Indiana State University – dwkcommentaries

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).

U.S. State Department Unjustly Continues To Allege That Cuba’s Foreign Medical Missions Engage in Forced Labor

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.