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).
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
“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)
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. 
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.)
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.
- 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).)
- 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.
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).
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. 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.
 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).
 Report at 36-37, 40-41, 48.
 Report at 162-64..
 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).
 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. . . .”)
 Erisman, Brain Drain Politics: the Cuban Medical Professional Parole Programme, Int’l J. Cuban Studies 269, 286-87 (2012).
 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).
 State Dep’t, On the Centenary of the Founding of the International Labor Organization (June 21, 2019).
 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.)