MODERATOR: Good afternoon and welcome to the Washington Foreign Press Center. We're very pleased to have with us today USAID Administrator Dr. Rajiv Shah. He's going to discuss his recent trip to Pakistan and provide us with an update on U.S. flood relief efforts and assistance in Pakistan.

ADMINISTRATOR SHAH: Thank you, and thank you for having me here. I'd like to start just by sharing with you the purpose of my trip. My recent trip to Pakistan was, in fact, to oversee the U.S. support for the flood response effort. And as you all know, and certainly getting a chance to be there and see the tragedy firsthand, the scale and the scope of this natural disaster is astronomical.

There are more than 20 million Pakistanis that are affected from the floods throughout the country. We estimate that more than 8-, perhaps more than 9 million people are in need of immediate support, whether food, clean drinking water, medicines, a safe place to stay, shelter for children and for families. And if you just pause to reflect on that size and scope in terms of the humanitarian needs and the fact that it is spread out over a landmass that is larger than the country of Italy, it gives you a sense of the some of the logistics and operational challenges that will be confronting – that are confronting and will continue to confront the overall relief effort.

In addition to the humanitarian consequences, which of course are tragic, the economic and social impact of this flood is going to be felt for a significant amount of time and also represents an area where there are urgent needs. Pakistan relies heavily on its agriculture to both feed itself and to provide employment to more than 60 percent of all Pakistanis. And the flood, based on the Indus River floodplain, which is the most productive part of Pakistani agriculture, has submerged 4.3 million acres of productive cropland, which represents 23 percent of the productive capacity of Pakistani agriculture.

Given the scale of this tragedy, the President of the United States and Secretary Clinton have instructed us to mount a strong and effective response in cooperation with the people of Pakistan, the Government of Pakistan, and the international humanitarian community. The U.S. Government has been at the forefront of that response from an international perspective. With the additional announced $50 million of flood relief support that I announced while in Pakistan, it brings our total commitment for the immediate relief and early recovery to $200 million. And it's important to note that right now the expenditure of these resources is generating real results. We always wish we could do more, but we are noting that in terms of food distributions, we're now reaching 1.9 million people with a 30-day ration of food and food commodities.

We know that access to clean drinking water, ironically, in a flood is often critically needed, and we now have water production units in Pakistan that have been provided by the United States that are providing clean drinking water to more than a quarter of a million people on a daily basis, with many more of these LMS units that each provides support for 20,000 people on the way.

We are, of course, concerned about waterborne illness. In floods, both as waters rise and as waters recede, the risk of waterborne illness goes up. And in an environment where not everybody had access to safe sanitation to begin with, this is of acute concern to the entire international community and to the Government of Pakistan. We're proud of the fact that USAID has worked with Pakistan preceding the flood and for many years to create a disease early warning system. And that disease early warning system is today producing real results.

The few identified cases of cholera, for instance, were identified through this system and we were able to provide immediate mobile medical support to communities where we thought there was an acute risk of the spread of cholera. We're also expanding our support for diarrheal treatment centers and, in fact, we're seeing an increase in acute diarrhea amongst children. And so the risk of continued waterborne illness and its disproportionate challenge that children will face is something we're acutely concerned about and expanding our efforts in relation to.

As part of this, we're also expanding our work in hygiene, which now has reached more than a million Pakistanis with hygiene kits and hygiene information. These kits contain soap, towels, basic hygiene materials, but also, through SMS texting, radio messaging, and other forms of door-to-door or settlement-to-settlement messaging, we're able to provide information to people about how to protect themselves from the risk of disease.

Our shelter efforts are now reaching more than 150,000 people. This is small compared to what is needed in aggregate, but it is important that we do more and get more effective every day.

And of particular importance, frankly, prior to this particular tragedy, USAID has worked with the Government of Pakistan to create a National Disaster Medical – Management Authority. This is the first natural disaster in which Pakistani leadership is actually setting the strategic direction and leading the operational response through the NDMA. And I was happy to spend time with General Nadeem, who has experience working to support the earthquake response in 2005 and the person who has set up the NDMA, together with USAID support, who is leading that effort.

My trip allowed me to visit specific areas that have been affected. We – General Nadeem and I traveled north through the Swat Valley to Kalam and saw the tragedy firsthand, as much of the infrastructure in that area, including bridge after bridge and the main arteries and main roads were destroyed through the floods.

It's important to note that the U.S. support, the helicopter and evacuation support, has evacuated more than 6,000 individuals. In that northwest – in that northern Swat Valley area alone, the Pakistani military, under the direction of the NDMA, evacuated 16,000 Pakistanis and saved untold number of lives through that effort.

I also had the chance to visit Sukkur and to visit a settlement that had just been set up along with the WFP food distribution site and to talk with people who have suffered from tremendous losses. When you do that, you get a very personal sense of the scale and impact of the tragedy.

I met a man in the first site who – whose family had been – had lost their possessions and lost their farm and who is actually living by the roadside, and then he had lost one of his children in an accident with a vehicle that happened while he was on the roadside. I met with women who talked about losing everything they had and trying – giving everything they have to feed their children in an environment where more and more of their children were reporting tummy aches and diarrhea, and we all know that that has tremendous risks for child survival.

I had the chance to meet with General Nadeem, as I mentioned, of the NDMA, and observe his strong leadership, and also to spend time with Foreign Minister Qureshi and with President Zardari and Ambassador Haqqani to discuss their efforts on the relief, their planning for the transition from relief to recovery to reconstruction, and their thoughts on building accountability and transparency mechanisms into the large-scale reconstruction that we all know will be necessary.

And we also had the chance to talk about what the long-term needs will look like. We know that when the flood waters recede, some of the disaster needs assessments that are going to take place and have already begun in certain areas, in the north in particular, will have much more information about what's needed to mount an effective reconstruction. We've noted that this will require significant resources and a significant partnership with the international community, and we've highlighted the need for transparency and accountability in how those resources are spent so that taxpayers around the world, including those in Pakistan, are both making commitments to this effort and knowing that those commitments are achieving real results for the Pakistani people.

And while it's hard at this time of tragedy and when you see the scale of this disaster to fully internalize the concept that we can, in fact, build back a better and more resilient economy and society in areas that have been affected, it's worth noting a particular example from the earthquake response that USAID conducted together with the people of Pakistan. This earthquake in 2005 ended up killing more than 79,000 Pakistanis and it was a tragedy of significant proportion at that time.

USAID worked for many years afterwards to mount a significant relief, recovery, and reconstruction effort. And in just one example, in education, we helped, together with Pakistan, build 56 schools back to a higher than usual earthquake and seismic standard that has currently provided an effective education of more than 20,000 Pakistani children, and has also actually helped set up local construction firms that can meet earthquake construction standards to build a more resilient and disaster-proof environment. So while it's hard to imagine that those things are possible, it is possible to build back better, and that will be a big part of the focus for the ongoing recovery and reconstruction.

So with that, I'm happy to take questions and appreciate your being here. Thank you.

MODERATOR: Just a reminder that please wait for the microphone on either side of the hall. Dr. Shah has a limited amount of time, but we will start off, so please limit yourself to one question. And we'll start right here with APP Pakistan.

QUESTION: Thank you for the opportunity. Ali Imram from Associated Press of Pakistan. You have talked about the humanitarian crisis and you visited camps and met with people. Can you tell us what is the spirit of people, the morale of people facing such a huge catastrophe and do they look forward to recovering? And what was their feel – response to U.S. assistance and that has been done so far?

ADMINISTRATOR SHAH: Yeah. Well, I have to tell you, I was just absolutely struck by how resilient people were. Even the gentleman who told me about losing his child also talked about wanting to get back to work, back into agriculture and farming. Of course, millions of Pakistani farmers have lost their seed stock, they've lost – their land may or may not be waterlogged for some time, it may or may not drain efficiently and effectively.

And my personal sense is people have been through unbelievable tragedy and loss, but they are far more resilient than most people realize and that they are eager to get back to work. They're eager to have access to cash and to restart local economies. They're eager to be part of the solution. And so even as we mount an aggressive and hopefully effective humanitarian effort, we have to do things like track local market prices of food commodities to make sure we're not creating disincentives for farmers to produce.

We have to make sure, as we provide health services, we're doing that in a way that allows a local health service sector to reemerge and take on those responsibilities of primary care and public health. And we have to get kids back into school. It's just – it's amazing to see and talk to these children, some of whom – because I saw them in settings where they were getting food and water, were noting that they were getting enough food and water, but clearly they need to be in school as soon as possible. So I would just observe that the resilience of the Pakistani people comes through in a really powerful way, even in a very tragic circumstance.

QUESTION: And your response to the U.S. assistance?

ADMINISTRATOR SHAH: Oh, I sensed an absolute gratefulness, and at the same time, people are suffering acutely. Even when you have people that you're providing food and water, they are often ill, they need medicine, they're often wondering when they will get back to getting their lives on track. And I think, rightly, their primary focus is on that. But I sense that they were certainly happy to be visited by a U.S. delegation and they certainly valued the immediate shelter, food, and water that was being provided that was helping them survive in a very, very difficult environment.

MODERATOR: Okay. We'll go to the young lady here.

QUESTION: Sue Pleming from Reuters. Well, you mentioned accountability and transparency. Are you looking at setting up a special sort of mechanism for international funds to go into, much like the Palestinians have the temporary international mechanism, or the TIM, as it was finally called, something like that? And are you – how are you going to program the Kerry-Lugar funds? Did you get any further in working on that?

And then I – sorry, I just have one little thing. You visited a camp which was apparently run by – or extremist charities – I'll call them extremist or charities – or links to extremists had donated some food. Were you aware of that, and what were the circumstances of that? Because there were some conflicting reports on that.

ADMINISTRATOR SHAH: Sure. Let me address all three. Remind me the first one.

QUESTION: The first one was: Are you looking at having some kind of special mechanism so that there's transparency?

ADMINISTRATOR SHAH: Oh, the mechanism, yeah. So, that's a great question and thank you for asking that. As you look around the world, and we obviously have a huge amount of experience, from Haiti to Indonesia to the Palestinian Authority to any number of other situations, there are many different models for creating a mechanism that allows for improved transparency and accountability and country ownership in the process of reconstruction and funds management in reconstruction. I think it's important to always connect those two.

It's easy for the international community to focus on accountability and transparency. Just as important, these mechanisms should be a vehicle that allow countries to say this is our plan for reconstruction and building back, and we're going to insist that partners work in a cooperative way to do that, in a way that's transparent and in partnership.

This was very much the subject of my conversations with government leadership, and they all indicated a strong willingness to put in place the right type of structure and mechanism. So I expect we will hear more about that in the future as they work through exactly what structure is most appropriate. But I do think something like that would be helpful and I am glad that the Pakistani Government has been also very focused on learning from different examples so that they can move in that direction.

The second question was?

QUESTION: Kerry-Lugar-Berman.

ADMINISTRATOR SHAH: Oh, Kerry-Lugar, right.

QUESTION: The Kerry-Lugar-Berman and --

ADMINISTRATOR SHAH: Well, I want to thank Senator Kerry specifically. While I was out there, he sent a message that we should do whatever gets the highest returns on investment of U.S. tax dollars in terms of improving human economic and social outcomes and be willing to consider reprogramming of those resources.

I announced an initial $50 million of reprogramming, but that's really an initial step within a larger frame. There's some areas where reprogramming will be somewhat obvious. We had been focusing on drip irrigation, for example, which may not be the immediate priority given the amount of water and waterlogging. And if you think of the goal not as the mechanism of getting there, but improving productive agriculture in a way that allows for sustainable livelihoods, you may do some things differently.

So our mission team in the Embassy is looking pretty broadly at how to best move forward with a real focus on doing those things that generate the highest rates of return, some of which will require further reprogrammings, and we'll be prepared to do so. Another example is sort of replenishing seed stocks for farmers, for example, that have lost the seed that they saved to plant for the winter wheat season and for subsequent planting seasons.

And the third question I am glad you asked; it is important and I'd like the chance to clarify. First, I think it's important to step back and note the purpose of the trip was to oversee and manage and do everything we can to mount the most effective humanitarian response possible and that we carry out that moral mission because we are committed to saving lives that are in danger and alleviating extraordinary suffering when it occurs.

I had the chance – you're referring to a site in Sukkur – I had the chance to visit a World Food Program food distribution. It is, in fact, a World Food Program distribution and to note that it is the first structured 30-day ration – the first structured distribution of 30-day rations being conducted in that area. So I felt it was important to highlight that as an important part of the solution, an important part of protecting people from starvation.

While there, I had the chance to meet with aid workers from WFP and from our implementing partner. I also had the chance to talk directly with women who were standing in line. And these were the people who pointed out to me that they didn't have shoes because they had lost all of their possessions. They barely had clothing. Their children were malnourished and ill. One woman had her child in a hospital somewhere and wasn't exactly sure what was happening to her child. It just – it's such a tragedy of such immense proportion, and I really did want to listen to the people standing in line and learn about how we, together with our partners, can mount the most effective response on their behalf. I had hoped to spend more time talking to people in line, but within a few minutes of being there, our Diplomatic Security detail informed me that there were some suspicious individuals in the area and we needed to leave. So we tried to make as graceful and appropriate an exit as possible.

It's important to note that USAID and the World Food Program and all of our implementing partners only support and work with absolutely validated organizations. We're sometimes criticized for moving too slowly in providing resources to local groups without doing – because we have to do careful auditing and compliance. But the fact that we do that auditing and compliance ensures that I'm able to stand here and say that I know, with certainty, that we work with only partners that are validated.

I understand in this situation, and perhaps in others, the TTP and others have actually been threatening aid relief workers and international aid relief workers. I can't tell you how disappointed and inappropriate that feels when you've been there and you've talked to people who have literally lost everything and are just trying to survive.

The fact that suspicious individuals had been in this site – in part because they knew I was coming, and the day before, our security folks who had gone out there, of course, hadn't seen any signs of them – is an indication these are open sites. People can get there. The whole point is to have people who are in urgent need come and get food. So it's just – it's deeply saddening that others would choose to use these environments to propagate themselves or to threaten international aid workers.

But I'm happy that I had the chance to talk to a few women. I would have liked to talk to more. I think the stories you learn from them really motivate and provide information that can help us do a better job. And our goal right now is just to make sure we're feeding and saving as many people as possible.

MODERATOR: Let's go to Aziz.

QUESTION: Raj, good to see you.

ADMINISTRATOR SHAH: Hi, Aziz.

QUESTION: Yeah. Piggybacking on Sue's last question, on a broader level, how do you avoid running into these situations? Because there is no denying the Taliban, the Jamaat ud-Daawa and groups like that are also very active in terms of trying to alleviate the suffering of these people because they've got these charitable arms, too. So how do you avoid running into such situations and also sort of the seepage of USAID money and other funding that goes into these?

And at a philosophical level, when you came into this job, you were going to do a lot of development projects in Afghanistan-Pakistan in terms of reaching the hearts and minds of those people. And then you were beset with these two huge natural disasters, first in Haiti and now in Pakistan. How do you cope with this, and has this put back a lot of the development work that USAID was going to do in these areas?

ADMINISTRATOR SHAH: Well, thank you for both of those. On the first part of the question, Aziz, we have systems that allow us to track our food, our commodities, and our dollars very carefully. If other people show up at sites either to intimidate or in some cases to help, my sense is – or to just be visible and try to take credit for what other people are doing – those are things that happen and this is a fluid response environment and the people we work with are just – share our commitment to service and saving lives and feeding the hungry. So I think it's a fluid environment and it's difficult. But certainly, on behalf of the U.S. tax dollars and tax payers, we can track our money and our commodities quite closely because we work with a set of validated implementing partners that are providing direct services to people in critical needs.

On the second part of your question, I appreciate that also. A former USAID administrator told me that you'll be surprised at how much time you spend on disasters, and he told me that on, I think, January 3rd. And I thought that he's probably wrong about that in my case, because I'm going to be very focused.

But in some ways, the tragedy in Haiti and the tragedy here and our ability to provide humanitarian assistance elsewhere in the world, in my mind showcases both to me, to the agency, and to the rest of the world what USAID can do when we need to move fast, when people – our people need to be creative and entrepreneurial. I love seeing the excellence of our team on the ground. We have a 16-person disaster assistance response team based in the embassy, working hand-in-glove with General Nadeem and the National Disaster Management Authority. They use data to make decisions. They have focused on waterborne illness because they know from case history that that's the most acute need. And they're very smart about structuring transition from relief to early recovery to reconstruction so that development can happen.

And there's going to be case after case, where we are able to actually leapfrog the previous development picture and build back to a better standard, whether if we're distributing seed to farmers who have lost their seed stocks, you can distribute improved varieties and improve the core production system that they're putting in place.

If you're building back schools or physical structures that have been destroyed, you can build back to higher standards, and you can do that using local materials and training local construction workers and masons.

If you're putting in place health assets to provide immediate needs, either in a disease early warning system or these diarrheal treatment centers that will provide oral rehydration therapy and do basic diagnostics and manage fluids for children who otherwise would die from acute diarrhea. You can then use those – that infrastructure as a way to build out, over the long term, a health system that has more outreach into rural communities and affected communities.

So it's very, very tough at this point in time to be optimistic about the future. But our teams have enough experience to see those opportunities, and we try to do the relief work in a way that sets up for that kind of success over time.

MODERATOR: Okay. We will go in the back to the gentleman with the green tie.

QUESTION: Hi, I'd like to know today – like China and many countries already send --

MODERATOR: Can you say your name and news organization?

QUESTION: Okay. I'm a Phoenix TV reporter. My name is Ching-Yi Chang. And I'd like to know, like China and many country already send the international aid to their country, how the U.S. Government see the international effort helping Pakistan?

ADMINISTRATOR SHAH: Yeah.

QUESTION: Thank you.

ADMINISTRATOR SHAH: Well, thank you for that question. There is no question that right now more can be done, and that resources spent on the immediate relief will save lives, feed people who need food, and help keep children from experiencing sort of long-term morbidity from diarrhea and a range of other illnesses.

So my trip only validates a point that I had tried to make last week at the United Nations where Secretary Clinton gave a powerful statement to the world about how the world needed to come together and provide support to the people who are suffering right now. This is a core global humanitarian imperative and we need more international support.

I'm pleased that after last week's meeting at the United Nations there appears to be a significant increase in pledges and commitments. Certainly, I was on airfields and able to see commodities come in in a more effective and aggressive way. But when you look at the scope of what needs to be done here, you have more than 8 million people – probably more than that – who need acute services in order to survive and to start to think about building back their lives and livelihoods, and we need more resources and support from inside Pakistan and outside of Pakistan in order to be successful with that. So that's going to be true through recovery and reconstruction as well, and I'm glad you asked the question.

MODERATOR: We'll go here, VOA.

QUESTION: Thank you very much. Dr. Shah, I'm Iftikhar Hussain. I work for Voice of America Pashtu to the border region service. We broadcast through the region you visited which is most affected by the floods.

My first question is: Looking beyond the immediate relief activities, how the USAID is looking for involvement, particularly in the agricultural sector. And the second question is: We are hearing from the people and also from the government of Khyber-Pakhtunkhwa province, which is (inaudible) with the most affected region, that aid coming from the international community, including the USAID, it is not reaching out to them and have you shared any ideas on the mechanism that making sure that USAID help goes equally to all the people there?

Thank you very much.

ADMINISTRATOR SHAH: Thank you. Let me address your first question first. This Administration, under President Obama and Secretary Clinton, has from the beginning of our Administration been very committed to establishing an effective, diverse, and long-term commitment to the people of Pakistan in partnership with Pakistan. As a result of that, we've conducted the Strategic Dialogue and we have 13 working groups that have been taking forward partnerships in areas like energy and agriculture, water management and irrigation, for example, and health, education, and other social services.

In that context, we will continue our long-term commitment. This flood only intensifies our immediate response and our commitment to that long-term process. And specifically in agriculture, we will have to look at and reprioritize what we were planning to do in that sector. We're doing that directly with the ministries and leadership of the Government of Pakistan and with so many of the non-profit partners that we're already working with in that sector. But with 23 percent of cropland under water, they're going to need a real strategy in agriculture.

And I would note that in the 1970s, it was USAID that worked with the government and people of Pakistan to bring about a green revolution, based on improved wheat varieties and improved production technologies that saved countless people from starvation and acute famine. So we have some history of working with Pakistan in agriculture and we're going to have to re-intensify that particular sector and our partnership in that area.

In terms of the region you spoke of, in terms of KPK, we actually have more distribution capability in those areas than we do right now in the south, and that's because we've been working in those areas with – for a range of other programs: protecting IDPs, providing services in certain areas. And so we need to intensify that effort and we're trying to get – I was just on the phone with some of my counterparts from other countries talking about how we all need to do more in that area and also in the south. We need to get more of our international NGO leadership out there so that there's greater capacity for a larger humanitarian response, and we have to encourage our partners in Pakistan to do more across the board there. But I would also note that in the south, the tragedy is still unfolding, and the flooding is reaching new communities.

And while people are being evacuated, the tremendous kind of acute needs in the south are also going to be very important; in particular, the waterborne illness concerns in the south with potentially slower drainage there for a variety of reasons, from soil type to everything else. It means we have to stay vigilant about protection in that environment as well.

Thank you.

MODERATOR: We're out of time. Thank you, Dr. Shah.

ADMINISTRATOR SHAH: Okay.

MODERATOR: Thank you for coming.

ADMINISTRATOR SHAH: Thank you.