As noted in a prior post, the U.S. State Department on June 27, 2017, issued its annual report on human trafficking, and Its discussion of Cuba (pp. 143-45) included the allegation that Cuba had engaged in illegal forced labor with its foreign medical mission program.
This allegation has been present in previous annual reports, some of which have been discussed in other posts.[1]
Report Regarding Cuba’s Alleged Forced Labor in Its Foreign Medical Missions
The latest report observes, presumably correctly, that the Cuban penal code does not criminalize forced labor. Therefore, the report, also presumably correctly, states that Cuba “did not make efforts to identify or protect victims of forced labor” and “did not report having procedures to identify victims of forced labor.”
In addition, the report says, presumably correctly, “The government is the primary employer in the Cuban economy, including in foreign medical missions that employ more than 84,000 workers in more than 67 countries, including Bolivia, Brazil, Colombia, and Venezuela. These medical missions constitute a signficant source of Cuban government income.”
Implicitly conceding that there was conflicting evidence, this report said, “Some participants in foreign medical missions as well as other [unnamed] sources allege that Cuban officials force or coerce participation in the program; the [Cuban] 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.” (Emphases added.)
This report continued, “The Cuban government acknowledges that it withholds passports of overseas medical personnel in Venezuela due to security concerns; 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. In the past, there have been claims that Cuban authorities coerced participants to remain in the program, including by allegedly withholding their passports, restricting their movement, using “minders” to monitor participants outside of work, or threatening to revoke their medical licenses or retaliate against their family members in Cuba if participants leave the program.“ (Emphasis added.)
“In 2015, Cuba reinstituted restrictions on travel for specialized doctors and some medical personnel, requiring them to obtain an exit permit from their superiors before leaving the country. On September 9, 2015, the government agreed to reinstate medical personnel who had left their positions while abroad. As of April 1, 2016, the Cuban authorities claimed that 274 medical professionals who returned to Cuba and were rehired at the same salary and level of responsibility they had before leaving. More recent data was not available.”
This report, consistent with prior reports, alleges or assumes that Cuba is engaged in illegal forced labor of Cuban medical personnel in foreign medical missions and that Cuba does not recognize forced labor as a possible issue affecting its nationals in medical missions abroad.
Analysis of the Allegation
This U.S. allegation is flawed for at least the following seven reasons.
First, while previous reports admitted that “information on the scope of . . . forced labor in Cuba is limited,” the latest report admits there is conflicting evidence about whether medical personnel’s participation in the foreign mission program is coerced and that the Cuban government denies such illegal coercion.
Second, most of this report’s recitation of alleged facts about the foreign mission program do not relate to, or substantiate, the forced labor allegation.
Third, “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.[2]
Fourth, 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.[3]
Fifth, relevant to this issue, but not mentioned in the Report, 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.[4]
Sixth, this Report and its predecessors do not cite to the relevant international legal definition of “forced labor” to assess this claim or set forth any legal analysis purportedly supporting the allegation. This is not surprising as 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.)[5]
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.
Seventh, there has not been any fair adjudicative process that has determined that such illegal coercion exists.
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[1] Relevant posts to dwkcommentaries.com: U.S. Upgrades Cuba in State Department’s Annual Report on Human Trafficking (Aug, 7, 2015); U.S. Reasserts Upgrade of Cuba in Annual Human Trafficking Report (July 2, 2016); U.S. Senate Hearing on on 2016 Trafficking in Persons Report (July 20, 2016).
[2] Ledn, Cuban doctors share their experiences in internationalist missions, Granma (Nov. 26, 2015).
[3] Erisman, Brain Drain Politics: the Cuban Medical Professional Parole Programme, Int’l J. Cuban Studies 269, 286-87 (2012).
[4] Raul Castro Discusses Socio-Economic Issues in Report to Seventh Congress of Communist Party of Cuba, dwkcommentaries.com (April 19, 2016).
[5] 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.