Since the beginning of the COVID-19 pandemic, Cuba has sent over 1,200 healthcare workers to more than 22 countries in order to help fight the virus.1 This medical internationalism, colloquially known as ‘doctor diplomacy’ continues a policy held by the Cuban government since Castro’s revolution and has seen Cuba deploy ‘over 400,000 health workers across 164 countries’ who have estimated to have ‘attended 2.6 million births, conducted 9.1 million surgeries, administered 12.8 million vaccinations, and saved an estimated 5.7 million lives’.2 3 Despite this seemingly altruistic policy of universal healthcare the programme is looked upon cynically by many in the western world. So, who are the Cuban international medical corps and what do they do?
As briefly mentioned previously, medical internationalism became a firm policy in the new Castro government in 1959 due to ‘free healthcare as a universal human right’ being one of the key ideals of the revolution.4 This doctor diplomacy was seen as a way in which to export Cuba’s revolutionary agenda and make allies, as well as leading by example with their socialist ideals. Since the establishment of the policy the sending of doctors abroad has become Cuba’s most lucrative export, bringing $6 billion dollars into the country in 2018; double that earned through tourism.5 Before the COVID-19 pandemic Cuba boasted more than 28,000 medical staff in 60 countries, having been the first to help with the 2014 Ebola outbreak in West Africa whilst also playing a prominent role in the 2004 tsunami recovery and the 2010 Haiti earthquake and cholera outbreak.6 In fact the Cuban international medical corps have become so well-renowned and respected that they have been nominated for a Nobel peace prize three times and the Henry Reeve Emergency Medical Contingent have been awarded the prestigious Dr Lee Jong-wook Memorial Prize for Public Health at the World Health Assembly in 2017 ‘in recognition of its emergency medical assistance to more than 3.5 million people in 21 countries affected by disasters and epidemics since the founding of the Brigade in September 2005’.7 In line with their beliefs in solidarity and universal healthcare Cuba have also offered to help countries not ideologically aligned with themselves and have sent medical brigades to Italy, Andorra and Peru.8 The country was also praised for their ‘great gesture of solidarity’ after treating and repatriating citizens from the virus-hit British cruise ship, MS Braemar, previously rejected from making port by multiple countries in the area.9 In addition to this, compensation for Cuba’s medical services is only received from wealthier countries with low-income countries receiving medical help free of charge.10 Further to the exporting of medical personnel, Cuba also set up the Latin American School of Medicine in 1998, which has, as of 2019, graduated 29,000 doctors from 105 countries, many of which have become frontline medical workers against COVID-19 in developing countries.11 Within this number of graduates, comprising 100 different ethnic groups, 50% were women and 75% were children of agricultural workers.12
However, during the COVID-19 pandemic, the administration of President Trump has called on nations not to accept help from Cuba’s medical brigades and have accused the Cuban government of worker exploitation.13 The government have also been accused of violating Cuban medical workers rights to privacy, freedom of expression and association, liberty, and movement, all of which are protected under the International Covenant on Civil and Political Rights, through the implementation of resolution 168 by the Ministry of External Commerce and Foreign investment in 2010. The resolution is said to ban Cuban medical staff from forming relationships or friendships with those ‘who promote a way of life contrary to the Cuban revolution’ as well as prohibiting the visiting of places which could damage ‘a doctor’s prestige’ whilst on missions. In addition to this, there have also been reports of passports being confiscated, intelligence officers spying on medical workers, and the setting of quota’s for drugs administered and lives saved that could reveal more authoritarian undertones to the programme.14 In light of these accusations a lawsuit has been filed by a Cuban opposition-linked group called the Cuban Prisoners Defenders. The lawsuit accuses Raul Castro and current President Miguel Diaz-Canel of crimes against humanity as well as ‘for running a programme that acts as a form of modern slavery, with testimonies from 622 doctors claiming that they did not volunteer to join missions abroad or that they felt strongly pressured to serve abroad.15 16 A further criticism of the policy lodged by the Trump administration is the fact that the Cuban government typically keeps 75% of the money paid by the host country for the doctors, which the administration has equated to ‘human trafficking’.17
Whilst some accusations levied against the Cuban government regarding their medical brigades are indefensible, such as the seemingly authoritarian resolution 168, other criticisms could arguably be seen as an extension of the zero-tolerance policy on Cuba perpetrated by the USA for decades. This zero-tolerance policy has seen a crippling embargo levied against Cuba, the expulsion of Cuban doctors from right-leaning Latin American countries (leaving many harder-to-reach areas underserved) and a US ‘Cuban Medical Professional Parole Programme’, started under President Bush in 2006 and ended by President Obama in 2016, which encouraged overseas Cuban medical staff to defect.18 19 One such criticism, which is arguably levied unfairly, is the claim that the Cuban State takes the vast amount of the fee charged for a doctor; emerging in 2018 that Brazil was paying $3,100 per month per doctor with the Cuban State taking 70% of this fee.20 When refuting this criticism Professor John Kirk, of Spanish and Latin American Studies at Dalhousie University, has said it is important to consider that a typical doctors salary is $100 a month working in Cuba and so a placement abroad is a considerable pay rise. Further to this, schooling, including medical school along with other facilities are free in Cuba, unlike other countries and so there is less needed to be paid for, with the 70% taken by the government going towards paying for this.21 Professor Kirk has also said that over a 12-year period he interviewed 270 medical personal and ‘none of the respondents felt that they had been forced to work abroad’.22 However, that is not to say that those who have filed a case against Castro and Diaz-Canel do not have legitimate grievances as there are obvious barriers to voicing your complaints in an authoritarian leaning state such as Cuba.
After the legacy and accolades, which have followed the international medical corps through its history, it is hard to write off the programme simply and cynically as exploitative or propaganda, especially when much of the criticisms originate from ardent opposition to Cuba. However, criticism surrounding exploitation have tainted the programme meaning that it needs to be looked at with a critical eye and not taken on face value alone. That being said the idea of an international medical brigade is obviously needed and is best summed up by Gaston Brown, the Prime Minister for Antigua and Barbuda, who said ‘If the U.S. could have offered it, we would have taken it. We are a small developing country. What are our options?’.23 As vocal critics of the providers of what is considered to be life-saving expertise by many developing countries, the US and other critics of Cuba should offer their own alternative to the Cuban medical brigades. One thing that separates Cuban medical assistance from that of others is their emphasis on solidarity where others prioritise aid in terms of defence and security. Until this priority is adjusted it is evident that Cuba will be the first port of call for many developing countries in times of crisis.