Caribbean Countries Blast US Plans to Sanction Cuban Medical Missions Around the World
While Cuba exports doctors to the world, the US exports sanctions.
Perhaps one of the least surprising features of US foreign policy during these first few months of Trump 2.0 is that it includes an intensification of the economic blockade of Cuba, now in its 63rd year. With the State Department under the aegis of a fanatical Cuban-American politician like Marco Rubio who has built his entire career on demonising the Cuban Revolution and trying to economically starve into submission the people of his parents’ homeland, it was odds on that US-Cuban relations would get even worse.
But what was perhaps not quite so clear was the extent to which the US’ new actions against Cuba would further isolate Washington from most of the countries in its own “backyard”, not to mention the world at large. Below is a visual reminder of just how out of step Washington already is on the world stage wrt its ongoing economic embargo on Cuba. This map, courtesy of Ben Norton’s Geopolitical and Economy Report, shows how many countries voted in favour of lifting the blockade in the latest UN resolution, held in October.
For years, the rest of the world, including long-standing US vassal states like all EU member states, the UK, Japan, South Korea, Australia and Canada, have demanded an end to the US embargo. Only the US and Israel consistently vote against the resolution. The only US government to break with this trend was the Obama Administration, which abstained in the 2016 vote, notes the Washington Office on Latin America (WOLA):
[It also] lifted restrictions for Cuban-Americans to travel and to send family and donative remittances, reestablished the U.S. Embassy in Havana, removed Cuba from the SSOT list, expanded access to the internet, and licensed a range of trade opportunities for U.S. companies. Beyond these specific policies, this shift in discourse by a U.S. president signaled the biggest change in U.S.-Cuba policy since diplomatic relations were severed in 1961, and ushered in a new era in the relations, leading to 23 bilateral accords on issues of mutual interest. The next two years saw an unprecedented boom in private-sector activities in Cuba, significant openings for civil society discourse, and other reforms by the Cuban government.
In 2017, the Trump administration undid all the progress Obama achieved and more. It swiftly imposed new restrictions prohibiting U.S. companies from doing business with certain Cuban companies managed by the armed forces and prohibited U.S. visitors from staying in hotels operated by those companies. It eliminated people-to-people educational travel, placed strict caps on family remittances, and made it impossible to send remittances by wire service.
A New Low for US Foreign Policy
Now, Trump 2.0 seems to determined to isolate the US even further by trying to prevent some of the world’s poorest countries from availing of the medical assistance provided, often free of charge, by Cuba’s medical missions. It is yet another new low for US foreign policy. As Helen Yaffe writes for Jacobin, while Cuba exports doctors, the US exports sanctions (and, of course, other weapons of war).
On February 25, Rubio’s State Department announced visa restrictions for both government officials in Cuba as well as any other officials in the world who are found to be “complicit” in the island nation’s overseas medical assistance programs. The sanctions would extend to “current and former” officials and the “immediate family of such individuals,” and could also include trade restrictions for the countries involved.
In essence, the US government is accusing Cuba of using forced labour, even likening overseas Cuban medical personnel to slaves. If this latest sanctions gambit is successful, it will have crippling effects on a Cuban economy that has been cut out of the US-dominated financial system for years and is now grappling with nationwide power outages. It will also hurt dozens of the world’s poorest countries that depend upon Cuban medical missions precisely at a time when many of them are facing the prospect of looming debt crises.
The real objective, writes Yaffe, is “to undermine both Cuba’s international prestige and the revenue it receives from exporting medical services”:
[F]or decades tens of thousands of Cuban medical professionals (far more than the World Health Organization’s workforce) were stationed in some sixty countries, mostly to work in underserved… populations in the Global South. By threatening to withhold visas from foreign officials, the U.S. government intends to sabotage these Cuban medical missions abroad. If the measure works, millions of people will suffer…
Since 2004, earnings from exports of Cuban medical and professional services have been the island’s largest 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.
Since launching inaugural missions in Chile and Algeria in the early 1960s, more than 605,000 Cuban medical professionals have been dispatched to an estimated 180 (out of 195) countries, mainly in the Caribbean and Latin America. They have provided essential medical care and support during natural disasters (e.g., Chile’s largest ever earthquake in 1960), wars (e.g., Algeria’s war for independence from France), epidemics (e.g., Cholera in Haiti, Ebola in Africa, to COVID-19 pandemic), nuclear disasters (Chernobyl) and have even helped countries establish their own public health care systems.
The World Health Organization awarded the Henry Reeve brigades, established in 2005, with the prestigious 2017 Dr Lee Jong-wook Memorial Prize for Public Health in 2017, by which time they had helped 3.5 million people in 21 countries. In the COVID-19 pandemic nearly 40 countries across the world received assistance from Cuba’s medical missions, including even wealthy, western nations like Andorra and Italy and South American nations not politically aligned with Cuba, such as Peru.
As NBC reported at the time, the island nation “has once more punched far above its weight in medical diplomacy,” describing the medics’ success as “a setback for the administration of U.S. President Donald Trump”, which had “launched an unprecedented campaign against Cuba’s medical missions in recent years, citing what it calls their exploitative labor conditions.”
A Six-Decade Policy of Forced Hunger
The medical missions are now the largest source of income for the government in Havana, bringing in $6 to $8 billion per year, far more than the proceeds from tourism. Now, the US intends to bring pressure to bear on the dozens of countries that continue to benefit from the Cuban medical missions in an attempt to cut Cuba off from its largest source of external financing.
This is part of an ongoing six-decade policy set out in a 1960 memorandum whose aim is “to weaken the economic life of Cuba . . . [to deny] money and supplies to Cuba, to decrease monetary and real wages, to bring about hunger, desperation and overthrow of government.” The US has long achieved all of those aims apart from the overarching one: the overthrow of the Cuban government.
As already mentioned, this is not the first time the US has targeted Cuba’s medical missions as part of its raft of sanctions against the island. In Trump’s first administration, his then-Secretary of State Mike Pompeo pressured countries on the American continent to expel Cuban medical staff in the midst of the COVID-19 pandemic, calling them victims of forced labour and human trafficking. Washington aligned governments in the region such as Bolsonaro’s Brazil and Guillermo Lasso’s Ecuador acceded, with fatal consequences. From the NYT:
“In their zeal to get rid of the Cuban doctors, the Trump administration has punished every country in the hemisphere, and without question that has meant more Covid cases, and more Covid deaths,” said Mark L. Schneider, a former head of strategic planning for the Pan-American Health Organization who was a State Department official in the Clinton administration. “It is outrageous.”
Smaller, less powerful countries like Ecuador felt the pain. Ecuador acceded to American pressure and sent home nearly 400 Cuban health care workers shortly before the pandemic. Then the country also suffered from the Trump administration’s freeze on funding for the health organization, which hampered its ability to provide emergency supplies and technical support.
Now, Trump 2.0 wants to extend this practice of crushing Cuba’s medical missions to the entire globe. But the idea is already getting pushback in the US’ direct neighbourhood. Last week, several leaders of countries of the Caribbean Community (Caricom) lambasted the restrictions, arguing that Cuba’s medical missions are fundamental for the survival of the region’s health systems. They have also rejected the US allegations that hiring Cuban doctors is labour exploitation.
The Prime Minister of Barbados, Mia Mottley, current president of Caricom, said she is prepared, like other leaders in the region, to forego her US visa if “a sensible agreement” is not reached on this matter, since “principles matter”.
Similar arguments were made by Gaston Browne, Ralph Gonsalves and Keith Rowley, the respective prime ministers of Antigua and Barbuda, Saint Vincent and the Grenadines, and Trinidad and Tobago.
“I just returned from California and, if I never go back there in my life, I will make sure that the sovereignty of Trinidad and Tobago is respected by all,” Rowley said.
All Caricom leaders also agreed that availing of Cuba’s medical missions does not represent a form of human trafficking.
“We pay them the same as the Barbadians,” said Mottley. “We repudiate and reject the idea, spread not only by this U.S. government but by the previous one, that we were involved in human trafficking.”
The US allegations that the Cuban government is engaging in human trafficking do not much bear scrutiny. In countries below a certain income level, the cost of the medical missions is entirely borne by the Cuban state. In countries like Barbados, the Cuban doctors are paid the same as local medical staff.
Cuba started monetising its medical services primarily out of basic economic necessity. After the collapse of its most important ally and economic partner during the Cold War era, the Soviet Union, in the early 1990s, Cuba began introducing reciprocal agreements to share the financial burden of the medical programs with recipient countries that could afford it. Following the launch of the famous “oil-for-doctors” program with Venezuela in 2004, the export of medical professionals became Cuba’s main source of revenue.
However, as Yaffe points out, “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.”
By contrast, when a comparatively rich nation such as Qatar opts to staff some of its hospitals with Cuban doctors, the doctors can receive as little as 10% of what other foreign medical professionals can make working in government hospitals in Qatar while still earning significantly more than they would in Cuba. The remainder is pocketed by the government in Havana.
This situation is still relatively rare but has become increasingly common as Cuba has leveraged its medical knowhow and resources. Even though doctors volunteer to take part in the missions, US-based critics of the Cuban government claim the programme is exploitative, as The Guardian reported in 2019:
However, others argue the medical missions are highly-coveted opportunities in a country where doctors earn just $40 to $70 a month.
“I don’t believe that they are being exploited,” says John Kirk, professor of Spanish and Latin American studies at Dalhousie University in Canada. “They are earning significantly more than they would earn at home. They have been trained in a socialist system, have paid nothing for their medical training, and understand that the superior amount paid to the Cuban government is used to subsidise the healthcare system back in Cuba.”
The Guardian spoke to several medics at the Cuban hospital and some defended the system.
“I believe we should help everybody,” says one. “Based on that, yes it is fair, because I know that the other amount is used to support our health and education system … but if you think only of yourself, of course it’s not fair.”
In the US’ purely-for-profit healthcare system, by contrast, the managers think only of themselves and their companies’ bottom line — hence why so many people in the US still have no access to basic healthcare while hundreds of thousands of people are plunged into bankruptcy each year by extortionate medical costs.
This is one of the main reasons, together with life-style and dietary trends in the US and the near-total absence of processed food in Cuba, why life expectancy in the US, the world’s richest economy, is now over two years lower than in Cuba, one of the world’s poorest countries whose government nonetheless has poured much of its scarce resources into healthcare provision.
Despite that poverty, Cuba is arguably the world’s most generous provider of overseas aid. As Yaffe documents, “Guatemalan researcher Henry Morales reframed Cuba’s international solidarity as ‘official development assistance’ (ODA), using average international market rates and adopting the methodology of the Organization for Economic Cooperation and Development (OECD), to calculate the magnitude of its contribution to global development and facilitate comparison with other donors”:
According to Morales, the monetary value of Cuba’s professional medical and technical services, ODA, exceeded 71.5 billion dollars between 1999 and 2015 alone, which is equivalent to 4.87 billion dollars per year. This means that Cuba annually devoted 6.6% of its GDP to ODA, the highest proportion in the world. In comparison, the European average was 0.39% of GDP and the United States contributed only 0.17%. Given that the U.S. blockade cost Cuba between $4 billion and $5 billion annually in this period, without this burden the island could have doubled its contribution to ODA.
Waning US Influence
By targeting sanctions against Cuba’s professional medical and technical services, the Trump Administration’s presumed goal is to isolate Cuba globally as well as tip its embattled government over the edge by depriving it of its main source of income. However, by taking such a drastic step the US risks further ostracising itself from the countries in its own neighbourhood as well as the world at large.
Perhaps more government officials in Latin America and the Caribbean will follow Mia Mottley’s example and simply forego their US visas, resulting in further loss of US influence in the region. Also, Cuba is far from alone on the world stage. Last year, it was among 13 nations invited to join the BRICS as partner countries. While not granting full membership, the partnership status offers a potential pathway toward full membership.
Russia has also pledged to help Cuba restore its energy system. Russian trade with Cuba has increased in recent years, helped along by US sanctions on both countries as well as the war in Ukraine. Russian naval flotillas have docked in Havana twice so fare this year as a show of military strength. But deliveries of Russian oil, like deliveries of Venezuelan oil, have largely petered out. However, that may change if the US continues to turn the screw on Cuba’s economy in its attempt to tip the government in Havana over the edge.
China has also said it will continue to support the Cuban people in standing against foreign interference and the blockade. That said, trade between the two countries has slumped in recent years, even as trade between China and Latin America has surged.
One country that is significantly upping its support of Cuba is Mexico, which has gradually strengthened its ties with Havana since Andrés Manuel López Obrador became president in 2018. His government has signed numerous agreements with the government in Havana to receive hundreds of doctors from the Caribbean nation. Yesterday (Oct 31), López Obrador’s sucessor as head of state, Claudia Sheinbaum, confirmed that her government will also support Cuba for humanitarian reasons:
“Even if there is criticism, we are going to be in solidarity.”
Mexico’s state-owned oil company, Petroleos de México (aka Pemex), dispatched 400,000 barrels of oil and finished gasoline and diesel to the island nation in just a few days during October. Asked about the shipment, Sheinbaum said that “Mexico produces 1.6 to 1.8 million barrels a day (…), so 400,000 barrels is not even one day’s production.” Sheinbaum also recently defended her government’s decision to employ Cuban doctors to help fill Mexico’s shortage of medical personnel, particularly in rural areas.
Mexico, like Russia and Venezuela before it, is becoming Cuba’s energy lifeline. But while Russia and Venezuela are both, like Cuba itself, heavily sanctioned by Washington and depend on schemes to circumvent sanctions, Mexico is currently the US’ largest trading partner. It remains to be seen how Washington will respond to Mexico’s growing support of Cuba but it will presumably involve the threat of sanctions, tariffs or some other economic weapon.