Last February, the Twitter account of the Cuban Embassy in China posted a picture showing two Cuban doctors being instructed about the coronavirus (Sars-CoV-2) crisis in China. In the room where the doctors stand, a map of China and a picture of Fidel Castro decorate the walls. The caption explained that Cuban doctors were sent to help fight against the virus and help Cuban citizens in China. The story of the Cuban doctors was further reported in an article by the Communist Cuban Party magazine, Granma, which focused on the collaboration between the Cuban and Chinese authorities to guarantee the security of their respective citizens. Cuba Por La Salud (Cuba for Health): this is what the government called the initiative.
In the past few months, Cuban doctors have been travelling the world to help countries facing the coronavirus pandemic. In March, doctors’ brigades arrived in Nicaragua and Venezuela, along with Cuban medicine. At the same time, the Brazilian Ministry of Health communicated that the government was willing to hire additional doctors and nurses to face the threat of the spreading coronavirus in the country. Among the doctors to be hired, authorities were considering welcoming 1,800 Cubans into the country. In Italy, the leftist newspaper il Manifesto recently published an article in which it reported a statement by a Cuban citizen living in Italy who said to his neighbour: “Don’t worry Roberto, we’ll send our doctors and medicine to help you in Italy in a little while.” And, indeed, it was announced on March 20 that Cuban doctors were flying to the Italian region of Lombardy, the most affected by the crisis.
In this time of such a devastating health crisis, which has imposed border closings and forced countries to focus on their national priorities, it is rather surprising to look at the images of Cuban doctors flying to several countries bringing their expertise and medicine. Yet, Cubans have prepared for this: since the 1960s, these doctors have travelled to other countries amid various health crises to bring their medical support to the most disadvantaged regions, in both the global North and South.
After the Cuban revolution in 1959, universal healthcare became one of the main objectives of Fidel Castro’s government in Havana. In addition, universal free education was introduced to guarantee a well-educated population and, as a result, well-prepared doctors. In 1960, a program was created to support the diffusion of Cuban revolutionary values and practices to countries of the global South, using Cuban health knowledge and skills. It was called Cuban medical internationalism.
In practice, the program started in 1963 in Algeria, where a first brigade of Cuban doctors was sent to initiate the program. At that time, Algeria had just achieved independence from France and Cubans arrived to replace the French doctors who were fleeing back to their country. The support of Cuban doctors started long-lasting relations between the two states and launched the program around the world. After Algeria, Cuban doctors worked in Guinea-Bissau during the liberation struggle against Portugal, as well as in Angola, Chile and Nicaragua in 1972 after a massive earthquake. Cuban medical teams were present during the Gulf War in 1991 and arrived in Kosovo at the time of the Yugoslavian Wars. Today, they still continue to intervene during various health crises, as seen in the current coronavirus pandemic.
Still, the Cuban medical internationalism program is not confined to health crises or wars. Throughout the decades, indeed, Cuban doctors have been able to settle permanently in some of the most isolated regions of the world, where many local doctors are not willing to work. The case of Brazil is notable. Here, Cuban doctors arrived through the programme Mais Médicos (More Doctors) that was launched in 2013 during Dilma Rousseff’s presidency with the objective of attracting doctors in the small and isolated towns of the backcountry, home to many indigenous Brazilians with very low income per capita. At that time, the government hired four thousand Cuban doctors. Half of the personnel was hired through the Mais Médicos programme. As Ligia Bahia, a professor at the Federal University of Rio de Janeiro, said, “The willingness of Cuban doctors to work in difficult conditions became a cornerstone of the public health system.”
The Cuban revolutionary government has always portrayed its medical programme as a demonstration of Cuban solidarity with countries that were willing to accept its support and recognise the values and principles of the Cuban Revolution. Still, behind the more humanitarian objective, Cuban medical internationalism since the 1960s has become something more: it has been a plan for achieving urgent political and economic objectives.
First, as several scholars have argued, Cuban medical internationalism is what would be called a “soft power” strategy that aims at enhancing Cuba’s international profile and disseminating the values and principles of the Cuban Revolution to other countries. Most of the time, the approach has been rather successful. Today, it is reported that Cuba has around 500,000 doctors, spread out over 67 countries. They are called the “Diplomacia branca” (White diplomacy).
An example of this success is the case of Honduras. Here, Cuban medical staff arrived as a response to the devastating Hurricane Mitch of 1998 and had an extremely positive impact in supporting the Honduran national health infrastructure. Since this event, the government in Honduras, which had previously been sceptical of Cuban politics, started to improve its diplomatic relations with Cuba, which were ultimately normalised in 2002, after the two countries had suspended relations back in 1961.
What’s more, the programme has become the biggest source of income for Cuba. Each year, the medical staff abroad brings about $11 billion each year in state revenue. This is impressive if compared to the second most lucrative business in the country, tourism, which generates on average only $3 billion per year. Due to continuous difficulties faced by the national economy since the end of the Soviet Union’s support to the country, the income coming from doctors’ programs around the world is more essential than ever for the country. Last year, despite predictions of the Cuban government, the national GDP increased only by around 0.5%. And the economic performance was equally insufficient in previous years (-0.6% in 2016; +1.6% in 2017; +2.2% in 2018), with less than the minimum 5% annual growth necessary for sustained economic growth.
In recent years, the Cuban economy, in particular, suffered from the election of Donald Trump and his shift in US policy towards Cuba. As soon as he became president, Trump imposed further restrictions on Cuba, with the ban on all flights between the US and Cuba. Today, tourists from the US can arrive in Cuba only by organised cruises during the weekends. Then, they have to come back, leaving Cubans working in hospitality with few other ways to earn their living throughout the rest of the week.
In addition, the Cuban economy has suffered enormously from the Venezuela economic crisis. In 2000, the country signed a pact with the Venezuelan government in which it was agreed that the latter would provide Cuba with oil at reduced prices in exchanges of services (including the transfer of medical staff). Yet, as the Venezuelan economy entered into a stage of deep recession, the government was unable to provide Cuba with the same amount of oil, causing an energy supply shortage and increased consumer prices. Plus, at the same time, Cuban continuous support for Nicolás Maduro’s government during the crisis led to further restrictions from the US, which was opposed to his rule.
Despite the rather stable and secure income generated through the medical staff working abroad, many criticisms have been raised both internally and from other countries regarding the Cuban medical internationalism program. Indeed, stories have been reported that denounced the working conditions of Cuban doctors around the world and their unequal relations to the government.
This is, for example, the case of Brazil. When the Mais Médicos programme was announced, the two governments signed a pact agreeing that the salaries of the Cuban doctors would not be paid directly from Brazil but rather from Cuban authorities. This allowed the Cuban Communist government to retain the majority of the money. During his campaign, Jair Bolsonaro strongly criticised the programme, which he accused of violating the rights and freedoms of the Cuban doctors in Brazil due to their wage reduction that only served the political and economic interests of the governing elite in Havana. Once Bolsonaro was elected, the Cuban government asked all its doctors working in the country to return home.
Similar conflicting stances emerged in other countries, such as Qatar. The Guardian reported that Cuban doctors used to receive as little as 10% of what foreign medical personnel normally earn. The remaining 90% that should be paid to these Cuban doctors, instead, went back to Cuba, where it was received by the national government. In addition, if a doctor decides to abandon the programme, he or she is banned from Cuba for at least eight years, which means not being able to see their families. This is what Annarella O’Mahony, member of the group of Cuban doctors No Somos Desertores (“We are not deserters”) said to the media: “They are using what they love the most to make them think twice before leaving. It’s cruel, it’s inhumane, it’s unconstitutional and against international law.”
Yet, contrasting perspectives exist. One Cuban doctor interviewed in Qatar, for example, stated, “The education in Cuba is free. The government has prepared us for many years and so the government needs to take something for this.” And many people in Cuba are extremely proud of their doctors abroad.
In addition, there is sometimes an economic incentive: working in other countries is still more lucrative than staying home, where doctors earn only around $50 a month. Abroad, they are normally paid $1,000.
The debate over Cuban medical internationalism is, therefore, complicated and multifaceted. After all, it is the debate over the Cuban regime: a state constructed around the most respectable vales and principles of solidarity and humanity, that wants to guarantee the well-being and equality of its citizens, but also a state that has not always been able, in practice, to create a government that respects and supports these values and principles.
However, what remains certain is that Cuban doctors will nevertheless be a precious support for many countries that are facing severe health crises due to the current coronavirus pandemic.