On January 9, Cuba-American U.S. Senators Bob Menendez (Dem., NJ) and Marco Rubio (Rep., FL) offered S.Res. 14—Affirming that the Government of Cuba’s foreign medical missions constitute human trafficking.[1]
This proposed resolution, however, is based upon a false premise as will be shown in the final section of this post. First, we will examine this new resolution itself and the two Senators statements in support of the resolution and then the basics of the Cuban medical mission program and the former U.S. immigration parole program for Cuban medical professionals engaged in that program.
The Cuban Medical Mission Program[2]
According to a 2011 article in the Wall Street Journal, since Cuba since 1973 has been sending medical ‘brigades’ to foreign countries, “helping it to win friends abroad, to back ‘revolutionary’ regimes in places like Ethiopia, Angola and Nicaragua, and perhaps most importantly, to earn hard currency. [The] Communist Party newspaper Granma reported in June [2010] that Cuba had 37,041 doctors and other health workers in 77 countries. Estimates of what Cuba earns from its medical teams—revenue that Cuba’s central bank counts as ‘exports of services’—vary widely, running to as much as $8 billion a year.”
Again, according to the same Wall Street Journal article, Cuban doctors often desire such overseas assignments because they provide opportunities to earn significantly more money than at home. “When serving overseas, they get their Cuban salaries [of $25 per month], plus a $50-per-month stipend—both paid to their dependents while they’re abroad. . . . In addition, they themselves receive overseas salaries—from $150 to $1,000 a month, depending on the mission.” Many on-the-side also engage in private fee-for-service medical practice, including abortions. As a result, many of the Cubans are able to save substantial portions of their overseas income, which they often use to purchase items they could not have bought in Cuba like television sets and computers. Other desirable purchases are less expensive U.S. products that they can sell at a profit when they return to Cuba.
In more recent years, many of the Cuban medical missionaries have gone to Venezuela and Brazil, the latter of which late last year terminated the program and most of the Cubans returned to the island, while some remained in Brazil.
The U.S. State Department in its annual reports on human trafficking has alleged that Cuba’s use of Cuban medical personnel in its foreign medical mission program constitutes illegal forced labor.[3] This allegation will be rebutted in the last section of this post.
The Former U.S. Immigration Parole Program fo Cuban Medical Professionals[4]
On August 11, 2006, the U.S. Department of Homeland Security in conjunction with the Department of State, announced a program] that . . . would allow “Cuban medical personnel conscripted to study or work in a third country under the direction of the Cuban government to enter the United States.”
Under the program “Cuban Medical Professionals” (i.e., health-care providers such as doctors, nurses, paramedics, physical therapists, lab technicians and sports trainers) are eligible if they meet the following criteria: (1) Cuban nationality or citizenship, (2) medical professional currently conscripted to study or work in a third country under the direction of the Government of Cuba, and (3) not otherwise ineligible for entry into the U.S. Spouses and/or minor children are also eligible for such parole.
The program “was the brainchild of Cuban-born Emilio González,” a former U.S. Army colonel, the director of the U.S. Citizen & Immigration Services from 2006 to 2008 and a “staunchly anti-Castro exile.” “He has characterized Cuba’s policy of sending doctors and other health workers abroad as ‘state-sponsored human trafficking.’” The Cuban doctors, he says, work directly for health authorities in other countries and have no say in their assignments.
On January 12, 2017, in the final days of his president, President Obama terminated this program. The announcement said that the U.S. “and Cuba are working together to combat diseases that endanger the health and lives of our people. By providing preferential treatment to Cuban medical personnel, the medical parole program contradicts those efforts, and risks harming the Cuban people. Cuban medical personnel will now be eligible to apply for asylum at U.S. embassies and consulates around the world, consistent with the procedures for all foreign nationals.”
The Cuban government applauding the end of this program, said it “was part of the arsenal to deprive the country of doctors, nurses and other professionals of the sector, . . . and an attack against Cuba’s humanitarian and solidarity medical missions in Third World countries that need it so much. This policy prompted Cuban health personnel working in third countries to abandon their missions and emigrate to the [U.S.], becoming a reprehensible practice that damaged Cuba’s international medical cooperation programs.”
The termination of this program was welcomed by Senators Patrick Leahy (Dem., VT) and representative Kathy Castor (Dem., FL), but criticized by Senators Rubio and Menendez with Rubio expressly calling for the then new Trump Administration to restore the program.
The Proposed New Resolution[5]
After multiple Whereas clauses, the proposed Resolution would declare that it is the sense of the Senate that:
- “The Government of Cuba subjected Cuban doctors and medical professional participating in the Mais Medicos program to state-sponsored human trafficking;
- Cuban doctors participating in the MaisMedicos program should have been permitted to work under the same conditions as all other foreign 9 doctors participating in the program;
- the Government of Cuba should compensate Cuban doctors that participated in the Mais Medicos programs for the full amount of wages that were garnished by the Government of Cuba;
- Foreign governments that sign agreements with the Government of Cuba or the for-profit Cuban Medical Services Trading Corporation (CMS) or other companies affiliated with the Government of Cuba to procure the services of Cuban professionals directly assume risks related to participation in forced labor arrangements;
- The Pan American Health Organization must immediately provide greater transparency about its participation in the Mais Medicos program and its agreement with the Government of Cuba and the for-profit Cuban Medical Services Trading Corporation (CMS);
- The United States Department of State must downgrade Cuba to Tier 3 in its annual Trafficking in Persons (TIP) report, given new evidence on Cuba’s foreign medical missions and the Government of Cuba’s longstanding failure to criminalize most forms of forced labor; and
- the Department of State must re-establish the Cuban Medical Professionals Parole (CMPP) program.”
The Senators’ ‘Press Releases for the New Resolution[6]
The two Senators issued essentially identical press releases. Here is what Senator Menendez’s stated.
Senator Menendez condemned “ the Cuban regime for a program that sends tens of thousands of Cuban medical professionals to foreign countries to work under conditions that qualify as human trafficking.” In addition, he stated.“For 60 years, the Cuban regime has been finding new ways to exploit its people. Recent information from Brazil shows how the Cuban government profits from its state-sponsored foreign medical missions, which they sell as medical diplomacy but look a lot more like indentured servitude. This bipartisan resolution sheds additional light on the Cuban regime’s role in human trafficking, and is another call for greater accountability from Cuban officials, their overseas partners, and the international community.”
The press release also quoted Senator Rubio. ““It is outrageous, though not surprising, that the Cuban dictatorship continues to manipulate and traffic physicians in order to enrich itself. This form of forced labor should not go unnoticed by the international community. We must stand against the regime’s modern-day slavery scheme and support the doctors seeking justice after serving in these so-called international medical missions.”
Finally the press release stated that the “introduction comes after an investigative report by the Diario de Cuba recently revealed the indentured servitude of Cuban medical professionals described in Brazilian diplomatic cables detailing the terms of the Government of Cuba’s medical missions to Brazil. In 2016 alone, it is estimated that the Castro regime earned more than $8,000,000,000 from exporting the services of Cuban professionals, of which foreign medical missions represent the majority of the income.”
Analysis of the Merits of the Resolution[7]
The resolution is without merit and should be rejected. Why? Because the Cuban medical mission program is not illegal forced labor.
The U.S. parole program for Cuban medical personnel was and is also unjustified. Cuban students receive their medical education without any tuition. As a result, it is only reasonable to require such students, after receiving their medical degrees, to “give back” by serving on a Cuban foreign medical mission for which they are paid more than they would have earned in Cuba. Yes, the Cuban government is paid more for their services on such missions by foreign governments than the medical personnel are paid by the Cuban government, but that also is reasonable and appropriate. The contention that such service is illegal forced labor or semi-slavery is absurd.
- First, the State Department reports admit that there is conflicting information and allegations on the foreign medical mission work. Coercion is alleged by “some participants” and unnamed “other sources.” On the other hand, the reports admit that the Cuban government denies these allegations, and instead the Government and “some participants” assert the postings are “voluntary and well paid compared to jobs within Cuba.” The reports also concede there is conflicting information on whether other means, including withholding Cuban passports, are used to coerce or force participants to remain in the program.
- Second, there apparently has not been any fair adjudicative process to determine which of these conflicting sets of information is valid.
- Third, the accusation of forced labor for such participants has been rejected in a 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.
- Fourth, According to Granma, Cuba’s Communist Party’s newspaper, “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.” The Granma article included the reflection of four Cuban doctors who have participated in such missions and who treasure the positive impact of those experiences on their professional and personal lives.
- Fifth, this reports do not cite to the relevant legal definition of “forced labor” to assess this claim. Most pertinent is Article 2(2) of the Forced Labour Convention, 1930, which states, in part, ”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.” (Emphasis added.)
Moreover, as a previous post noted, a respected international journalist, Alma Guillermoprieto, recently reported that Cuban medical doctors serving on the island now earn $67 per month, but $500 per month when serving on a foreign medical mission.
The $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.
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[1] Resolution by Bob Menéndez and Marco Rubio asks to restore the US refugee program for Cuban doctors, DiariodeCuba Cuba (Jan. 10, 2019); Menéndez: the Cuban regime and its foreign partners ‘must be held accountable’ for the exploitation of doctors, DiariodeCuba (Jan. 10, 2019).
[2] See New York Times Calls for End of Special Immigration Relief for Cuban Medical Personnel, dwkcommentaries.com (Nov. 22, 2014).
[3] See these posts to dwkcommentaries: U.S. Upgrades Cuba in State Department’s Annual Report on Human Trafficking (Aug. 7, 2015); U.S. Reasserts Upgrade of Cuba in Annual Report on Human Trafficking (July 2, 2016); Cuba’s Unchanged Status in U.S. State Department’s Annual Report on Human Trafficking (Aug. 15, 2017).
[4] Ibid; U.S. Ends Special Immigration Benefits for Cubans, dwkcommentaries.com (Jan. 13, 2017).
[5] S. Res. 14- a resolution affirming that the Government of Cuba’s foreign medical missions constitute human trafficking. (Jan. 9, 2019); Sen. Menendez, Press Release: Senators Menendez, Rubio Introduce Senate Resolution Condemning Castro Regime’s Forced Labor of Cuban Doctors (Jan. 10, 2019);CubanSen. Rubio, Press Release: Rubio, Menendez Introduces [sic] Resolution Condemning Castro Regime’s forced Labor of Cuban Doctors (Jan. 10, 2019).
[6] Ibid.
[7] See posts listed in the “Cuban Medical Personnel & U.S.” section of List of Posts to dwkcommentaries.com—Topical (CUBA).