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CUBA SENDS DOCTORS, THE US SENDS SANCTIONS  
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Helen Yaffe
March 8, 2025
Jacobin
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_ The United States calls Cuba’s medical internationalism "human
trafficking" — but it’s really an internationalist lifeline for
the Global South. _

Doctors and nurses from one of Cuba’s Henry Reeve brigades are bid
farewell before leaving to Turkey to care for the victims of the
earthquake the, at the Central Unit of Medical Cooperation in Havana,
on February 10, 2023. , Yamil Lage / AFP via Getty Images

 

On February 25, US secretary of state Marco Rubio announced
restrictions
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on visas for both government officials in Cuba and any others
worldwide who are “complicit” with the island nation’s overseas
medical-assistance programs. A US State Department statement
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clarified that the sanction extends to “current and former”
officials and the “immediate family of such persons.” This action,
the seventh measure targeting Cuba in one month, has international
consequences; for decades tens of thousands of Cuban medical
professionals have been posted in around sixty countries, far more
than the World Health Organization’s (WHO) workforce, mostly working
in under- or unserved populations in the Global South. By threatening
to withhold visas from foreign officials, the US government means to
sabotage these Cuban medical missions overseas. If it works, millions
will suffer.

Rubio built his career around taking a hard line on Cuban socialism,
even alleging that his parents fled Fidel Castro’s Cuba until the
_Washington Post_
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revealed that they migrated to Miami in 1956 during the Fulgencio
Batista dictatorship. As Trump’s secretary of state, Rubio is in
prime position to ramp up the belligerent US-Cuba policy first laid
out in April 1960 by deputy assistant secretary of state Lester
Mallory: to use economic warfare against revolutionary Cuba to bring
about “hunger, desperation and overthrow
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government.”

Cuba stands accused by the US government of human trafficking, even
equating overseas Cuban medical personnel to slaves. Rubio’s tweet
parroted this pretext. The real objective is to undermine both
Cuba’s international prestige and the revenue it receives from
exporting medical services. Since 2004, earnings from Cuban medical
and professional services exports have been the island’s greatest
source of income. Cuba’s ability to conduct “normal”
international trade is currently obstructed by the long US blockade,
but the socialist state has succeeded in converting its investments in
education and health care into national earnings, while also
maintaining free medical assistance to the Global South based on its
internationalist principles
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Cuban Medical Internationalism: A Core Feature of Cuban Foreign Policy

The four approaches of Cuban medical internationalism were initiated
early in the 1960s, all despite the post-1959 departure of half of the
physicians in Cuba.

* _Emergency response medical brigades._ In May 1960, Chile was
struck by the most powerful earthquake on record, with thousands
killed. The new Cuban government sent an emergency medical brigade
with six rural field hospitals. This established a modus operandi
under which Cuban medics mobilize rapid responses to “disaster and
disease” emergencies throughout the Global South — since 2005
these brigades have been organized under the name “Henry Reeve
International Contingents.” By 2017, when the WHO praised the Henry
Reeve brigades with a public health prize, they had helped 3.5 million
people in twenty-one countries. The best-known examples include
brigades in West Africa to combat Ebola
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in 2014 and in response to the COVID-19 pandemic
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in 2020. Within one year, Henry Reeve brigades treated 1.26 million
coronavirus patients in forty countries, including in Western Europe.
* _Establishment of public health care apparatuses abroad._ Starting
in 1963, Cuban medics helped establish a public health care system in
newly independent Algeria. By the 1970s, they had set up and staffed
Comprehensive Health Programs all throughout Africa. By 2014, 76,000
Cuban medical personnel had worked in thirty-nine African countries.
In 1998, a Cuban cooperation agreement with Haiti
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committed to send 300 to 500 Cuban medical professionals there all
while training Haitian doctors back in Cuba. By December 2021, more
than 6,000 Cubans medical professionals had saved 429,000 lives
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in the poorest country in the western hemisphere, conducting 36
million consultations. And for two decades now, Cuba has maintained
over 20,000 medics in Venezuela
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2013, the Pan American Health Organization contracted 11,400 Cuban
doctors to work in under- and unserved regions of Brazil. By 2015,
Cuban Integral Healthcare Programs were operating in forty-three
countries.
* _Treating foreign patients in Cuba._ In 1961, children and wounded
fighters from Algeria’s war for independence from France went to
Cuba for treatment. Thousands followed from around the world. Two
programs were developed to treat foreign patients en masse: The first
is the “Children of Chernobyl” program which began in 1990 and
lasted for twenty-one years, during which 26,000 people affected by
the Chernobyl [[link removed]] nuclear
disaster received free medical treatment and rehabilitation on the
island — nearly 22,000 of them children. The Cubans covered the
cost, despite the program coinciding with Cuba’s severe economic
crisis, known as the Special Period, following the collapse of the
socialist bloc. The second program to treat foreign patients en masse
was Operation Miracle, set up in 2004 for Venezuelans with reversible
blindness to get free eye operations in Cuba to restore their sight.
It subsequently expanded regionally. By 2017, Cuba was running
sixty-nine ophthalmology clinics in fifteen countries under Operation
Miracle, and by early 2019 over four million people in thirty-four
countries had benefited.
* _Medical training for foreigners, both in Cuba and overseas._
It’s important to note that the Cuban state never sought to foster
dependence. In the 1960s, it began training foreigners in their own
countries when suitable facilities were available, or in Cuba when
they were not. By 2016, 73,848 foreign students from eighty-five
countries had graduated in Cuba while that nation was running twelve
medical schools overseas, mostly in Africa, where over 54,000 students
were enrolled. In 1999, the Latin American School of Medicine (ELAM),
the world’s largest medical school, was established in Havana. By
2019, ELAM had graduated 29,000 doctors from 105 countries (including
the United States) representing 100 ethnic groups. Half were women,
and 75 percent from worker or campesino families.

The Monetary Cost of Cuba’s Contribution

Since 1960, some 600,000 Cuban medical professionals have provided
free health care in over 180 countries. The government of Cuba has
assumed the lion’s share of the cost of its medical
internationalism, a huge contribution to the Global South,
particularly given the impact of the US blockade
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and Cuba’s own development challenges. “Some will wonder how it is
possible that a small country with few resources can carry out a task
of this magnitude in fields as decisive as education and health,”
noted Fidel Castro in 2008. He did not, though, provide the answer.
Indeed, Cuba has said little about the cost of these programs.

However, Guatemalan researcher Henry Morales
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has reformulated Cuba’s international solidarity as “official
development assistance” (ODA), using average international market
rates and adopting the Organisation for Economic Co-operation and
Development (OECD) methodology, to calculate the scale of their
contribution to global development and facilitate comparison with
other donors. According to Morales, the monetary value of medical and
technical professional services, Cuba’s ODA, was over $71.5 billion
just between 1999 and 2015, equivalent to $4.87 billion annually. This
means that Cuba dedicated 6.6 percent of its GDP annually to ODA, the
world’s highest ratio. In comparison, the European average was 0.39
percent of GDP, and the United States contributed just 0.17 percent.
Since the US blockade cost Cuba between $4 and $5 billion annually in
this period, without this burden the island could potentially have
doubled its ODA contribution.

These costs exclude Cuban state investments in education and medical
training and infrastructure on the island. There are also considerable
losses to Cuba from either charging recipients below international
market rates or, in many cases, simply not charging them at all.

Medical Services as Exports

During “the Special Period” in the 1990s, Cuba introduced
reciprocal agreements to share the costs with recipient countries that
could afford it. Starting in 2004, with the famous
“oil-for-doctors” program with Venezuela, the export of medical
professionals became Cuba’s main source of revenue. This income is
then reinvested into medical provision on the island. However, Cuba
continues to provide medical assistance free of charge to countries
who need it. Today there are different cooperation contracts, from
Cuba covering the full costs (donations and free technical services)
to reciprocity agreements (costs shared with the host country) to
“triangulated collaboration” (third-party partnerships) and
commercial agreements. The new measure announced by Rubio will impact
them all.

In 2017, Cuban medics were operating in sixty-two countries; in
twenty-seven of those (44 percent) the host government paid nothing,
while the remaining thirty-five paid or shared the costs according to
a sliding scale. Where the host government pays all costs, it does so
at a lower rate than that charged internationally. Differential
payments are used to balance Cuba’s books, so services charged to
wealthy oil states (Qatar, for example) help subsidize medical
assistance to poorer countries. Payment for medical service exports
goes to the Cuban government, which passes a small proportion on to
the medics themselves. This is usually in addition to their Cuban
salaries.

In 2018, the first year Cuba’s Office of National Statistics
published separate data, “health services exports” earned $6.4
billion. Revenues have since declined, however, as US efforts to
sabotage Cuban medical internationalism have succeeded, for example in
Brazil, reducing the island’s income by billions.

US Criminalization of Cuban Medical Internationalism

Already in 2006, the George W. Bush administration launched its
Medical Parole Program to induce Cuban medics to abandon missions in
return for US citizenship. Barack Obama maintained the program until
his final days in office in January 2017. By 2019, Trump renewed
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attack, adding Cuba to its Tier 3 list of countries failing to combat
“human trafficking” on the basis of its medical internationalism.
The US Agency for International Development (USAID) even launched a
project to discredit and sabotage Cuban health care programs. In 2024,
the US House Committee on Appropriations bill
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included exposing the “trafficking of doctors from Cuba,”
withdrawing aid from “countries participating in this form of modern
slavery,” and prohibiting funds to Cuban laboratories. Meanwhile it
allocated $30 million for “democracy programs” for Cuba, a
misnomer for the regime change that Mallory strategized in 1960.

The service contracts that Cuban medics sign before going abroad are,
in fact, voluntary; they receive their regular Cuban salary, plus
remuneration from the host country. The volunteers are guaranteed
holidays and contact with families. Whatever their motivations to
participate, Cuba’s medical professionals make huge personal
sacrifices to volunteer overseas, leaving behind families and homes,
their culture and communities, to work in challenging and often risky
conditions for months or even years. Interviewed for our documentary
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Public Health, Science and Solidarity_, Dr Jesús Ruiz Alemán
explained how a sense of moral obligation led him to volunteer for the
Henry Reeve Contingent. He went on his first mission to Guatemala in
2005, West Africa for Ebola in 2014, and to Italy in 2020 when it was
the epicenter of the COVID-19 pandemic. “I have never felt like a
slave, never,” he insisted. “The campaign against the brigades
seems to be a way to justify the blockade and measures against Cuba,
to damage a source of income for Cuba.”

In the same documentary [[link removed]],
Johana Tablada, deputy director for the United States at Cuba’s
Ministry of Foreign Affairs, condemned the “weaponization and
criminalization” of Cuban medical internationalism that has
“wreaked havoc,” particularly in countries pressured to end their
partnerships with Cuba shortly before the COVID-19 pandemic, such as
Brazil and Bolivia. “The reason that the US calls it slavery or
human trafficking has nothing to do with the international felony of
human trafficking.” This is cover, she says, for a policy of
sabotage that is “impossible to hold up to public scrutiny.” The
United States cannot tell people in developing countries to give up
medical services provided by Cuban medical brigades “just because it
doesn’t match their policy to have international recognition and
admiration [for Cuba].” The US is certainly not offering to replace
Cuban doctors with its own.

The Threat of a Good Example

The predominant global approach, exemplified by the United States, is
to regard health care as an expensive resource or commodity to be
rationed through the market mechanism. Medical students “invest”
in their education, paying high tuition fees and graduating with huge
debts. They then seek well-paid jobs to repay those debts and pursue a
privileged standard of living. To ensure medics are well remunerated,
demand must be kept above supply. The World Economic Forum
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projects a shortfall of ten million health care workers worldwide by
2030. But the Cuban investment in medical education raises the supply
of professionals globally, thus threatening the status of physicians
operating under a market system. Critically, the Cuban approach
removes financial, class, race, gender, religious, and any other
barriers to joining the medical profession.

The key features of the Cuban approach are: the commitment to health
care as a human right; the decisive role of state planning and
investment to provide a universal public health care system with the
absence of a parallel private sector; the speed with which health care
provision was improved (by the 1980s Cuba had the health profile of a
highly developed country); the focus on prevention
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of community-based primary care. By these means, socialist Cuba has
achieved comparable health outcomes to developed countries but with
lower per capita spending — less than one-tenth the per capita
spending in the United States and one-quarter in the UK. By 2005, Cuba
had achieved the highest ratio of doctors per capita in the world: 1
to 167. By 2018, it had three times the density of doctors in the US
and the UK.

Today Cuba is in the midst of a severe economic crisis, largely
resulting from US sanctions. The public health care system is under
unprecedented strain, with shortages of resources and of personnel
following massive emigration since 2021. Nonetheless, the government
continues to dedicate a high proportion of GDP on health care (nearly
14 percent
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in 2023), maintaining free universal medical provision, and currently
has 24,180 medical professionals in fifty-six countries.

Revolutionary Cuba was never solely concerned with meeting its own
needs. According to Morales’s data, between 1999–2015 alone,
overseas Cuban medical professionals saved 6 million lives, carried
out 1.39 billion medical consultations and 10 million surgical
operations, and attended 2.67 million births, while 73,848 foreign
students graduated as professionals in Cuba, many of them medics. Add
to that the beneficiaries between 1960 and 1998, and those since 2016,
and the numbers climb steeply.

The beneficiary nations have been the poorest and least influential
globally; few have governments with any leverage on the world stage.
Recipient populations are often the most disadvantaged and
marginalized within those countries. If Cuban medics leave, they will
have no alternative provision. If Rubio and Trump are successful, it
is not just Cubans who will suffer. It will also be the global
beneficiaries whose lives are being saved and improved by Cuban
medical internationalism right now.

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Helen Yaffe is a senior lecturer at the University of Glasgow. She is
the author of We Are Cuba! How a Revolutionary People have Survived in
a Post-Soviet World and Che Guevara: The Economics of Revolution.

* Cuba; Internationalism; Health Care; Marco Rubio;
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