For decades, the Cuban dictatorship redoubled efforts to present the country as a world medical power. However, behind this alleged feat lies a dark system of human trafficking and exploitation driven by the medical missions that the regime sends to dozens of countries around the world. The NGO Human Rights Foundation (HRF) made a report in which it reveals details of how this complex scheme is developed, which has provided billions of dollars to the dictatorship.
According to the Trafficking in Persons Report (TIP), issued annually by the United States Department of State, countries such as Cuba, Afghanistan, China, Iran, North Korea, Russia and Syria, among others, have a “policy or pattern ” of human trafficking from government-funded programs, forced labor in government-affiliated medical services, sexual slavery, or child recruitment.
In the case of Cuba, intergovernmental organizations and foreign governments have denounced state-sponsored human trafficking in Cuban medical missions.
According to the HRF report, during the last 59 years, Cuban medical missions deployed more than 400,000 health workers in 164 countries. At the time of sending them, the regime presents them as “missionaries of the Cuban Revolution.” Currently, there are between 34,000 and 50,000 professionals in more than 60 countries in Africa, Latin America, Europe and the Middle East.
The dictatorship took advantage of the context of the coronavirus pandemic to expand its medical missions abroad. Since March 2020, the number and size of those missions has increased, sending more than 2,770 additional health workers to 26 countries. Although the regime sent its doctors in a supposed show of “solidarity” with the serious crisis that the whole world was going through, the reality is that the medical missions allowed it to compensate for the loss of income due to the lack of tourism due to the pandemic. .
The entire medical system in Cuba is controlled exclusively by the State. Since the early 2000s, the sale of medical mission services has become the island’s main source of foreign income, generating more than any other sector of the local economy. The 2021 TIP Report estimated that the Castro regime collects between six and eight billion dollars annually through the missions.
But the clear beneficiary is the State. “The Cuban totalitarian regime has used its disproportionate power over medical professionals and their employment conditions to exploit and abuse health workers through countless coercive mechanisms, ranging from the threat of family separation and forced exile to movement restrictions and wage theft,” the Human Rights Foundation report states.
The dictatorship takes advantage of the low pay of Cuban doctors to further coerce them into the medical mission program. Once in the program, staff “face violations of their rights to freedom of association, freedom of movement, and freedom of expression.” Likewise, if they refuse to take part or do not comply with what is established by the State, the workers must also face strong persecution and threats from the authorities.
The coercive recruitment practices employed by the regime also include economic pressures. According to the labor contracts negotiated by the State, Cuban doctors receive between 9 and 25% of their salaries; the rest goes to the coffers of the dictatorship. These salaries range between 70 and 75 dollars, figures that are usually below the minimum wage or the poverty line of the host country.
For example, Cuban doctors working in the Mais Médicos mission in Brazil received $400 a month – 9.36% of what the Brazilian government paid them – according to the Brazilian Federal Court of Accounts. Almost half of the doctors’ salaries are kept in a Cuban bank account that the doctors cannot access until they return to Cuba after completing their mission. However, if the workers “abandon” the mission, the regime confiscates the part of their wages withheld on the island. “This exploitative arrangement helps Cuba avoid ‘defections’ by imposing a strong financial incentive on doctors to finish their contractual obligations and return home.”
According to testimonies of former participants in the missions, 88.4% of the workers stated that “the situation of extreme poverty” and their low salary influenced their decision to join the missions. Once again, Cuba leaves doctors no choice but to join medical missions to supplement their low salaries.
Any doctor who abandons a mission is declared a “traitor to the country.” In addition to not being able to dispose of the money generated by their work, these people, who for the regime become “deserters”, are prohibited from entering the island -without exception- for a period of eight years. “The 8-year ban holds the families of medical workers hostage due to the credible threat of lengthy family separation. Keep in mind that medical workers must leave their families in Cuba for the duration of their contract (usually 2 or 3 years) and can only take one month of paid vacation per year. Even in case of serious illness or death of a close family member, doctors cannot travel back without government authorization. In this way, the Cuban government not only violates the freedom of movement and association of doctors, but also the human rights of their spouses and children,” the Human Rights Foundation report states.
Cuban doctors are also unable to practice abroad, since the state requires a special permit that the Ministry of Health often refuses to issue. The restrictions tightened in 2018, when the government banned the legalization of academic or other documents for health professionals serving on missions or attending international events. In this way, the dictatorship seeks to ensure that the doctors only participate in the missions, and then return to the country. As an additional measure to prevent desertions, the dictatorship issues workers a special passport that prevents them from traveling anywhere other than Cuba and the assigned host country. In fact, upon arrival in the country, the passports are retained by Cuban supervisors.
Another norm promulgated by the Cuban Communist Party establishes the impossibility of doctors obtaining permanent residence in the host country through marriage or the search for people who can sponsor their relatives.
But while Cuban doctors are subjected to this exploitation, foreign governments take advantage. The country that has received the most health workers so far is Venezuela. In the year 2000, the countries signed an agreement whereby Havana undertook to send medical personnel in exchange for 53,000 barrels of oil a day from Caracas.
In 2013, for its part, Cuba created the “Mais Médicos” program with Brazil. That deal was one of the largest and most profitable for the island. But when Jair Bolsonaro became president he put an end to the mission. The president then said that the program could only continue if the Cuban doctors received their salaries directly from Brazil and could bring their families during their assignments, among other conditions. Of course, the Cuban dictatorship refused and the agreement was terminated.
In recent years, as the experiences of deserting doctors and workers who have already completed their mission became known, there were more and more complaints against the Cuban dictatorship for human trafficking and labor exploitation.
In November 2019, Urmila Bhoola (UN Special Rapporteur on contemporary forms of slavery) and Maria Grazia Giammarinaro (UN Special Rapporteur on trafficking in persons, especially women and children) sent a letter to the Castro regime in the one that affirmed that the working conditions that had been communicated to them “by first-hand sources” could be equivalent to “forced labor”. Added to that report are dozens of complaints from international organizations and countries.
But despite allegations of human trafficking, the regime has and continues to promote its medical missions, “undermining its binding obligation to comply with the Palermo Protocol and the ILO Conventions on forced labor.” Havana argues that all these accusations respond to a “campaign” by the United States government and its allies to “discredit” the medical missions.
“Cuban medical missions have served to export the island’s misleading brand of medical diplomacy and promote the myth of Cuba as a ‘world medical power,'” concludes the HRF report.
The full Human Rights Foundation report: