Senators Menendez and Rubio Call for Restoring U.S. Parole Program for Cuban Doctors

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).

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).