Foreign military personnel played a crucial role in stemming the Ebola outbreak in Liberia and Sierra Leone, researchers said on Monday, but warned against treating their intervention as a blueprint for future humanitarian crises.
Military help was required as health systems in Liberia and Sierra Leone were ill-equipped and many aid agencies withdrew staff and halted operations when the outbreak began, University of Sydney researchers said.
More than 5,000 troops from the United States, United Kingdom, China, Canada, France and Germany were deployed in 2014, mainly training local health workers and building Ebola treatment units, according to the Saving Lives report.
Yet poor coordination between governments, aid agencies and armed forces and a lack of understanding of their roles may have hindered the Ebola response, researcher Adam Kamradt-Scott said.
"There is a risk of causing confusion and unintended harm," the report's lead author told the Thomson Reuters Foundation.
Some people said they did not understand why soldiers carried guns when they were "fighting a disease," according to the report, which was based on interviews with health and aid workers, military personnel, and government and UN officials.
One military officer said aid agencies were more preoccupied with "their reputation" than supporting armed forces, while some respondents said foreign military personnel were too risk-averse and their confinement to barracks alienated local people.
The use of foreign troops was well received by most people interviewed, but they might not be welcomed in other countries and could exacerbate future humanitarian crises, Kamradt-Scott warned.
"The response that we saw in Ebola may not serve as a great blueprint for future operations, and we need to do more work to identify when and where militaries are called upon to assist."
The magnitude of the outbreak and the slow international response meant foreign military involvement was a "last resort", aid agencies told the Thomson Reuters Foundation.
The World Health Organisation (WHO) was widely criticised for its slow response and admitted serious failings in its handling of the Ebola crisis earlier this year.
"The crisis was simply too big for humanitarian agencies to deal with on their own," said Elodie Schindler, spokeswoman for the International Committee of the Red Cross in Africa.
Medecins sans Frontieres (MSF) called on world leaders last year to deploy civilian and military medical teams, in an "exceptional response to an unprecedented outbreak," MSF senior humanitarian specialist Michiel Hofman said.
"It is too early to judge the medical impact of the foreign military... but the call of desperation as a last resort unleashed a wave of international support," Hofman said.
Kamradt-Scott called for clarification as to when outside military help should be sought in future.
"Do we only call on the military when everything else has failed? Or is there a threshold before that we can use?
"We shouldn't have to wait until the situation is dire, out of control, and large numbers of people are dying, which is effectively what happened with the Ebola outbreak," he said.
The world's worst recorded Ebola outbreak has infected more than 28,000 people and killed 11,300 in Guinea, Liberia and Sierra Leone since it began in December 2013.
It was believed to be coming under control, but the case of Scottish nurse Pauline Cafferkey, the Ebola survivor who had an apparently life-threatening relapse, has revived fears about the prospects for the 17,000 survivors.
(Reporting by Kieran Guilbert, editing by Tim Pearce. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, corruption and climate change.)