Latin America Advisor

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Is the Government of Cuba Exploiting Medical Workers?

Ralph Gonsalves, the prime minister of St. Vincent and the Grenadines (center), welcomed Cuban doctors to his country last March. // File Photo: Prensa Latina. Ralph Gonsalves, the prime minister of St. Vincent and the Grenadines (center), welcomed Cuban doctors to his country last March. // File Photo: Prensa Latina.

U.S. Senators Rick Scott (R-Fla.), Marco Rubio (R-Fla.) and Ted Cruz (R-Tex.) in June introduced legislation to require the State Department to publish a list of countries that receive doctors from Cuba through its medical program, and to consider that as a factor in its annual Trafficking in Persons report. What does Cuba’s doctors program consist of, and how important is it for Cuba in terms of both diplomacy and revenue inflows? To what extent and in what ways does the program exploit Cuban medical experts, as its critics allege? Which countries benefit the most from the program, and if the bill is enacted, how much would they stand to lose?

Marco Rubio, U.S. senator (R-Fla.): “The Cuban regime’s so-called ‘foreign medical missions’ have created an international human trafficking scheme through which Raúl Castro and Miguel Díaz-Canel have perfected the art of exploitation and illegal enrichment. As a lifeline for the Communist regime, reports have noted that these ‘medical missions’ withhold a substantial portion of the Cuban doctors’ and medical personnel’s wages. Through deplorable working conditions, confiscation of legal identification and unfair compensation, these ‘missions’ constitute a form of forced labor and modern-day slavery.” 

Lenier González, founder and deputy secretary general of Cuba Posible: “This subject has much more nuance and sides than the belligerent narrative that demonizes it. There are currently more than 30,000 Cuban health personnel in many countries assisting vulnerable communities. Over the years, they have provided assistance in three ways. First, they have intervened in world catastrophes without charging anything in return. Second, they have cooperated with third-country agencies to assist in disaster situations, like Norway and the United States have done. And third, Cuba has exported medical services as part of its economic strategy. The country successfully faced the Covid-19 pandemic and also gave its support to 21 nations, a unique experience these days. This has translated into an enormous benefit for developing countries and also a high recognition for the doctors and for the island at an international level. The subject articulates solidarity with a criterion of economic opportunity, since it contributes billions of dollars to GDP. Cuban doctors participate in the missions with their own free will. Before leaving Cuba, the doctor signs a contract for a certain amount of money (set by the government). Physicians’ wages should be higher, their working conditions should be better, and control over doctors should be lessened. Control and centralization are distinctive features of the Cuban sociopolitical and economic systems, not only in the medical missions. It is something that must change to make Cuba’s future sustainable. That said, let’s be frank: the accusations of ‘slave labor’ have a clear political connotation, and they only make sense as the electoral cycle in the United States and Florida becomes relevant.”

Otto Reich, president of Otto Reich Associates LLC and former U.S. assistant secretary of state for Western Hemisphere Affairs: “Under the guise of a ‘voluntary, humanitarian, internationalist program,’ Cuba generates between $8 billion and $11 billion every year from the forced labor of doctors and medical workers exported to foreign countries. The ‘forced labor’ description is not mine; it is the U.S. State Department’s language in its most recent Trafficking in Persons Report to the U.S. Congress. The above revenues comprise the single largest source of income for the Cuban military’s coffers. More than 60 countries currently employ about 40,000 Cuban doctors under this system, and 12,000 medical workers have defected over the years. Reports from Brazil and Venezuela, as well as a federal lawsuit filed by Cuban doctors now living in the United States, have exposed these missions as human trafficking, in violation of U.S. and international law. Far from being primarily humanitarian, the missions are an extension of the Marxist government’s propaganda and intelligence apparatus. Cuban doctors assigned to Venezuela, for example, were forced to withhold medical care from patients who didn’t support Maduro. Doctors assigned to Brazil were required to tell patients they had to vote for Rousseff government politicians (favorable to Cuba) to maintain the health care program. All doctors are monitored and surveilled 24 hours a day by Cuban intelligence officials in the foreign countries to make sure they remain loyal to the regime. In addition to these and other illegal practices, the Cuban government keeps 80-90 percent of what the foreign countries pay for their services, and the doctors get only a small fraction of the total. It is easy to see why these programs are so important for Cuba’s military rulers. If the regime cared for the doctors, they would allow them to be paid directly by the foreign employer and to keep their passports while abroad in case they wanted to travel. Why they don’t is self-evident.”

Wazim Mowla, researcher for the African & African Diaspora Studies program at Florida International University: “Cuban medical professionals have been an integral component of Caribbean public health systems for more than 30 years, so it was natural that the region’s leaders looked to Cuba during the Covid-19 pandemic. As Caribbean governments recognized that the pandemic would be a shock to their tourism-dependent economies, they quickly requested Cuban medical support to defend themselves against the virus and lessen the future contraction of their economies. Caribbean leaders have been sensitive to right-wing accusations that the medical workers suffer from human trafficking as their experience has assured them otherwise. If this bill is enacted, not only would it undermine the sovereign right of Caribbean countries, but states such as Barbados and Belize could be affected as early as 2021. Both countries were placed on the U.S. State Department’s annual Trafficking in Persons Report’s Tier 2 Watch List for two consecutive years. A country placed on the Tier 2 Watch List for a third year automatically finds itself on the Tier 3 list. The designation would result in U.S. funding restrictions and give the U.S. president the power to direct his representative at multilateral development banks to use their best efforts to deny loans to these countries. With seven Caribbean countries already on the Tier 2 list (one notch below the Tier 2 Watch List), others in the region could face a similar circumstance. Given the economic and public health challenges Caribbean countries will soon face, the region’s leaders are likely to view the bill’s enactment as unfriendly and inhumane.”

Vicki Huddleston, retired U.S. ambassador and former chief of the U.S. Interests Section in Havana: “The legislation that Senators Rubio, Cruz and Scott proposed is nothing new. It is a ploy to garner conservative Cuban-American votes and resources and to deny revenues to the Cuban government by using the false rationale that Cuban doctors are being trafficked. The opposite is true; the majority of doctors seek out these positions as their salaries abroad are considerably greater than at home, where there is a glut of physicians. The prime minister of St. Vincent and the Grenadines and incoming chairman of Caricom, Ralph Gonsalves, said that engaging with Cuba’s medical missions ‘is not human trafficking’ and that, by classifying it as such, the United States makes ‘more difficult the fight against genuine human trafficking’ and underestimates ‘the big impact of how much the Cubans are helping.’ Unfortunately, should this legislation pass, we will become even more unpopular with our Caribbean neighbors and important allies such as Mexico and Italy, all of whom are truly grateful for Cuba’s help. It is true that the Cuban government isn’t completely altruistic; it desperately needs the foreign exchange paid by the recipient countries for the physicians’ services. More worrisome, Cuba tarnishes its image by limiting the freedom of the physicians and by confiscating their passports, thereby denying them the right to travel. Yet, the bottom line is this: Cuba has eradicated the coronavirus at home and provided succor to others, while the Trump administration has failed to staunch the pandemic at home and abandoned its leadership abroad.”

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