Cuba Says Biden Applies Blockade Even More Aggressively Than His Predecessors

Biden has maintained many of Trump’s sanctions against Cuba. He must fulfill his promise to reverse Trump’s actions.

By Marjorie Cohn

January 6, 2023

Z Article

Source: TruthOut

End the Embargo Against Cuba!


“The current U.S. government, the one of Joseph Biden, of all those that the Cuban Revolution has known, is the one that has most aggressively and effectively applied the economic blockade,” Carlos Fernández de Cossío, vice minister of Foreign Affairs of Cuba, declared in a speech on December 14. “It is the one that punishes the most, the one that causes the most damage to the daily life of Cubans and the economy as a whole.”

Fernández de Cossío cited the disruption of Cuba’s fuel receipt by sea, and economic depression resulting in the “extraordinary flow of Cuban migrants” as examples of the severe harms that Cubans have faced due to the Biden administration’s implementation of the blockade.

In his address at a conversation series on “Cuba in the Foreign Policy of the United States of America,” held on December 14 at the Higher Institute of International Relations in Havana, Fernández de Cossío took aim at the Biden administration’s enforcement of the blockade against Cuba, stating, “there can be no doubt that the economic blockade is the defining factor in the bilateral relations” between the United States and Cuba.

Biden pledged during his 2020 presidential campaign that he would “try to reverse the failed Trump policies that inflicted harm on Cubans and their families.” In 2021, he claimed, “We stand with the Cuban people.”

But Biden’s actions belie his words. Fernández de Cossío said that Biden has applied “with absolute and surprising loyalty … the policy of maximum economic pressure that was designed by his predecessor, Donald Trump.”

In 2015, the Obama administration restored full diplomatic relations with Cuba, released Cubans imprisoned in the U.S. for trying to deter further terrorist attacks against Cuba, relaxed restrictions on Americans traveling to Cuba, and ended some economic prohibitions between the U.S. and Cuba. It also facilitated the export of U.S. internet hardware and telecommunications and established increased cooperation between the United States and Cuba in intelligence-gathering, drug interdiction, scientific research and environmental protection.

Trump undid the progress Obama had made and imposed 243 onerous new sanctions — known as unilateral coercive measures in international law — on Cuba as part of his “maximum pressure” strategy.

The Embargo Was Imposed to Cause Cubans Hunger and Desperation

More than 60 years ago, following the triumph of the 1959 Cuban Revolution, the U.S. government imposed an economic embargo on Cuba. The rationale for the embargo was detailed in a State Department memo that advocated the “disenchantment and disaffection” of the Cuban people through “economic dissatisfaction and hardship” so they would overthrow the Fidel Castro government. The memo recommended the denial of “money and supplies to Cuba, to decrease monetary and real wages, to bring about hunger, desperation and overthrow of government.”

The embargo (which the Cubans call a blockade) “is not a single law, but a complex patchwork of laws, presidential proclamations, and regulations that Fidel Castro once called ‘a tangled ball of yarn,’” American University professor and Cuba scholar William M. LeoGrande wrote in the National Security Archive. “It has evolved over the sixty years since President John F. Kennedy put it in place, loosening and tightening from one administration to the next, depending on the president’s preference for using hard power or soft power in dealing with Cuba.”

Since the Cuban Revolution, the United States “has waged an unceasing assault, both military and economic, against the Cuban people, organizing an invasion, assassinations, terrorist attacks against civilians and systematic economic sabotage,” Isaac Saney wrote at Resumen. The blockade has cost Cuba more than $130 billion in damage, according to the United Nations.

Some Positive Bilateral Steps Taken Last Year

Despite this rocky history, Fernández de Cossío acknowledged that some positive bilateral steps were taken between the United States and Cuba last year. He cited migration cooperation; U.S. grants of 20,000 visas annually; a return to U.S. embassy services in Havana; cooperation between Cuban Border Guard Troops and the U.S. Coast Guard for interception on the high seas and return to Cuba; an agreement to hold exchanges on law enforcement, oil spills, health and the environment; and commercial flights from the United States to different Cuban provinces. The United States has again authorized “people to people” educational group travel to Cuba, but individual travel for education is still prohibited.

Fernández de Cossío also praised U.S. offers of humanitarian aid to Cuba “without political conditions” after a fire at the supertanker base in Matanzas last August and $2 million for repairs after Hurricane Ian. But Cuba still has not received that assistance.
Negative Steps Taken by the Biden Administration

The vice minister of foreign affairs also listed “developments in the opposite direction.” These include the recent U.S. designation of Cuba as a country of special concern in matters of religious freedom “without any real basis, on grounds that are dishonest.”

“In late 2022, the Biden administration took the unprecedented action to list Cuba as a nation of ‘special concern’ regarding religious freedom — which even the Trump administration did not do, and which was not recommended by the related commission created by U.S. law. This is absurd,” Art Heitzer, co-chair of the National Lawyers Guild’s Cuba Subcommittee, told Truthout.

“Members of my Methodist church were prosecuted by the U.S. government for visiting their sister Methodist church’s centennial in Havana,” Heitzer said. “The late Cardinal Jaime Ortega, then head of Cuba’s Roman Catholic Church, told me after mass at the cathedral that he favored ending the U.S. embargo; and because of religious objections, the Cuban government delayed by several years the referendum process which has now granted constitutional protection to same-sex marriage.”

Fernández de Cossío also mentioned the Biden administration’s commitment in May to allow remittances to Cuba, but said that still has not happened and there is no “commitment to dismantle the measures announced by the Trump administration to disrupt the remittances.”

In addition, although the U.S. government announced measures to boost internet penetration and interconnection in Cuba, the United States still prohibits access for Cubans to more than 200 private commercial websites, according to Fernández de Cossío. This includes sites for education, health, science and technology, art, culture and innovation.

The U.S. government, Fernández de Cossío stated, admits that it “intends to promote the Cuban private sector, not to contribute to the development of the Cuban economy, not to improve the standard of living of the population, not to help a majority sector of the population, but rather identifies it as an instrument of political subversion … a political weapon.”

What Biden Could Do to Relax the Blockade

Fernández de Cossío described steps Biden could take “to deliver on his declared priority of promoting human rights and caring for the welfare of the Cuban people.”

Biden could remove Cuba from the list of State Sponsors of Terrorism. In 2015, the Obama-Biden administration removed Cuba from the list. But at the end of Trump’s term, his State Department added Cuba back onto the list. Within weeks, Fernández de Cossío noted, “45 banks and financial institutions with long-standing relations with Cuba severed their ties with our country.” This impacted Cuba’s trade and access to credit. “It is a devastating impact,” he said. “And even today, on account of its presence on that list, Cuba is still encountering trade and financial organizations that refuse to interact with us for fear of retaliation by the U.S. government.”

Dozens of lawyers have signed an open letter to Biden, stating, “There is no legal or moral justification for Cuba to remain on the State Sponsors of Terrorism list.” They wrote, “Biden has the power to remove Cuba from [the list] and reverse many Trump-era sanctions through executive action. However, Biden has chosen to defend Trump’s aggressive policies.”

Trump also stiffened the economic and travel blockade and activated Title III of the Helms Burton Act, which was enacted to discourage foreign investment in Cuba. Trump’s activation of Title III greenlighted thousands of lawsuits that will discourage tourism and investment in Cuba. In one such lawsuit, U.S. District Judge Beth Bloom issued an order on December 30 against four Florida-based cruise shipping companies that sailed to Cuba, requiring them to pay more than $400 million in damages. Fernández de Cossío pointed out that Biden could have suspended Title III like Trump’s predecessors. Activating Title III has had “a deterrent impact on our developmental purpose of attracting foreign capital,” he added.

In addition, “[The Biden] administration could have ceased the practice of pressuring governments in Africa, Asia, and Latin America to refuse medical cooperation provided by Cuba,” Fernández de Cossío said. “This U.S. action, of course, is intended to prevent dozens of thousands of people from receiving medical services, which is what Cuban doctors provide.”

Biden could also have ended “punitive measures, threats, and persecution against fuel exporting companies, shipping companies, port agencies, insurance and reinsurance agencies all aimed at depriving Cuba of fuel supplies that our country requires to function,” which “has had an extremely severe impact on the economy and the lives of the Cuban people,” according to Fernández de Cossío.

The Purpose of the Blockade Is Regime Change

The blockade, the vice minister said, “has an impact on everything.” That includes electrical service, transportation, the availability of medicine and material for medical services, and the ability to obtain supplies for food production and building materials.

“The U.S. government cannot pretend to treat Cuba as if it were part of its territory or treat Cuba as if it were a colonial dominion, or treat Cuba as if it were an adversary defeated in a war. We are none of the three,” Fernández de Cossío declared. He cited Cuban President Miguel Díaz-Canel’s observation that the intention of the United States is “to strangle the Cuban economy and thus try to provoke social collapse and a political crisis in Cuba.” Although the U.S. has failed in that purpose, it has led to “economic depression” in Cuba and “the extraordinary flow of Cuban migrants.”

Biden himself has called Cuba a “failed state,” and his administration “is doing virtually all that it can to make it so,” Heitzer said.

“The embargo’s overt purpose is to strangle the Cuban economy to promote regime change,” according to the Alliance for Cuba Engagement and Respect (ACERE), a coalition of organizations working to end the Cuba blockade. The United States spends more than $25 million each year to fund regime change programs against Cuba.

On November 3, for the 30th time, the United Nations General Assembly called for an end to the illegal U.S. blockade against Cuba. The vote was 185 in favor, two opposed (the U.S. and Israel), and two abstentions (Brazil and Ukraine). The resolution affirmed “the sovereign equality of States, non-intervention and non-interference in their internal affairs and freedom of international trade and navigation, which are also enshrined in many international legal instruments.”

Joe Biden must make good on his promise to reverse Trump’s actions tightening the blockade against Cuba, return to the measures taken by the Obama-Biden administration, and work to dismantle the illegal and immoral blockade once and for all.

Copyright Truthout. Reprinted with permission.

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Marjorie Cohn is professor emerita at Thomas Jefferson School of Law, former president of the National Lawyers Guild, and a member of the national advisory boards of Assange Defense and Veterans For Peace, and the bureau of the International Association of Democratic Lawyers. A prominent scholar and lecturer, her books include Cowboy Republic: Six Ways the Bush Gang Has Defied the Law; and Drones and Targeted Killing: Legal, Moral and Geopolitical Issues She provides commentary for local, regional, national and international media and is co-host of “Law and Disorder” radio.

Trump’s Cuba Memorandum Provokes Strong Criticism Amid New US Aggressiveness Abroad   

W. T. Whitney

 July 16, 2025

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Photograph Source: hakkun – CC BY-SA 3.0

The Trump administration on June 30 released its “National Security Presidential Memorandum 5” on U.S. plans for Cuba. Criticism from Cuba’s government and international commentators welled up, as if entirely new forms of anti-Cuba aggression were in the works. That may or may not be so.  Actually, the recent Memorandum was a re-issue of the document put forth by the first Trump administration on June 16, 2017. 

The eruption of an unusually forceful reaction to a Memorandum that says nothing new seems odd. It’s not. For one thing, the Memorandum creates an opening for U.S. government departments and agencies to fashion entirely new devices aimed at destroying Cuba’s economy. The 2017 Memorandum did exactly that, and what happened was disastrous.

And more: the international context of U.S. assaults on Cuba has drastically changed. U.S. foreign intervention now shows as war from the sky against Iran and as U.S. support and military hardware for genocide against Gazans. Is Cuba next in line for extreme measures?

Prescriptions

The Memorandum’s ostensible use is as a directive to heads of the various departments making up the U.S. government’s executive branch. It requires them to send President Trump reports on new tools they have devised for beating up on Cuba, and to do so within 30 days. They must “adjust the current Cuba regulations in order to ensure adherence, so that unauthorized transactions with Cuba and impermissible travel to Cuba are effectively banned.”

The document attests to the authority already vested in the departments to take action against Cuba. It cites the 1996 Helms-Burton Law as having legitimized the U.S. purpose of regime change for Cuba. 

The Memorandum sets forth various U.S. goals and various ways to implement them. These include promotion of free enterprise in Cuba, channeling funds to the Cuban people and not to their government, “restructuring certain travel arrangements and [US] travel,” and ending supposed human rights abuses in Cuba. This year’s Memorandum once more calls for depriving Cuba’s military and intelligence services of money derived from U.S. tourism. 

This Memorandum, as with the other one, bans U.S. tourism to the island. All U.S. citizens traveling to Cuba for permitted reasons must keep records of their transactions in Cuba and for five years ensure that they are available for potential Treasury Department inspection. 

The Memorandum directs U.S. officials to expand Cubans’ access to the Internet and to a “free press” and to oppose efforts at the United Nations and “other international forums” aimed at blocking U.S. policies on Cuba. Annually, the secretaries of the various departments of the executive branch must report to the president “regarding the engagement of the United States with Cuba to ensure that engagement is advancing the interests of the United States.” 

President Biden never disavowed Trump’s 2017 Memorandum. As a result, actions adverse to Cuba carried out under its authority remain in force.

Reaction

In discussion on July 2 with Randy Alonso Falcón, host of Cuban TV’s “Round Table” (Mesa Rotunda), Cuban Vice Foreign Minister Carlos Fernández de Cossío portrayed the recent Memorandum as a “political platform, a political document that is propagandistic, but also one that is a political declaration of U.S. intentions serving as a cover for actions it will take and others already in effect.” 

As examples of the latter, he cited both sanctions applied to ships of third countries bringing fuel to Cuba and denial of access to the U.S. Visa Waiver program to those otherwise eligible citizens of 40 named countries who have visited Cuba. Now, potential travelers to Cuba often choose not to visit Cuba so as to preserve their eligibility.  The intended result has been damage to Cuba’s tourism industry.

Cossio claimed that U.S. measures prompted by the recent Memorandum pose extra danger from “the hand of [Secretary of State] Marco Rubio … [and] of that clique that has made money and political careers out of hostility towards Cuba.” He laments harassment against individuals and businesses licensed to export goods to Cuba’s private sector, suggesting that the U.S. government seeks to harm Cuba’s private sector.  He worries that some Cuban-Americans visiting in Cuba may be barred from returning to the United States.  

The foreign ministry official pointed to a big change. Cubans have been “receiving privileged treatment on crossing the US border.” They are now vulnerable to “all [U.S.] anti-migrant actions including the alligator prison in Florida.”

International criticism of the recent Trump Memorandum erupted promptly and from many quarters, beginning in Cuba. Cuban president Miguel Díaz-Canel condemned the U.S. “purpose of inflicting the greatest possible damage and suffering.” National Assembly President Esteban Lazo, predicted their “vile purpose will fail in the face of Cubans’ unity and determination. “Cuba will defeat this new aggression,” pronounced Prime Minister Manuel Marrero Cruz.

The Bolivarian Alliance for the Peoples of Our America (ALBA) judged the Memorandum to be “aimed at forcefully hitting at all sectors of Cuban society.” Argentina’s International Committee for Peace, Justice, and Dignity for the Peoples declared its support for U.S. opponents of the Memorandum. Brazil’s Landless Workers Movement (MST) on July 3 initiated an international fundraising campaign to send essential medicines to Cuba. 

Mexican President Claudia Scheinbaum on July 2 denounced the Memorandum, while declaring that “Mexico is the country that for decades voted against the blockade of Cuba and that will always be our position.” Mao Ning, spokesperson for China’s Ministry of Foreign Affairs on July 2 stated that, “We exhort the USA to immediately raise the blockade and sanctions against Cuba, and eliminate the U.S. list of state sponsors of terrorism.” 

The most explosive and revealing reaction came from Rosa Miriam Elizalde, editor of Cubadebate.cu. She was echoing Vice Minister Cossio’s observation that “Perhaps U.S. officials imbued with this euphoria over a new U.S. foreign policy of imposing peace through force are demanding something similar with Cuba.”

Writing for Mexico’s La Jornada news service on July 5, Elizalde points to “[D]éjà vu: More than 20 years after the United States invaded Iraq under false pretexts, we are witnessing the same warmongering operetta in South Florida … During the spring of 2003, while the missiles were falling on Baghdad, the ultra-sector of Cuban emigration took to the streets of Miami with a disturbing slogan: ‘Iraq now; Cuba later’”. 

She notes that, “[T]he Miami propaganda machine is once again waving the flag of armed intervention [in Cuba], while the U.S. and Israel are escalating their military offensive in Iran.” She highlights Congresswoman María Elvira Salazar’s remark that, “This is how tyrants are confronted, not only in Iran, but also satraps in Cuba, Venezuela and Nicaragua. Peace through force. That’s the American way.” 

Elizalde regards as ominous that “Trump invokes as an American military success the sad memory of the Hiroshima and Nagasaki bombs.” She describes a volatile situation in which “[i]mmigrants are hunted down like beasts, just like communists and Jews before World War II.” 

She views the current political climate as recalling that of 2003, when the United States invaded Iraq: “The logic is the same: misinform, isolate, demonize, justify sanctions and, if conditions are right, authorize intervention in the “dark places of the planet.”

W.T. Whitney Jr. is a retired pediatrician and political journalist living in Maine

Cuban Boom

Cuba booms thanks to Canada.

Speaking Friday at a congress of leftist economists, Rodriguez said Cuba had transformed its economy since the collapse of the Soviet Union, once its chief supporter and trade partner.

An economy whose exports were 90 percent goods and only 10 percent services in 1989 now leans toward services, he said. Services now account for 76 percent of Cuba’s overall economy while primary goods, such as crops, amount to only 4 percent.

Rodriguez said growth in Cuba’s GDP "should reach more than 10 percent this 2007" despite high prices for imported food and fuel. Cuba has been aided by steadily rising domestic oil production as well as by significant fuel aid from Venezuela.

He said that if social services and commerce were dropped from the count, Cuba still would have shown 9.5 percent growth last year.

Cuba was aided last year by high prices for nickel and cobalt and by a continuing flow of tourists.

Rodriguez put the number of tourists for 2006 at 2.22 million – a slight drop from the 2.3 million Cuba reported for 2005 to the Caribbean Tourism Organization.

And it is far safer as a tourist resort than Mexico.

Air Canada launches seasonal Cuba link

Cuba ranks among Canadians' top three holiday destinations, Smith noted, adding that Air Canada flies to the Caribbean island 27 times per week.

And Canada's economic and political relationship with Cuba not only includes the tourist industry, but Sherritt and its unique bilateral trade agreement with Cuba for production of coal, oil, nickel and cobalt. Despite American attempts to apply their laws against Sherritt and other Canadian companies doing business in Cuba.

The U.S. government also appears to be stepping up its enforcement of the best known of its extra-territorial measures - laws enforcing its 45-year-old Cuban embargo.

One law prevents foreign subsidiaries of U.S. companies from having virtually any dealings with or in Cuba, while another allows U.S. entry to be refused to executives and directors of any company found to be "trafficking" assets confiscated by Cuba after the 1959 revolution.

Under the latter legislation, executives and directors of the Toronto resource company Sherritt International have been barred from the U.S. because the company has interests in a nickel mine and oil-and-gas ventures in Cuba.

And thankfully Canada continues to exert its sovereignty when dealing with Cuba.

Canada's silence on Washington's Cuba policy speaks volumes

Canadians continue to visit Cuba by the millions each year. Canadian businesses pursue mining, tourism and other interests on the island. And the Canadian government maintains normal diplomatic relations with Havana, normal being the operative word, says longtime Cuba observer John Kirk.

Both Kirk and Ritter, who visit the island regularly, emphasize that nothing is likely to shift in Cuba for many years, with or without Castro. They note that Cuba's economy has been getting progressively stronger over the past decade, with higher nickel prices, cheap oil from Venezuelan ally Hugo Chavez and more tourists - all developments that point away from civil unrest in the country.

That cheap oil from Chavez is payment for one of the service industry exchanges that Cuba is exporting; Docs-for-oil trade shows Cuba's flair

The OAS is now looking at its position on Cuba, and Canada as a member of the OAS is in the position of offsetting the United States, which opposes any rapprochement with Cuba.

And thanks to Canada you have a further extension of civil liberties in Cuba

US-based Episcopal Church names woman bishop in Cuba

Cuba was a diocese of the U.S. church until 1967, when it was forced to break away because hostility between the U.S. and Cuban governments made contacts difficult. Cuba's communist leaders were embracing official atheism at the time, a stance abandoned in the early 1990s.

It has operated under a Metropolitan Council now chaired by the archbishop of Canada, Andrew Hutchison. It also includes Jefferts Schori and the archbishop of the West Indies.

And Cuba's export Rum; Havana Club is number two in world sales, which included Canada and Europe but not the United States. Their loss.

I particularly like the Havana Club seven year old amber, which is has a smoky chocolate flavour and is so smooth you can drink straight or on the rocks, no mix. It is like a fine brandy or cognac.

The number one brand is Bacardi which continues to use its wealth to fund anti-Cuban Terrorists in Florida.

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cuba, castro, trade, Canada, tourism, rum, Sherritt, economy,

 Cuba Sends Doctors, the US Sends Sanctions

The United States calls Cuba’s medical internationalism "human trafficking" — but it’s really an internationalist lifeline for the Global South.

By Helen Yaffe

March 12, 2025

Source: Jacobin


May Day marchers in Havana, Cuba. (Credit: CSC)

On February 25, US secretary of state Marco Rubio announced restrictions on visas for both government officials in Cuba and any others worldwide who are “complicit” with the island nation’s overseas medical-assistance programs. A US State Department statement clarified that the sanction extends to “current and former” officials and the “immediate family of such persons.” This action, the seventh measure targeting Cuba in one month, has international consequences; for decades tens of thousands of Cuban medical professionals have been posted in around sixty countries, far more than the World Health Organization’s (WHO) workforce, mostly working in under- or unserved populations in the Global South. By threatening to withhold visas from foreign officials, the US government means to sabotage these Cuban medical missions overseas. If it works, millions will suffer.

Rubio built his career around taking a hard line on Cuban socialism, even alleging that his parents fled Fidel Castro’s Cuba until the Washington Post revealed that they migrated to Miami in 1956 during the Fulgencio Batista dictatorship. As Trump’s secretary of state, Rubio is in prime position to ramp up the belligerent US-Cuba policy first laid out in April 1960 by deputy assistant secretary of state Lester Mallory: to use economic warfare against revolutionary Cuba to bring about “hunger, desperation and overthrow of government.”

Cuba stands accused by the US government of human trafficking, even equating overseas Cuban medical personnel to slaves. Rubio’s tweet parroted this pretext. The real objective is to undermine both Cuba’s international prestige and the revenue it receives from exporting medical services. Since 2004, earnings from Cuban medical and professional services exports have been the island’s greatest source of income. Cuba’s ability to conduct “normal” international trade is currently obstructed by the long US blockade, but the socialist state has succeeded in converting its investments in education and health care into national earnings, while also maintaining free medical assistance to the Global South based on its internationalist principles.
Cuban Medical Internationalism: A Core Feature of Cuban Foreign Policy

The four approaches of Cuban medical internationalism were initiated early in the 1960s, all despite the post-1959 departure of half of the physicians in Cuba.Emergency response medical brigades. In May 1960, Chile was struck by the most powerful earthquake on record, with thousands killed. The new Cuban government sent an emergency medical brigade with six rural field hospitals. This established a modus operandi under which Cuban medics mobilize rapid responses to “disaster and disease” emergencies throughout the Global South — since 2005 these brigades have been organized under the name “Henry Reeve International Contingents.” By 2017, when the WHO praised the Henry Reeve brigades with a public health prize, they had helped 3.5 million people in twenty-one countries. The best-known examples include brigades in West Africa to combat Ebola in 2014 and in response to the COVID-19 pandemic in 2020. Within one year, Henry Reeve brigades treated 1.26 million coronavirus patients in forty countries, including in Western Europe.
Establishment of public health care apparatuses abroad. Starting in 1963, Cuban medics helped establish a public health care system in newly independent Algeria. By the 1970s, they had set up and staffed Comprehensive Health Programs all throughout Africa. By 2014, 76,000 Cuban medical personnel had worked in thirty-nine African countries. In 1998, a Cuban cooperation agreement with Haiti committed to send 300 to 500 Cuban medical professionals there all while training Haitian doctors back in Cuba. By December 2021, more than 6,000 Cubans medical professionals had saved 429,000 lives in the poorest country in the western hemisphere, conducting 36 million consultations. And for two decades now, Cuba has maintained over 20,000 medics in Venezuela, peaking at 29,000. In 2013, the Pan American Health Organization contracted 11,400 Cuban doctors to work in under- and unserved regions of Brazil. By 2015, Cuban Integral Healthcare Programs were operating in forty-three countries.
Treating foreign patients in Cuba. In 1961, children and wounded fighters from Algeria’s war for independence from France went to Cuba for treatment. Thousands followed from around the world. Two programs were developed to treat foreign patients en masse: The first is the “Children of Chernobyl” program which began in 1990 and lasted for twenty-one years, during which 26,000 people affected by the Chernobyl nuclear disaster received free medical treatment and rehabilitation on the island — nearly 22,000 of them children. The Cubans covered the cost, despite the program coinciding with Cuba’s severe economic crisis, known as the Special Period, following the collapse of the socialist bloc. The second program to treat foreign patients en masse was Operation Miracle, set up in 2004 for Venezuelans with reversible blindness to get free eye operations in Cuba to restore their sight. It subsequently expanded regionally. By 2017, Cuba was running sixty-nine ophthalmology clinics in fifteen countries under Operation Miracle, and by early 2019 over four million people in thirty-four countries had benefited.
Medical training for foreigners, both in Cuba and overseas. It’s important to note that the Cuban state never sought to foster dependence. In the 1960s, it began training foreigners in their own countries when suitable facilities were available, or in Cuba when they were not. By 2016, 73,848 foreign students from eighty-five countries had graduated in Cuba while that nation was running twelve medical schools overseas, mostly in Africa, where over 54,000 students were enrolled. In 1999, the Latin American School of Medicine (ELAM), the world’s largest medical school, was established in Havana. By 2019, ELAM had graduated 29,000 doctors from 105 countries (including the United States) representing 100 ethnic groups. Half were women, and 75 percent from worker or campesino families.
The Monetary Cost of Cuba’s Contribution

Since 1960, some 600,000 Cuban medical professionals have provided free health care in over 180 countries. The government of Cuba has assumed the lion’s share of the cost of its medical internationalism, a huge contribution to the Global South, particularly given the impact of the US blockade and Cuba’s own development challenges. “Some will wonder how it is possible that a small country with few resources can carry out a task of this magnitude in fields as decisive as education and health,” noted Fidel Castro in 2008. He did not, though, provide the answer. Indeed, Cuba has said little about the cost of these programs.

However, Guatemalan researcher Henry Morales has reformulated Cuba’s international solidarity as “official development assistance” (ODA), using average international market rates and adopting the Organisation for Economic Co-operation and Development (OECD) methodology, to calculate the scale of their contribution to global development and facilitate comparison with other donors. According to Morales, the monetary value of medical and technical professional services, Cuba’s ODA, was over $71.5 billion just between 1999 and 2015, equivalent to $4.87 billion annually. This means that Cuba dedicated 6.6 percent of its GDP annually to ODA, the world’s highest ratio. In comparison, the European average was 0.39 percent of GDP, and the United States contributed just 0.17 percent. Since the US blockade cost Cuba between $4 and $5 billion annually in this period, without this burden the island could potentially have doubled its ODA contribution.

These costs exclude Cuban state investments in education and medical training and infrastructure on the island. There are also considerable losses to Cuba from either charging recipients below international market rates or, in many cases, simply not charging them at all.
Medical Services as Exports

During “the Special Period” in the 1990s, Cuba introduced reciprocal agreements to share the costs with recipient countries that could afford it. Starting in 2004, with the famous “oil-for-doctors” program with Venezuela, the export of medical professionals became Cuba’s main source of revenue. This income is then reinvested into medical provision on the island. However, Cuba continues to provide medical assistance free of charge to countries who need it. Today there are different cooperation contracts, from Cuba covering the full costs (donations and free technical services) to reciprocity agreements (costs shared with the host country) to “triangulated collaboration” (third-party partnerships) and commercial agreements. The new measure announced by Rubio will impact them all.

In 2017, Cuban medics were operating in sixty-two countries; in twenty-seven of those (44 percent) the host government paid nothing, while the remaining thirty-five paid or shared the costs according to a sliding scale. Where the host government pays all costs, it does so at a lower rate than that charged internationally. Differential payments are used to balance Cuba’s books, so services charged to wealthy oil states (Qatar, for example) help subsidize medical assistance to poorer countries. Payment for medical service exports goes to the Cuban government, which passes a small proportion on to the medics themselves. This is usually in addition to their Cuban salaries.

In 2018, the first year Cuba’s Office of National Statistics published separate data, “health services exports” earned $6.4 billion. Revenues have since declined, however, as US efforts to sabotage Cuban medical internationalism have succeeded, for example in Brazil, reducing the island’s income by billions.
US Criminalization of Cuban Medical Internationalism

Already in 2006, the George W. Bush administration launched its Medical Parole Program to induce Cuban medics to abandon missions in return for US citizenship. Barack Obama maintained the program until his final days in office in January 2017. By 2019, Trump renewed the attack, adding Cuba to its Tier 3 list of countries failing to combat “human trafficking” on the basis of its medical internationalism. The US Agency for International Development (USAID) even launched a project to discredit and sabotage Cuban health care programs. In 2024, the US House Committee on Appropriations bill included exposing the “trafficking of doctors from Cuba,” withdrawing aid from “countries participating in this form of modern slavery,” and prohibiting funds to Cuban laboratories. Meanwhile it allocated $30 million for “democracy programs” for Cuba, a misnomer for the regime change that Mallory strategized in 1960.

The service contracts that Cuban medics sign before going abroad are, in fact, voluntary; they receive their regular Cuban salary, plus remuneration from the host country. The volunteers are guaranteed holidays and contact with families. Whatever their motivations to participate, Cuba’s medical professionals make huge personal sacrifices to volunteer overseas, leaving behind families and homes, their culture and communities, to work in challenging and often risky conditions for months or even years. Interviewed for our documentary, Cuba & COVID-19: Public Health, Science and Solidarity, Dr Jesús Ruiz Alemán explained how a sense of moral obligation led him to volunteer for the Henry Reeve Contingent. He went on his first mission to Guatemala in 2005, West Africa for Ebola in 2014, and to Italy in 2020 when it was the epicenter of the COVID-19 pandemic. “I have never felt like a slave, never,” he insisted. “The campaign against the brigades seems to be a way to justify the blockade and measures against Cuba, to damage a source of income for Cuba.”

In the same documentary, Johana Tablada, deputy director for the United States at Cuba’s Ministry of Foreign Affairs, condemned the “weaponization and criminalization” of Cuban medical internationalism that has “wreaked havoc,” particularly in countries pressured to end their partnerships with Cuba shortly before the COVID-19 pandemic, such as Brazil and Bolivia. “The reason that the US calls it slavery or human trafficking has nothing to do with the international felony of human trafficking.” This is cover, she says, for a policy of sabotage that is “impossible to hold up to public scrutiny.” The United States cannot tell people in developing countries to give up medical services provided by Cuban medical brigades “just because it doesn’t match their policy to have international recognition and admiration [for Cuba].” The US is certainly not offering to replace Cuban doctors with its own.
The Threat of a Good Example

The predominant global approach, exemplified by the United States, is to regard health care as an expensive resource or commodity to be rationed through the market mechanism. Medical students “invest” in their education, paying high tuition fees and graduating with huge debts. They then seek well-paid jobs to repay those debts and pursue a privileged standard of living. To ensure medics are well remunerated, demand must be kept above supply. The World Economic Forum projects a shortfall of ten million health care workers worldwide by 2030. But the Cuban investment in medical education raises the supply of professionals globally, thus threatening the status of physicians operating under a market system. Critically, the Cuban approach removes financial, class, race, gender, religious, and any other barriers to joining the medical profession.

The key features of the Cuban approach are: the commitment to health care as a human right; the decisive role of state planning and investment to provide a universal public health care system with the absence of a parallel private sector; the speed with which health care provision was improved (by the 1980s Cuba had the health profile of a highly developed country); the focus on prevention over cure; and the system of community-based primary care. By these means, socialist Cuba has achieved comparable health outcomes to developed countries but with lower per capita spending — less than one-tenth the per capita spending in the United States and one-quarter in the UK. By 2005, Cuba had achieved the highest ratio of doctors per capita in the world: 1 to 167. By 2018, it had three times the density of doctors in the US and the UK.

Today Cuba is in the midst of a severe economic crisis, largely resulting from US sanctions. The public health care system is under unprecedented strain, with shortages of resources and of personnel following massive emigration since 2021. Nonetheless, the government continues to dedicate a high proportion of GDP on health care (nearly 14 percent in 2023), maintaining free universal medical provision, and currently has 24,180 medical professionals in fifty-six countries.

Revolutionary Cuba was never solely concerned with meeting its own needs. According to Morales’s data, between 1999–2015 alone, overseas Cuban medical professionals saved 6 million lives, carried out 1.39 billion medical consultations and 10 million surgical operations, and attended 2.67 million births, while 73,848 foreign students graduated as professionals in Cuba, many of them medics. Add to that the beneficiaries between 1960 and 1998, and those since 2016, and the numbers climb steeply.

The beneficiary nations have been the poorest and least influential globally; few have governments with any leverage on the world stage. Recipient populations are often the most disadvantaged and marginalized within those countries. If Cuban medics leave, they will have no alternative provision. If Rubio and Trump are successful, it is not just Cubans who will suffer. It will also be the global beneficiaries whose lives are being saved and improved by Cuban medical internationalism right now.

The Healthcare System in Cuba

How a Tiny Island Defies U.S. Sanctions to Lead in Healthcare

by Renée L. Quarterman / March 13th, 2025

In the heart of the Cuban capital, the Dr. Cosme Ordoñez Carceller Teaching Polyclinic stands as a testament to the nation’s unique approach to healthcare: universal, free of charge, accessible, regionalized, community-centered, and deeply rooted in preventive medicine. Unlike the profit-driven models that dominate much of the world, Cuba’s system prioritizes equitable access, public health education, and early intervention.

At the core of this approach is a commitment to health promotion through education, disease prevention through habit management, and the integration of medical care and rehabilitation. By emphasizing proactive healthcare rather than reactive treatment, the system ensures that communities receive continuous, comprehensive support to maintain overall well-being.

During a recent visit to the Dr. Cosme Ordoñez Carceller Teaching Polyclinic in Havana, the staff detailed how the system was developed and how it ensures that no Cuban, regardless of income, is left without medical care.

The Structure of Cuba’s Healthcare System

Cuba’s National Health System operates as a hierarchical, state-run model designed to ensure seamless coordination of care. At the top, the National Assembly oversees the Ministry of Public Health, which sets national policies and directs specialized health institutes that tackle broader public health concerns.

Below the Ministry, provincial governments, answering directly to the Assembly, oversee provincial health departments, which manage larger hospitals and specialized medical facilities. These provincial bodies, in turn, delegate responsibilities to municipal governments, which run the municipal health departments and smaller hospitals that serve local populations. At the community level, municipal health departments manage Cuba’s extensive polyclinic network, the cornerstone of the country’s healthcare system. These polyclinics not only provide specialized care, diagnostics, and emergency services, but they also coordinate closely with family doctor-and-nurse teams, who serve as the first point of contact for Cuban citizens.

These frontline providers play a crucial role beyond immediate treatment, emphasizing preventive care, home visits, and alternative therapies such as nutrition counseling, acupuncture, and plant-based medicine. Despite supply shortages exacerbated by U.S. sanctions, this integrated, top-down approach ensures that resources are distributed efficiently, maintaining consistent healthcare access nationwide.

Founded in 1974, the Dr. Ordoñez Carceller, Polyclinic serves approximately 13,000 residents, offering care in medical specialties such as cardiology, orthopedics, fertility consultations, and genetic testing. The clinic is named after Dr. Cosme Ordoñez Carceller (1927–2019), an epidemiologist and pioneer of Community Medicine, who championed the polyclinic model that emerged in the 1960s and 1970s. He played a key role in training young physicians in comprehensive general medicine and launched innovative programs like the Grandparents’ Circles, a senior care initiative so effective that it was replicated nationwide.

Unlike the profit-driven models that dominate much of the world, Cuba’s system prioritizes equitable access, public health education, and early intervention. The country’s healthcare approach is rooted in promoting health through education, preventing disease by managing habits, and ensuring comprehensive medical care and rehabilitation. Unlike the fragmented, for-profit U.S. healthcare model, Cuba’s integrated, community-based approach ensures better health outcomes and higher patient satisfaction. At polyclinics like Ordoñez Carceller, primary care is not just about treating illness but about education, prevention, and holistic well-being. This commitment to accessible, people-centered medicine reflects Cuba’s broader philosophy: that healthcare is not a privilege, but a fundamental human right.

Cuba’s Healthcare Achievements: A Global Leader in Public Health

Despite enduring over six decades of economic embargo, Cuba has achieved remarkable public health milestones. The following list highlights key accomplishments of both the Ordoñez Carceller Polyclinic and the Cuban healthcare system as a whole:

• AIDS: Cuba identified HIV in 1983 and quickly set up a system to track and treat it. By 2014, it eliminated mother-to-child transmission of HIV and syphilis, a milestone the U.S. has yet to reach.

• COVID: Cuba developed two COVID vaccines, kept infections low, and even sent vaccines abroad.

• Diabetes: The nation has developed an effective medication that treats diabetic ulcers (skin wounds that result from poor blood sugar control)

• Alzheimer’s Research: Cuba developed a drug that may help reverse Alzheimer’s effects.

• Maternal-fetal medicine: 99% of Cuban children are vaccinated, and the country has a lower infant mortality rate than the U.S.

• Nutrition: While obesity is not an issue in Cuba, malnutrition is an increasing concern due to shortages caused by the U.S. embargo

• Home health Doctors make house calls to care for the elderly and new mothers.

Profit vs. Public Health: How Medical Education and Healthcare Delivery Differ in Cuba and the U.S.

The paths to becoming a doctor in Cuba and the United States could not be more different. In the U.S., medical students take on crippling debt, often exceeding $200,000, before ever treating a patient. The pressure to repay loans steers many toward high-paying specialties, leaving primary care and rural communities underserved. The system is structured around financial incentives rather than public need, reinforcing the idea that medicine is a business first, a service second.

Cuba takes the opposite approach. Medical education is fully state-funded, allowing students to focus on patient care instead of profit. Training begins immediately after secondary school, with students placed in community clinics early in their careers. By the time they specialize, they have already served in primary care settings, ensuring that the system produces physicians committed to public health, not private wealth.

A Focus on Prevention, Not Just Treatment

Cuba’s prevention-first model stands in stark contrast to the reactive nature of U.S. healthcare. While American medicine often prioritizes treatment over lifestyle interventions, Cuban doctors routinely incorporate nutrition, exercise, and disease prevention strategies into care plans. The country’s polyclinic system ensures patients receive consistent, community-based healthcare rather than navigating a fragmented, for-profit system that often leaves them behind.

The U.S. Blockade: An Unjust Barrier to Health

The U.S. embargo continues to hinder Cuba’s healthcare system by restricting access to essential medicines, medical equipment, and scientific research. Pharmaceutical and shipping companies, fearing U.S. penalties, avoid business with Cuba—leading to severe shortages of everything from aspirin to cancer treatments.

Even medical journals and online resources are blocked due to U.S. restrictions, forcing Cuban researchers to work under constraints that most Western physicians never encounter.

Yet, rather than succumbing to these barriers, Cuba has turned to self-sufficiency, investing in biotechnology, vaccine development, and herbal medicine research to compensate for limited imports. If freed from economic sanctions, Cuba’s contributions to global healthcare innovation could expand exponentially.

For decades, Cuba has exported medical expertise worldwide, sending doctors to disaster-stricken and underserved regions. These global medical brigades have provided care to millions, particularly in Latin America, Africa, and the Caribbean. Yet, rather than supporting these humanitarian efforts, Washington has sought to dismantle them. In February 2025, the U.S. expanded sanctions on Cuba’s international medical program, further restricting its ability to send doctors abroad. The move reflects a deeper failure to understand Cuba’s model of solidarity-driven healthcare, a stark contrast to the U.S. system, where medicine is often dictated by profit rather than public service.

It is within this profit-driven framework that Cuba’s medical missions are misunderstood, labeled as “forced labor” by those who cannot imagine doctors choosing service over salary. The very idea of healthcare as a human right, rather than a commodity, challenges the U.S. worldview, leading to efforts to discredit and sanction those who practice it differently.

What Could Be if the Embargo Were Lifted

Cuba’s healthcare system is a model of resilience and innovation, but its full potential remains hindered by decades of U.S. sanctions. If given access to global resources and technology, Cuban researchers could expand medical advancements in infectious diseases, chronic illness treatment, and disaster response. For now, Cuban doctors continue their work—undaunted by external pressures, committed to the principle that healthcare is a right, not a privilege.

Renée L. Quarterman, MD, FACS, is a surgical breast specialist. She is the director of Delaware Breast Care, a part of US Oncology. Read other articles by Renée.