Cuban medical internationalism has been a cornerstone of the nation’s foreign policy since the 1960s, characterized by the deployment of healthcare professionals to underserved regions worldwide. This report delves into the historical evolution, objectives, key missions, impact, challenges, and contemporary relevance of Cuba’s medical missions abroad.

Introduction 

As the consultant responsible for conducting the largest CARICOM study on human trafficking in the Caribbean region, I have been approached by multiple individuals seeking a better understanding of the current controversy surrounding the Cuban medical internationalism program and its categorization by the United States as a form of human trafficking or forced labour.

Since the 1959 Cuban Revolution, Cuba has deployed medical professionals to both developing and developed nations, including Brazil, Italy, countries in Latin America and the Caribbean, and West Africa. These doctors and nurses have played a vital role in combating outbreaks like COVID-19 and Ebola. Some have even lost their lives while serving in conflict zones. Despite this, a growing number of critics, particularly from the U.S. government, claim that these missions constitute forced labour and human trafficking.

Photo taken from the BBC: article: The hidden world of the doctors Cuba sends overseas

Understanding Human Trafficking To evaluate these claims, it is essential to begin with a clear understanding of the relevant terminology.

According to the United Nations:

“Human trafficking involves the recruitment, transportation, harboring and/or exercising control, direction or influence over the movements of a person in order to exploit that person, typically through sexual exploitation or forced labour. It is often described as a modern form of slavery.” (UNODC)

Applying this definition, the U.S. government argues that Cuban doctors face heavy restrictions and control while abroad, including the confiscation of passports, constant surveillance, and consequences for their families if they attempt to defect. Such conditions may fulfill the criteria for trafficking.

Diplomatic and Regional Reactions In response to expanded U.S. visa restrictions targeting individuals involved in these missions, several Caribbean leaders have expressed strong support for Cuba’s program, emphasizing the critical healthcare services provided. However, based on the terminology outlined by the United Nations, the Cuban medical program fits the description of human trafficking. Additionally, although Caribbean countries maintain high standards in labour laws, many Latin American, African, and Asian countries where Cuban doctors are deployed do not have comparable protections. While Caribbean leaders highlight their own labour standards, the broader program has been criticized by many as a form of forced labour.

Forced Labour Practices in the English-speaking Caribbean

The Caribbean region distinguishes itself by having stronger labour protection laws than many Latin American and African countries. These robust legal frameworks provide enhanced safeguards for workers’ rights, including those extended to foreign professionals such as Cuban doctors. Additionally, Cuban medical personnel deployed across Caribbean nations generally receive higher salaries and better working conditions compared to their counterparts stationed in other regions.

In 2019, we conducted research interviews with over 49 Cuban medical workers in 16 Caribbean countries, including Jamaica, Grenada, Saint Vincent and the Grenadines, Guyana, and Trinidad and Tobago. These interviews revealed no evidence of violations related to forced labour practices. These findings imply that, although coercion and exploitation remain areas of concern in certain international contexts, the circumstances faced by Cuban doctors in the Caribbean appear to differ notably from those experienced by their colleagues elsewhere.

Understanding these regional differences is crucial for developing a balanced and nuanced perspective on the question of whether Cuban medical professionals deployed internationally can be considered victims of human trafficking.

What Is Forced Labour? According to the International Labour Organization’s Forced Labour Convention, 1930 (№29):

“All work or service which is exacted from any person under the threat of a penalty and for which the person has not offered himself or herself voluntarily.”

The U.S. maintains that many Cuban medical professionals are coerced into these missions under threat, with significant limitations on their freedoms and considerable state retention of wages.

Photo taken from: https://www.reddit.com/r/dataisbeautiful/comments/r468au/oc_cuba_has_a_lot_of_doctors/?rdt=43094

Exploring the Cuban Medical Program Cuba’s international medical program is often held up as a beacon of socialist solidarity. Since the 1960s, hundreds of thousands of Cuban doctors have participated in international healthcare missions. The Cuban government refers to this group as its “army of white coats,” a symbol of altruism and national pride.

Despite this portrayal, economic incentives play a significant role. These missions bring in billions of dollars annually for the Cuban government, and the salaries offered abroad far exceed the domestic earnings of Cuban doctors. While a Cuban doctor earns approximately $25 to $50 per month at home, missions abroad can offer $150 to $250 monthly, and their families may receive a $50 monthly stipend.

With Dr. Ezra Mathias, consultant on the CARICOM Human Trafficking study

Human Trafficking Concerns A 2019 report by Cuban Prisoners Defenders highlighted several concerning practices:

• 89% of surveyed doctors said they had no prior knowledge of their specific assignment location.
• 41% reported having their passports confiscated upon arrival.
• 91% stated they were under surveillance and were encouraged to inform or spy on colleagues.
• 57% said they did not volunteer but felt compelled to participate, while 39% reported significant pressure to accept the assignment.

In Brazil, President Jair Bolsonaro’s administration characterized the missions as “slave labour,” citing the Cuban government’s practice of retaining up to 75% of the doctors’ salaries. Cuban authorities have rejected this characterization, defending the dignity and professionalism of their international medical staff.

Key Missions and Initiatives

• Henry Reeve Brigade: Established in 2005, this unit specializes in disaster response and epidemic control. It has been deployed to countries facing health crises, including Haiti and West Africa.
• Operación Milagro (Operation Miracle): Launched in 2004, this program provides free eye surgeries in collaboration with Venezuela. Over 4 million people across 34 countries have benefited.
• Latin American School of Medicine (ELAM): Founded in 1999, ELAM trains students from underserved communities globally, with the expectation that they return to serve their countries.

Impact and Achievements Cuban medical missions have:

• Expanded healthcare access in remote areas.
• Assisted in controlling global epidemics.
• Supported local health system capacity through training and infrastructure.

Photo taken from the article: BBC: listed in the reference

Challenges and Criticisms Cuban medical internationalism faces ongoing challenges:

• Political Tensions: The U.S. has accused Cuba of labour exploitation, leading to policy measures such as visa restrictions.
• Economic Pressures: Concerns exist over wage retention and fairness of compensation.
• Human Rights Concerns: Restrictions on movement, speech, and contract transparency for participating doctors have drawn international criticism.

Contemporary Relevance Despite controversies, Cuban doctors continue to serve globally:

• During the COVID-19 pandemic, Cuban medical teams were sent to over 40 countries.
• The program strengthens diplomatic ties, especially within the Global South.

Final Thoughts Cuban medical internationalism represents a complex interplay of humanitarian aid, economic strategy, and political diplomacy. While the benefits of global health support are tangible, the coercive practices reported by some medical professionals raise serious ethical and legal concerns. A balanced, fact-based, and rights-focused dialogue is necessary to address these challenges and ensure protection for all workers involved.

Below is a list of countries where Cuban medical professionals have been present:

1. Venezuela

2. Brazil

3. Bolivia

4. Haiti

5. Nicaragua

6. Guatemala

7. Honduras

8. El Salvador

9. Mexico

10. Colombia

11. Peru

12. Ecuador