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The changing politics of Cuban international health diplomacy

By Bryan Ch. Campbell Romero-

Cuban doctors arrive in South Africa to help fight COVID-19. Source:

Over the past few months, Cuba has seen a new surge in international demand for its help as a result of the global spread of Covid-19. The Caribbean island is leveraging the rising need for quality medical services to reinvigorate and expand its long-lasting healthcare assistance programmes in developing and wealthier nations alike. Through the extension of medical aid to more than 30 countries as a direct response to the current pandemic, the Cuban government is emerging as a responsible player during a time when many established international actors have failed to act.

However, Cuba’s medical missions are also a major source of political tension and controversy. The United Nations High Commissioner for Human Rights, prominent civil society organizations such as Human Rights Watch and various governments around the world condemn the programmes, alleging human rights violations by Cuban authorities to the participating doctors. The critics point out that the government in Havana does not inform the professionals involved of the conditions of their contracts, withholds their passports and pays them only a small fraction of the funds disbursed by host countries.

Another important criticism focuses on how Cuba’s health programmes serve as an entry point into critical geopolitical developments. Since they began with Cuba’s first official medical mission in 1963 to support Algeria in its territorial conflict with Morocco, to the involvement in internal military conflicts in Latin America and Africa during the Cold War, Cuba's medical programmes have come under intense scrutiny by members of the international community. Recently, the interim government of Juan Guaidó in Venezuela, the caretaker government of Jeanine Áñez in Bolivia and President Lenín Moreno in Ecuador have accused Cuban authorities of using its health assistance as a cover to conduct espionage and other security-related operations.

Cuba denies these accusations and continues to use healthcare as a legitimizer of its ideology and form of government. As doctors become trusted members of the communities in which they operate, it forges long term links and consolidates a favourable image for the country in various communities overseas. The construction of an advantageous relationship in terms of economic and strategic affairs with Venezuela is an example of the effectiveness of Cuban medical aid as a soft power tool. This model of South-South cooperation is a centrepiece of the Cuban strategy for political survival on the global stage.

The economic and political aspects of Cuban medical aid

Cuba’s aid reaches all aspects of public health assistance. Including disaster relief, epidemiological monitoring, staffing of secondary and tertiary care hospitals in beneficiary countries, as well as direct provision of medical care and education for foreign nationals in Cuba. While the Cuban government considers international medical cooperation an extension of key premises of the Cuban revolution, such as universal healthcare and internationalism, these programmes are heavily motivated by economic incentives as well. Medical cooperation abroad has been instrumental in providing considerable material capital, especially through programmes likeDoctors for Oil” in Venezuela and commercial agreements with countries such as Brazil, South Africa and Qatar. In 2018, the leasing of health professional services generated a $6.3 billion profit for Cuba, becoming one of the main sectors of its economy.

The economic value of Cuba’s health assistance programmes made them a target for the Trump administration. As part of one of President Trump’s distinctive policies towards the Western Hemisphere, which centred on a failed bid to overthrow the so-called “troika of tyranny”, the US engaged in a maximum pressure campaign against the Cuban government, directed at cutting its main lines of foreign exchange earnings. Furthermore, the Trump administration limited US travel to Cuba and cut virtually every legal channel for remittances, which are two areas of strategic relevance for Cuba’s ailing economy. The US has also doubled down in an effort to guarantee the unviability of Cuban medical cooperation, classifying it as forced labour, asking host countries to reject Cuban assistance, and adding Cuba to a blacklist of countries that “do not do enough to fight human trafficking.”

Many governments in Latin America have joined the US in a call for more transparency in the operation of these programmes. Recent drastic political changes in Brazil, Bolivia, Ecuador and El Salvador have jeopardized Cuba’s medical cooperation in a region that remains at the centre of the Caribbean island’s project to gain income and influence through healthcare.

The most prominent critic among Latin-American politicians has been President Jair M. Bolsonaro, who demanded substantial reforms to the programme known in Brazil as Mais Medicos and even threatened to cut diplomatic relations with Cuba after assuming office. Mais Medicos, which was originally arranged by the Pan-American Health Organization (PAHO) in 2013, dispatched 20,000 doctors who treated approximately 113.5 million people, according to official data from PAHO. Cuban authorities unilaterally ended the agreement after President Bolsonaro vowed to take action against the programme and called Cuban doctors “slaves”.

The controversial nature of these programmes spreads beyond Latin America. In South Africa, which has received Cuban assistance since the fight against apartheid – a conflict that included Cuban troops who fought in southern Angola – Cuban presence is now a political issue as local medical associations and the US government question Cuba’s role in the African country’s health system. Italy, the first European country to receive Cuban medical aid, and Qatar, also recently experienced US pressure and criticism for participating in the programme.

Cuban health cooperation and a Biden administration

Despite this polarized landscape, the election of Joe Biden as the next US president will likely bring a cooling effect and a change of rhetoric. A future Biden administration will most likely aim for policies of engagement with Cuba. Even when the Caribbean island isn't a priority on the US foreign policy agenda, Biden’s commitment to becoming a global leader in the fight against Covid-19 could facilitate medical cooperation between the two countries.

However, US policy towards Cuba will be significantly defined by American congressional politics. The US Senate is considering the “Combatting Trafficking of Cuban Doctors Act”, a bipartisan bill that will penalise recipient countries of Cuban medical aid. This legislation, if enacted, will also demand “corrective action and governance reforms” to the Pan-American Health Organization (PAHO) for its involvement in the Mais Médicos Cuban programme in Brazil.

This bill will potentially strain US relations with allies and regional bodies, such as the African Union and Caribbean Community (CARICOM), both major beneficiaries of Cuba’s health missions. During the pandemic, almost all Caribbean nations, including Britain and France’s overseas territories asked for Cuban medical support. CARICOM countries have condemned the extraterritorial effects of the bill, which will install funding restrictions from the US and could allow US-based multilateral development banks and the International Monetary Fund to deny loans and institutional funds for recipient countries.

The “Combatting Trafficking of Cuban Doctors Act” will also affect the work of PAHO, the main multilateral health organization in the hemisphere, whose services have been highly demanded during the Covid-19 pandemic. PAHO is also facing legal challenges in US courts, as many Cuban doctors who worked in the programme known as Mais Medicos accuse the organization of benefiting from a forced labour scheme.

Despite these political challenges, Cuban medical assistance is likely to expand. Due to the Covid-19 pandemic, many countries are no longer in a position to condition cooperation agreements with Cuba and the inauguration of a Biden administration in the US will bring the opportunity to engage in diplomatic conversations, reducing pressure on beneficiary countries. Although the US could maintain certain sanctions on Cuba over its support to the Maduro government in Venezuela and human rights issues, including labour conditions of Cuban medical professionals working abroad, the new administration probably won't be inclined to prosecute Cuba’s health assistance programs with the intensity of the Trump era.

Bryan Ch. Campbell Romero is an Analyst & LatAm Practice Head at DaMina Advisors, where he covers significant geopolitical developments in Latin American frontier markets and leads the firm’s research on emerging political and economic trends in the region. He also contributes regularly to other publications offering commentary and insights on Cuban and Latin American politics, society, economy and entrepreneurial ecosystems. Originally from Cuba, Bryan holds a Bachelor’s degree in Philosophy (Licenciatura en Filosofía) from the University of Havana.




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