Epidemic

by Reid Wilson

  After the devastating civil wars of the past several decades, the United Nations already had a peacekeeping mission in Liberia, dubbed UNMIL (United Nations Mission in Liberia). A similar mission in Sierra Leone had wound down a few years earlier. Rededicating those troops deployed in Liberia to the other two countries, and redefining their mission in the process, was not feasible. Instead, Power and her fellow ambassadors crafted a new resolution to go before the UN Security Council, one that would establish the United Nations Mission for Ebola Emergency Response, or UNMEER. The resolution passed unanimously just before the UN’s annual General Assembly, when dozens of world leaders descend on New York. The timing helped focus the attention of assembled heads of state on the crisis at hand.

  The resolution represented the first time the United Nations had declared a public health emergency.

  “The gravity and scale of the situation now requires a level of international action unprecedented for an emergency,” UN Secretary General Ban Ki-moon told the Security Council. The UN’s top Ebola response coordinator, David Nabarro, WHO director general Margaret Chan, and a health worker from Médicins Sans Frontières briefed the council by video conference from Monrovia.2

  Some in the American delegation worried that the UN, a diplomatic body that works at a glacial pace, might be unprepared to mount a quick and aggressive response. In what may have been a telling omen, the resolution passed the Security Council unanimously—but only after all forty-five delegates spoke in its favor.

  Even before Volesky heard from the Pentagon, he tasked his top civil affairs officer, Lieutenant Colonel Ross Lightsey, with learning all he could about Ebola, about the situation on the ground in West Africa, and about the mission they were likely to undertake. Lightsey came back from a quick trip to Washington a few days later, armed with organizational flow charts showing the key players, from the White House to the United Nations to the Liberian government itself. Their mission, as Obama had defined it in Atlanta, would be to build Ebola treatment units (ETUs) across Liberia, train workers who would operate those ETUs, to set up laboratories capable of testing blood samples, and to support USAID, CDC, and other agencies, which meant ferrying them around the country on helicopters.

  Army culture is steeped in visual symbolism, and some officers taking in his presentation took exception to one of Lightsey’s slides, which showed the 101st’s logo behind and underneath USAID’s. Lightsey explained his graphical design. This was not a situation like Iraq or Afghanistan, he said, where the military would be in charge of the vast majority of operations. Their mission was to support USAID, the lead American agency operating in Liberia, to work through the U.S. embassy, and to work alongside the Liberian Army, which had close ties to America’s own.

  “Liberia is the center of gravity here. The U.S. Army is not the center of gravity. We don’t own Liberia, we don’t own this mission,” Lightsey told those present. “This is not combat, like Afghanistan or Iraq, where we own it. This is a sovereign country, with a legitimate president, with a fully functioning Army, and we’re in a supporting role.”

  Volesky nodded in agreement.

  Senior leaders at the 101st spent three straight days learning all they could about the Ebola virus, a reflection that this mission was unlike any other they had undertaken before. They had an enemy, to be sure. This enemy, this virus, wouldn’t shoot back at them, but they also wouldn’t be able to see it. Like other Americans unfamiliar with all but the basics of the Ebola virus, the soldiers of the 101st had some preconceived notions.

  “We didn’t know anything about Ebola,” Volesky said. “It made people think that there was a guy with Ebola hanging out of a tree like a zombie.” The briefings from academics, Volesky said, “took away all that mythology.”

  Back in Liberia, Williams designated the Special Purpose Marine Air-Ground Task Force–Crisis Response, a rapid response team based at Morón Air Base, south of Seville, Spain, as the unit that would evacuate any exposed or infected troops. On September 26, Defense Secretary Chuck Hagel called Volesky to formally assign the 101st Airborne Division to Operation United Assistance. Hagel made clear that Volesky could take any support units he wanted—engineers, air support, and others, especially from Fort Campbell—so that the 101st would be working alongside fellow soldiers with whom they already had a relationship.

  In a sign of how dangerous their mission might become, the storied division was told to prepare for 10,000 active Ebola cases, according to an internal military document prepared after they returned home.

  In the coming months, the Army would ship in thousands of troops, 400,000 Ebola home health and treatment kits, and the construction supplies to build 17 treatment centers in Liberia alone, at a cost of more than $360 million.

  Williams and his team took medical precautions to the extreme. On one day, Williams later recalled, his temperature was taken eight times.3 Several times, troops reported symptoms that might be associated with Ebola, like fevers and headaches. Each time, it was a false alarm.

  Much of the military mission was about psychology, as well as logistics. The new treatment facility near the airport, and public promises to evacuate anyone infected and the military’s presence, American officials said later, were both meant to lure NGOs back into Liberia. Though the Army never made any promise to protect foreign NGOs or Western responders, the mere fact that there were thousands of Americans with guns around helped assuage security concerns.

  The NGOs “couldn’t get enough responders because they didn’t know that either medical evacuation or world-class treatment existed should they get infected,” Shah said later. “Once we put that in place, both the Medivac and the unit [to treat Westerners], it became clear we would be able to take care of the responders.”

  Days after Williams landed, Major Tony Costello’s phone rang thousands of miles away at Fort Hood, Texas. Costello had been in Texas, assigned to the 36th Engineer Brigade, for only a few months, after being redeployed from an assignment in Italy. After graduating from West Point, his fifteen years in the Army had included several deployments to Iraq and Afghanistan. Now, he was told, he would be deploying one more time, to Liberia, where he and his team of engineers would oversee an ambitious plan to scale up the nation’s Ebola treatment capacity.

  As the disease struck more people, Liberia needed the beds in isolation units to treat them. The Army, Costello was told, would be building seventeen Ebola treatment units across Liberia. It was up to his team to develop plans for those new units, figure out how to get them built, even in remote corners of a remote country, and supervise the construction. And he had two weeks at Fort Hood to plan before he would be on a plane to West Africa.

  It was fortuitous that Costello had only recently returned from Italy, for many of the first Americans who hit the ground in Liberia had served with Costello in Europe. He set up conference calls introducing his team in Texas to his former colleagues from Italy in the days before they deployed. Together, the two teams went over blueprints of previously constructed ETUs, sent over by engineers at MSF.

  Two weeks after he was told he would deploy, an advance team made up of Costello and four of his fellow engineers were on a plane. Though Williams’s team was working on opening an air corridor, it had not been established yet. So while Costello had deployed to Iraq and Afghanistan in the belly of mammoth U.S. Army transports, this time he found himself crammed into coach class of a commercial airliner bound for Washington’s Dulles Airport, then to Brussels, then to Dakar, Senegal. The first sign that something out of the ordinary was taking place came in Dakar, when the cabin crew who had flown with them from Brussels stepped off the plane. They were replaced by a special cabin crew that operated the short leg between Dakar and Monrovia, in order to limit the number of Brussels Airlines employees who might be exposed to Ebola.

  If Costello needed another reminder of the foreignness of his experience, it came when the plane touched down at Roberts International Airport in Monrovia. The field
reminded him less of a bustling international hub than of a tiny regional airport in the Midwestern United States. He didn’t even see distance markers on the runway, signs that let a pilot know how much runway is left—and, hence, how hard to slam on the brakes. (Costello’s team would eventually be the ones to install those markers, a few months later.)

  The small team pushed their way through the chaotic scene at the airport until they found their liaison from U.S. Army Africa Command. The liaison guided them to their first lodging, a spartan complex called the Phoenix Apartments that sat next to the old American embassy. The building’s plumbing worked. The power worked, sometimes. The lack of furniture meant the team had to set up cots on which to sleep, though none minded the barren trappings. They had to hunt for a safe place to lock up their nine-millimeter sidearms. In Iraq and Afghanistan, military barracks had arms rooms where weapons were kept under lock and key; there were no such rooms in Monrovia.

  The next morning, a Liberian driver in a rented van picked up Costello and his men for the short drive to the Palm Spring Resort, where U.S. Army Africa Command had set up their headquarters. The hotel was a strategic choice: It sat just a few hundred yards from the Ministry of Health and Social Welfare’s main building. Headquarters turned out to be the hotel’s main ballroom, though it was crowded with so many organizers, planners, and logisticians that Costello and his team found it easier to work down the hall, in the hotel’s restaurant. At least the restaurant had Wi-Fi; if they needed to print anything, they would walk back to the ballroom.

  As the 101st Airborne Division arrived, Volesky formally took charge from Williams on October 25. His troops had been building a tent city at the Barclay Training Center, a few blocks from the National Museum and the University of Liberia. After years in Afghanistan and Iraq, what the military calls “mature theaters,” troops had been accustomed to at least some creature comforts, like real bunks. In Liberia, the accommodations were much more spartan. They spent four days setting up tents and arranging water, toilets, and fuel supplies. Even after the base was established, they had no hot water in which to bathe. Though they were not in a war zone, the Army maintained strict rules about which service members could leave base, and where they could go. They didn’t want anyone snapping photos of themselves in a market where bats and monkeys were sold as food. It was a risk of exposure the Army just didn’t want to take.

  At the same time, massive C-17s loaded with helicopters from Fort Bliss were landing at Monrovia’s airport, illustrating the benefits of sending in the U.S. Army. No other organization in the world could move so many people, and so much equipment, so quickly. Within days, a functioning Army unit could be established anywhere in the world; in October, that anywhere was the middle of Liberia.

  Lightsey, who had returned to the United States from Afghanistan only a few months earlier, found himself shuttling between a series of meetings, coordinating the Army response with the myriad other agencies already on the ground. His day started with an 8:30 a.m. status meeting led by General Volesky. From there, he would sit in on the Incident Management System meeting headed by Tolbert Nyenswah, or check in with the new UNMEER teams and the UNMIL. His staff of forty or so in the civil affairs office were scattered around Libeira, coordinating directly with more local groups running the on-the-ground response. From their base at Barclay, Lightsey gave Volesky a daily overview of all that was happening in Liberia, from updates on the upcoming elections to the latest aid proposals by WHO in Geneva.

  Volesky made a habit of showing himself in some of Liberia’s most remote corners. He traveled by helicopter, frequently with Ambassador Deborah Malac and top Liberian military officials. Lightsey’s staff made sure the logistics on the ground were taken care of. At times, though, Lighstey reflected on the strange arrangements: Where American soldiers were not present, Volesky’s security was at times maintained by UNMIL—which had a sizable contingent of Chinese Army troops. The sight of an Army general being guarded by Chinese troops was disconcerting, though it underscored the humanitarian nature of their mission. “It was rather unique to have them participate in that,” Lightsey said later.

  A week after arriving, Costello’s team got their first assignment. They would be building an Ebola treatment unit in Buchanan, the coastal capital of Grand Bassa County, population about 34,000 and three hours by car from Monrovia, where the outbreak had begun to spread. A British rubber company had donated land next to a river about ten minutes from downtown. Though it was so close to town, the site was a jungle; a local construction company was already at work removing trees and leveling the ground. Costello would be in charge of a team from the 902nd Engineer Company, who deployed from Germany.

  Soon enough, Buchanan made the furnitureless accommodations in Monrovia look cosmopolitan. They spent the first week living on the second floor of a warehouse near the forested site—it was the only nearby space that was covered by a roof. The team did not even have tents: someone had forgotten to add them to the unit’s packing list. By the second week, when carpenters had built floors and a tent roof on the new Ebola treatment unit, the team simply moved in. It saved plenty of time in the morning, as the platoon of about forty people just rolled out of their cots and started working. Costello kept in touch with his superiors back in Monrovia with a BlackBerry, the only device that seemed to work in Buchanan. If he needed more supplies—he recalled having to order a specific type of roofing nail—he would send a message up north. His superiors would send someone to a store that reminded Costello of a miniature Home Depot, to find the right equipment.

  Once the Buchanan facility was on track, Costello and his team deployed to more remote sites. They visited Tappita, a tiny town in northern Nimba County; Barclayville, the capital of Grand Kru County in the far southeast; and Sinje, in Grand Cape Mount County west of Monrovia, to build new ETUs. In all three cases, he was struck by a remoteness that defied anything he had experienced before: Costello’s team had to helicopter in to Sinje, hitching a ride with the 1st Armored Helicopter Brigade on one of the choppers that arrived in the belly of a C-17. At other sites, the lack of infrastructure sometimes meant that the only functioning bridge across a river consisted of a few felled trees. Costello found himself calculating how much weight those trees could hold, and whether dump trucks dispatched to haul gravel to the sites would make it across. In Barclayville, one overloaded dump truck snapped a bridge it was crossing; the driver scrambled out of the cab, but the truck languished for hours, dangling over the river. The gravel was crucial to the overall sanitation of an Ebola unit. It allowed safer drainage, an added layer of protection between the unit and the water table.

  Other units fanned out to build Ebola treatment facilities in Voinjama, in Lofa County, the epicenter of the outbreak in Liberia; Zorzor and Ganta, along the border with Guinea; Gbediah, in River Cess County; Tubmanberg and Bopolu, outside of Monrovia. Constructing a facility took thirty days of hard labor, transforming a patch of forest into a miniature city. Engineers would fell trees and level a site, putting down gravel to ensure proper drainage. They would then build wooden floors and walkways, on which would sit tents housing everything from bathroom and shower facilities to the dangerous hot zones where patients were treated. The process was similar, though less arduous, for the six diagnostic laboratories that would test blood samples across the country, built by Army and Navy engineers, to go along with the USAMRIID lab run by Randy Schoepp in Monrovia.

  Soon, the soldiers settled into something approaching a routine, one marked by early mornings, late nights, and predictable hurdles. Water became a serious challenge. Because ETUs require so much water, both for patient care and hygiene, Army builders needed to make sure that every unit they built had access to its own well or water source. They didn’t want the units to be pulling water from local populations; many villages had enough trouble finding sustainable water sources on their own. And they did not want to have to truck in water, an expensive proposition that wouldn’t survive aft
er the deep-pocketed Pentagon pulled up stakes.

  But Liberia is not blessed with a plethora of well-drillers. The few that Costello’s team could track down were jury-rigged contraptions that looked liable to fall to pieces at any moment. One of the more reliable contractors would show up with his driller attached to the pickup bed of an ancient GMC Sierra. Even getting that guy to show up everywhere proved a challenge. At least two of the Army-built ETUs were delayed in opening over problems with water supplies.

  Monrovia reminded Costello and his men of Kabul, a dusty town with garbage strewn in the gutters. After several deployments to a war zone, Costello was used to taking precautions, and to carrying his sidearm. But he soon felt something different in Liberia, something more welcoming.

  When they deployed, Costello thought he was walking into familiar, dangerous territory. “We were thinking the Iraq, Afghanistan model. ‘We’ve got to have weapons,’ ” Costello recalled thinking. “But we really didn’t have to do that. We’re not fighting these people.”

  Costello, who grew up in Atlanta, found the Southern Baptist and AME churches familiar. So too were the cars, many of which had clearly been shipped over from home. A self-described car fanatic, Costello saw cars with Liberian license plates screwed over plates from Minnesota and South Dakota. He kept half-expecting to see an old Mustang convertible, his dream car, flash down the street—until he actually saw one.