Cuba Foreign Medical Missions

U.S. State Department Reiterates Criticism of Cuba’s Human Rights

On March 11, the U.S. State Department released its latest annual report on human rights around the world and repeated its criticisms of Cuba on this subject.

Secretary Pompeo’s Introduction of the Report[1]

The Secretary used these words to announce the release of the report: “As our founding documents remind us, nothing is more fundamental to our national identity than our belief in the rights and dignity of every single human being. It’s in our Declaration of Independence.” With the U.S. Declaration of Independence of 1776 as its foundation, “The State Department’s Commission on Unalienable Rights is exploring the deep roots of America’s foundational belief in these ideals, and I look forward to receiving the commission’s work sometime around the Fourth of July of this year, a fitting time.” (Emphasis added.)

The Secretary then shifted to highlighting the report’s discussion of “human rights abuses . . . that are happening in China, Iran, Venezuela, and in Cuba.” His comments on Cuba focused entirely on the situation of Cuban dissident José Daniel Ferrer, which will be covered in a subsequent post.

The Executive Summary of the Report on Cuba[2]

“Cuba is an authoritarian state led by Miguel Diaz-Canel, president of the republic, with former president Raul Castro serving as the first secretary of the Cuban Communist Party (CCP). Despite ratifying a new constitution on February 24, Cuba remains a one-party system in which the constitution states the CCP is the only legal political party and the highest political entity of the state.”

“The Ministry of Interior exercises control over the police, internal security forces, and the prison system. The ministry’s National Revolutionary Police is the primary law enforcement organization. Specialized units of the ministry’s state security branch are responsible for monitoring, infiltrating, and suppressing independent political activity. The national leadership, including members of the military, maintained effective control over the security forces.”

“Significant human rights issues included: reports of abuse of political dissidents, detainees, and prisoners by security forces; harsh and life-threatening prison conditions; arbitrary arrests and detentions; significant problems with the independence of the judiciary; political prisoners; and arbitrary or unlawful interference with privacy. The government severely restricted freedom of the press, used criminal libel laws against persons critical of leadership, and engaged in censorship and site blocking. There were limitations on academic and cultural freedom; restrictions on the right of peaceful assembly; denial of freedom of association, including refusal to recognize independent associations; restrictions on internal and external freedom of movement and severe restrictions of religious freedom. Political participation was restricted to members of the ruling party, and elections were not free and fair. There was official corruption, trafficking in persons, outlawing of independent trade unions, and compulsory labor.”

“On February 24, the country adopted a new constitution in a coerced referendum marred by violent government repression against those that opposed the proposed constitution. On February 12, for example, 200 police and security agents raided the homes of leaders of the Patriotic Union of Cuba (UNPACU) [which is headed by José Daniel Ferrer] for openly campaigning against the draft constitution, detaining and reportedly beating UNPACU members. Other opponents reported that the government had blocked their email and texts to keep them from disseminating opposition campaign materials. Article 5 of the constitution enshrines one-party rule by the CCP, disallowing for additional political expression outside of that structure. Although the new constitution adds explicit protections of freedom and human rights, including habeas corpus, authorities did not respect them, nor did the courts enforce them.”

“Government officials, at the direction of their superiors, committed most human rights abuses and failed to investigate or prosecute those who committed the abuses. Impunity for the perpetrators remained widespread.”

Some Negative Details of the Report

Disappearance (Section 1.B): “There were confirmed reports of long-term disappearances by or on behalf of government authorities. There were multiple reports of detained activists whose whereabouts were unknown for days or weeks because the government did not register these detentions; many detentions occurred in unregistered sites.”

Torture and Other Cruel, Inhumane or Degrading Treatment or Punishment (Section 1.C):

“There were reports that members of the security forces intimidated and physically assaulted human rights and prodemocracy advocates, political dissidents, and other detainees and prisoners during detention and imprisonment, and that they did so with impunity. Some detainees and prisoners also endured physical abuse by prison officials or by other inmates with the acquiescence of guards.”
“There were reports police assaulted detainees or were complicit in public harassment of and physical assaults on peaceful demonstrators.”
“State security officials frequently deployed to countries such as Venezuela and Nicaragua, where they trained and supported other organizations in their use of repressive tactics and human rights abuses, and sometimes participated in them directly.”
“Prison conditions continued to be harsh and life threatening. Prisons were overcrowded, and facilities, sanitation, and medical care were deficient. There were reports that prison officials assaulted prisoners.”
“The government subjected prisoners who criticized the government or engaged in hunger strikes and other forms of protest to extended solitary confinement, assaults, restrictions on family visits, and denial of medical care.”
“The government did not permit monitoring of prison conditions by independent international or domestic human rights groups and did not permit access to detainees by international humanitarian organizations.”

Arbitrary Arrest or Detention (Section 1.D):

“Arbitrary arrests and short-term detentions increased, becoming a routine government method for controlling independent public expression and political activity.”
Authorities “routinely ignored” the requirement to “furnish suspects a signed ‘report of detention,’ noting the basis, date, and location of any detention in a police facility and a registry of personal items seized during a police search.”
“Police used laws against public disorder, contempt, lack of respect, aggression, and failure to pay minimal or arbitrary fines as ways to detain, threaten, and arrest civil society activists. Police officials routinely conducted short-term detentions, at times assaulting detainees.”
“The law allows for ‘preventive detention’ for up to four years of individuals not charged with an actual crime, based on a subjective determination of “precriminal dangerousness,” which is defined as the ‘special proclivity of a person to commit crimes, demonstrated by conduct in manifest contradiction of socialist norms,’ which is sometimes used “to silence peaceful political opponents.”
“There were reports that defendants met with their attorneys for the first time only minutes before their trials and were not informed of the basis for their arrest within the required 168-hour period;” that bail “typically [was] not granted to those arrested for political activities;” that “police and security forces at times relied on aggressive and physically abusive tactics, threats, and harassment during questioning;” that “authorities may detain a person without charge indefinitely;” that officials often detain “suspects longer than the legally mandated period without informing them of the nature of the arrest, allowing them to contact family members, or affording them legal counsel;” that the “government [often] held detainees for months or years in investigative detention, in both political and nonpolitical cases.”

Denial of Fair Public Trial (Section 1.E):

“[P]olitically motivated trials were at times held in secret, with authorities citing exceptions for crimes involving ‘state security’ or ‘extraordinary circumstances.’”
“[C]ourts regularly failed to protect or observe these [due process] rights. The law presumes defendants to be innocent until proven guilty, but authorities often ignored this, placing the burden on defendants to prove innocence.”
“Criteria for admitting evidence were arbitrary and discriminatory.” In cases involving “‘crimes against the security of the state,’ defense attorneys were not allowed access until charges were filed.”
For charges of ‘precriminal dangerousness,’ “the state must show only that the defendant has “proclivity” for crime, so an actual criminal act need not have occurred.”
“The government continued to hold political prisoners and detainees but denied it did so and refused access to its prisons and detention centers by international humanitarian organizations and the United Nations.”
There are “political prisoners,’ but details are difficult to obtain.
“No courts allowed claimants to bring lawsuits seeking remedies for human rights violations.”

Arbitrary or Unlawful Interference with Privacy, Family, Home, or Correspondence (Section 1.E):

“Reportedly government officials routinely and systematically monitored correspondence and communications between citizens, tracked their movements, and entered homes without legal authority and with impunity.”
“Covert techniques to obtain information . . . . included information gathering by undercover officers, voice recording, location monitoring, filming, communications intercepts, and surreptitious access to computer systems.”
“The Ministry of Interior employed a system of informants and neighborhood committees, known as “Committees for the Defense of the Revolution,” to monitor government opponents and report on their activities.”

Freedom of Expression, Including for the Press” (Section 2.A):

“Laws banning criticism of government leaders and distribution of antigovernment propaganda carry penalties ranging from three months to 15 years in prison.”
“The government did not tolerate public criticism of government officials or programs and limited public debate of issues considered politically sensitive.”
“[S]ome religious groups reported increased restrictions to express their opinions during sermons and at religious gatherings.”
“The government directly owned all print and broadcast media outlets and all widely available sources of information.”
“The government harassed and threatened any independent citizen journalists who reported on human rights violations in the country.”
“The law prohibits distribution of printed materials considered ‘counterrevolutionary’ or critical of the government.”
“The government used a combination of website blocking, pressure on website operators, arrests, intimidation, imprisonment, and extralegal surveillance to censor information critical to the regime and to silence its critics.”
“The government restricted academic freedom and controlled the curricula at all schools and universities, emphasizing the importance of reinforcing ‘revolutionary ideology’ and ‘discipline.’”

Freedoms of Peaceful Assembly and Association (Section 2.B):

The constitutional “limited right of assembly . . . is subject to the requirement that it may not be ‘exercised against the existence and objectives of the socialist state.’ The law requires citizens to request authorization for organized meetings of three or more persons.”
“Independent activists, as well as political parties other than the CCP, faced greater obstacles, and state security forces often suppressed attempts to assemble, even for gatherings in private dwellings and in small numbers. The government refused to allow independent demonstrators or public meetings by human rights groups or any others critical of any government activity.”
“The government, using undercover police and Ministry of Interior agents, organized “acts of repudiation” in the form of mobs organized to assault and disperse those who assembled peacefully.”
“The government routinely denied citizens freedom of association and did not recognize independent associations. The law proscribes any political organization not officially recognized. A number of independent organizations, including opposition political parties and professional associations, operated as NGOs without legal recognition, and police sometimes raided their meetings.”
“The government routinely denied citizens freedom of association and did not recognize independent associations. The law proscribes any political organization not officially recognized. A number of independent organizations, including opposition political parties and professional associations, operated as NGOs without legal recognition, and police sometimes raided their meetings.”

Freedom of Movement (Section 2.D):

“There continued to be restrictions on freedom of movement within the country, foreign travel, and migration with the right of return.”
“The government also barred citizens and persons of Cuban descent living abroad from entering the country, apparently on grounds that they were critical of the government or for having “abandoned” postings abroad.”

Protection of Refugees (Section 2.F): “Cuba is not a signatory to the 1951 Refugee Convention [Treaty].”

Freedom to Participate in the Political Process (Section 3):

“[C]itizens do not have the ability to form political parties or choose their government through the right to vote in free and fair elections or run as candidates from political parties other than the CCP. The government forcefully and consistently retaliated against those who sought peaceful political change.”
“The new constitution includes many sections that restrict citizens’ ability to participate fully in political processes by deeming the CCP as the state’s only legal political party and the ‘superior driving force of the society and the state.’”

Corruption and Lack of Transparency in Government (Section 4): The government did not effectively enforce the law against corruption.

Governmental Attitude Regarding International and Nongovernmental Investigation of Alleged Abuses of Human Rights (Section 5):

“The government subjected domestic human rights advocates to intimidation, harassment, periodic short-term detention, and long-term imprisonment on questionable charges.”
“The government refused to recognize or meet with any unauthorized NGOs that monitored or promoted human rights.”
“The government continued to deny international human rights organizations, including the United Nations, its affiliated organizations, and the International Committee of the Red Cross, access to prisoners and detainees.”

Discrimination, Societal Abuses, and Trafficking in Persons (Section 6):

“The government specifically targeted activists organizing a campaign called Women United for Our Rights that asked the state to update data on crimes against women, train officials to handle crimes against women, and define gender-based violence in the law.”
“A large number of persons with disabilities who depended on the state for their basic needs struggled to survive due to lack of resources and inattention.”
“Afro-Cubans often suffered racial discrimination, and some were subject to racial epithets while undergoing beatings at the hands of security agents in response to political activity. Afro-Cubans also reported employment discrimination, particularly in positions of prominence within the tourism industry, media, and government.”
Although Cuba has “a history of state-sanctioned events in support of the LGBTI community,” several “unrecognized NGOs that promote LGBTI human rights faced government harassment, not for their promotion of such topics, but for their independence from official government institutions.”

Freedom of Association and the Right to Collective Bargaining (Section 7.A): “The government continued to prevent the formation of independent trade unions in all sectors. use politically motivated and discriminatory dismissals against those who criticized the government’s economic or political model.”

Prohibition of Forced or Compulsory Labor (Section 7.B): “Many citizens were employed by state-run entities contracted by foreign entities inside the country and abroad to provide labor, often highly skilled labor such as doctors or engineers. These employees received a small fraction of the salaries paid to the state-run company, often less than 10 percent. For example, in the “Mais Medicos” program run in cooperation with the Pan-American Health Organization in Brazil, of $1.3 billion the Brazilian government paid for the services of Cuban doctors, less than 1 percent–only $125 million–was paid to the doctors who provided the services. The rest went into the Cuban government’s coffers. Doctors in the program complained of being overworked and not earning enough to support their families. Former participants described coercion, nonpayment of wages, withholding of their passports, and restriction on their movement, which the government denied. Similar practices occurred in the tourism sector.”

Comments

The U.S.’ repeated allegation that Cuban medical personnel on foreign missions are engaged in illegal forced labor does not make it so. Moreover, there is a strong legal argument against that allegation.[3]

There may well be legitimate Cuban arguments against the other allegations mentioned above, which Cuba would need to assert and prove.

More importantly, the U.S. allegations ignore the long history of U.S. overt and covert hostile actions against the much smaller and militarily weaker island nation, and hence Cuba’s well-founded need to be suspicious of its domestic critics and to take some actions against those critics. This, however, does not provide Cuba with legitimate excuses for all of those actions.

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[1] State Dep’t, Secretary Michael R. Pompeo on the Release of the 2019 Country Reports on Human Rights Practices (Mar. 11, 2020); Jakes, Critics Hear Political Tone as Pompeo Calls Out Diplomatic Rivals Over Human Rights, N.Y. Times (Mar. 11, 2020).

[2] State Dep’t, 2019 Country Reports on Human Rights Practices: Cuba (Mar. 11, 2020).

[3] See, e.g., these posts to dwkcommentaries.com: U.S. Unjustified Campaign To Discredit Cuba’s Foreign Medical Mission Program (Sept. 4, 2019); U.S. Litigation Over Cuba Medical Mission Program (Feb. 12, 2020); Cuba Response to U,S, Campaign Against Cuba’s Medical Missions (Feb. 13, 2020).

U.S. Unjustified Campaign To Discredit Cuba’s Foreign Medical Mission Program

Over the last several years, the U.S. has been waging a campaign seeking to discredit Cuba’s foreign medical mission program. This campaign includes the State Department’s annual reports on human trafficking that have alleged Cuba has been engaged in illegal forced labor of some of its medical professionals in these programs. Another part was the recent decision to deny U.S. visas to Cuban officials directing the medical mission program.[1] The most recent measure has been the U.S. Agency for International Development (USAID’s) soliciting bids to conduct research and analysis of evidence regarding the forced labor allegation. Some Congressmen also have suggested reactivation of a U.S. program providing U.S. parole visas for such medical professionals to be admitted to the U.S.[2] Unsurprisingly Cuba denies these allegations and condemns these U.S. programs. (Emphases added.)

Here we will look at key parts of this trafficking in persons report, the recent USAID solicitation of bids for research and analysis, Cuba’s response to that solicitation and a demonstration why the U.S. allegations are specious.

U.S. 2019 Trafficking in Persons Report [3]

The most recent such report, which was issued on June 20, 2019, said the following, in part:

“In November 2018, Cuban healthcare workers filed a class action in the U.S. District Court Southern District of Florida under the Trafficking Victims Protection and the Racketeering Influenced and Corrupt Organization Acts alleging the Cuban government profited from the export of healthcare professionals; the case remains pending.[4] In Brazil, the Cuban government collected revenue for each professional’s services and paid the worker a fraction of the revenue depositing a large percentage of the worker’s wages in an account in Cuba only accessible upon completion of the mission and return to Cuba. . . . Some participants in foreign medical missions as well as other sources allege Cuban officials force or coerce participation in the program; the government has stated the postings are voluntary, and some participants also have stated the postings are voluntary and well-paid compared to jobs within Cuba. Observers report the government does not inform participants of the terms of their contracts, making them more vulnerable to forced labor. The Cuban government acknowledges that it withholds passports of overseas medical personnel in Venezuela; the government provided identification cards to such personnel. Some Cuban medical personnel claim they work long hours without rest and face substandard working and living conditions in some countries, including a lack of hygienic conditions and privacy. Observers note Cuban authorities coerced some participants to remain in the program, including by withholding their passports, restricting their movement, using “minders” to conduct surveillance of participants outside of work, threatening to revoke their medical licenses, retaliate against their family members in Cuba if participants leave the program, or impose criminal penalties, exile, and family separation if participants do not return to Cuba as directed by government supervisors.” (Emphases added.)

USAID’s Solicitation of Research Bids [5]

On August 12, 2019, the U.S. Agency for International Development (USAID) announced that it was offering up to $3 million to organizations that would “investigate, collect, and analyze information related to human rights violations – including forced labor – of Cuban medical personnel exported overseas.”

USAID purported to justify this effort by alleging, “The Cuban regime exploits its medical professionals, teachers and other workers, using them to buy international financial and political support and keep its struggling economy afloat, while pocketing the majority of these workers’ salaries and subjecting them to poor living conditions, constant surveillance, and threatening those who wish to leave their mission. At the same time, Cubans on the island struggle to find adequate healthcare and other basic services while the regime touts the false narrative that it has the best medical care in the world.” (Emphasis added.)

In addition, USAID said, “the information collected should also document the effects of these practices on Cubans on the island. The data collected would be used for advocacy within Cuba, in Latin America and with regional and international bodies, such as the Inter-American Commission on Human Rights (IACHR) and the United Nations Human Rights Council (UNHRC) in an effort to pressure the Cuban regime to improve the living conditions of doctors and other workers, and promote greater respect for labor and other basic human rights for all Cuban citizens.”

Cuba’s Response[6]

In an August 30 Declaration, the Cuba Foreign Ministry “energetically denounces and condemns the recent aggression of the government of the United States against Cuba via a USAID program designed to fund actions and information searches to discredit and sabotage the international cooperation being provided by Cuba in the health area in dozens of countries for the benefit of millions of persons. This is an endeavor added to the crude pressures exercised against a number of governments in order to obstruct Cuban cooperation and to the earlier efforts for the same purpose such as the special ‘parole’ program designed to steal human resources trained in Cuba.”

“The heart of this immoral calumny consists of alleging, with no factual foundations whatsoever, that Cuba is involved in the traffic of persons or in the practice of slavery, and wishing to degrade the meritorious work that hundreds of thousands of Cuban health professionals and technicians are voluntarily undertaking, and have been undertaking, throughout history, in a number of countries, especially in the Third World.”

This is “an affront to the bilateral and intergovernmental cooperation programs, all lawfully set up between the Cuban Government and the governments of dozens of countries, which have been consistent with the [U.N.] guidelines referring to South–South cooperation and which have responded to the health requirements that those same governments have defined in a sovereign manner.”

“This is an attack against the efforts in solidarity which have received the acknowledgement of the international community and the specific praise from the most senior officials of the United Nations, the World Health Organization and the Pan-American Health Organization.”

“These lies reveal the low morality of the [U.S.] government and its politicians who devoted themselves to the business of aggression against Cuba. The campaign has millions of dollars of funds and the complicity of a number of the mass media giants and, particularly, of unscrupulous reporters who have sacrificed their so-called impartiality and objectivity in the service of the political interests of the [U.S.] government.”

“For decades . . . in those nations having more unfavorable economic conditions, that cooperation has been provided, and is being provided, as a gesture of solidarity; its expenses are covered by Cuba practically in their entirety. Likewise, and following the [U.N.] conceptions on cooperation between developing countries, this is being offered in various nations on the basis of complementarity and partial compensation for services rendered.”

Cuba has provided “self-sacrificing and humanist professionals ready and willing to work of their own free will in the most difficult of conditions, and of the ideas of health coverage that years of successful experience has permitted us to build up.”

“The Cuban technicians and professionals participating in those programs do so in an absolutely free and voluntary manner. While serving their missions, they continue to be paid their entire Cuban salaries and they also receive stipends from the destination countries, along with other forms of compensation.”

“In cases where Cuba receives compensation for the cooperation being provided, those . . . [countries] distinguish themselves by contributing a highly valued, fair and totally lawful amount for the funding, sustainability and development of the massive and free health system that is accessible to each and every Cuban, as well as for the cooperation programs that are carried into many parts of the world.”

“Access to health is a human right. The United States is committing a crime when it wishes to deny that or to obstruct it for political reasons or as aggression.”

This Cuban criticism was echoed in an August 31 tweet by President Miguel Diaz-Canel, who said, “The carelessness, the lie, the perversity of the empire crumble before the moral height accumulated by the dignified history of the Cuban missions in health.”

The Specious U.S. Allegation of Illegal Forced Labor [7]

The contention that Cuban medical personnel in Cuba’s foreign medical mission program are engaged in illegal forced labor is meritless for at least the following reasons:

Medical education in Cuba is free and requiring medical graduates to pay the country back by such participation seems entirely appropriate and may indeed be a contractual or quasi-contractual obligation.
International medical aid has been a significant part of the Cuban people’s tradition of international solidarity, and some Cuban medical personnel have said that such service had a major positive impact on their lives and medical careers.
The relevant standard for evaluating the allegationthat Cuba’s international medical mission program violates international law is the International Labor Organization’s Forced Labour Convention, 1930.
That multilateral Convention or treaty provides that “for the purposes of this Convention, 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.” (Art. 2(2)(b).) (Emphasis added.)
Although it is true that the Cuban government receives direct payment from other countries for the foreign medical mission program and that the Cuban government retains some of those payments before paying the Cuban medical professionals, it also is true that such payments to those professionals exceed what they would have earned for similar services in Cuba. In addition, some of the payments to the Cuban professionals are deposited in Cuban accounts only accessible upon their completion of service and return to Cuba. But such practices do not constitute proof of forced labor.
While it also is true that some Cuban medical professionals who have participated or are now participating in the foreign medical mission program allege that they were coerced into doing so, the report indicates that the Cuban government and other participants deny that allegation and that there has been no independent adjudication of that allegation. (Emphases added.)
Also relevant to this allegation is Cuban medical professionals’ undoubted awareness of the significantly higher compensation they potentially could obtain if they were able to relocate in the U.S. or certain other countries.
A detailed study by Indiana State University’s Emeritus Professor of International Politics and Latin America, Dr. H. Michael Erisman, has rejected this accusation of forced labor.

The latest report on Cuba also fails to mention that the U.S. and Cuba apparently had friendly bilateral discussions about other human trafficking issues during the Obama Administration (2015 through January 17, 2017) and the Trump Administration (2017-2018).

The hypocrisy of the State Department’s repeated assertion of this claim of forced labor without recognizing the ILO’s Forced Labour Convention is shown by Secretary of State Pompeo’s congratulating the ILO on its centennial anniversary only one day after the release of the 2019 Trafficking in Persons Report. The Secretary said:

“The dignitaries that convened in Paris in 1919 to end the Great War knew that any lasting peace needed to be rooted in the protection of individual rights, including the rights of workers and employers to associate freely and bargain collectively. “
The United States proudly hosted the first International Labor Conference in 1919 and the “war-time conference that enshrined the ILO’s enduring founding principles and aims in the Declaration of Philadelphia. As strong supporters of the ILO and its mission, we reflect on the important role played by Americans to create and sustain this organization, including David Morse, who served as ILO Director-General for 22 years, and under whose leadership the ILO won the Nobel Peace Prize.”
“As the ILO enters its second century pursuing objectives critical to economic prosperity and security around the world, the United States recommits itself to advancing the rights of workers globally.

Another rebuttal of the U.S. allegations about the medical mission program recently was provided by a U.S. citizen, Dr. Graham Sowa, who has a Cuban medical degree and who now is a resident in internal medicine in a Florida hospital. He did not participate in the Cuban medical mission program, but his Cuban friends who are now physicians have done so and who totally reject this allegation. Sowa said, ““Cuba says they want to provide humanity with medical care. It is their commitment toward international solidarity.”

Conclusion

No matter how many times the U.S. alleges that Cuba’s foreign medical mission program engages in illegal forced labor does not make it so. The U.S. has not even publicly submitted an attempted legal justification for these allegations. The U.S. is wasting money on this specious claim.

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[1] New U.S. Government Hostility Towards Cuba’s Medical Mission Program, dwkcommentaries.com (Aug. 14, 2019)

[2] Senators Rubio and Menendez Call for Restoring U.S. Parole Program for Cuban Doctors, dwkcommentaries.com (Jan. 11, 2019). See also posts listed n the “Cuban Medical Personnel & U.S.” section of List of Posts to dwkcommentaries—Topical: CUBA.

[3] State Department Unjustly Downgrades Cuba in Annual Report on Human Trafficking, dwkcommentaries.com (June 22, 2019).

[4] Pais, Health Organization Accused of Trafficking Doctors to Brazil, Courthouse News Service (Dec. 3, 2018) The class action complaint, which was filed November 30, 2018, alleges that the Pan American Health Organization collected over $75 million since 2013 by enabling and managing the illegal trafficking of Cuban medical professionals in violation of the Trafficking Victims Protection Act and the Racketeering Influenced and Corrupt Organizations Act. Nothing of substance has happened so far in this case. The last docket entry was on July 2, 2019, for an order setting a hearing on July 18, 2019, for Pan American Health’s objections to and appeal from a magistrate judge’s order denying its motion to transfer the case to the U.S. District Court for the District of Columbia. (Civil Docket, Rodriguez v. Pan American Health Org., Case #: 1:18-cv-24995-DPG (Aug. 30, 2019).

[5] Eaton, USAID plans to spend up to $3 million to investigate Cuban doctors, Cuba Solidarity Campaign (Aug. 12, 2019).

[6] Cuba Foreign Ministry, Statement: The Government of the United States Is Earmarking Millions of Dollars To Obstruct Cuban Medical Cooperation (Aug. 30, 2019); The regime blames the US for complaints about the exploitation of Cuban doctors, Diario de Cuba (Aug. 29, 2019); Diaz-Canel described the ‘attacks’ and the ‘attacks by the US on the slae of medical services, Diario de Cuba (Sept. 1, 2019).

[7] State Department Unjustly Downgrades Cuba in Annual Report on Human Trafficking, dwkcommentaries.com (June 22, 2019); Guzzo, Are Cuban physicians human trafficking victims? No way, says Brandon doctor with Havana degree, Tampa Bay Times (Aug. 29, 2019).

State Department Unjustly Downgrades Cuba in Annual Report on Human Trafficking

On June 20, 2019, the U.S. State Department released its 2019 Trafficking in Persons Report, as required by the U.S. Trafficking Victims Protection Act of 2000, as amended (TVPA).[1]

After examining this statute’s framework, we will look at the report’s flawed concentration of its discussion of Cuba on its foreign medical mission program.

The Statutory Framework[2]

“Severe forms of trafficking in persons.” That statute defines “severe forms of trafficking in persons” as: “sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age;” or “the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.” (Emphasis added.)

“Minimum Standards for the elimination of trafficking in persons.” This phrase in the statute is defined as follows:

“(1) The government of the country should prohibit severe forms of trafficking in persons and punish acts of such trafficking. “
“(2) For the knowing commission of any act of sex trafficking involving force, fraud, coercion, or in which the victim of sex trafficking is a child incapable of giving meaningful consent, or of trafficking which includes rape or kidnapping or which causes a death, the government of the country should prescribe punishment commensurate with that for grave crimes, such as forcible sexual assault.”
“(3) For the knowing commission of any act of a severe form of trafficking in persons, the government of the country should prescribe punishment that is sufficiently stringent to deter and that adequately reflects the heinous nature of the offense.”
“(4) The government of the country should make serious and sustained efforts to eliminate severe forms of trafficking in persons.”

The statute then goes on with great detail on 12 indicia of “serious and sustained efforts” as used in the last of these four minimum standards.

Finally the statue sets forth the following four categories or “tiers” for ranking all countries of the world in the State Department’s annual reports:

Tier 1. “Countries whose governments fully meet the TVPA’s minimum standards for the elimination of trafficking.”
Tier 2. “Countries whose governments do not fully meet the TVPA’s minimum standards but are making significant efforts to bring themselves into compliance with those standards.”
Tier 2 Watch List. “Countries whose governments do not fully meet the TVPA’s minimum standards but are making significant efforts to bring themselves into compliance with those standards, and for which: a) the absolute number of victims of severe forms of trafficking is very significant or is significantly increasing; b) there is a failure to provide evidence of increasing efforts to combat severe forms of trafficking in persons from the previous year, including increased investigations, prosecution, and convictions of trafficking crimes, increased assistance to victims, and decreasing evidence of complicity in severe forms of trafficking by government officials; or c) the determination that a country is making significant efforts to bring itself into compliance with minimum standards was based on commitments by the country to take additional steps over the next year.”
Tier 3. “Countries whose governments do not fully meet the TVPA’s minimum standards and are not making significant efforts to do so. No tier ranking is permanent. Every country, including the United States, can do more. All countries must maintain and continually increase efforts to combat trafficking.”

2019 Report on Cuba (Tier 3)[3]

Preliminarily it should be noted that Inclusion in Tier 3 allows the president to introduce restrictions on U.S. non-humanitarian, non-trade-related assistance, but the U.S. currently does not provide any such aid to Cuba and there is no prospect of any such new aid being offered. [4]

The Report’s summary of the reasons for the 2019 ranking included the following: “The Government of Cuba does not fully meet the minimum standards for the elimination of trafficking and is not making significant efforts to do so; therefore Cuba was downgraded to Tier 3. Despite the lack of significant efforts, the government took some steps to address trafficking, including prosecuting sex traffickers and one labor trafficker and imprisoning sex tourists engaged in child sex trafficking. However, the government did not take action to address forced labor in the foreign medical mission program, despite persistent allegations Cuban officials threatened and coerced some participants to remain in the program.” (Emphasis added.)

The Report’s ”Prioritized Recommendations” for Cuba had two relevant points. First, :“Implement policies to prohibit force, fraud, or coercion by foreign labor recruiters and state-owned or controlled enterprises, including foreign medical missions in recruiting and retaining employees.” Second, Ensure participants in the foreign medical missions program retain control of their passports.” (Emphases added.)

The final section of the report on Cuba (“Trafficking Profile”) was devoted almost entirely to its foreign medical mission program. It stated, “the government employed between 34,000-50,000 healthcare professionals in more than 60 countries in Africa, the Americas, Asia, the Middle East, and Portugal in foreign medical missions through contracts with foreign governments and, in some countries, with international organizations serving as intermediaries. In November 2018, Cuba ended the five-year-old “Mais Medicos” medical mission program in Brazil, which was facilitated by a UN-affiliated organization, following demands from Brazil’s then president-elect to improve the treatment and employment conditions of Cuban healthcare professionals after allegations of coercion, non-payment of wages, withholding of passports, and restrictions on their movement. In November 2018, Cuban healthcare workers filed a class action in the U.S. District Court Southern District of Florida under the Trafficking Victims Protection and the Racketeering Influenced and Corrupt Organization Acts alleging the Cuban government profited from the export of healthcare professionals; the case remains pending. In Brazil, the Cuban government collected revenue for each professional’s services and paid the worker a fraction of the revenue depositing a large percentage of the worker’s wages in an account in Cuba only accessible upon completion of the mission and return to Cuba. The Cuban government collected approximately 7.2 billion pesos ($7.2 billion) in annual revenue from the export of services, including foreign medical missions in 2017. Some participants in foreign medical missions as well as other sources allege Cuban officials force or coerce participation in the program; the government has stated the postings are voluntary, and some participants also have stated the postings are voluntary and well-paid compared to jobs within Cuba. Observers report the government does not inform participants of the terms of their contracts, making them more vulnerable to forced labor. The Cuban government acknowledges that it withholds passports of overseas medical personnel in Venezuela; the government provided identification cards to such personnel. Some Cuban medical personnel claim they work long hours without rest and face substandard working and living conditions in some countries, including a lack of hygienic conditions and privacy. Observers note Cuban authorities coerced some participants to remain in the program, including by withholding their passports, restricting their movement, using “minders” to conduct surveillance of participants outside of work, threatening to revoke their medical licenses, retaliate against their family members in Cuba if participants leave the program, or impose criminal penalties, exile, and family separation if participants do not return to Cuba as directed by government supervisors.” (Emphasis added.)

Reaction

The contention that Cuban medical personnel in Cuba’s foreign medical mission program are engaged in forced labor is meritless for at least the following reasons:

Medical education in Cuba is free and requiring medical graduates to pay the country back by such participation seems entirely appropriate and may indeed be a contractual or quasi-contractual obligation.
International medical aid has been a significant part of the Cuban people’s tradition of international solidarity, and some Cuban medical personnel have said that such service had a major positive impact on their lives and medical careers.
The relevant standard for evaluating the allegation that Cuba’s international medical mission program violates international law is the International Labor Organization’s Forced Labour Convention, 1930.[5]
That multilateral Convention or treaty provides that “for the purposes of this Convention, 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.” (Art. 2(2)(b).)[6]
Although it is true that the Cuban government receives direct payment from other countries for the foreign medical mission program and that the Cuban government retains some of those payments before paying the Cuban medical professionals, it also is true that such payments to those professionals exceed what they would have earned for similar services in Cuba. In addition, some of the payments to the Cuban professionals are deposited in Cuban accounts only accessible upon their completion of service and return to Cuba. But such practices do not constute proof of forced labor.
While it also is true that some Cuban medical professionals who have participated or are now participating in the foreign medical mission program allege that they were coerced into doing so, the report indicates that the Cuban government and other participants deny that allegation and that there has been no independent adjudication of that allegation.
Also relevant to this allegation is Cuban medical professionals undoubted awareness of the significantly higher compensation they potentially could obtain if they were able to relocate in the U.S. or certain other countries.
A detailed study by Indiana State University’s Emeritus Professor of International Politics and Latin America, Dr. H. Michael Erisman, has rejected this accusation of forced labor.[7]

The latest report on Cuba also fails to mention that the U.S. and Cuba apparently had friendly bilateral discussions about human trafficking during the Obama Administration (2015 through January 17, 2017) and the Trump Administration (2017-2018).[8]

The hypocrisy of the State Department’s repeated assertion of this claim of forced labor without recognizing the Forced Labour Convention is shown by Secretary of State Pompeo’s congratulating the ILO on its centennial anniversary only one day after the release of the 2019 Trafficking in Persons Report.[9] The Secretary said:

“The dignitaries that convened in Paris in 1919 to end the Great War knew that any lasting peace needed to be rooted in the protection of individual rights, including the rights of workers and employers to associate freely and bargain collectively. “
The United States proudly hosted the first International Labor Conference in 1919 and the “war-time conference that enshrined the ILO’s enduring founding principles and aims in the Declaration of Philadelphia.[ [10]] As strong supporters of the ILO and its mission, we reflect on the important role played by Americans to create and sustain this organization, including David Morse, who served as ILO Director-General for 22 years, and under whose leadership the ILO won the Nobel Peace Prize.”
“As the ILO enters its second century pursuing objectives critical to economic prosperity and security around the world, the United States recommits itself to advancing the rights of workers globally.

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[1] State Dep’t, 2019 Trafficking in Persons Report (June 20, 2019) [“2019 Report”]; State Dep’t, Secretary of State Michael R. Pompeo at the 2019 Trafficking in Persons Report Launch Ceremony (June 20, 2019).

[2] Report at 36-37, 40-41, 48.

[3] Report at 162-64..

[4] Reuters, U.S. Human Trafficking Report Drops Child Separation Warning, N.Y. Times (June 20, 2019). Some of the State Department’s prior reports about trafficking in Cuba are discussed in the following posts to dwkcommentariess.com: U.S. Upgrades Cuba in State Department’s Annual Report on Human Trafficking (Aug. 7, 2015); Comment: Cuba’s International Medical Mission Doctors’ Reflections (Nov. 30, 2015); U.S. State Department’s 2015 Human Trafficking Report’s Objectivity About Cuba Is Still Unresolved (Nov. 16, 2015); U.S. Reasserts Upgrade of Cuba in Annual Human Trafficking Report (July 2, 2016); U.S. Senate Hearing on 2016 Trafficking in Persons Report (July 20, 2016); Cuba’s Unchanged Status in U.S. State Department’s Annual Report on Human Trafficking (Aug. 13, 2017); Cuba Remains on “Tier 2 Watchlist” in U.S. State Department’s Annual Human Trafficking Report (July 1, 2018).

[5] ILO, Forced Labour Convention, 1930 (No. 29). Cuba ratified the Convention on Forced Labour on October 8, 1953. The U.S., however, has not so ratified.

[6] The above provision of this Convention was reaffirmed in the Protocol of 2014 to the Forced Labour Convention, 1930, (Art. 1(3) (“The definition of forced or compulsory labour contained in the Convention is reaffirmed. . . .”)

[7] Erisman, Brain Drain Politics: the Cuban Medical Professional Parole Programme, Int’l J. Cuban Studies 269, 286-87 (2012).

[8] See these posts to dwkcommentaries.com.: This Week’s U.S.-Cuba Meetings in Havana (Jan. 18, 2015); U.S.-Cuba Bilateral Commission Sets Agenda for Future Discussions of Remaining Issues (Sept. 12, 2015); Results of Second Meeting of U.S.-Cuba Bilateral Commission (Nov. 11, 2015); United States-Cuba Bilateral Commission Meets To Review Normalization Status (May 18, 2016); U.S. and Cuba Hold Another Meeting of the Bilateral Commission (Sept. 30, 2016); U.S. and Cuba Continue To Implement Normalization of Relations (Jan. 17, 2017); U.S. and Cuba Hold Biannual Migration Talks (Dec. 12, 2017); U.S. and Cuba Hold Discussions About Human Trafficking and Migration Fraud (Dec. 15, 2017); U.S. and Cuba Continue To Confer Over Common Concerns (Feb.15, 2018).

[9] State Dep’t, On the Centenary of the Founding of the International Labor Organization (June 21, 2019).

[10] The Declaration of Philadelphia, was adopted in that city on May 10, 1944, by the ILO to restate its traditional objectives while also recognizing the centrality of human rights to social policy and the need for international economic planning. (Declaration of Philadelphia, Wikipedia.)

Cuba Remains on “Tier 2—Watch List” in U.S. State Department’s Annual Trafficking in Persons Report

On June 28 the U.S. State Department released its Trafficking in Persons Report (June 2018), [1] pursuant to a U.S. federal statute (The Trafficking Victims Protection Act of 2000, as amended), requiring annual reports on human trafficking in every country of the world. After looking at the background for this report, we will examine its report on Cuba.

Background

This statute defines “severe forms of trafficking in persons” as “sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age; or the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.” (Report at 5.)

This statute also defines the “minimum standards for the elimination of trafficking in persons” as follows:

“(1) The government of the country should prohibit severe forms of trafficking in persons and punish acts of such trafficking. (2) For the knowing commission of any act of sex trafficking involving force, fraud, coercion, or in which the victim of sex trafficking is a child incapable of giving meaningful consent, or of trafficking which includes rape or kidnapping or which causes a death, the government of the country should prescribe punishment commensurate with that for grave crimes, such as forcible sexual assault. (3) For the knowing commission of any act of a severe form of trafficking in persons, the government of the country should prescribe punishment that is sufficiently stringent to deter and that adequately reflects the heinous nature of the offense. (4) The government of the country should make serious and sustained efforts to eliminate severe forms of trafficking in persons.” (Report at 44.)

The statute then goes on with great details on 12 Indicia of “Serious and Sustained Efforts” as used in the last of these four minimum standards. (Report at 44-45.)

The report placed the countries in the world into the following five tiers or categories (Report at 54):

Tier	Definition	Number of Countries
1	“The governments of countries that fully meet the TVPA’s minimum standards for the elimination of trafficking.”	39
2	“The governments of countries that do not fully meet the TVPA’s minimum standards, but are making significant efforts to bring themselves into compliance with those standards.”	81
2-Watch List	“The government of countries that do not fully meet the TVPA’s minimum standards, but are making significant efforts to bring themselves into compliance with those standards, and for which: a) the absolute number of victims of severe forms of trafficking is very significant or is significantly increasing; b) there is a failure to provide evidence of increasing efforts to combat severe forms of trafficking in persons from the previous year, including increased investigations, prosecution, and convictions of trafficking crimes, increased assistance to victims, and decreasing evidence of complicity in severe forms of trafficking by government officials; or c) the determination that a country is making significant efforts to bring itself into compliance with minimum standards was based on commitments by the country to take additional steps over the next year.”	43
Tier 3	“The governments of countries that do not fully meet the TVPA’s minimum standards and are not making significant efforts to do so”	23
Special Cases		4
TOTAL		190

Report on Cuba

Cuba remained on Tier 2 Watch List for the fourth consecutive year after four years in Tier 3.[2] Its introductory paragraph stated the following:

“The Government of Cuba does not fully meet the minimum standards for the elimination of trafficking; however, it is making significant efforts to do so. The government demonstrated significant efforts by prosecuting and convicting more traffickers, including a trafficker that subjected a boy to forced begging; creating a directorate to provide specialized attention to child victims of crime and violence, including trafficking; and publishing its national anti-trafficking plan for 2017-2020. However, the government did not demonstrate increasing efforts compared to the previous reporting period. The government did not criminalize most forms of forced labor, or sex trafficking of children ages 16 and 17, and did not report providing specialized services to identified victims. The government lacked procedures to proactively identify forced labor victims and detained potential sex trafficking victims for unlawful acts committed as a direct result of being subjected to trafficking. Because the government has devoted sufficient resources to a written plan, that, if implemented, would constitute significant efforts to meet the minimum standards, Cuba was granted a waiver per the Trafficking Victims Protection Act from an otherwise required downgrade to Tier 3.” (Report at 156 (emphasis added.)[3]

The Report also provided the following “RECOMMENDATIONS FOR CUBA”

“Draft and enact a comprehensive anti-trafficking law that prohibits and sufficiently punishes all forms of human trafficking, including forced labor, sex trafficking of children ages 16 and 17, and the full range of trafficking ‘acts’ (recruiting, transporting, transferring, harboring, or receiving persons); vigorously investigate and prosecute both sex trafficking and forced labor offenses; implement formal policies and procedures on the identification of all trafficking victims and their referral to appropriate services, and train officials, including first responders, in their use; adopt policies and programs that provide trafficking-specific, specialized assistance for male and female trafficking victims, including measures to ensure identified sex and labor trafficking victims are not punished for unlawful acts committed as a direct result of being subjected to sex trafficking or forced labor; establish a permanent inter-ministerial anti-trafficking committee and implement the 2017-2020 national anti-trafficking action plan in partnership with international organizations; implement policies to prohibit force, fraud, or coercion by foreign labor recruiters and state-owned or controlled enterprises in recruiting and retaining employees; educate workers about trafficking indicators and where to report trafficking-related violations; and provide specialized training on trafficking indicators for hotline staff and interpretation for non-Spanish speakers.” (Report at 158.)

The Report’s conclusion on Cuba under the heading “Trafficking Profile” states as follows:

“As reported over the past five years, Cuba is a source, transit, and destination country for adults and children subjected to sex trafficking and forced labor. Sex trafficking and sex tourism, including child victims, occur within Cuba. Traffickers subject Cuban citizens to sex trafficking and forced labor in South America, the Caribbean, and the United States. Traffickers subject foreign nationals from Africa and Asia to sex trafficking and forced labor in Cuba to pay off travel debts. The government is the primary employer in the Cuban economy, including in foreign medical and other overseas missions that employ more than 84,000 workers in more than 67 countries, including Bolivia, Brazil, Colombia, and Venezuela. These medical missions constitute a significant source of Cuban government income. Some participants in foreign medical missions as well as other sources allege that Cuban officials force or coerce participation in the program; the government has stated the postings are voluntary, and some participants also have stated the postings are voluntary and well-paid compared to jobs within Cuba. The Cuban government acknowledges that it withholds passports of overseas medical personnel in Venezuela; the government provided ID cards to such personnel in place of passports. There are also claims about substandard working and living conditions in some countries. Observers noted Cuban authorities coerced some participants to remain in the program, including by allegedly withholding their passports, restricting their movement, using “minders” to monitor participants outside of work, threatening to revoke their medical licenses, retaliate against their family members in Cuba if participants leave the program, or impose exile if participants didn’t return to Cuba as directed by government supervisors. The government uses some high school students in rural areas to harvest crops and does not pay them for their work but claims this work is not coerced.” (Report at 158 (emphasis added.)

The portion of this Profile about Cuba’s foreign medical missions’ alleged use of forced labor is highlighted because, as discussed below, this blogger believes such allegation is erroneous.

Conclusion

There are at least two major objections to this report on Cuba.

First, there is no mention of the bilateral U.S.-Cuba discussions about human trafficking that have occurred since the December 17, 2014, announcement of U.S.-Cuba rapprochement. Unfortunately the brief official announcements of such discussions do not provide details of the substance of the discussions.[4] But such discussions may bear light on the U.S. report about Cuba.

Second, there also is no merit to the Report’s allegation that Cuba’s employment of Cuban medical personnel in foreign missions is illegal forced labor. Details are provided in a prior post, but here is a summary for that conclusion:

There is conflicting evidence on the coercion issue and there has been no adjudication of that issue.
International medical aid has been a significant part of the Cuban people’s tradition of solidarity, and some Cuban medical personnel have said that such service had a major positive impact on their lives and medical careers.
A detailed study by Indiana State University’s Emeritus Professor of International Politics and Latin America, Dr. H. Michael Erisman, rejects the accusation of forced labor.
Medical education in Cuba is free and requiring medical graduates to pay the country back by such participation seems entirely appropriate and may indeed be a contractual or quasi-contractual obligation.
Having Cuban medical personnel participate in foreign medical mission does not violate the relevant international legal standard (the Forced Labour Convention, 1930) because it expressly excludes “any work or service which forms part of the normal civic obligation of the citizens of a fully self-governing country.”

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[1] U.S. State Dep’t, Trafficking in Persons Report: June 2018. At the State Department’s Launch Ceremony public comments were made by Secretary of State Mike Pompeo and Kari Johnstone, the acting director for the Department’s Office to Monitor and Combat Trafficking in Persons plus 10 TIP Heroes from around the world. Earlier there was a background briefing for journalists. (See U.S. State Dep’t, Remarks at the 2018 Trafficking in Persons Report Launch Ceremony (June 28, 2018) ; U.S. State Dep’t, Senior State Department Official on the 2018 Trafficking in Persons Report (June 28, 2018).

[2] Some of the prior reports about trafficking in Cuba are discussed in the following posts to dwkcommentariess.com: U.S. Upgrades Cuba in State Department’s Annual Report on Human Trafficking (Aug. 7, 2015); Comment: Cuba’s International Medical Mission Doctors’ Reflections (Nov. 30, 2015); U.S. State Department’s 2015 Human Trafficking Report’s Objectivity About Cuba Is Still Unresolved (Nov. 16, 2015); U.S. Reasserts Upgrade of Cuba in Annual Human Trafficking Report (July 2, 2016); U.S. Senate Hearing on 2016 Trafficking in Persons Report (July 20, 2016); Cuba’s Unchanged Status in U.S. State Department’s Annual Report on Human Trafficking (Aug. 13, 2017).

[3] The Report provides greater details on Cuba’s Prosecution, Protection and Prevention. (Report at 156-58.)

[4] See these posts to dwkcommentaries.com about such mentions of bilateral discussions about human trafficking: This Week’s U.S.-Cuba Meetings in Havana (Jan. 18, 2015); U.S.-Cuba Bilateral Commission Sets Agenda for Future Discussions of Remaining Issues (Sept. 12, 2015); Results of Second Meeting of U.S.-Cuba Bilateral Commission (Nov. 11, 2015); United States-Cuba Bilateral Commission Meets To Review Normalization Status (May 18, 2016); U.S. and Cuba Hold Another Meeting of the Bilateral Commission (Sept. 30, 2016); U.S. and Cuba Continue To Implement Normalization of Relations (Jan. 17, 2017); U.S. and Cuba Hold Biannual Migration Talks (Dec. 12, 2017); U.S. and Cuba Hold Discussions About Human Trafficking and Migration Fraud (Dec. 15, 2017); U.S. and Cuba Continue To Confer Over Common Concerns (Feb. 2, 2018).