Canadian Government Also Baffled by Medical Problems of Diplomats in Cuba

For nearly two years the U.S. publicly remains baffled by the causes of the medical problems of 26 U.S. diplomats stationed in Cuba. Twelve Canadian diplomats while in Cuba also have suffered similar problems, and the Canadian government publicly also remains baffled.[1]

Now the Canadian government has engaged brain injury experts from the Brain Repair Center, affiliated with Dalhousie University, the Nova Scotia Health Authority and the Isaak Walton Killam Health Center, to investigate the symptoms and possible causes that left Canadian diplomats and family members with a series of mysterious symptoms.[2]

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[1]  See posts listed in the “U.S. Diplomats Medical Problems in Cuba, 2017-18” section of List of posts to dwkcommentaries—Topical: CUBA.

[2]   Campion-Smith, Ottawa teams with brain injury experts as it probes mystery attacks on Canadian diplomats in Cuba, Toronto Star (Sept. 30, 2018); Experts in brain injuries will examine Canadians affected by the ‘attacks’ in Havana, Diario de Cuba (Oct. 2, 2018).

State Department’s Cuba Accountability Review Board Report

On August 30, the U.S. Secretary of State submitted a report to Congress about the Cuba Accountability Review Board’s (ARB) investigation and report regarding the State Department’s responses to medical problems of some U.S. diplomats in Cuba. [1]

The ARB’s 30 recommendations, all of which were accepted by the Department were grouped into the following six areas:

  • “Accountability: The ARB found the lack of a single designated senior-level Department official with responsibility for responding to the attacks resulted in insufficient communications with employees and impeded coordination within the Department and with other agencies. The ARB recommended elevating the overall responsibility for the Cuba response to the Deputy Secretary of State. In May, the Deputy Secretary – at the Secretary’s request – established the interagency Health Incidents Response Task Force to direct a multi-agency response to the unexplained health incidents that have affected U.S. government personnel and family members stationed overseas. The Department has committed to reviewing – and revising when necessary – procedures for ensuring continued senior-level leadership at all times, as well as validating and strengthening guidance for Chiefs of Mission (including Chargés), emphasizing their responsibility for the safety and security of personnel abroad. The Department is establishing a new position solely responsible for longer-term outreach and assistance to personnel affected by these incidents.”
  • “Interagency Coordination: The ARB found that interagency information sharing should be enhanced to improve understanding of the problem and more coordinated initial responses. The ARB noted the Department’s well-established and successful procedures for dealing with crisis situations and highlighted the benefit of reviewing its processes for communication and coordination with interagency partners, as well as reminding leaders of these processes. The Department agrees with these recommendations and will re-issue guidance outlining the various tools and processes Washington and posts abroad have available to prepare for and respond to crisis situations. The Department will reinforce the importance of proper and timely implementation of these procedures, and is committed to working with interagency partners to ensure coordination of efforts on the response to the incidents.”
  • Medical Issues: The ARB found the Department’s Bureau of Medical Services provided competent and professional response to an unprecedented situation, but they had insufficient resources to support the long-term care and follow-up needed for these types of incidents. To address the ARB’s recommendations, the Department, in coordination with other appropriate U.S. government agencies, is identifying and reviewing applicable legal authorities and resources for long-term medical follow-up and treatment for U.S government personnel and families impacted by the incidents in Cuba, and will seek legislative remedies where necessary. The Department is also working closely with the Department of Labor to allow for the proper adjudication of workers’ compensation claims from Department personnel. Additionally, the ARB recommended the Department make pre-departure and post-assignment medical screening a mandatory condition for assignment to, or temporary duty in, Havana. The Department is in the process of developing policy modifications to make such screenings mandatory. The ARB also recommended the Department engage the Centers for Disease Control and Prevention (CDC) to undertake a comprehensive medical and epidemiologic study of the symptoms and clinical findings related to the incidents in Cuba. The Department is working with the CDC to support such an analysis.”
  • Internal Communication and Information Sharing: The ARB made several recommendations to facilitate communication and information sharing in the case of any future incidents. The Department is implementing the ARB’s recommendations, with the goal of: clarifying responsibilities, providing centralized points of contact to coordinate efforts, establishing clear notification protocols, and ensuring as much transparency as possible to those affected, taking into account the privacy of the individuals involved as well as sensitive law enforcement and national security information.”
  • “Risk/Benefit Analysis: The ARB made several recommendations to ensure the Department enacts its already established processes to conduct formal risk/benefit analyses and ensure any actions balance Department priorities with risk management. The Department is implementing these recommendations, and taking steps to enhance broader awareness of these processes throughout the Department. For example, the Department has processes to conduct an analysis at least once annually of mitigation measures and residual risks associated with operating at high threat, high risk posts and at those posts on Authorized or Ordered Departure for 90 days or more due to security reasons. The Department will continue to implement this approach.”
  • “Diplomatic Security: The ARB found individual offices within the Bureau of Diplomatic Security (DS) responded to the Cuba incidents reports based on their respective areas of expertise, but that the overall response would have benefitted from the formulation and resourcing of a formal DS multi-disciplinary working group. The Department agreed, and DS formed a Health Incidents Response Working Group with members from all relevant DS offices reporting to the DS Assistant Secretary. This working group has increased communication among the various interagency investigative representatives, and ensured action items are addressed quickly and comprehensively. Additionally, to address future potential unexplained health-security incidents, the Department developed standardized formal guidance, leveraging existing crisis response processes, designed to ensure a consistent response from all agencies at post. All posts are reviewing and updating their emergency action plans to incorporate this guidance. The ARB also suggested the Department review its training programs for security personnel. DS is in the process of reviewing its training and briefing programs to ensure security officers have adequate knowledge of these types of incidents prior to going to post.

The report to Congress stated that the Department already had implemented half of the ARB’s 30 recommendations and is actively working to complete the rest.

“The ARB’s mandate was not to determine the cause of the unexplained health incidents.” (Emphasis added.)

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[1] U.S. State Dep’t, Cuba Accountability Review Board (Aug. 30, 2018). The underlying developments for the ARB are discussed in the “U.S. Diplomats’ Medical Problems in Cuba” section of List of Posts to dwkcommentaries–Topical: CUBA.

 

U.S. State Department Softens Travel Advisory for Cuba

On August 23, the U.S. State Department revised its Travel Advisory for Cuba. Now, Cuba is “Level 2: Exercise Increased Caution.[1] The new Advisory  states the following:

  • “Exercise increased caution in Cuba due to attacks targeting U.S. Embassy Havana employees resulting in the drawdown of embassy staff.”
  • “Numerous U.S. Embassy Havana employees appear to have been targeted in specific attacks.  We are unable to identify the source.  Many of these employees have suffered injuries.  Affected individuals have exhibited a range of physical symptoms including ear complaints and hearing loss, dizziness, headaches, fatigue, cognitive issues, visual problems, and difficulty sleeping.”
  • “Attacks have occurred in U.S. diplomatic residences (including a long-term apartment at the Atlantic) and at Hotel Nacional and Hotel Capri in Havana.”
  • “The U.S. Embassy in Havana is operating with reduced staffing.  Family members cannot accompany U.S. government employees who work in Cuba.
  • “If you decide to travel to Cuba:
  • Avoid Hotel Nacional and Hotel Capri.
  • If you experience any acute auditory or sensory phenomena, immediately move to another area.
  • Know where to seek medical carein Cuba.
  • Consult with a medical professional prior to traveling if you have personal health concerns or upon return if you believe you have suffered symptoms similar to those listed above.
  • Enroll in the Smart Traveler Enrollment Program (STEP)to receive Alerts and make it easier to locate you in an emergency.
  • Follow the Department of State on Facebook and Twitter.
  • Review the Crime and Safety Reportfor Cuba.
  • S. citizens who travel abroad should always have a contingency plan for emergency situations.  Review the Traveler’s Checklist.”

This action supersedes and thereby cancels the Level 3 Category issued this January that advised Americans to reconsider travel to the island. Thus, the new Advisory is an upgrade, and its legend “Exercise Increased Caution” implicitly means increased caution over that for the Level 1 (top) category. [2]

Orna Blum, a spokeswoman for the State Department’s Bureau of Western Hemisphere Affairs, said, “The Department conducted a comprehensive risk assessment for U.S. private citizen travelers in Cuba and decided that a Level 2 travel alert was appropriate. The health attacks appear to be directed at U.S. government personnel and occur mainly in the residences of embassy staff.”

Reactions

“We are pleased that the State Department has made this common-sense decision,” said Martha Honey, executive director of the Center for Responsible Travel (CREST), a coalition of U.S. tour operators and organizations. “Cuba is one of the safest countries in the world, and people-to-people exchanges, which began to flourish under the Obama administration, ground almost to a halt when the travel restrictions were imposed last year.”

A similar reaction came from Collin Laverty, president of Cuba Educational Travel, who said, “It is a breath of fresh air in a highly politicized process of confusion, anxiety and speculation which led to an excessive measure by the State Department.” He said the initial decision to elevate the Cuban travel advisory was politically motivated and that now the United States is “righting its wrong by assessing that Americans need not reconsider travel to Cuba in order to stay safe.”

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[1]  U.S. State Dep’t, Travel Advisory: Cuba—Level 2: Exercise Increased Caution (Aug. 23, 2018); Whitefield & Gámez, U.S. softens its Cuba travel advisory, still advised caution, Miami Herald (Aug. 23, 2018); Reuters, U.S. State Department Softens Travel Advisory on Cuba, N.Y. Times (Aug. 23, 2018).

[2] State Department’s New Travel Advisory System for Cuba and Other Countries, dwkcommentaries.com (Jan. 11, 2018).

U.S. and Cuba Continue To Hold Dialogues on Common Issues

On July 10 and 11, 2018, the U.S. and Cuba in Washington D.C. continued to hold bilateral meetings. On July 10, the subject was law enforcement. On the 11th, migration. As was true for other such meetings, each country released statements about the meetings. Here is a summary of those statements.

Law Enforcement Dialogue[1]

U.S. Statement

According to the U.S. State Department, the two countries  “addressed topics of bilateral interest on national security matters, including fugitives and the [U.S.] return [to Cuba] of Cuban nationals with [U.S.] final orders of removal.” They also “reviewed recent progress in the law enforcement relationship, such as new bilateral cooperation that resulted in the [U.S.] conviction of a Cuban national who murdered an American citizen and who had fled prosecution in the [U.S.], as well as areas where there is more work to be done, such as trafficking in persons.”

The U.S. also said there was discussion about “the health attacks against diplomatic personnel at the U.S. Embassy in Havana, including two recent cases. The U.S. delegation reminded the Cubans of their responsibility to protect U.S. diplomats from harm.”[2]

Cuban Statement

The Cuban Foreign Ministry’s statement had these words about the medical issues of certain U.S. diplomats in Cuba: “The Cuban delegation urged the U.S. government to desist from the continued political manipulation of the alleged health incidents that became a pretext to adopt new unilateral measures that affect the operation of the respective embassies, particularly, the rendering of consular services depended upon by hundreds of thousands of people.”

“The investigations carried out by specialized agencies and experts from Cuba and the United States for more than one year confirmed that there is no credible evidence or hypothesis or science-based conclusions that justify the actions taken by the U.S. government against Cuba to the detriment of bilateral relations. Last June 5, U.S. Secretary of State himself affirmed that ‘the precise nature of the injuries suffered by the affected personnel, and whether a common cause exists for all cases, has not yet been established.’”

Nevertheless, the Cuban delegation “reiterated its unchanged commitment to cooperate with the U.S. authorities to clarify this situation. Ensuring the health and security of Cubans and foreign citizens is and will be a priority of the Cuban government. “

In addition, the Cuban statement said, “The purpose of these exchanges is to coordinate the bilateral cooperation in the field of law enforcement and to advance in the combat against the different crimes that threaten the security of the two countries such as terrorism, illicit drug trafficking, trafficking in persons, cybercrimes, among others.”

Cuba added, “While reviewing the exchanges on the different areas of security, the Cuban side made reference to the concrete results of this bilateral cooperation, which has contributed to prevent crimes and prosecute offenders. The Cuban delegation also made emphasis on the information and requests for cooperation [while still waiting for a U.S. response] to further advance in the implementation of this mechanism.”

“Both sides agreed to continue with this dialogue and to keep holding the technical meetings between the law enforcement agencies from both countries to bring bilateral cooperation to fruition.”

Migration Dialogue[3]

U.S. Statement

“The delegations discussed the significant reduction in irregular migration from Cuba to the [U.S.] since the implementation of the [January 12, 2017 Joint Declaration]. Apprehensions of Cuban migrants at U.S. ports of entry decreased by 88 percent from fiscal year 2017 to 2018. The [U.S.] again raised the need for increased Cuban cooperation in the [U.S.] return of Cubans with final orders of removal from the [U.S.]”[4]

The [U.S.] also reiterated that until it is safe to fully staff our Embassy, we are able to adjudicate only official and emergency visas in Havana.”

“A strong migration policy is vital to the [U.S.’] national security. The Migration Talks, which began in 1995, provide a forum for the [U.S.] and Cuba to review and coordinate efforts to ensure safe, legal, and orderly migration between Cuba and the [U.S.].”

Cuban Statement

Both “parties acknowledged the benefits of the Joint Declaration of January 12, 2017, in particular the elimination of the policy of “Dry feet-wet feet” and the “Parole Program for Cuban Medical Professionals,” in the decrease of irregular emigration.”

“They also agreed on the usefulness of the exchange between [U.S.] Coast Guard Troops and the [Cuban] Coastguard Service held in January 2018, and the technical meeting on trafficking in persons and immigration fraud carried out in December 2017.”

In addition, “compliance with bilateral agreements was reviewed, in order to guarantee a regular, safe and orderly migration; discourage irregular migration, and prevent and confront associated illicit acts. Cuba demonstrated that it rigorously fulfills its obligations, and reiterated its willingness to maintain and expand bilateral cooperation in this area.”

“The Cuban delegation urged the government of the [U.S.] to fully comply with its commitments to issue visas for migrants, in accordance with the Migration Agreements. . . . [The U.S.] decision to suspend visa processing services at its embassy in Havana directly affects migratory relations and family ties, damaging institutional exchanges and travel between the two countries.”

The Cubans also “expressed concern about the [U.S.’] Cuban Adjustment Act, which, together with other US regulations, encourages the irregular emigration of Cubans and exposes them to becoming victims of illegal traffickers and gangs associated with organized crime.”

Conclusion

Despite the Trump Administration’s continued hostile rhetoric and actions regarding Cuba, it is reassuring that the two countries are continuing to have respectful dialogue on many common issues and reaching agreement on some of these problems. May it continue!

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[1]  U.S. State Dep’t, United States and Cuba Hold Fourth Law Enforcement Dialogue in Washington, DC (July 10, 2018); Cuba Foreign Ministry, Cuba and the United States hold fourth meeting on law enforcement dialogue, Minrex (July 11, 2018); Washington once again reminds Havana of its responsibility in the protection of its diplomats, Diario de Cuba (July 11, 2018). The most recent prior meeting was in September 2017. (U.S. State Dep’t, United States and Cuba Hold Third Law Enforcement Dialogue in Washington, D.C. (Sept. 15, 2017).) This blog has commented on prior bilateral meetings. E.g., Cuba and U.S. Continue To Hold Bilateral Meetings on Various Issues (Jan. 18, 2018).

[2]  On July 11, 2018, the issue of the medical problems of the U.S. diplomats cane up at a House of Representatives Foreign Affairs Committee hearing. Kenneth Merten, Acting Principal Deputy Assistant Secretary for Western Hemisphere Affairs, testified, “We don’t know who is responsible and we don’t know what is responsible for this. . . . We have taken this … very seriously, both in the Cuba context and the China context which is, frankly, still very much evolving.” At the hearing, Reps. Ed Royce (R-Calif.) and Eliot Engel (D-N.Y.) — the Foreign Affairs Committee chairman and ranking member, respectively — said they planned to meet with Deputy Secretary of State John Sullivan on Wednesday afternoon and would discuss the health incidents with him.”  (Reuters, State Department Still Investigating Diplomats’ Illnesses in Cuba, China, N.Y. Times (July 11, 2018); Greenwood, State Dept: No answers in sonic attacks in Cuba, China, The Hill (July 11, 2018).) Prior posts about these medical problems are listed in the “U.S. Diplomats Medical Problems in Cuba, 2017-18” section of List of Posts to dwkcommentaries.com—Topical: CUBA.

[3] U.S. State Dep’t, U.S. and Cuba Hold Biannual Migration Talks in Washington, DC (July 11, 2018); Cuba Foreign Ministry, Migratory Round Held between Cuba and the United States (July 11, 2018); Celebrated Migratory round between Cuba and the United States, Cubadebate (July 11, 2018). Two days before the latest migration meeting, a Cuba Foreign Ministry official in an  interview asserted that Cuba  has “rigorously” complied with its migration agreements with the U.S. despite the U.S. creation of “obstacles to the fulfillment of its obligations.” (Cuba Foreign Ministry, Cuba strictly complies with migration agreements with the US, MINREX (July 9, 2018).)

[4] The January 2017 Joint Declaration eliminated the U.S. policy of admitting into the U.S. Cubans who arrived on land with “dry feet” and the U.S. Program for Parole for Cuban Medical Personnel. See these posts to dwkcommentaries.com: U.S. Ends Special Immigration Benefits for Cubans (Jan. 13, 2017); Additional Reactions to End of Special Immigration Benefits for Cubans (Jan. 14, 2017); Other Current Developments Regarding Cuban Migrants to U.S. (Jan. 15, 2017).