The United States calls Cuban medical internationalism "human trafficking" - but in reality it is an internationalist lifeline to the global South.
On February 25, U.S. Secretary of State Marco Rubio announced visa restrictions for both government officials in Cuba and all others around the world who are "complicit" in the island nation's overseas medical aid programs. A statement from the US State Department clarified that the sanctions also apply to "current and former" officials and "the immediate family of such persons." The action, the seventh measure taken against Cuba in one month, has international implications; for decades, tens of thousands of Cuban health workers, far more than the World Health Organization (WHO) workforce, have been sent to some sixty countries. They mostly work in underserved or un-served populations in the Global South. By threatening to deny visas to foreign officials, the U.S. government intends to sabotage these Cuban medical missions overseas. If it succeeds, millions of people will suffer.
Rubio built his career on a hard-line stance on Cuban socialism, even claiming his parents fled Fidel Castro's Cuba until the Washington Post revealed they moved to Miami in 1956 during the Fulgencio Batista dictatorship. As Trump's secretary of state, Rubio is in prime position to roll out the bellicose U.S.-Cuba policy first articulated in April 1960 by Undersecretary of State Lester Mallory: to use economic warfare against revolutionary Cuba to provoke "hunger, despair, and the overthrow of the government."
Cuba has been accused of human trafficking by the US government, even likening overseas Cuban medical personnel to slaves. Rubio's tweet parroted this excuse. The real aim is to undermine both Cuba's international prestige and the income it receives from the export of medical services. Since 2004, revenues from Cuba's exports of medical and professional services have been the island's largest source of income. Cuba's ability to conduct "normal" international trade is currently hampered by the long U.S. blockade, but the socialist state has managed to turn its investments in education and health care into national earnings while maintaining free medical aid to the global South based on its internationalist principles.
Cuban medical internationalism: a key feature of Cuban foreign policy
The four approaches of Cuban medical internationalism were initiated in the early 1960s, despite the departure of half of the physicians in Cuba after 1959.
- Emergency medical brigades. In May 1960, the most powerful earthquake in history struck Chile, killing thousands. The new Cuban government dispatched an emergency medical brigade with six rural field hospitals. This created a modus operandi whereby Cuban medics deploy rapid responses to "catastrophic and morbid" emergencies throughout the global south - since 2005, these brigades have been organised under the name "Henry Reeve International Contingents". By 2017, when WHO awarded the Henry Reeve Brigades with the Public Health Award, they had helped 3.5 million people in twenty-one countries. The most famous examples include the brigades in West Africa to fight Ebola in 2014 and in response to the COVID-19 pandemic in 2020. In one year, the Henry Reeve Brigades treated 1.26 million coronavirus patients in forty countries, including Western Europe.
- Setting up public healthcare outfits abroad. Starting in 1963, Cuban health workers helped establish a public health care system in the newly independent Algeria. By the 1970s, they had established and staffed comprehensive health programs throughout Africa. By 2014, 76,000 Cuban health workers were working in thirty-nine African countries. In 1998, a Cuban cooperation agreement with Haiti committed Cuba to sending 300 to 500 Cuban medics, while Haitian doctors are trained in Cuba. By December 2021, more than 6 thousand Cuban medics had saved 429 thousand lives and performed 36 million consultations in the poorest country in the Western Hemisphere. And for two decades, Cuba has maintained more than 20,000 health workers in Venezuela, with the highest number being 29,000. In 2013, the Pan American Health Organization contracted with 11,400 Cuban doctors to work in underserved and unserved areas of Brazil. By 2015, Cuban programmes were operating Integral Healthcare (integral health care) in forty-three countries.
- Treatment of foreign patients in Cuba. In 1961, children and wounded fighters from the Algerian war of independence from France went to Cuba for treatment. Thousands followed from all over the world. Two programmes were developed for the mass treatment of foreign patients: the first is the 'Children of Chernobyl' programme, which began in 1990 and lasted twenty-one years, during which 26 000 people affected by the Chernobyl nuclear disaster received free medical care and rehabilitation on the island - almost 22 000 of them children. Cubans covered the costs, despite a program that coincided with Cuba's severe economic crisis, known as the Special Period after the collapse of the socialist bloc. The second program for mass treatment of foreign patients was the operation Miracle (Miracle), established in 2004 for Venezuelans with reversible blindness to receive free eye surgery in Cuba to restore their sight. It subsequently expanded regionally. By 2017, Cuba operated 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 is important to note that the Cuban state has never sought to cultivate dependency. 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 the state ran twelve medical schools overseas, mostly in Africa, where over 54,000 students were enrolled. In 1999, the Latin American School of Medicine (ELAM), the largest medical school in the world, was founded in Havana. By 2019, 29,000 physicians from 105 countries (including the United States), representing 100 ethnic groups, had graduated from ELAM. Half were women and 75 percent came from working-class or peasant families.
Monetary cost of the Cuban contribution
Since 1960, some 600,000 Cuban health workers have provided free health care in more than 180 countries. The Cuban government has assumed the lion's share of the cost of its medical internationalism, a huge contribution to the global South, especially given the impact of the U.S. blockade and Cuba's own development challenges. "Some will wonder how it is possible that a small country with few resources can accomplish a task of such magnitude in such crucial fields as education and health," Fidel Castro remarked in 2008. But he did not provide an answer. Cuba has not commented much on the cost of these programmes.
Guatemalan researcher Henry Morales, however, reframed 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 extent of their contribution to global development and facilitate comparisons with other donors. According to Morales, the monetary value of medical and technical professional services, Cuba's ODA, amounted to over $71.5 billion (about 1.642 trillion Czech crowns) between 1999 and 2015 alone, equivalent to $4.87 billion annually. This means that Cuba devoted 6.6 percent of its GDP annually to ODA, the highest ratio in the world. By comparison, the European average was 0.39 percent of GDP and the United States contributed only 0.17 percent. Since the U.S. blockade cost Cuba between $4 and $5 billion a year during this period, without this burden the island could potentially double its ODA contribution.
These costs do not include Cuban state investment in education and medical training and infrastructure on the island. Cuba also loses significantly by either charging beneficiaries below international market rates or, in many cases, simply not charging them at all.
Medical services as an export
During the "special period" in the 1990s, Cuba introduced reciprocal cost-sharing agreements with recipient countries that could afford it. Since 2004, thanks to the famous "oil for doctors" programme with Venezuela, the export of health workers has become Cuba's main source of income. This income is then reinvested in the provision of health care on the island. However, Cuba continues to provide free medical aid to countries in need. Today, there are various cooperation agreements, ranging from Cuba covering all costs (donations and free technical services) to reciprocity agreements (costs shared with the host country) to "trilateral cooperation" (third-party partnerships) and trade agreements. The new measure announced by Rubio will affect everyone.
In 2017, Cuban health workers operated in sixty-two countries; in twenty-seven of these (44 percent), the host government paid nothing, while the remaining thirty-five paid or shared costs on 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 offset Cuba's bills, so services charged to oil-rich countries (such as Qatar) help subsidize medical aid to poorer countries. Payment for exported medical services goes to the Cuban government, which passes a small portion on to the health workers themselves. This is usually added to their Cuban salaries.
In 2018, Cuba's National Statistics Office published separate data in its first year; "health services exports" earned $6.4 billion. However, revenues have since fallen as US efforts to sabotage Cuba's medical services internationalism have succeeded, for example in Brazil, reducing the island's revenues by billions.
The American criminalization of Cuban medical internationalism
As early as 2006, the George W. Bush administration launched a medical parole program to induce Cuban medics to leave their missions in exchange for U.S. citizenship. Barack Obama maintained this program until his last days in office in January 2017. By 2019, Trump renewed the attack and put Cuba on the list of countries Tier 3where it fails 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 Cuba's medical programmes. In 2024, the U.S. House of Representatives appropriations bill included an expose of the "Cuban medical trafficking," withdrawal of aid from "countries involved in this form of modern slavery," and a ban on funding for Cuban laboratories. Meanwhile, it earmarked $30 million for "democracy programs" for Cuba, a dubious name for the regime change Mallory strategized in 1960.
The service contracts that Cuban health workers sign before going abroad are in fact voluntary; they receive a regular Cuban salary plus remuneration from the host country. Volunteers are guaranteed holidays and contact with their families. Whatever the motivation for participation, Cuban medics make huge personal sacrifices to volunteer overseas, leaving behind families and homes, their culture and communities, to work for months or even years in challenging and often risky conditions. In an interview for our documentary Cuba & COVID-19: Public Health, Science and Solidarity, Dr. Jesús Ruiz Alemán explained how his sense of moral obligation led him to become a volunteer for the Henry Reeve contingent. He went on his first mission to Guatemala in 2005, to West Africa for Ebola in 2014 and to Italy in 2020, when it was the epicentre of the COVID-19 pandemic. "I never felt like a slave, never," he insisted. "The campaign against the brigades seems to be a way to justify the blockade and the measures against Cuba, to damage Cuba's source of income."
In the same document, Johana Tablada, deputy director for the United States at the Cuban Ministry of Foreign Affairs, denounced the "weaponization and criminalization" of Cuban medical internationalism, which has "wreaked havoc," especially in countries that were pressured to end their partnerships with Cuba shortly before the COVID-19 pandemic, such as Brazil and Bolivia. "The reason the US calls it slavery or human trafficking has nothing to do with the international crime of human trafficking." She said it is a cover for a policy of sabotage that "cannot be kept from public scrutiny." The United States cannot order people in developing countries to forgo medical services provided by Cuba's medical brigades "simply because it does not conform to its policy of 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 prevailing global approach, exemplified by the United States, is to regard health care as an expensive resource or commodity to be rationed through a market mechanism. Medical students 'invest' in their education, pay high tuition fees and graduate with huge debts. They then seek well-paying jobs to pay off these debts and achieve a privileged standard of living. To ensure that health professionals are well remunerated, demand must keep outstripping supply. The World Economic Forum projects that by 2030 there will be a shortage of ten million health workers worldwide. However, Cuba's investment in medical education is increasing the supply of professionals globally, threatening the position of doctors operating in a market system. Cuba's approach critically removes financial, class, racial, gender, religious and all other barriers to entry into the medical profession.
The key features of the Cuban approach are: commitment to health care as a human right; the critical role of state planning and investment to ensure a universal public health care system, with the absence of a parallel private sector; the speed with which health care delivery has improved (until the 1980s, Cuba had the health profile of a highly developed country); a focus on prevention over cure; and a system of community-based primary care. In this way, socialist Cuba achieved health outcomes comparable to those of developed countries, but with lower per capita spending-less than one-tenth the per capita spending of the United States and one-quarter that of the United Kingdom. By 2005, Cuba had the highest ratio of doctors per capita in the world: 1 to 167. By 2018, it had three times the density of doctors than the US and UK.
Today, Cuba is in the midst of a serious economic crisis that is largely the result of US sanctions. The public health care system is under unprecedented pressure, with a shortage of resources and staff following a massive emigration from 2021. However, the government continues to devote a high share of GDP to health care (nearly 14 percent in 2023), maintains free universal health care provision, and currently has 24,180 health workers in fifty-six countries.
Revolutionary Cuba has never been concerned only with meeting its own needs. According to Morales' figures, between 1999 and 2015 alone, Cuban medical professionals saved 6 million lives overseas, performed 1.39 billion medical consultations and 10 million surgical operations, and attended 2.67 million births, while 73,848 foreign students, many of them medical professionals, completed their professional training in Cuba. When you add in beneficiaries between 1960 and 1998 and beneficiaries since 2016, the numbers rise steeply.
The recipient states have been the poorest and least influential in the world; few of them have governments that have any influence on the world stage. The recipient populations in these countries are often the most disadvantaged and marginalized, the outcasts. If Cuban health workers leave, they will have no alternative provision. If Rubio and Trump are successful, it won't just be Cubans who suffer. It will also be the global beneficiaries whose lives Cuban internationalism in medicine is saving and improving 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.
Helen Yaffe for The Jacobin, 8. 3. 2025
Translation by Vladimir Sedlacek
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