Cuba’s Medical Internationalism

Helen Yaffe

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 programmes. 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 Organisation’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.

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. “
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.

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.

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 strategised in 1960.

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 marginalised 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.

[Helen Yaffe is a senior lecturer at the University of Glasgow. She is the author of We Are Cuba! How a Revolutionary People have Survived in a Post-Soviet World and Che Guevara: The Economics of Revolution]