On July 28, 2019, U.S. Secretary of State Michael Pompeo announced that the U.S. would no longer issue visas to Cuban officials who were directing that country’s medical mission program. Here is the text of that announcement:
- “The Cuban government engages in exploitative and coercive labor practices while it earns money on the backs of its citizens through its overseas medical missions program. To address this labor abuse, the Department has imposed visa restrictions on certain Cuban officials and other individuals responsible for these coercive labor practices under the Immigration and Nationality Act Section 212(a)(3)(C). These practices include working long hours, housing in unsafe areas, and compelling Cuban medical professionals to advance the regime’s political agenda. Such visa restrictions could include immediate family members of these individuals.”
Response to U.S. Action
Previous posts have discussed Cuba’s foreign medical mission program and the invalidity of U.S. allegations that the program engages in illegal forced labor. Here the main reasons for that invalidity:
First, “Internationalist medical aid has been a longstanding part of the Cuban people’s tradition of solidarity, since the beginning of the Revolution. As early as 1960 a brigade was sent to Chile following an earthquake there, and to Algeria in 1963, to support the new country recently liberated from colonialism.” At least four Cuban doctors who have participated in such missions have recorded how they treasure the positive impact of those experiences on their professional and personal lives.
Second, the accusation of forced labor for such participants has been rejected in a detailed study by Indiana State University’s Emeritus Professor of International Politics and Latin America, Dr. H. Michael Erisman. He says, although there may be “some cases where . . . [Cuban medical professionals] are pressured into accepting overseas assignments, . . . most evidence indicates that the overwhelming majority are motivated by philosophical and/or pragmatic considerations. In the first instance, one needs to understand that the Cuban medical profession . . . is permeated by norms which stress self-sacrifice and service to the community, both at home and abroad. At the core of this ethos is the principle, which is firmly entrenched in the curriculum of the island’s medical schools and reinforced throughout one’s career, that health care should not be seen as a business driven by a profit motive, but rather as a human right that medical personnel have an unconditional duty to protect. Such convictions often underlie participation in the medical aid brigades. There are, however, also some pragmatic factors that can come into play. Overseas service could . . . help to further one’s professional aspirations and for some assignments the total remuneration involved is more generous than what is available back in Cuba. . . . [T]hese are the considerations which apply to the vast majority of people” in such programs, not involuntary servitude.
Third, relevant to this issue is the fact that medical education in Cuba (at the Latin American School of Medicine) is free. As a result requiring medical graduates to pay the country back by such participation seems entirely appropriate and may indeed be a contractual or quasi-contractual obligation. The recent $67 monthly salary for Cuban physicians in Cuba compared with the $24 or $27 monthly income of other Cubans is a result of Cuba’s adoption of a “pyramid” compensation system whereby highly trained workers like physicians earn more than lower-skilled workers like busboys. This system, however, is being undermined by lower-skilled workers like gas-station attendants and waiters earning additional income from stealing and illegally selling gasoline and from earning tips in hard currency at restaurants and hotels serving foreign tourists. Indeed, Raúl Castro in his speech at the April 2016 Congress of the Communist Party of Cuba called this the “inverted pyramid” problem that had to be solved.
Fourth, international law does not support this allegation.
Most pertinent is the Forced Labour Convention, 1930, which Cuba and 177 other state members of the International Labour Organization have ratified (as of 2016). The U.S., however, has not so ratified, yet another reason why the U.S. charge is inapt.
This treaty’s Article 2(1) preliminarily defines “forced or compulsory labour” as “all work or service which is exacted from any person under the menace of any penalty and for which the said person has not offered himself voluntarily,” But there are five exceptions to this definition set forth in the treaty’s Article 2(2). One such exception, in subsection (b), states ”the term forced or compulsory labour shall not include . . . any work or service which forms part of the normal civic obligations of the citizens of a fully self-governing country.” (Emphases added.)
Cuba clearly is a “fully self-governing country” and the participants in the foreign medical missions are Cuban “citizens,” and as previously stated, such participation is regarded as “part of the normal civic obligations” of such citizens with the appropriate medical qualifications. Thus, under the most relevant statement of international law, Cuba has not engaged in illegal forced labor with respect to the foreign medical missions.
Fifth, there has not been any fair adjudicative process that has determined that such illegal coercion exists.
 U.S. State Dep’t, Press Statement: Visa Actions Against Cuban Officials (July 28, 2019); NBC News-Miami, US Restricts Visas for Cubans Involved in Overseas Medicine (July 28, 2019).
 See U.S. State Department Unjustly Continues to Allege That Cuba’s Foreign Medical Missions Engage in Forced Labor (Aug. 17, 2017) See also the list of posts in the “Cuban Medical Personnel & U.S” in List of Posts to dwkcommentaries—Topical: Cuba.
 Ledn, Cuban doctors share their experiences in internationalist missions,Granma (Nov. 26, 2015).
 Erisman, Brain Drain Politics: the Cuban Medical Professional Parole Programme, Int’l J. Cuban Studies 269, 286-87 (2012).
 This and other parts of the definition of “forced or compulsory labour” were reaffirmed in Article 1(3) of the Protocol of 2014 to the Forced Labour Convention, 1930.
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