Establishment of the Health Incident Response Task Force

May 23, 2018



Report by the U.S. Government Accountability Office (GAO) on Health Attacks

published/publicly released Sep. 6, 2018

REPORTED INJURIES TO U.S. PERSONNEL IN CUBA: Preliminary Observations on State's Response and Management Challenges



Foreign Affairs Committee - Subcommittee Hearing "U.S. Policy Toward Cuba"

Sep. 6, 2018


GAO's Acting Director - International Affairs and Trade - Brian M. Mazanec, Ph.D.:


[40:37] Thank you. Good afternoon chairman Cook, ranking member, distinguished members of the subcommittee and staff. Thank you for the opportunity to discuss GAO's work on the Department of State's response to the Health Incidents in Havana Cuba. As you are aware and as was just mentioned, since late 2016, U.S. personnel and their families in Havana have experienced incidents associated with unusual sounds or auditory sensations that resulted in serious injuries. The unprecedented and unexplained nature of these incidents created some management challenges for State as it responded and continues to respond. It is important to identify and address these challenges in order to help State improve security programs and practices at all overseas posts. 


First, I will be discussing our July 2018 report, which was released yesterday, on States process for convening an Accountability Review Board or ARB. Second, I will be discussing our preliminary observations on three key management challenges related to the unexplained nature of the incidents. On the first topic, we found that State does not have policies to ensure that its office responsible for initiating the process for convening an ARB is made aware of incidents that may meet the ARB criteria. The responsible office, State’s Office of Management Policy, Rightsizing, and Innovation (M/PRI) starts the incident vetting process as soon as it becomes aware of a potentially qualifying incident. However, M/PRI relies on informal communication to identify such incidents. With regard to the situation in Havana, other State offices began responding to the incidents in January of 2017. However, M/PRI was not made aware of the incidents until eight months later in mid-August when a former M/PRI official contacted the office after seeing media coverage of the incidents. Officials from the responding State Office have told us it was unclear whether the incidents met the criteria for convening an ARB and thus they did not inform M/PRI. However it is not the role of State offices to evaluate whether the incidents meet ARB criteria before reporting them to M/PRI. If M/PRI is not aware of incidents, it cannot initiate State's ARB incident vetting process. This puts State at risk of not meeting statutory timeframes for convening an ARB and most importantly could result in State being less able to improve security at overseas posts. In our report, we recommended that State revise its policies to improve communication to M/PRI of incidents that may meet ARB criteria. 


The second topic I'd like to discuss today is our preliminary observations from our broader ongoing review of State's response to the incidents in Cuba. To date we've identified three key management challenges related to the unexplained nature of the incidents. The first management challenge relates to mitigating risk to US personnel given the unknown nature of the incidents. Because the Department does not have definitive answers on the cause or source of the attacks, it has not been able to comprehensively reduce the risk of injury to personnel. Instead, State has taken other actions to mitigate risk such as ordering the departure of family members and non-emergency personnel in Havana and directing all posts to review and if necessary revise their emergency action plans. The second management challenge we identified is caring for affected personnel and family members. State officials have made it clear that caring for affected individuals is their top priority. However, State has faced multiple issues in providing this care. For example, the Bureau of Medical Services (MED) lacked authority for domestic medical evacuations to send individuals to the University of Pennsylvania for evaluations in care. This issue was addressed just last week when State delegated full authority for domestic med evacs to MED. 


The third and final management challenge I want to highlight is State's communication with internal and external stakeholders. As mentioned earlier, State had issues ensuring M/PRI was in the loop as the incidents initially occurred. Externally, State also experienced difficulties in communicating with other departments and agencies and responded to these incidents. As Ambassador Bodde noted the ARB has completed its work. The ARB identified some of the same challenges I just mentioned and State has also established the Health Incidence Response Task Force in May to direct a multi-agency response to the incidents. Both of these efforts are resulting in changes that may address some of these management challenges. As GAO continues its broader review, we will be examining the ARB's findings and State's ongoing response. Chairman Cook, ranking member (...) and members of the Subcommittee this concludes my statement. I look forward to your questions.


Full text of Statement: