New U.S. Government Hostility Towards Cuba’s Medical Mission Program

On July 28, 2019, U.S. Secretary of State Michael Pompeo announced that the U.S. would no longer issue visas to Cuban officials who were directing that country’s medical mission program.[1] Here is the text of that announcement:

  • “The Cuban government engages in exploitative and coercive labor practices while it earns money on the backs of its citizens through its overseas medical missions program.  To address this labor abuse, the Department has imposed visa restrictions on certain Cuban officials and other individuals responsible for these coercive labor practices under the Immigration and Nationality Act Section 212(a)(3)(C).  These practices include working long hours, housing in unsafe areas, and compelling Cuban medical professionals to advance the regime’s political agenda.  Such visa restrictions could include immediate family members of these individuals.”

Response to U.S. Action

Previous posts have discussed Cuba’s foreign medical mission program and the invalidity of U.S. allegations that the program engages in illegal forced labor.[2] Here the main reasons for that invalidity:

First, “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.[3]

Second, 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.[4]

 Third, relevant to this issue 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.[5]

 Fourth, 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.

Fifth, there has not been any fair adjudicative process that has determined that such illegal coercion exists.

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[1] U.S. State Dep’t, Press Statement: Visa Actions Against Cuban Officials (July 28, 2019); NBC News-Miami, US Restricts Visas for Cubans Involved in Overseas Medicine (July 28, 2019).

[2]  See U.S. State Department Unjustly Continues to Allege That Cuba’s Foreign Medical Missions Engage in Forced Labor (Aug. 17, 2017) See also the list of posts in the “Cuban Medical Personnel & U.S”  in List of Posts to dwkcommentaries—Topical: Cuba.

[3] Ledn, Cuban doctors share their experiences in internationalist missions,Granma (Nov. 26, 2015).

[4] Erisman, Brain Drain Politics: the Cuban Medical Professional Parole Programme, Int’l J. Cuban Studies  269, 286-87 (2012).

[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.

 

Nancy Pelosi and Other House Democrats Visit Cuba

A delegation of Democratic members of the U.S. House of Representatives led by Nancy Pelosi, the Minority Leader of the House, visited the island, February 17-19. They went “to build upon the announcement of U.S. normalization of relations and other initiatives announced by President Obama” and “to advance the U.S.-Cuba relationship and build on the work done by many in the Congress over the years, especially with respect to agriculture and trade.” [1]

The eight members of the delegation were David Cicilline (RI), member of the House foreign Affairs and Judiciary Committees; Rosa DeLauro (CT), the senior Democrat on the House Agriculture Appropriations Subcommittee and Co-chair of the Democratic Steering and Policy Committee;  Eliot Engel (NY), the senior Democrat on the House Foreign Affairs Committee; Anna Eshoo (CA), Ranking Member on the House Energy and Commerce Committee’s Subcommittee on Communications Technology; Steve Israel (NY), Chair of the Democratic Policy and Communications Committee; Jim McGovern (MA), member of the House Agriculture Committee and Co-Chair of the congressional Tom Lantos Human Rights Commission; Collin Peterson (MN), the senior Democrat on the House Agriculture Committee; and Nydia Velazquez (NY), the senior Democrat on the House Small Business Committee. [2]

After their arrival in Cuba, they first went to the U.S. Interests Section’s building on Havana’s Malecon. There they met with the Chief of Mission, Jeffrey DeLaurentis, and his team. “We are proud of them and the U.S. Marines serving us there,” Pelosi said. 

cuba-nancy-pelosi-bruno-rodriguezOn February 18th the delegation had a three and one-half hour meeting with Cuban Foreign Minister, Bruno Rodriguez. and Josefina VIdal, the Foreign Ministry’s leader of the current negotiations with the U.S. (Left is a photograph of Pelosi and Rodriguez.) According to a Cuban website, they “discussed issues related to the current context of ties between the two countries, including restoring diplomatic relations, opening embassies and the debate in Congress on lifting the blockade [embargo] against Cuba.” Afterwards, Pelosi said, ““We discussed areas of interest to the United States and Cuba, and our delegation listened to their concerns, including the embargo, bank and credit financing,” Pelosi said. “We underscored our commitment to human rights in Cuba and agreed to build upon the historic opportunity before us to make progress in our relationship.”

Pelosi+Diaz

On the 19th Pelosi and the delegation met with Miguel Diaz-Canel, Cuba’s First Vice President and presumptive next Cuban president. (Right is a photograph of Pelosi and Diaz-Canel.) They talked about Cuba’s market-style economic reforms, bilateral relations and prospects of the U.S. Congress lifting the country’s 53-year-old trade embargo of Cuba. Afterwards Pelosi told reporters, “There is strong bipartisan support to lift the embargo in the Congress, however it’s not universal and it certainly does not appear to be shared by those in power who have the ability to bring a bill to the floor.”

The delegation also met with leaders of Cuba’s legislature (National Assembly), including its vice president, Ana María Mari Machado. According to Pelosi, “During the meeting, we exchanged views about the actions taken by President Obama and President Raúl Castro. We agreed to continue our interparliamentary dialogue on areas of agreement and disagreement.”

U.S. House of Representatives Democratic leader Pelosi, Archbishop of Havana Cardinal Ortega and members of a delegation of congressional Democrats pose for a photograph in Havana

Other meetings were held with Cuban Cardinal Jaime Ortega (left is a photograph of the Cardinal and the delegation); American students at the Latin American School of Medicine; young entrepreneurs of the island’s emerging private sector; and representatives of civil society, but not with Cuban dissidents.

At a press conference on their last day on the island, Pelosi said, “We’re very positively impressed by what we heard here about our future prospects and the relationship.” Representative Engel noted they had raised the topic of human because “We’re very concerned with human rights and dissident rights. I’d like to see more changes from the Cuban side.”  Representative McGovern concurred with this comment: “The best way to promote human rights is to accelerate this new process to establish formal embassies in Havana and Washington.” The delegation also said they also spoken with Cuban officials about U.S. food sales to the island, internet technology and the island’s emerging small-business sector.

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[1] This post is based upon the following: Press Release, Pelosi Leads Congressional Delegation to Cuba (Feb. 17, 2015); Reuters, Pelosi Traveling with Lawmakers to Cuba, N.Y. Times (Feb. 17, 2015); Fram, Pelosi Leads House Democrats Visiting Cuba, Assoc. Press (Feb. 17, 2015); Press Release, Pelosi Statement on Historic Delegation’s Meetings in Havana (Feb. 18, 2015); Miller, Nancy Pelosi visits Havana, meets with top Castro regime officials, Wash. Times (Feb. 19, 2015); Oleaga, US, Cuba Relations Update: Representative Nancy Pelosi Leads congressional Delegation to Cuba, Hopes to Advance Renewed Relations, Latin Post (Feb. 19, 2015); Cuba FM Meets with Nancy Pelosi, Havana Times (Feb. 19, 2015); Cuban FM meets U.S. lawmakers on normalization of ties, Xinhua (Feb. 19, 2015); Trotta, U.S. congressional delegation meets Cuba’s heir apparent, Reuters (Feb. 19, 2015); Miroff, In Havana, Pelosi delegation promotes Obama’s Cuba thaw, Wash. Post (Feb. 19, 2015); Agence France-Presse, US-Cuba talks tackle human rights, reopening embassies (Feb. 19, 2015);Torres, Pelosi and other Democrats meet with Cuban officials in Havana, Miami Herald (Feb. 19, 2015); Miguel Diaz-Canel received the leader of the Democratic Party in the House of Representatives of the US, Granma (Feb. 19, 2015); Nancy Pelosi: The lock [embargo] is a “measure unsuccessfully,” CubaDebate (Feb. 19, 2015)(English translation by Google Translate); Press Release, Pelosi Statement on Historic Congressional Delegation’s Final Day of Meetings in Cuba (Feb. 20, 2015).

[2] Representative Peterson is a cosponsor of H.R.403 (Free Trade with Cuba Act) while Representatives DeLauro, McGovern and Velazquez are cosponsors of H.R.664 (Export Freedom to Cuba Act of 2015).