Challenges of the Gaza Humanitarian Aid Pier Offer Lessons for the US Army

A truck carries humanitarian aid across Trident Pier, a temporary pier to deliver aid, off the Gaza Strip, amid the ongoing conflict between Israel and the Palestinian group Hamas, near the Gaza coast, May 19, 2024. US Army Central/Handout via REUTERS
A truck carries humanitarian aid across Trident Pier, a temporary pier to deliver aid, off the Gaza Strip, amid the ongoing conflict between Israel and the Palestinian group Hamas, near the Gaza coast, May 19, 2024. US Army Central/Handout via REUTERS
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Challenges of the Gaza Humanitarian Aid Pier Offer Lessons for the US Army

A truck carries humanitarian aid across Trident Pier, a temporary pier to deliver aid, off the Gaza Strip, amid the ongoing conflict between Israel and the Palestinian group Hamas, near the Gaza coast, May 19, 2024. US Army Central/Handout via REUTERS
A truck carries humanitarian aid across Trident Pier, a temporary pier to deliver aid, off the Gaza Strip, amid the ongoing conflict between Israel and the Palestinian group Hamas, near the Gaza coast, May 19, 2024. US Army Central/Handout via REUTERS

It was their most challenging mission.
US Army soldiers in the 7th Transportation Brigade had previously set up a pier during training and in exercises overseas but never had dealt with the wild combination of turbulent weather, security threats and sweeping personnel restrictions that surrounded the Gaza humanitarian aid project.
Designed as a temporary solution to get badly needed food and supplies to desperate Palestinians, the so-called Joint Logistics Over-the-Shore system, or JLOTS, faced a series of setbacks over the spring and summer. It managed to send more than 20 million tons of aid ashore for people in Gaza facing famine during the Israel-Hamas war.
Service members struggled with what Col. Sam Miller, who was commander during the project, called the biggest “organizational leadership challenge” he had ever experienced.
Speaking to The Associated Press after much of the unit returned home, Miller said the Army learned a number of lessons during the four-month mission. It began when President Joe Biden announced in his State of the Union speech in March that the pier would be built and lasted through July 17, when the Pentagon formally declared that the mission was over and the pier was being permanently dismantled.
The Army is reviewing the $230 million pier operation and what it learned from the experience. One of the takeaways, according to a senior Army official, is that the unit needs to train under more challenging conditions to be better prepared for bad weather and other security issues it faced. The official spoke on condition of anonymity because assessments of the pier project have not been publicly released.
In a report released this week, the inspector general for the US Agency for International Development said Biden ordered the pier's construction even as USAID staffers expressed concerns that it would be difficult and undercut a push to persuade Israel to open “more efficient” land crossings to get food into Gaza.
The Defense Department said the pier “achieved its goal of providing an additive means of delivering high volumes of humanitarian aid to the people of Gaza to help address the acute humanitarian crisis.” The US military knew from the outset “there would be challenges as part of this in this complex emergency,” the statement added.
The Biden administration had set a goal of the US sea route and pier providing food to feed 1.5 million people for 90 days. It fell short, bringing in enough to feed about 450,000 people for a month before shutting down, the USAID inspector general's report said.
The Defense Department’s watchdog also is doing an evaluation of the project.
Beefing up training Army soldiers often must conduct their exercises under difficult conditions designed to replicate war. Learning from the Gaza project — which was the first time the Army set up a pier in actual combat conditions — leaders say they need to find ways to make the training even more challenging.
One of the biggest difficulties of the Gaza pier mission was that no US troops could step ashore — a requirement set by Biden. Instead, US service members were scattered across a floating city of more than 20 ships and platforms miles offshore that had to have food, water, beds, medical care and communications.
Every day, said Miller, there were as many as 1,000 trips that troops and other personnel made from ship to boat to pier to port and back.
“We were moving personnel around the sea and up to the Trident pier on a constant basis,” Miller said. “And every day, there was probably about a thousand movements taking place, which is quite challenging, especially when you have sea conditions that you have to manage.”
Military leaders, he said, had to plan three or four days ahead to ensure they had everything they needed because the trip from the pier to their “safe haven” at Israel's port of Ashdod was about 30 nautical miles.
The trip over and back could take up to 12 hours, in part because the Army had to sail about 5 miles out to sea between Ashdod and the pier to stay a safe distance from shore as they passed Gaza City, Miller said.
Normally, Miller said, when the Army establishes a pier, the unit sets up a command onshore, making it much easier to store and access supplies and equipment or gather troops to lay out orders for the day.
Communication difficulties While his command headquarters was on the US military ship Roy P. Benavidez, Miller said he was constantly moving with his key aides to the various ships and the pier.
“I slept and ate on every platform out there,” he said.
The US Army official concurred that a lot of unexpected logistical issues came up that a pier operation may not usually include.
Because the ships had to use the Ashdod port and a number of civilian workers under terms of the mission, contracts had to be negotiated and written. Agreements had to be worked out so vessels could dock, and workers needed to be hired for tasks that troops couldn't do, including moving aid onto the shore.
Communications were a struggle.
“Some of our systems on the watercraft can be somewhat slower with bandwidth, and you’re not able to get up to the classified level,” Miller said.
He said he used a huge spreadsheet to keep track of all the ships and floating platforms, hundreds of personnel and the movement of millions of tons of aid from Cyprus to the Gaza shore.
When bad weather broke the pier apart, they had to set up ways to get the pieces moved to Ashdod and repaired. Over time, he said, they were able to hire more tugs to help move sections of the pier more quickly.
Some of the pier's biggest problems — including the initial reluctance of aid agencies to distribute supplies throughout Gaza and later safety concerns from the violence — may not apply in other operations where troops may be quickly setting up a pier to get military forces ashore for an assault or disaster response.
“There’s tons of training value and experience that every one of the soldiers, sailors and others got out of this,” Miller said. "There’s going to be other places in the world that may have similar things, but they won’t be as tough as the things that we just went through.”
When the time comes, he said, “we’re going to be much better at doing this type of thing.”
One bit of information could have given the military a better heads-up about the heavy seas that would routinely hammer the pier. Turns out, said the Army official, there was a Gaza surf club, and its headquarters was near where they built the pier.
That "may be an indicator that the waves there were big,” the official said.



New Mpox Strain Is Changing Fast; African Scientists Are ‘Working Blind’ to Respond 

Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
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New Mpox Strain Is Changing Fast; African Scientists Are ‘Working Blind’ to Respond 

Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)
Dr. Robert Musole, medical director of the Kavumu hospital (R) consults an infant suffering from a severe form of mpox at the Kavumu hospital, 30 km north of Bukavu in eastern Democratic Republic of Congo, August 24, 2024. (AFP)

Scientists studying the new mpox strain that has spread out of Democratic Republic of Congo say the virus is changing faster than expected, and often in areas where experts lack the funding and equipment to properly track it.

That means there are numerous unknowns about the virus itself, its severity and how it is transmitting, complicating the response, half a dozen scientists in Africa, Europe and the United States told Reuters.

Mpox, formerly known as monkeypox, has been a public health problem in parts of Africa since 1970, but received little global attention until it surged internationally in 2022, prompting the World Health Organization to declare a global health emergency. That declaration ended 10 months later.

A new strain of the virus, known as clade Ib, has the world's attention again after the WHO declared a new health emergency.

The strain is a mutated version of clade I, a form of mpox spread by contact with infected animals that has been endemic in Congo for decades. Mpox typically causes flu-like symptoms and pus-filled lesions and can kill.

Congo has had more than 18,000 suspected clade I and clade Ib mpox cases and 615 deaths this year, according to the WHO. There have also been 222 confirmed clade Ib cases in four African countries in the last month, plus a case each in Sweden and Thailand in people with a travel history in Africa.

"I worry that in Africa, we are working blindly," said Dr. Dimie Ogoina, an infectious diseases expert at Niger Delta University Hospital in Nigeria who chairs the WHO's mpox emergency committee. He first raised the alarm about potential sexual transmission of mpox in 2017, now an accepted route of spread for the virus.

"We don’t understand our outbreak very well, and if we don't understand our outbreak very well, we will have difficulty addressing the problem in terms of transmission dynamics, the severity of the disease, risk factors of the disease," Ogoina said. "And I worry about the fact that the virus seems to be mutating and producing new strains."

He said it took clade IIb in Nigeria five years or more to evolve enough for sustained spread among humans, sparking the 2022 global outbreak. Clade Ib has done the same thing in less than a year.

MUTATING 'MORE RAPIDLY'

Mpox is an orthopoxvirus, from the family that causes smallpox. Population-wide protection from a global smallpox vaccine campaign 50 years ago has waned, as the vaccinating stopped when the disease was eradicated.

Genetic sequencing of clade Ib infections, which the WHO estimates emerged mid-September 2023, show they carry a mutation known as APOBEC3, a signature of adaptation in humans.

The virus that causes mpox has typically been fairly stable and slow to mutate, but APOBEC-driven mutations can accelerate viral evolution, said Dr. Miguel Paredes, who is studying the evolution of mpox and other viruses at Fred Hutchison Cancer Center in Seattle.

"All the human-to-human cases of mpox have this APOBEC signature of mutations, which means that it's mutating a little bit more rapidly than we would expect," he said.

Paredes and other scientists said a response was complicated by several mpox outbreaks happening at once.

In the past, mpox was predominantly acquired through human contact with infected animals. That is still driving a rise in Congo in clade I cases – also known as clade Ia - likely due in part to deforestation and increased consumption of bushmeat, scientists said.

The mutated versions, clade Ib and IIb, can now essentially be considered a sexually transmitted disease, said Dr. Salim Abdool Karim, a South African epidemiologist and chair of the Africa CDC’s mpox advisory committee. Most of the mutated clade Ib cases are among adults, driven at first by an epidemic among female sex workers in South Kivu, Congo.

The virus also can spread through close contact with an infected person, which is likely how clusters of children have been infected with clade Ib, particularly in Burundi and in eastern Congo’s displacement camps, where crowded living conditions may be contributing.

Children, pregnant women and people with weakened immune systems or other illnesses may be at greater risk of serious mpox disease and death, say the WHO and mpox scientists.

Clade I has typically caused more severe disease, with fatality rates of 4%-11%, compared to around 1% for clade II. Ogoina said data from Congo suggests few have died of the new Ib version, but he feared some data is being mixed up.

More research is urgently needed, but three teams tracking mpox outbreaks in Africa say they cannot even access chemicals needed for diagnostic tests. Clade Ib can also be missed by some diagnostic tests.

Planning a response, including vaccination strategies, without this is difficult, the scientists said.

Karim said around half of cases in eastern Congo, where Ib is particularly prevalent, are only being diagnosed by doctors, with no laboratory confirmation.

Getting samples to labs is difficult because the healthcare system is already under pressure, he said. And around 750,000 people have been displaced amid fighting between the M23 rebel group and the government.

Many African laboratories cannot get the supplies they need, said Dr. Emmanuel Nakoune, an mpox expert at the Institut Pasteur in Bangui, Central African Republic, which also has clade Ia cases.

"This is not a luxury," he said, but necessary to track deadly outbreaks.