered around a stretcher with a young man lying on it. One man in particular looked up from the patient and met my gaze. The look on a trauma family member’s face is unmistakable and is the same no matter where you are from. Grief and sorrow mixed with disbelief and hope - there is hope in there as well. Hope that the news will be good. Hope that the injuries will be minor. Hope that if they are not minor, that their family member will recover quickly and without lasting harm. Hope that you will be able to help. 

I was stopped in the hospital corridor the day following that trauma by that same family member – this family member described the trauma victims as his people. He wanted to thank me for helping his people. He was not satisfied by my simple “you are welcome” but in our mixed conversation of American English, British English, and Swahili I think I managed to convey that it really was my pleasure to be here and to be able to help. 

His cousin in particular was one of the more seriously injured but went home after a few days of monitoring on the wards – grateful to be able to get back to his job and his family. 

This is what Kijabe is able to provide by combining the work of so many – a resource, a place for people to come to heal. A place where it is a true pleasure to be able to help, where one can join with many others to keep the lights on.



Editor's Note: William Frist, the former Republican majority leader of the U.S. Senate, is a physician. 

CNN photo

(CNN) -- Why should Americans care about the unfolding crisis in Somalia when our own economy is in chaos? 

To shed some light on that question, I joined Dr. Jill Biden, wife of Vice President Joe Biden, on a fact-finding mission over the past several days to a Somali refugee camp close to the Kenya-Somalia border. 

We saw the answer as we listened to a grief-stricken mother of five, who had marched for 15 days across the parched Somali land to find food and security in a border camp. They arrived malnourished, sick and thirsty to a camp of 430,000 other refugees. They competed with 1,500 others who had made it to the camp that day, only to find it filled to capacity. Inside they would find adequate food and water. 

They would find the vaccinations that are saving the lives of thousands. They would survive because of the generosity of Americans (the U.S. is responsible for 47% of the food being provided) and increasingly because of members of the world community who are standing up, in spite of challenging times in their own communities. 

More than 29,000 children have died over the past three months in what is the most acute food security emergency on Earth. It's worsening by the minute and outstripping available supplies. Thousands never make it to the camps, and those that do might have to wait outside the confines where 50,000 others are waiting. 

Drawing from my experiences as a doctor in refugee camps in southern Sudan and Darfur, the conditions Biden and I saw this week constitute among the worst, the result of a cruel nexus of war, drought and poverty. The issue is complex, but we know with certainty that a primary focus on health greatly improves the chances of preventing death and of establishing security throughout the Horn of Africa. It's a worthy investment.

Drought occurs regularly throughout the region, but a dysfunctional government in Somalia is incapable of responding. Direct access by the international aid community is difficult and dangerous. This is why our focus on assistance in Ethiopia and Kenya is essential.

The five regions of famine in Somalia lead to death locally and to an exodus of children and families to Kenya and Ethiopia for food. The arrival each day of 1,400 to 2,000 new Somali refugees to the Dadaab Camp alone places a huge food, economic and environmental stress on eastern Kenya.

The good news for the American taxpayer is that investments by our humanitarian and development organizations have worked. Through past advances in agriculture and food security led by the United States, we learned that from the more plentiful regions of Kenya, food is flowing to the areas of greatest need. Even though tens of thousands have died in recent weeks because of the famine, I am certain that the number would have been much higher if the American people had not so smartly invested over the past decade. 

Drought and famine are not new to the Horn of Africa. By examining past famines, we have learned that among the most important acute interventions is taking steps to improve health. This primacy of health is not generally recognized by the public, but it is by USAID administrator Rajiv Shah, who accompanied us. 

Drought leads to famine, and famine leads to deteriorating health. Therapeutic health intervention with vaccines and oral rehydration is easy and cheap. But we have to get material to the region. And that is why the increased aid of $105 million announced Monday by our government is so important. This also shows that we can make such a difference as individuals through our own contributions (see for organizations). 

The region is witnessing the worst drought in 60 years with more than 12 million people in need of outside assistance. Even though contributions by government, NGOs and the international community are growing, the needs are growing faster than the world is responding.

Will the American people respond in these difficult times? I know based on my experiences in southern Sudan, Darfur, Chad, Haiti and Bangladesh that the American people will give generously and support our nation's ongoing response.

Americans are at their best when they respond unselfishly to others in need -- and they do so generously when they know that their investments, both personal gifts and government contributions, have value in saving lives in the short-term and supporting prevention in the long-term.

They know that their help will make a difference. Americans will act as they always do to help those in need.

The opinions expressed in this commentary are solely those of William Frist.

From Dadaab Refuge Complex

WHF and Biden 8.8.11

This week I traveled with Second Lady Dr. Jill Biden to refugee camps in eastern Kenya along the Somali border to witness the impact of the most acute food security emergency on earth. We need your help, and your help I promise will make a difference.
Yesterday we visited intake centers just on the border where over 1,500 Somalis who walked for weeks with their starving children (over 29,000 young children have died of malnutrition and disease in Somalia alone over the past 90 days) arrive each day to find food and a safe place to live. But the camps are at capacity (the Dadaab camp has 430,000 refugees today; it was designed for 90,000) and new arrivals are left to fend for themselves on the outskirts of the camp.

Over the years I have delivered medical care in refugee camps on a number of trips, to camps in Darfur, Chad (on the border of Sudan), and in boy soldier camps in southern Sudan. I go as a doctor – and an observer of how we as individuals back at home can make a difference. Providing age appropriate health care to the vulnerable and malnourished children and adults is crucial to combat rapidly spreading disease and death. I see how we can use medicine and health as a currency for security and peace.

At Dadaab, I met with the nurses and doctors in clinics closed to the press.  Vaccinations for measles and polio are in need. The crowded conditions in the camps make the kids especially susceptible to these deadly infectious diseases. That’s why we are seeing the current outbreaks of measles in the camps. Measles are  preventable and treatable but we need more help. And that is where each of us comes in.

I saw the miracle of inexpensive oral rehydration with nutrients for babies and children who would otherwise die from the common diarrheal diseases that come from malnutrition. Much needed vitamins bolster the children’s immune systems. These are all simple, cheap interventions that are needed today.  And they are all within our reach to provide.

The American people have done and are doing a lot (we are contributing over 47% of the current food aid coming to the Horn of Africa) which has markedly lessened the unfolding tragedy in the region, but the need today is growing faster than we and the entire international community are responding.

Dr. Biden and I, accompanied by USAID administrator Rajiv Shah, also saw in the field how our nation’s past investments are paying off. Due to our country’s investments in agricultural and livestock advancements in Kenya and Ethiopia over the past decade, they are able to handle the drought without the death associated with famine. But, lacking these investments over the past decade in war-torn Somalia, thousands have died and millions are at risk.

Aid agencies estimate that over $1 billion more is needed during this critical period to stop further deaths and get proper food, water, and health care, especially to the children who are most vulnerable.

How can you help? Hope Through Healing Hands is launching an East Africa Famine Campaign to raise funds to provide assistance to aid agencies who are on the ground now in the Horn of Africa. Based on my personal experiences, we will select beneficiaries whom we know and trust, who are on the ground now delivering care, and who will be providing both food and medical care to the victims of the famine.
Over 12 million are being affected. They need your support today.

We need your help,

Bill Frist Signature 
Bill Frist, MD

P.S. Please follow our blog and Facebook updates for more on the East Africa Famine Crisis.

Africa: Briefing on Dr. Jill Biden's Recent Visit to Kenya
Tue, 09 Aug 2011 12:50:32 -0500

Briefing on Dr. Jill Biden's Recent Visit to Kenya

Eric P. Schwartz
Assistant Secretary, Bureau of Population, Refugees, and Migration
Senator Bill Frist, and Special Assistant to the President Gayle Smith
Via Teleconference
Washington, DC

August 9, 2011

MR. TONER: Thank you, and thanks to all of you for joining us this morning. As you know, East Africa is facing the worst drought in 60 years, and the UN has declared that famine now affects five regions in Somalia and predicts that it could expand throughout the southern Somalia.

Over the weekend, Dr. Jill Biden led a delegation to Kenya to view firsthand the situation on the ground. And joining us this morning to discuss that trip as well as our overall assistance efforts in the region are several members of the delegation – Special Assistant to the President Gayle Smith, Senator Bill Frist, as well as Assistant Secretary of State for Population, Refugees, and Migration Eric Schwartz.

Just a reminder that this is an on-the-record briefing this morning. And so with that, I’ll hand it over to our first speaker, Gayle Smith.


MS. SMITH: Sure. Thanks, Mark. Good morning, everybody, and thanks for joining us. We were also joined on the trip by USAID Administrator Raj Shah, who is on a plane right now. Otherwise, he’d be on the call with us.

Dr. Biden wanted to do this trip – and thankfully, Senator Frist agreed to join us very early on – to highlight the crisis in the Horn of Africa and basically help mobilize both an American response, but also a global response to a crisis that is acute – I’m sure you’ve all heard the figures of 29,000 kids dying in the last 90 days – but to also underscore the fact that there is a lot we can about it; that we can get assistance to people; that the people in Kenya and Ethiopia, while adversely affected, are in a better position today than they might have been because of things that have been done over the last 10 years; and importantly, that in the long range, we can also support food security.

We visited the Kenyan Agricultural Research Institute, which is supported by the U.S. Government, as a way of highlighting, again, that there are things we can do to reduce the prevalence of famine in the future. We traveled to the Dadaab refugee complex, where Dr. Biden, Senator Frist, and the rest of us were able to both see the relief operations that are going on and meet with many of the Somali refugees that have recently walked to Kenya from inside Somalia.

What we’d like to do this morning is hear from Senator Frist and my colleague Eric Schwartz. I can help address any questions that may come from – for AID given that Raj Shah is unable to be with us. And then we’d like to open up to questions.

So Senator, if I could turn over to you first, and thank you again for joining us on the trip.

SENATOR FRIST: Gayle, thank you. And I’ll be brief. People over the next couple of days are going to ask again and again why in the world did Dr. Biden and all of us take this trip. I went at the invitation of Dr. Biden with a real purpose of helping – in addition to looking to the healthcare needs, which I as a physician do, but really drawing some attention so that the world better understands the size of this catastrophe, the needs, and the fact that in spite of the U.S. stepping up and the world stepping up, the demands and the needs are growing even faster than what is being provided. So it’s not just to learn, but also to help mobilize a domestic response, but also an international response to what a lot of people don’t realize, especially in this environment, of what’s happening in terms of the economy here and at home, but this is the most acute food security emergency anywhere in the world now and in recent years.

As a physician, I did spend time looking at the health and the health needs of the people of the Horn of Africa in part because through our past experiences and as underscored by USAID by focusing on the health needs and therapeutic feeding, we really engage one of the most effective ways of lifting people up in times of need. Food is very important, response in terms of food security, critically important, but the health needs themselves, also very important, and some would even say a prime area of importance.

The crisis is growing fast, and we saw that firsthand on the ground and talking to individual families as they were coming into refugee camps who literally have walked for 15 and 16 days – a mom with her four children, a husband, a father who is absent who is still in Somalia; they don’t know whether or not he’s alive. I think the things we can do is two things – make sure the world knows this is unfolding and know that people’s help and investment, as they have responded in the past here in America, can make a huge, huge difference.

Now with that, I’ll sort of stop because that’s the purpose. Our observations – now it’s up to us to share with the American people and with the world. It’s a nonpartisan issue. I think my presence, in part, demonstrates that. It is everybody coming together in the United States, at a time that many things are very fractured, around a common good and a common cause where past investments have paid off – and we saw that in Kenya, and we saw that in Ethiopia – and where if we continue to invest in the future, we know that these catastrophes don’t reach the threshold that they have today in being one of the great famines of the last 50 years, one of the most tragic famines of the last 50 years.

Now, with that, let me turn to Eric. Again, we had a great team on the ground. We were able to look at these issues from a medical standpoint under Dr. Biden’s leadership putting this team together, under a USAID standpoint, and a State Department and refugee standpoint. With that, let me turn it over to Eric.

ASSISTANT SECRETARY SCHWARTZ: Thank you very much, Senator Frist. And let me also say – join my colleague Gayle in thanking you for your willingness to participate in this trip, and we were honored and extremely – your participation was extremely valuable. We – and let me talk a little bit about Kenya if I may.

The Dadaab refugee complex in the – in northeast Kenya is the host to – was already the host to a very large and protracted refugee population on the order of 300,000 refugees or more. And for that and the management of that relief effort over many, many years and the assistance of the management, we’re very grateful to the Government of Kenya that has provided refuge to Somalis.

But what they’ve seen in recent months is an enormous increase in the numbers. Right now, the numbers of refugees in the Dadaab complex is estimated at over 420,000. There are probably about 477,000 Somalis in camps throughout Kenya, but in Dadaab it’s well over 420,000. The refugees from Somalia are coming in at a rate of late of about 1,400 to 1,800 per day, although that number obviously changes as the situation changes. And the challenges are substantial. People are coming in in very, very difficult conditions. The rates of malnutrition are very, very high. It has severely taxed the registration capabilities in the camps.

At the same time, it’s very important to note that the Somalis who are coming in with all of those difficulties are receiving basic food and sustenance when they get in to the camps and that the United Nations is hard at work with the involvement and support of the Government of Kenya on the expansion of this facility. There are three camps in the Dadaab complex, and one of those camps is being expanded substantially. In addition, they’re building a fourth facility as well. So efforts are hard – are underway and are moving forward in terms of expanding the capability of the camps to handle this inflow of Somalis.

Similarly, we are making substantial efforts to provide assistant to the Government of Ethiopia, which is providing about – assistance to about 160,000 Somali refugees, as well as our efforts to provide assistance to those areas within Somalia which we can reach with assistance. So the effort is full on and will continue in the days and weeks and months to come.

The visit, I think, was important in terms of shedding light on the important efforts that are underway and the importance of continued support from the international community. With that, I guess I’ll turn it back either to Gayle or to Mark. I don’t know who our moderator is right now.

MR. TONER: Great. Thanks, Eric. Mark here. Thank you all. And, operator, we’re ready to open it up to questions now. Again, just a reminder this is an on-the-record briefing, and if you could just state your name and media affiliation, that would be a big help.


OPERATOR: Thank you. We will now begin the question-and-answer session. If you would like to ask a question, please press *1. To withdraw your request, press *2. Once again, if you would like to ask a question, please press *1. One moment, please, for the first question.

Our first question comes from Mina al-Oraibi. Your line is open.

QUESTION: Good morning. I’m with Asharq Alawsat newspaper, Arabic language paper. Thanks for doing this. I wanted to ask you in terms of international response, I know there is a UN appeal out at the moment, but if you could speak a little more about what can be done on an international scale to support those in Somalia but also those in Ethiopia and Kenya.

MS. SMITH: Sure, I’m happy to take a first cut at this. Eric, you may want to add. This is Gayle Smith.

The UN has issued an appeal, but the biggest need, quite frankly, right now is for cash contributions. That enables folks on the ground, both UN agencies and NGOs, to provide whatever may be needed the most effectively, whether it is food, whether it’s therapeutic feeding, whether it’s access to water and so on.

We’re seeing already, although the response is not as large as it needs to be to keep up with the spread of famine in Somalia and ensure that we are able to prevent conditions from getting worse in Ethiopia or for Kenyans in Kenya and to manage the refugee flow, there are donors contributing from all over the world. But what we need really from everybody is to increase those donations as quickly as possible, again, so we can keep pace.

Eric, do you want to say something about the appeal itself?

ASSISTANT SECRETARY SCHWARTZ: Well, the appeal is – the United States has been a generous contributor to the international appeal. It’s an appeal – a multi-donor agency appeal. I don’t have the specific figures of how much of the appeal has been subscribed, but we’re – but at this point, we’re calling on other governments to really kind of step up to the plate here and give generously to all of the UN agencies.

But a number of the UN agencies also accept contributions from the public, such as UNICEF and others, and contributions from the public in these kinds of situations can be extremely valuable. The nongovernmental community, I should say for example, in the tsunami response a couple of years ago, of the entire amount that was contributed, about 5 billion of the 13 billion that was spent on the tsunami response came from the nongovernmental community supported by private donations. So the role for private donors can be quite substantial in these circumstances.

SENATOR FRIST: Eric, let me pick up on that just a little bit, though the question is really about the international community, only because I’m totally in the private sector now and this is important, especially for everybody on the call. There’s a great need. All of you know that. The data is there. We saw it. The big thing that I want to share with people is that everybody can make a difference, not just the governments per se. And we saw firsthand over the last 36 hours, just how effective these donations can be to improving health and literally, literally saving lives.

People say, well, where to go, and the easiest thing to do is to send people to, In there, on the website, there’s a listing of all the nongovernment organizations, many of whom we saw on the ground working side-by-side in partnership with governments. We really do hope speaking here at home, or I hope and what I really want to be stressing, is that we know that Americans act – we’ve seen it in the past, we saw it at the tsunami, we saw it at the tragedy in Haiti – and to really do what they always do to help those in need. And the big thing is these tiny donations can make a huge difference. And again, the easiest site is the USAID site because they’ve taken the time to put a lot of the nongovernment organizations that we depend on, and you can see which organizations are doing this sort of work.

So yes, the government is important. The support for our past investments we saw firsthand at the agricultural center, but also individual donations to these sites saves lives.

MR. TONER: Thank you. I think we’re ready for our next question.

OPERATOR: Thank you. The next question comes from Lachlan Carmichael. Your line is open.

QUESTION: Hi. Yes, as far as Kenya is concerned, do you think the Kenyan authorities are measuring up to the scale of the disaster facing them in their own country? I mean, the government spokesman said, I think just last month, that not one Kenyan had died of – as a result of hunger. And apparently, there are harvests in parts of the country that are good but nothing distributed to the areas hit by famine.

MS. SMITH: Let me just say something about that. That’s a – it’s a good question. I think one of the very good things we’re seeing, although obviously more can be done, is that for Ethiopians in Ethiopian and Kenyans in Kenya, as Dr. Frist said, there are a lot of things being done to assist them because they can be reached. Now, there’s more that can be done to make sure that grain stocks available in the region are more accessible and can be moved more freely. We and others are working on that with those two governments to make sure that where food stocks are available, they can be purchased and moved to people who need them.

I think that what we’re seeing – and again, I want to be careful here – is that we don’t have enough assistance even for the people of Ethiopia and Kenya that are affected. But in those cases, for two reasons, we’ve got a slightly better shot than we do with the difficulties we face in Somalia. The first, as Dr. Frist said, is some of the programs that have been put in place by USAID, by other donors, by those governments, to make sure those people are less vulnerable to droughts of this scale. And the second is, again, because they are accessible.

So I can’t answer to whether a single person has died or not. I do think that what we’ve got there is a case that with sufficient assistance, with the agility of those markets to which you point, we really can help get these people through a very bad year of drought and to the next set of rains.

ASSISTANT SECRETARY SCHWARTZ: If I can just comment on a question that – on a question, actually, that perhaps wasn’t asked but is related in terms of the government’s response with respect to the refugee situation, I think we have to give the Government of Kenya substantial credit for its willingness to continue to provide first asylum to this population. After all, if you just take the population of the refugee camps in the Dadaab area, you’re talking about one percent of the entire population of Kenya. And so for the Government of Kenya to continue to provide refuge, as it certainly should – but for the government to continue to do this, I think is – the United States is very appreciative of these efforts and that is why we are doing everything we can to assist the government in its efforts to continue to stay the course on this.

MR. TONER: Thank you. I think we’re ready for our next question.

OPERATOR: Thank you. Our next question comes from Carmen Russell. Your line is open.

QUESTION: Hello? Hi. Sorry. My question is where exactly is the U.S. aid going? Are we able – I mean, how well are we able to track this? How likely is it that the U.S. itself will step up its contributions as the situation gets worse? And what other political action is the U.S. willing to take?

MS. SMITH: We announced yesterday an additional contribution of $105 million to the regional relief effort, including both people who are affected in their own countries and to the refugee effort, bringing us up to over $560 million. We are the lead donor. But importantly there, we will continue to support the relief effort, but we are also aggressively reaching out to other countries because this is of a scale that we certainly can’t do it alone. We need other countries to step up with us. And I think, as I said earlier, we are seeing that other countries are responding. But part of our mission is both, as I say, to respond but also to reach out and use our position as the United States to encourage other donors to ramp up their responses. So we’re certainly willing to keep doing that, and that’s our intention.

MR. TONER: All right. Thank you. I think we’re ready for our next question.

OPERATOR: Thank you. Our next question is from Michele Kelemen. Your line is open.

QUESTION: Yeah, hi. I was wondering – the al-Shabaab pullout of Mogadishu, whether that’s made any difference for access there, and whether you’ve seen any aid agencies taking up your offer to ease restrictions on going into the south of Sudan – Somalia.

MS. SMITH: Again, I’m happy to take this and have others amplify. Hi, Michele.

The move of al-Shabaab out of Mogadishu is a good sign. It’s too early to tell whether it is a good and lasting sign, but it does offer the possibility of getting more assistance in through Mogadishu and to assist people there, because one of the things we’ve seen is the congregation of internally displaced people as Somalis move into Mogadishu in search of assistance.

There are agencies that are moving in to take advantage of that opening. One of the things that we’re very mindful of here is that we want to make sure that NGOs and UN agencies and others that are trying to provide assistance are able to do so in the utmost security, so I’m inclined to be a little bit careful about exactly who is doing what. But one of the very good things we have on hand is some of the most seasoned humanitarian operators in the world, given the complexity of this environment, and they are moving very swiftly to seize every opening that they can possibly have.

USAID is engaged with a number of nongovernmental organizations from around the world, and particularly American NGOs who are looking to ramp up their assistance and are doing that right now. So we are seeing a really, really good response from, as I say, UN agencies, international organizations, and NGOs who are poised and, with our assistance, trying to access every bit that they can as the situation unfolds.

QUESTION: If I could ask just one other question about the aid money that was announced yesterday --

MS. SMITH: Mm-hmm.

QUESTION: Is that specifically going to any country? Is it going mainly to Kenya --

MS. SMITH: Yeah.

QUESTION: -- and Ethiopia or is going into --

MS. SMITH: We can get you a breakdown of that. USAID issued a fact sheet last night, and if you need more information, we’d be happy if you want to check back with Mark. Mark can direct you to one of us who can get you the exact breakdown. But that assistance covers the full range of things for the people of Kenya and Ethiopia, for assistance inside Somalia, and also and importantly, for refugees in both Kenya and Ethiopia, so it’s part of a comprehensive response. But we can get you the specific breakdown after the call if you’d like it.

QUESTION: Great. Thanks, Gayle.

MR. TONER: Yeah. We’ll make sure that we push that out to folks.

Great. Next question?

OPERATOR: At this time, there are no further questions.

MR. TONER: Great. Well, okay, very good, then. Well, I just want to thank all the journalists who joined us this morning and especially thank all of our participants for taking time out to talk about this important issue, and to discuss the trip. So thanks to all of you again and have a very good day.

MS. SMITH: Thank you.


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