MONROVIA, Liberia -- As bodies littered the streets and the sick lay dying in front of overwhelmed clinics last year, President Barack Obama ordered the largest U.S. intervention ever in a global health crisis, hoping to stem the deadliest Ebola epidemic in history.
But after spending hundreds of millions of dollars and deploying nearly 3,000 troops to build Ebola treatment centers, the United States ended up creating facilities that have largely sat empty: Only 28 Ebola patients have been treated at the 11 treatment units built by the U.S. military, American officials now say.
Nine centers have never had a single Ebola patient.
"My task was to convince the international organizations, 'You don't need any more ETUs,'" said Dr. Hans Rosling, a Swedish public-health expert who advised Liberia's health ministry, referring to Ebola treatment units.
"I warned them, 'The only thing you'll show is an empty ETU,'" he added. "'Don't do it.'"
The U.S. response, it turns out, was outpaced by the fast-moving and unpredictable disease.
Facing criticism that his reaction to the epidemic had been slow and inadequate, Obama announced his plan in mid-September, focusing on Liberia, America's longtime ally.
But even before the first treatment center built by the U.S. military opened there, the number of Ebola cases in Liberia had fallen drastically, casting doubt on the U.S. strategy of building facilities that took months to complete.
The emphasis on constructing treatment centers ended up having much less impact than the inexpensive, nimble measures taken by residents to halt the outbreak, many officials say.
Liberia could be declared free of Ebola as early as next month. But with health officials warning that it is only a matter of time before another outbreak, they are drawing important lessons from the successes and shortcomings of the response by international and West African leaders.
Had the Americans and other donors been more flexible, critics and some officials contend, the money could have been put toward rebuilding Liberia's shattered health care system or backing the efforts of local communities.
"I knew that most of the ETUs that were being built may not receive a single patient," said Dr. Francis Kateh, who helped lead the response of the Liberian government, which decided with the Americans where to build the centers.
"But at the same time, you couldn't put a stop to that process," he added. "The train was coming full force."
The United States has spent $1.4 billion on its Ebola mission in West Africa, with most of it going to Liberia. Deploying the military cost $360 million, not including the construction, staffing and operating expenses at the treatment centers it built.
As the world's biggest donor to the Ebola campaign, the United States also supported a wide range of important efforts, like building a new cemetery and increasing body-collection teams. But the vast majority of aid, about 90 percent, came after Ebola cases in Liberia had already begun to drop.
Of the 11 centers built by the U.S. military, all but one opened after Dec. 22. By then, Ebola cases had already fallen to the point that Liberian and foreign officials were discussing the closing of treatment units built by other organizations that were no longer needed.
U.S. officials point out that building treatment centers made sense given the epidemic's trajectory when the decision was made.
The outbreak in Liberia peaked just one week after Obama's announcement, with countless Ebola patients unable to find beds in hospitals and clinics. Dire estimates were suggesting that as many as 1.4 million people in Liberia and Sierra Leone could be infected if the world did not act immediately.
Jeremy Konyndyk, who headed the Ebola response for the U.S. Agency for International Development, which was in charge of the U.S. campaign, said there had been no "template" for tackling an epidemic of this scale, as there was for conventional disasters like famines or earthquakes.
"Our initial expectation, based on some of the models and some of the experiences and precedents from past Ebola outbreaks, was that the way you would beat this would be to get enough ETU beds," he said.
He added, "On balance, I think we took the right approach. The challenge in this kind of a response is you don't know where the fire is going to break out, but you're going to need a fire station there when it does."
Liberia has had 9,862 total infections and the most recorded deaths -- 4,408. Worldwide, more than 25,500 cases and more than 10,500 deaths have been recorded, with new infections continuing in Guinea and Sierra Leone.
As Ebola cases in Liberia ebbed, U.S. officials said they adapted by dropping plans for the military to build three additional centers and reducing the size of others.
A Section on 04/12/2015