Paratroopers with the 19th Special Forces Group (Airborne), 9th Psychological Operations Battalion, Utah National Guard and Moroccan armed forces land in a drop zone near Ben Guerir, Morocco, during exercise African Lion on May 20, 2024. (Nathaniel Free/Army)

This year’s African Lion became real-world action for members of the 86th Aeromedical Evacuation Squadron, who airlifted a U.S. soldier with a gastrointestinal infection from Tunisia to Ramstein Air Base in Germany three weeks into the major exercise.

The ailing soldier was flown from El Aouina Air Base aboard a Tunisian C-130J Super Hercules on May 4 after receiving treatment at a local hospital, according to a statement this week by the 86th Airlift Wing.

U.S. Air Force Staff Sgt. Chelsea Castro, assigned to the 349th Aeromedical Evacuation Squadron, and members of the Moroccan armed forces train together on aeromedical evacuations during exercise African Lion at Kenitra Air Base, Morocco, on May 24, 2024. Earlier in May, the 86th AES evacuated a U.S. soldier from El Aouina Air Base, Tunisia, to Ramstein Air Base in Germany. (Jenna Bond/Air Force)

Wing officials did not immediately respond Friday to requests for an update on the condition of the soldier, who had complications to upper and lower extremities at the time of evacuation, Capt. Maria Oliver said in the statement.

The airlift was a textbook case of the sort of cooperation fostered between the U.S. and allies by African Lion, which was recognizing its 20th anniversary before wrapping up Friday after six weeks.

“I loved working with the Tunisian air force because they were so accommodating and eager to help us complete our mission,” Staff Sgt. Dylan Cruse, a technician with the 86th Aeromedical Evacuation Squadron, said in the statement. “They went out of their way to help us.”

A Senegalese soldier fires an M249 squad automatic weapon while Maryland National Guardsman Sgt. Mathew Angell serves as a range safety officer during African Lion in Dodji, Senegal, on May 23, 2024. (Nicholas J. De La Pena/Army)

This year’s African Lion took place in Tunisia, Ghana, Senegal and Morocco. It was the largest yet, with more than 8,100 participants from 27 nations, organizers said.

What started as a bilateral exercise between the U.S. and Morocco 20 years ago now has expanded in size and scope.

“The biggest thing is the consistency. It continues to grow and get bigger and attract more partners,” Lt. Col. Michael Weisman, a spokesman for the Southern European Task Force, Africa said Thursday in an interview.

U.S. Army Maj. Amber Morton-Chism, a public health nurse with U.S. Army Health Center Vicenza, Italy, consults with a translator as part of exercise African Lion in Damongo, Ghana, on May 17, 2024. (Caitlinn Belcher/Army)

Although the majority of participants are African countries, the U.K., Italy, Hungary, the Netherlands and other countries under a NATO contingent join as well.

This year, some countries were concerned about counterterrorism because of an increase in violent extremist organizations in West Africa, Weisman said.

“So we offer training like how to sustain a brigade, what does medical infrastructure look like, intelligence, surveillance and reconnaissance, building trust with the population,” he said. “The ultimate solution to terrorism is not military. It’s a whole-government approach.”

This year’s African Lion coincided with Flintlock 24, an exercise to strengthen partner nations’ ability to counter violent extremist organizations and cooperate across borders.

Still, some past partners were missing this year. Most notable was Niger, which participated in Flintlock last year and hosted it in 2014.

But after a military coup in July 2023, the U.S. froze security support as required by law and paused counterterrorism activities in the country.

In April, the U.S. agreed to remove its troops from Niger, putting the future of the $110 million American drone base in Agadez in doubt.

And this month, Niger’s ruling group revoked an accord in place since 2012 that allowed U.S. military personnel in the country.

The rifts have created opportunities for Russia, which has dispatched troops to train Nigerien forces.