Cuba’s Largest Export Is a Human Rights Disaster
By Julia Alexander
Often when we think about Cuba’s top exports, a few products come to mind: oil, sugar, tobacco.[1] But what many do not realize is there is one export that is driving Cuba’s economy and strategically positioning Cuba on a global scale: its international medical mission doctors.[2] “An army of whitecoats” sent to hundreds of countries abroad brings in a multi-billion dollar revenue to Cuba each year.[3]
The origin of this medical internationalism seems relatively ordinary; Cuba began sending its doctors abroad in the 1960s to countries in need of medical aid in order to build stronger ties and create relationships with new allies to remedy the isolation it faced by the international community during the Cold War era.[4] But what did Cuba get in exchange for sending medical aid to these states?
In the example of Cuba and Venezuela, Cuba’s benefit becomes evident: Cuba sends tens of thousands of medical workers to Venezuela to work for free in areas of need, and in exchange, Venezuela sends over 50,000 barrels of oil to Cuba every day.[5]
While these deals seem straightforward enough and seem to help contribute to the welfare and economy of Cuba, as well as the countries it deals with in these transactions, one cannot help but think: how is the Cuban government treating its doctors it sends on these missions?
Human rights organizations and governments of other nations have characterized Cuba’s medical mission program for what it truly is at its core: an advanced, state-run human trafficking scheme.[6] The United States Justice Department defines human trafficking as involving “compelling or coercing a person to provide labor or services.”[7]
The United States State Department also investigates trafficking abroad through its annual Trafficking in Persons report, where it ranks countries on a three-tiered scale, with Tier 1 countries being in compliance with international standards, and Tier 3 nations not even complying with minimum standards and refusing to do so.[8] The State Department has characterized Cuba as a Tier 3 state due to its “deceptive and coercive tactics” to enlist its citizens in state-sanctioned forced labor.[9]
As the medical missions are run through the state government in Cuba, its tools for coercion and punishment seem to be even more effective for its victims. States like Cuba tend to use methods like “withdrawing public benefits, withholding salaries, [and] threatening to punish family members,” among other tactics to force compliance by its state workers.[10] To keep its workers in line, Cuba heavily monitors its workers and restricts their movements by withholding passports and travel documents while they are working on their missions.[11]
Medical Scrubs. Image courtesy of Shopify.
The state of Cuba is not blind to its treatment of its medical mission doctors; Cuba has written in its Penal Code that deserters of state-run programs, like the medical mission program, will be punished with imprisonment.[12] To even be associated with a deserter or someone who speaks out against the Cuban government are grounds for punishment under this statute.
In recent years, several countries, such as Brazil, Ecuador and Bolivia, have recognized these injustices and ended their agreements with the Cuban government to send medical mission doctors to their respective countries.[13] As a result, the number of Cuban medical mission doctors abroad has dropped nearly in half.[14]
However, if it is so apparent that these medical mission doctors are being trafficked by the state of Cuba, how has this program not only survived, but thrived, in the last sixty years? States that host Cuban medical mission doctors still rely heavily on their services in order to provide adequate healthcare to its citizens.[15]
For example, in Italy where many doctors have left the profession as a result of the Covid-19 pandemic, there was a severe shortage of medical personnel in certain parts of Italy.[16] Due to this, Italy’s government requested the assistance of Cuba and its medical mission personnel.[17] Cuba’s medical mission doctors have been said to “bring oxygen” back into the medical field and Italy itself.[18] In Haiti, a similar story emerges, where Cuban medical mission doctors are revered as heroes in their country.[19]
In order to bring an end to Cuba’s state-sanctioned human trafficking, it is likely not enough that a country like Ecuador cuts ties with this program; it would likely take Cuba’s best customer, Venezuela, to cut ties with Cuba to really make a statement. Venezuela would likely face great difficulty in ending its relationship with Cuba, as it not only pays to have medical mission doctors sent to Venezuela, but also other valuable personnel like “intelligence professionals and sports trainers.”[20] However, it is not impossible to imagine Venezuela cutting ties with Cuba when looking at Brazil as an example.[21] Brazil, like Venezuela, received a large influx of medical mission doctors for decades.[22] In 2018, under new leadership, Brazil notified Cuba that if treatment of medical mission doctors, such as doctors receiving their salaries directly and allowing their families to accompany them on missions, did not improve, that the missions would cease to exist in Brazil.[23] Resulting from a failure to come to an agreement, Brazil ended its medical mission relationship with Cuba.[24]
It appears that under international pressure and specific country conditions, Cuba will be faced with the option to either improve the conditions its medical workers work under or be forced to miss out on the economic benefits of its programs abroad.
[1] Cuba’s International Trade, Eᴜʀᴏᴘᴇᴀɴ Pᴀʀʟɪᴀᴍᴇɴᴛ (February 2015), https://www.europarl.europa.eu/RegData/etudes/ATAG/2015/548984/EPRS_ATA(2015)548984_REV1_EN.pdf.
[2] Ciara Nugent, How Doctors Became Cuba’s Biggest Export, Tɪᴍᴇ (Nov. 30, 2018), https://time.com/5467742/cuba-doctors-export-brazil/.
[3] Id.
[4] Human Trafficking in Cuba’s Medical Missions, Hᴜᴍᴀɴ Rɪɢʜᴛs Fᴏᴜɴᴅᴀᴛɪᴏɴ (Aug. 2022), https://hrf.org/wp-content/uploads/2022/08/HUMAN-TRAFFICKING-IN-CUBA-MEDICAL-MISSIONS-REPORT_FINAL.pdf?mc_cid=37395ca7e1&mc_eid=4e3e4ed79d.
[5] Id.
[6] See generally Human Trafficking in Cuba’s Medical Missions, Hᴜᴍᴀɴ Rɪɢʜᴛs Fᴏᴜɴᴅᴀᴛɪᴏɴ (Aug. 2022), https://hrf.org/wp-content/uploads/2022/08/HUMAN-TRAFFICKING-IN-CUBA-MEDICAL-MISSIONS-REPORT_FINAL.pdf?mc_cid=37395ca7e1&mc_eid=4e3e4ed79d; see also 2023 Trafficking in Persons Report: Cuba, U.S. Dᴇᴘᴀʀᴛᴍᴇɴᴛ ᴏғ Sᴛᴀᴛᴇ, https://www.state.gov/reports/2023-trafficking-in-persons-report/cuba (last visited Jan. 22, 2024).
[7] What Is Human Trafficking?, U.S. Dᴇᴘᴀʀᴛᴍᴇɴᴛ ᴏғ Jᴜsᴛɪᴄᴇ, https://www.justice.gov/humantrafficking/what-is-human-trafficking (last visited Jan. 22, 2024)(noting that this coercion can be “subtle or overt; physical or psychological.”).
[8] Brianna Gehring, What Is the Trafficking in Persons Report?, Hᴜᴍᴀɴ Tʀᴀғғɪᴄᴋɪɴɢ Iɴsᴛɪᴛᴜᴛᴇ (July 19, 2022), https://traffickinginstitute.org/what-is-the-trafficking-in-persons-report/.
[9] Id.
[10] Hᴜᴍᴀɴ Rɪɢʜᴛs Fᴏᴜɴᴅᴀᴛɪᴏɴ, supra note 4 at 8.
[11] Foreign Press Centers, A Call to Action: First-Hand Accounts of Abuses in Cuba’s Overseas Medical Missions, U.S. Dᴇᴘᴀʀᴛᴍᴇɴᴛ ᴏғ Sᴛᴀᴛᴇ (Sept. 26, 2019), https://2017-2021.state.gov/a-call-to-action-first-hand-accounts-of-abuses-in-cubas-overseas-medical-missions/.
[12] Hᴜᴍᴀɴ Rɪɢʜᴛs Fᴏᴜɴᴅᴀᴛɪᴏɴ, supra note 4 at 18.
[13] Mariya Petkova, Cuba Has a History of Sending Medical Teams to Nations in Crisis, Aʟ Jᴀᴢᴇᴇʀᴀ (Apr. 1, 2020), https://www.aljazeera.com/features/2020/4/1/cuba-has-a-history-of-sending-medical-teams-to-nations-in-crisis.
[14] Id. (noting that the number of medical mission doctors dropped from 50,000 to 28,000).
[15] Angela Giuffrida, ‘Giving Us Oxygen’: Italy Turns to Cuba to Help Revive Ailing Health System,Tʜᴇ Gᴜᴀʀᴅɪᴀɴ (Jan. 16, 2024), https://www.theguardian.com/world/2024/jan/16/italy-calabria-cuban-doctors-public-health-system.
[16] Id.
[17] Id.
[18] Id.
[19] Work of Cuban Medical Mission’s members highlighted in Haiti, Pʀᴇɴsᴀ Lᴀᴛɪɴᴀ (Jan. 31, 2024), https://www.plenglish.com/news/2024/01/31/work-of-cuban-medical-missions-members-highlighted-in-haiti/.
[20] Nugent, supra note 2.
[21] Michael Weissenstein & Marcelo De Sousa, Cuba Ends Medical Exchange Program With Brazil, AP Nᴇᴡs (Nov. 14, 2018), https://apnews.com/general-news-ecb41d0622df4022abd8724607faa505.
[22] Id.
[23] Id.
[24] Id.