1. Appendix 2 (Force Health Protection) to ANNEX Q of OPERATION COMBINED COMMAND - UNITED SHIELD OPORD 14-001 (U) UNCLASSIFIED Liberia

2. Appendix 2 (Force Health Protection) to ANNEX Q of OPERATION COMBINED COMMAND - UNITED SHIELD OPORD 14-001 (U) UNCLASSIFIED Liberia: Environmental Issues Topography Climate Sea Level Meters 5000 + 3000-5000 1000-3000 500-1000 0-500 Depression Climate tropical; hot, humid; dry winters with hot days and cool to cold nights; wet, cloudy summers with frequent heavy showers Terrain: mostly flat to rolling coastal plains rising to rolling plateau and low mountains in northeast lowest point: Atlantic Ocean 0 m highest point: Mount Wuteve 1,380 m

3. Appendix 2 (Force Health Protection) to ANNEX Q of OPERATION COMBINED COMMAND - UNITED SHIELD OPORD 14-001 (U) UNCLASSIFIED Liberia: Environmental Issues Air –Low risk –Some pollution near specific industrial and urban areas. Soil –Low risk but should be avoided when possible. –Soil contamination near industrial facilities and waste disposal sites. –Significant exposure unlikely in the absence of wind, active digging, or leakage into ground water.

4. Appendix 2 (Force Health Protection) to ANNEX Q of OPERATION COMBINED COMMAND - UNITED SHIELD OPORD 14-001 (U) UNCLASSIFIED Liberia: Environmental Issues Food –Food may also be contaminated with industrial particulates, chemicals from soil, pesticides, fertilizers, and fecal pathogens. Water –Water contaminated with raw sewage and microbes –Water sources near diamond mines may be contaminated with mercury and arsenic.

5. Appendix 2 (Force Health Protection) to ANNEX Q of OPERATION COMBINED COMMAND - UNITED SHIELD OPORD 14-001 (U) UNCLASSIFIED Liberia: Environmental Issues Greatest short-term environmental health risks –Water contaminated with raw sewage –Runoff containing fecal pathogens,

6. Appendix 2 (Force Health Protection) to ANNEX Q of OPERATION COMBINED COMMAND - UNITED SHIELD OPORD 14-001 (U) UNCLASSIFIED Liberia: Diseases of Operational Importance Highest risk country Diseases of greatest risk –Food and Waterborne Diseases: Bacterial diarrhea, Hepatitis A, Protozoal diarrhea and Typhoid/paratyphoid fever –Vector-borne Diseases: Malaria and Yellow fever. –Sexually Transmitted Diseases: HIV/AIDS, Hepatitis B. –Soil Contact Diseases: Lassa Fever –Water-contact Diseases: Schistosomiasis

7. Appendix 2 (Force Health Protection) to ANNEX Q of OPERATION COMBINED COMMAND - UNITED SHIELD OPORD 14-001 (U) UNCLASSIFIED Liberia: Diseases of Operational Importance

8. Appendix 2 (Force Health Protection) to ANNEX Q of OPERATION COMBINED COMMAND - UNITED SHIELD OPORD 14-001 (U) UNCLASSIFIED Staying Healthy Avoid foods and water from unapproved sources. Exercise caution when eating foods from local markets, etc.; do eat raw and undercooked meats. Avoid the consumption of water from unapproved sources; use approved bottled water for consumption. Do not swim/bath in non-treated fresh water streams/lakes to minimize the risk of infection; swim in chlorinated pools. Ensure personnel are current on their vaccinations/immunizations for missions to this area; issue/take anti-malarial medications when applicable. Use insect/mosquito netting around bedding; use repellants and approved insecticides on clothing; cover skin (long-sleeve shirts and pants). Avoid long term (weeks, months, years) co-habitation/close quartering with local nationals, when possible. Avoid contact with rodents: choose lodging locations that are (reasonably) rodent free; sleep off of the ground; store food stuffs in areas where rodents cannot easily access (containers, etc.); keep bedding and work areas reasonably clutter- free/trash-free to prevent harborage issues. BLUF: When mitigation measures are employed the risk of negative consequences decreases!!!