Remarks to Association of Physicians of Pakistani Descent
of North America
Gaylord Palms Resort and Convention Center
APPNA President, Dr. Mubashir Rana, Dr. Asif Mahmoud, Members of the Association of Physicians of Pakistani Descent of North America, Distinguished Guests, Ladies and Gentlemen:
Thank you for giving me the opportunity to speak to you tonight. I am delighted to be here to talk to you about the U.S. – Pakistan relationship.
First, I would like to take some time to recognize you. Pakistani physicians are famous for the quality of their preparation and dedication to their profession. Pakistani doctors are much in demand, and can be found throughout North America, as tonight’s participation demonstrates. For the United States, with a growing population and growing demand for health care, attracting high quality medical practitioners, as well as learning from practitioners working in Pakistan, is a priority.
Understanding this, our Embassy takes pains to educate our consular officers in the manifold reasons for medical practitioners to travel to and from the United States for the purposes of scientific exchange, conferences, practical experience, employment and immigration. Having heard from you, it is now easier than ever for a Pakistani medical student to undertake the opportunity to participate in a medical internship in the United States. It is also easier for physicians to travel to sit board exams, take advantage of in research opportunities as fellows, and explore employment as a practitioner throughout the United States. We value the contributions of Pakistani doctors to the healthcare field and are always looking for suggestions, within in law and regulation on how we can improve our facilitation.
Ladies and Gentlemen:
It has been my honor to be your Ambassador to Pakistan for nearly three years. My assignment is coming to close, as is my career as a Foreign Service Officer. As it happens yesterday was the 33rd Anniversary of my joining the State Department, and this fall I plan to retire from Government service.
It is therefore a time for personal as well as professional reflection, and I would like to offer my thoughts on the ties between the United States and Pakistan, one of the most interesting and complex bilateral relationships in the world.
The cliché about the US-Pakistan relationship is that it is a roller coaster: lots of ups and downs, twists and turns, occasional spills, certainly thrills and sometimes chills. I’m sure all of you are familiar with our history: alliance in the 50s and 60s, a more turbulent period in the mid and late 70s, close cooperation during the anti-Soviet Afghan war of 1980s, then the difficult period of the 1990s when Pakistan felt abandoned by the US, finally the post-9/11 alignment, based heavily on anti-terrorism cooperation. But even within the past decade we have had its ups and downs. It is no secret that we went through an annus horribilus in 2011 and 2012 when our relationship was strained by a series of difficult events.
Today, I am proud to say that relations between the United States and Pakistan are back on a firm footing. When I arrived in Pakistan in the fall of 2012 our relationship had been strained by the events of the previous year and half; But the two Governments, American and Pakistani, were working assiduously to improve the relationship. We did so on the basis of the guiding principles of mutual respect and mutual interest that President Obama’s laid out in his 2009 Cairo speech to the Muslim world. In particular, we focused on areas where American and Pakistani interests converge. But at a practical level, it was an exercise in sustained, consistent and painstaking, diplomacy. Tonight I would like to walk you through the history of some that diplomacy.
Let me start with the basics: we regard it as essential that we operate on a “Whole of Government” basis; the idea is that all US Government agencies, working together across their missions and mandates rather than in narrow stovepipes can more effectively deliver on our goals and objectives. Our Mission in Pakistan is one of the largest in the world, with nearly 800 Americans from about and several thousand Pakistani employees representing 15 agencies. In addition to the Embassy we have 3 Consulates, in Karachi, Lahore and Peshawar. Recently our Embassy offices moved into a new chancery building, the result of the largest single contract the State Department has ever let, and this magnificent new workplace symbolizes our commitment to Pakistan over the long term.
Strategic Dialogue
The conceptual framework of our partnership with Pakistan is the Strategic Dialogue. And it is a good example of how we have streamlined our relationship to mutual interests. As originally conceived in 2009-2010, the dialogue entailed 15 working groups, each meeting at the level of Cabinet secretaries or ministers twice a year. While conceptually desirable, it proved logistically cumbersome, and difficult to implement in practice. So we scaled back to a much more manageable 6 working groups focused on key areas. Today we focus on: counter terrorism, nuclear non-proliferation, defense cooperation, energy, economics and most recently, education, science and technology. The Dialogue provides a vehicle for candid discussions between friends, a means to find practical avenues to make progress on our shared goals, and enhance our people-to-people ties.
Within this framework, the practical work of the dialogue is carried out on a daily basis by our Mission on the ground, and much of it involves various assistance programs. Let me detail some of what we are doing.
Civilian Assistance
Last fall we marked the fifth anniversary of the authorization for increased assistance to Pakistan. The so-called Kerry-Lugar-Berman program resulted in the expenditure of about $5 billion and weaned the relationship off of disproportionate security assistance. While current assistance levels are lower – reflecting a worldwide trend in view of American fiscal priorities – our program in Pakistan is still one of the world’s largest.
We have implemented a number of civilian assistance projects that focus on the needs and priorities of the Pakistani people based on the premise that an economically vibrant Pakistan will contribute to the prosperity of the region. The United States works with Pakistan to address its economic and development priorities, including addressing Pakistan’s energy crisis and infrastructure needs. America has worked with Pakistan to upgrade power plants, transmission lines, and dams. Since 2009 our projects have added 1,500 megawatts of electrical power, meeting the needs of more than 16 million people. We have funded the construction of more than 500 kilometers of roads, many that link the traditionally underdeveloped regions of the Tribal Areas to the rest of Pakistan.
One particular aspect of our assistance program that this audience will appreciate is that the U.S. mission in Pakistan works closely with their Pakistani counterparts to promote improved healthcare and health education. For example, through USAID, we built the Jacobabad Institute of Medical Sciences, a state-of-the-art facility that is now offering excellent medical and surgical treatment for patients in Sindh, and neighboring Balochistan and South Punjab. In addition to providing much-needed healthcare, the institute has the mandate to be a nexus of research and training in the region.
Our USAID team is also focused on maternal and child health. USAID-trained community educators have conducted more than 350,000 visits, resulting in a five-fold increase among women referred to health facilities. We also launched two health awareness campaigns that reached 32.5 million women. Our “Mother’s First Expression of Love” campaign promoted early and exclusive breastfeeding, and another called “The Mirror” encouraged spouses to discuss birth spacing. Research shows these two actions create healthier and more stable families.
Finally, USAID’s Food for Peace initiative provides food supplemented `with micronutrients to help avert short-term hunger and reduce the level of stunting seen in Pakistani children due to chronic malnutrition.
Turning to terrorism, the United States and Pakistan have cooperated on mutual counter terrorism priorities, and it is not too much to say that over the past 14 years that cooperation has brought about the nearly complete dismantlement of core Al-Qaeda. While our cooperation is not a subject we can discuss in detail in public through our partnership with the Pakistani government, and vehicles like the Strategic Dialogue, we are able to have an on-going conversation about countering terrorist activity in Pakistan and the region, and have made progress not only in targeting al-Qaida leadership but also countering the threat that both our Armies face from improvised explosive devises.
Security Assistance
The United States also has a continuing commitment to Pakistan’s defense needs. We regularly hold bi-lateral military discussions and expedited the delivery of supplies to support ongoing operations. To demonstrate our long-term commitment to Pakistan’s security, we recently approved the sale of the state-of-the-art Bell AH-1Z (Zulu) helicopters – the so called Viper attack helicopter. We are also working with Pakistan to develop a medical prosthetics program and to provide the military critical equipment and training needed to support troop survivability and rehabilitation. For example, in May we had a team from the Defense Institute of Medical Operations visit a military hospital in Rawalpindi to train doctors and nurses in emergency combat care.
The United States recognizes and appreciates Pakistan’s support to Coalition Forces in Afghanistan, and in its overall fight against terrorism. In fact, the United States reimburses Pakistan for support it provides to coalition forces in Afghanistan. Since 2002, Pakistan has received roughly $13 billion dollars for its support of efforts to bring peace to Afghanistan.
We also provide Pakistan about $265 million through the Foreign Military Financing program for military equipment and training to support its counterterrorism and counterinsurgency operations. Pakistan will be the fourth highest recipient of Foreign Military Financing in 2015. Additionally, through our International Military Education and Training (IMET) program, the United States invests in the professional development of Pakistani military officers. [You will recall that this program was cut in the 1990s, with effects we are still feeling.] In 2014, 104 members of Pakistan military participated in training programs in the United States, including graduate-level study at our various staff colleges.
I would like to note that we made a special effort to accelerate assistance in the run-up to operation Zarb e-Azb in North Waziristan, delivering key materiel prior to the commencement of operations.
Public Diplomacy
I have talked about strategic and economic interests in Pakistan’s future, but the United States also works to build strong people-to-people connections. These connections will help broaden understanding between Pakistanis and Americans, and will help weather any ups and downs our governments face in the future.
One of the best kept secrets of foreign policy is academic exchanges. We invest more in the Fulbright Program in Pakistan than in any other country in the world. We have established sixteen university linkages between prestigious institutions in Pakistan and the United States. This year, the U.S. government will send more than 700 Pakistani students to academic exchange programs, and another 500 Pakistani professionals to shorter, work-related programs in the United States.
Tens of thousands of Pakistanis who have participated in exchange programs in the United States and returned to live and work in Pakistan play a key role in helping us build bridges between our countries, and in generating a more prosperous future for Pakistan.
We have also taken steps to counter the narrative that the USG is somehow responsible for Pakistan’s politics. For the past three years, and especially during the 2013 elections, the US was beyond reproach in its non-interference in domestic politics. When we are accused of interference, which happens less frequently, we can have a robust response.
Where Pakistan is now
These are just a handful of numerous examples of the U.S. commitment to our relationship with Pakistan. And we stand by Pakistan as it faces an increasingly complex set of internal and regional challenges, which I’d like to briefly outline.
Terrorism
On the issue of terrorism, our nations have both suffered gravely from the pernicious effects of transnational terrorism. The threat of terrorism by non-state actors is very real; the attack on the Army Public School in Peshawar is one of the most tragic reminders that there are forces that would tear Pakistani society apart, rather than build it up. Pakistan has been taking the fight to the terrorists – military operations in Waziristan have put the Pakistani Taliban on their heels.
That said, we continue to have concerns about Pakistan’s history of using proxies against perceived foes in the region. Although we’ve seen concrete actions by Pakistan to more clearly establish the writ of sovereignty, the military and civilian leadership must make good on their recently stated commitments not to differentiate between terrorists – meaning that they just as forcefully take action against groups like the Haqqani Network, which pose serious threats to American (and Afghan) lives, and Lashkar-e-Tayyiba, which has the potential to destabilize the region.
Economy
The economy is a focus for the current government, and we agree a stronger and growing economy will lead to more stability and a better future for Pakistanis. Our shared long term goal is to expand trade and investment, not just aid. The United States is currently Pakistan’s largest trading partner, with 2013 two-way trade totaling over five billion dollars. Despite some significant challenges, particularly in energy, I remain cautiously optimistic. Pakistan has a population of approximately one hundred and ninety million people, making it a huge potential. The country has a growing middle class that is becoming increasingly urbanized.
Nearly five million households will enter the middle class by 2025. More than sixty percent of Pakistan’s population is under the age of thirty. These youth will be tomorrow’s consumers.
Pakistan’s major cities are already industrial centers, with GDP growth expected to outpace country-wide GDP growth by more than two times. Pakistan also has a large, educated, English speaking labor force. So, if our future holds more trade, these are strong indicators for growth.
The US capitalized on these trends with the March visit of Commerce Secretary Pritzker, the highest level economic official to visit in 5 years. She came to endorse the message that Pakistan is open for business, but also to urge the Government to continue on the path of economic reform. Pakistan has now passed the initial stages of the 8th quarterly review of its IMF program. This is the country’s best effort toward macroeconomic stability and prosperity in many years. Many difficult decisions remain, however, and it is important that the pace of reform continues and does not falter.
Region
The regional picture for Pakistan is complex, dominated by two relationships: Afghanistan to the west, and India to the east. Pakistan has been instrumental in working with Afghanistan and the Ghani government to stabilize the border they share, and has been playing an important role in promoting peace talks with the Afghan Taliban. Pakistan has been very clear that it is in their own interest to see a stable Afghanistan, free of terrorism to their west. Pakistan faces the challenge of putting into actions the commitment is has made to President Ghani that the enemies of Afghanistan are the enemies of Pakistan.
Looking east, while Pakistan’s relationship with India cycles through periods of tension and glimmers of hope for a breakthrough, the international community has been consistent in its calls for dialogue and improved relations. Both countries should sustain the momentum from the recent meeting between Prime Ministers Sharif and Modi in Russia. It is welcome news that the two National Security Advisors are planning to meet. These initial steps are key to building trust and understanding, the right direction toward managing and resolving near, as well as long-term differences.
Democracy
Finally, let me say a word about Pakistan’s democracy. I’ve heard many allege that the U.S. is ambivalent about democracy in Pakistan – but that could not be further from the truth. We realize that the process of strengthening and embedding democratic rule will be gradual – but it is critical to Pakistan’s future, and I know this is understood by both Pakistan’s civilian and military leadership. It has been almost eight years since democracy was reinstated in Pakistan, and two and a half years since the country’s own historic transition of power from one civilian government to another. There continue to be challenges. Just a year ago, the Sharif government was beset by protests that fed rumors of a coup, but today, it appears that civilian and military leadership have come to an important modus vivendi, as preserving the centrality of civilian led, democratic institutions, is critical to Pakistan’s future stability and prosperity. It .looks like Democracy is here to stay)
Conclusion:
In conclusion, let me repeat what I said at the outset, it has been my honor to serve as the U.S. Ambassador to Pakistan. We have weathered some difficult periods and now have a stronger partnership focused on shared goals and values. Complex as it is, our relationship with Pakistan today is on a positive track. We envision a secure Pakistan, in a secure region. This vision is in the interest of Pakistan, the region, and the United States. I am left a great respect for the Pakistani people and their government, and have admired their courage and fortitude in the face of some significant challenges in recent years. While I am going to leave Pakistan soon, I foresee a strong and lasting relationship based on shared interests and values.
Thank you for your attention.
