TWELVE

Deployment

AFTER AN EYE-OPENING VISIT to Liberia, Jeremy Konyndyk and Tom Frieden took stock of what they had seen. The three West African countries were trying, and failing, to come to terms with a disease that had infiltrated both hard-to-reach rural areas and crowded slums in major cities. The health care systems in Liberia, Sierra Leone, and Guinea were so overwhelmed that other diseases were going untreated. Pillars of civil society in all three countries were breaking down; markets were shut, schools were closed. The World Health Organization (WHO) was plumbing new depths of ineptness on a near daily basis, while the vast majority of nongovernmental organizations (NGOs)—with the exceptions of Médecins Sans Frontières (MSF), Global Communities, and a few others—had pulled up stakes. On returning to Atlanta, Frieden had called President Obama to describe his experiences, and how the United States should respond. He was, by his own admission, worked up by what he had seen.

The Centers for Disease Control and Prevention (CDC) had asked for volunteers to deploy to West Africa, and those volunteers were being trained as fast as possible. But even the rapidly expanding American response was becoming overwhelmed. Members of the United States Agency for International Development Disaster Assistance Response Team (USAID DART), supplemented by doctors arriving on an almost daily basis, were no match for a disease that was infecting hundreds of new people every week.

Back in Washington, Konyndyk and Frieden shared the recognition that they needed more—more people, more resources, more expertise. Their agencies had never dealt with an emergency of this scope and complexity. In the following days, they briefed Anthony Fauci, of the National Institute for Allergy and Infectious Disease, who had heard similar reports from his own staff who had been to Africa. Together, they realized that the full force and weight of the entire American public health care system might not be enough to contain the outbreak.

Over the next two weeks, Konyndyk, Frieden, and Fauci dreamed up what they believed an effective response would look like. They needed thousands of responders to quickly—and safely—build the infrastructure necessary to care for so many more patients. They needed to project a sense of security, both for the West African people and for the foreign NGOs with the experience to fight an outbreak. They needed a regimented process to train the thousands of health-care workers who would be required to provide that medical response. They needed, in short, to create conditions on the ground that would be conducive to a long-term medical response.

There was only one organization in the world that had the capacity to deliver the manpower, the training process, and the security necessary to create those conditions: America needed to send in the U.S. Army, the single greatest logistical force the world had ever known.

“The decision to call in the military was a recognition that they can deliver speed and scale to a degree that no one else in the world can,” Konyndyk recalled later. “It signaled to the world that this is a big deal, at a time when, frankly, very few others recognized that.”

Konyndyk, Frieden, and Fauci first raised the prospect of sending in the military to other senior officials at the National Security Council (NSC), and with the Defense Department. Almost immediately, the NSC began gaming out the enormously complex questions a deployment to West Africa raised: How would they define the Army’s mission? What, exactly, would they be doing? If one of the troops got sick, how would he or she be evacuated? How and where, in the case that an American soldier actually died of Ebola, would the Armed Forces medical examiner conduct an autopsy on the body?

The Defense Department and Army general Martin Dempsey, chairman of the Joint Chiefs of Staff, was largely cooperative, the NSC and public health officials recalled. But Dempsey insisted that soldiers would focus on a narrow mission, to build treatment facilities, not to treat patients. Health-care agencies, he made clear, had their mission; the military would have its own. There would be no crossover between the two. Some at the National Security Council found that position needlessly inflexible. Others understood exactly why Dempsey wanted to draw such a bright line.

“The military was there to support the humanitarian effort, and they were constantly of the mindset of, ‘Who are we working with, and how do we build their capabilities so this is a short-term military engagement,’ ” Shah said. Amy Pope recalled Dempsey’s clear guidelines: “Our role needs to be well-defined, and our role needs to come with clear objectives and timelines.”

Frieden thought otherwise. He had been led to believe by Department of Defense officials that the Army would be able to set up and operate field hospitals within thirty days of deployment, and then staff those hospitals to serve patients. But Dempsey made clear to Frieden and others that the Army would not be staffing hospitals with sick patients.

To Dempsey, just a year away from retirement, the rules of engagement would dramatically reduce the risk any soldier faced. The military was already stretched thin after more than a decade at war in Iraq and Afghanistan, and Dempsey had neither the interest in nor the desire to get bogged down in another deployment with no clear exit strategy. Before a single Army soldier touched down in Liberia, Dempsey wanted to know who or what organization would be rotating in to replace them after their short deployment. Before the first tree was felled or the first cinderblock set, the Army had a plan to hand off each of the facilities it would build to a specific NGO.

The NSC worried, too, about the possibility that an American might get sick. The positive message such a show of force would convey, both to Liberians and to the world, could be completely undermined if the outbreak reached the Army. Even a single soldier falling ill would be a massive public relations disaster.

The prospect of a Western responder falling ill had already scared away many nongovernmental organizations. To prepare for the worst case scenario, and to alleviate fears that were keeping both the Army and foreign NGOs out of West Africa, the Pentagon decided to open a new Ebola treatment unit, one that would be reserved for Westerners alone, near the airport in Monrovia. It would be run by the U.S. government—more specifically, by the U.S. Public Health Service, a team of medical professionals more likely to be deployed to poor rural regions and Native American reservations with limited access to health care than to a hot zone like Liberia.

Rear Admiral Scott Giberson, who headed the Public Health Service, and Michael Schmoyer, who had coordinated the response to the Ebola crisis until members of DART deployed in August, traveled to West Africa to oversee construction of the facility, formally named the Monrovia Medical Unit. The bland and beige half-dome oval tent where patients were to be treated would be surrounded by supporting tents full of laboratory equipment and beds for the Public Health Service personnel.

On their way to Liberia, Giberson and Schmoyer missed their connection in Brussels. After three days cooling their heels in a hotel near the airport, they arrived in West Africa to find a metropolis on edge. Few cars were on the road, even in the middle of what should have been a busy workday. Even simple human courtesies went overlooked: when they came across a woman who had been hit by a car, screaming for help in the road, a group of Liberians would not come within ten feet of her, for fear she might be sick.

But the Monrovia Medical Unit itself was a wonder in the middle of a country in desperate need of help. By the time Rajiv Shah, Konyndyk’s boss at USAID, toured the new unit, it was the most advanced medical facility in Africa, capable of delivering nearly the same level of care that an infected patient would have received at Emory or the U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID).

At a meeting of NSC principals held Thursday, September 11, top officials agreed to formally ask the Pentagon for a plan. Department of Defense officials had been working on that plan for a few weeks; they delivered it to the NSC the following day, a Friday.

At the same time, the phone on Brian Gentile’s desk rang. Gentile, a stoic-looking colonel, served as deputy commander of USAMRIID, the Army’s medical research laboratory at Fort Detrick. He is steeped in Army culture, more comfortable reading through a PowerPoint presentation than speaking extemporaneously. Now, a top-ranking general needed quick action. He needed Gentile and his team to train the units that would deploy to Africa on the president’s order. And that training had to happen fast.

Two days later, Gentile’s first teams of trainers arrived at Fort Campbell, Kentucky, home of the famed 101st Airborne Division. They deployed another team to a military base in Germany, where troops were already preparing to deploy. Others went to Fort Bragg, in North Carolina, Fort Leavenworth, Kansas, and Fort Bliss, on the border between New Mexico and Texas. Within just a matter of weeks, USAMRIID deployed on 38 training missions, teaching more than 4,800 military and civilian personnel how to protect themselves from one of the most deadly viruses known to man. Some trainers returned home to Fort Detrick, in Maryland, only to be sent off to another base to train even more soldiers and civilians mere hours later.

Training is an important part of USAMRIID’s mission. Initially created to explore possible biological warfare agents, the institute now considers itself the U.S. government’s 911 emergency operator. They are the first call when another government agency—the military, humanitarian workers, or any other outfit—discovers a biological agent with which they are not familiar. A hotline, staffed twenty-four hours a day by medical experts, exists to help those other agencies identify what they are looking at in the field. USAMRIID even trained the Armed Forces medical examiner on how to conduct an autopsy of an Ebola victim, under biosecurity level-4 conditions—moon suits and all—in case Dempsey’s worst fears of an infected service member came true. With a plan in place and training already begun, the NSC presented President Obama with Operation United Assistance, the mission that would ultimately deploy 2,692 U.S. troops to Liberia and Senegal,1 where a few hundred support staff were based. The first commanding officer on the ground would be Major General Darryl Williams, the head of U.S. Army Africa Command, based in Vicenza, Italy. The Pentagon would then deploy thousands more troops from a division stationed back home.

The White House wanted to announce the mission as quickly as possible. The perfect opportunity was right around the corner, on Tuesday, September 16, when President Obama was scheduled to travel to CDC headquarters in Atlanta. That visit would provide a perfect backdrop to highlight the extent of the American response, to send a message to international partners and to an increasingly nervous American public that the situation would be brought under control.

But the timing was tenuous. When Obama landed at Atlanta’s Hartsfield-Jackson International Airport that morning, Williams was in the air, headed to Liberia from his base in Italy. A line in Obama’s speech declared that Williams was already on the ground. But speechwriters made clear to Gayle Smith, riding a few cars behind the president as the motorcade zipped toward the CDC base, that they would cut it if it was not accurate. As Obama’s motorcade drew closer to Frieden’s office, Smith pressed a cell phone to her ear, connected with a Department of Defense attaché at Monrovia’s airport, monitoring Williams’s plane. Just as Obama pulled onto the CDC campus, Williams landed. The line stayed in Obama’s speech—Williams “just arrived today and is now on the ground in Liberia,” he said.

“Our forces are going to bring their expertise in command and control, in logistics, in engineering,” Obama announced after touring the CDC with Frieden. “And our Department of Defense is better at that, our Armed Services are better at that than any organization on earth.”

The speed with which the deployment came to fruition stunned even those who were pushing to make it happen. It had taken just weeks for a major military deployment to go from concept to execution. It was a testament, in the minds of senior NSC officials, to just how seriously the administration was taking the outbreak. On the day Obama announced the new deployment, the cost of the United States response crossed the $100 million threshold.

“I don’t know that I’ve ever seen a high-level policy decision-making process that’s moved as quickly and decisively as that,” Smith said a year later.

The military’s arrival hailed a new moment in the fight against Ebola. At the darkest hour, when the situation felt so desperately out of hand, the most powerful force in the world was descending on Liberia to turn things around. Sending in the Army, American officials had hoped, would serve as a “hope multiplier.” Deborah Malac, the U.S. ambassador to Liberia, later recalled Williams’s arrival as a turning point. The next morning, she told Frieden, it felt as if hope was in the air once again.

Williams’s first order of business was to open an “air bridge,” an intermediate staging base that could accommodate the thousands of troops and the tons of construction and medical supplies bound for the area. The base needed to be close by, but not in-theater; Liberia’s infrastructure could not handle so much American military traffic. They settled on building a temporary base in Senegal, about 1,000 miles away.

As the first hints that the Army would be involved, Major General Gary Volesky did some quick calculus and concluded that he and the men he commanded in the 101st Airborne Division were likely to get the call. Of the Army’s ten active-duty divisions, several were deployed to Iraq and Afghanistan, several more had just rotated home, and some were training to return to combat zones. One more was on permanent guard on the Korean Peninsula. That meant, if the Army was looking for thousands of troops to send to West Africa, they would probably turn their attention to the 101st.

“When the Ebola outbreak occurred and the president made that announcement, there were really three courses of action, and we were number three,” Volesky said later. “It became apparent that the other two courses of action were not going to work.”

Volesky had taken command of the 101st just a few months earlier, after the division returned from Afghanistan. They were scheduled to deploy back to Afghanistan the following year, and rotating back into the field earlier than planned would present a logistical challenge—and a strain on the families who had just welcomed their soldiers home.

In New York, Samantha Power was running her own set of traps. Power, a former journalist and human rights expert who served as one of President Obama’s earliest foreign policy advisers, had become the American ambassador to the United Nations a few months before the first Ebola cases began popping up in rural Guinea. She and other senior members of the Obama administration’s foreign policy cohort, including Secretary of State John Kerry and National Security Advisor Susan Rice, had watched with growing alarm as the international public health community had fumbled the initial response. Now, as the case count skyrocketed, Power set to work convincing her fellow delegates to the United Nations to take the strongest stand they possibly could. The Americans hoped to send a message to the rest of the world that Ebola was serious, and that if they did not stop the disease in West Africa, they would be fighting it at home.

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 after 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.

The Army took seriously the concerns that Dempsey, chairman of the Joint Chiefs of Staff, had laid out: Costello and his team were only there to build facilities, not to treat patients; Costello himself never saw anyone infected with the disease they were fighting. While more than a few soldiers came down with minor ailments, from headaches to high fevers to regular aches and pains, not a single American solider contracted the Ebola virus.

Around them, it was a different story. By the time Costello landed in Monrovia on October 16, 8,973 people had been infected across the three West African nations, and 4,484 victims of the Ebola virus lay dead.