On August 30, the U.S. Secretary of State submitted a report to Congress about the Cuba Accountability Review Board’s (ARB) investigation and report regarding the State Department’s responses to medical problems of some U.S. diplomats in Cuba. 
The ARB’s 30 recommendations, all of which were accepted by the Department were grouped into the following six areas:
- “Accountability: The ARB found the lack of a single designated senior-level Department official with responsibility for responding to the attacks resulted in insufficient communications with employees and impeded coordination within the Department and with other agencies. The ARB recommended elevating the overall responsibility for the Cuba response to the Deputy Secretary of State. In May, the Deputy Secretary – at the Secretary’s request – established the interagency Health Incidents Response Task Force to direct a multi-agency response to the unexplained health incidents that have affected U.S. government personnel and family members stationed overseas. The Department has committed to reviewing – and revising when necessary – procedures for ensuring continued senior-level leadership at all times, as well as validating and strengthening guidance for Chiefs of Mission (including Chargés), emphasizing their responsibility for the safety and security of personnel abroad. The Department is establishing a new position solely responsible for longer-term outreach and assistance to personnel affected by these incidents.”
- “Interagency Coordination: The ARB found that interagency information sharing should be enhanced to improve understanding of the problem and more coordinated initial responses. The ARB noted the Department’s well-established and successful procedures for dealing with crisis situations and highlighted the benefit of reviewing its processes for communication and coordination with interagency partners, as well as reminding leaders of these processes. The Department agrees with these recommendations and will re-issue guidance outlining the various tools and processes Washington and posts abroad have available to prepare for and respond to crisis situations. The Department will reinforce the importance of proper and timely implementation of these procedures, and is committed to working with interagency partners to ensure coordination of efforts on the response to the incidents.”
- “Medical Issues: The ARB found the Department’s Bureau of Medical Services provided competent and professional response to an unprecedented situation, but they had insufficient resources to support the long-term care and follow-up needed for these types of incidents. To address the ARB’s recommendations, the Department, in coordination with other appropriate U.S. government agencies, is identifying and reviewing applicable legal authorities and resources for long-term medical follow-up and treatment for U.S government personnel and families impacted by the incidents in Cuba, and will seek legislative remedies where necessary. The Department is also working closely with the Department of Labor to allow for the proper adjudication of workers’ compensation claims from Department personnel. Additionally, the ARB recommended the Department make pre-departure and post-assignment medical screening a mandatory condition for assignment to, or temporary duty in, Havana. The Department is in the process of developing policy modifications to make such screenings mandatory. The ARB also recommended the Department engage the Centers for Disease Control and Prevention (CDC) to undertake a comprehensive medical and epidemiologic study of the symptoms and clinical findings related to the incidents in Cuba. The Department is working with the CDC to support such an analysis.”
- “Internal Communication and Information Sharing: The ARB made several recommendations to facilitate communication and information sharing in the case of any future incidents. The Department is implementing the ARB’s recommendations, with the goal of: clarifying responsibilities, providing centralized points of contact to coordinate efforts, establishing clear notification protocols, and ensuring as much transparency as possible to those affected, taking into account the privacy of the individuals involved as well as sensitive law enforcement and national security information.”
- “Risk/Benefit Analysis: The ARB made several recommendations to ensure the Department enacts its already established processes to conduct formal risk/benefit analyses and ensure any actions balance Department priorities with risk management. The Department is implementing these recommendations, and taking steps to enhance broader awareness of these processes throughout the Department. For example, the Department has processes to conduct an analysis at least once annually of mitigation measures and residual risks associated with operating at high threat, high risk posts and at those posts on Authorized or Ordered Departure for 90 days or more due to security reasons. The Department will continue to implement this approach.”
- “Diplomatic Security: The ARB found individual offices within the Bureau of Diplomatic Security (DS) responded to the Cuba incidents reports based on their respective areas of expertise, but that the overall response would have benefitted from the formulation and resourcing of a formal DS multi-disciplinary working group. The Department agreed, and DS formed a Health Incidents Response Working Group with members from all relevant DS offices reporting to the DS Assistant Secretary. This working group has increased communication among the various interagency investigative representatives, and ensured action items are addressed quickly and comprehensively. Additionally, to address future potential unexplained health-security incidents, the Department developed standardized formal guidance, leveraging existing crisis response processes, designed to ensure a consistent response from all agencies at post. All posts are reviewing and updating their emergency action plans to incorporate this guidance. The ARB also suggested the Department review its training programs for security personnel. DS is in the process of reviewing its training and briefing programs to ensure security officers have adequate knowledge of these types of incidents prior to going to post.
The report to Congress stated that the Department already had implemented half of the ARB’s 30 recommendations and is actively working to complete the rest.
“The ARB’s mandate was not to determine the cause of the unexplained health incidents.” (Emphasis added.)
 U.S. State Dep’t, Cuba Accountability Review Board (Aug. 30, 2018). The underlying developments for the ARB are discussed in the “U.S. Diplomats’ Medical Problems in Cuba” section of List of Posts to dwkcommentaries–Topical: CUBA.