Statement from the Cuba Nobel Organizing Committee
In July 2020 Human Rights Watch (HRW) issued a spurious report entitled “Cuba: Repressive Rules for Doctors Working Abroad,” repeating shameful and already debunked accusations that Cuban medical missions are a form of human trafficking because the personnel are alledgedly subjected to “regulations and laws that violate their right to privacy, freedom of expression and association, liberty, and movement.” Instead of commending the Cuban medical brigades that have saved lives all over the world, received a prestigious award from the World Health Organization and been nominated for the Nobel Peace Prize, HRW tries to discredit the program and misrepresents the regulations that affect Cuban doctors. It is astonishing that the report gives second-hand accounts from disgruntled former participants, but fails to include positive feedback from any of the 400,000 medical professionals who have participated in Cuba’s missions, bringing free or accessible healthcare to underserved populations throughout the world. It also fails to mention that not only are these missions abroad voluntary, but there are more Cubans who want to participate than there are spaces available.
Misrepresentation of the rights and obligations of Cuban medical volunteers
The bulk of the report focuses on the allegedly “draconian” rules placed on doctors deployed overseas, yet most of the rules mentioned are commonplace for diplomats. While volunteers for Cuba’s medical missions are not diplomats in a formal sense, they are representatives of the Cuban people and work for their government. As such, it makes sense that they are discouraged from visiting places that will “damage [their] prestige” or that they would need authorization to speak to the media. For comparison, the U.S. State Department, in a manual on protocol, tells its diplomats to “go along with traditions” of the host country, even if they exhibit gender bias. Does HRW condemn the U.S. for its “draconian” rules that violate diplomats’ rights to freedom of expression?
The HRW report considers it a violation of freedom of expression that Cuban volunteers require “authorization to participate in public acts of a political or social nature.” This is the same for diplomats, who have a duty to not interfere in the internal affairs of the receiving state. It is common sense that this same duty applies to Cuban medical personnel and it protects them from false accusations of political interference. The regulation also reassures a country like Honduras – where the government is the ideological opposite of Cuba – that the doctors it receives will not interfere in domestic Honduran affairs.
HRW also claims that Cuban medical staff who abandon their positions can face eight years in prison but was unable to find a single example of anyone being subjected to such a penalty. For comparison, a member of the U.S. military who abandons his or her post can face the death penalty.
Furthermore, HRW fails to contextualize the rules placed on Cuban doctors within the 60-year history of aggression from the United States. The report makes no mention of the blockade against Cuba, the U.S. policy of regime change towards Cuba, U.S. infiltration of Cuban organizations, or U.S. support for groups involved in terrorist activities against Cuba.
The report also fails to mention direct U.S. attacks on the medical missions. The Cuban Medical Professional Parole Program, for example, which began in 2006 and formally ended in 2017, sought to bribe Cuban doctors to defect by offering incentives such as residency in the U.S. – a practice that has been described as “brain drain politics.” Another example is the program by the Agency for International Development (USAID) that allocates millions of dollars to discredit the brigades by digging up “information related to human rights violations of Cuban medical personnel exported overseas.”
It is in response to this sort of aggression that Cuba implemented regulations to discourage “friendships or links of any types with … [people] who assume hostile or contrary positions to the Cuban Revolution.” Imagine if a U.S. diplomat befriended a member of the Taliban or another organization explicitly hostile to the United States. Wouldn’t the State Department be concerned? Would HRW condemn a prohibition against such fraternization?
Human Rights Watch also neglects to provide context as to why Cuban doctors volunteer to go abroad. Many professionals view their work abroad as something deeply moral. As Dr. Julio Guerra said while traveling to fight the coronavirus in Italy, “I’m going because I’m a doctor. This is how doctors everywhere should be educated—to cure people anywhere in the world.” An added incentive is that they earn more money than they can make at home. The personnel abroad still earn their Cuban salaries. If the host government pays salaries (which is not always the case, as there are poor governments that receive Cuban services free of charge), the Cuban personnel retain a portion of that. The portion kept by the Cuban government has, over the years, become a significant source of income to support Cuba’s health system, including the free education that all doctors receive. The revenue has been used to upgrade equipment and to repair and build health and social welfare facilities, such as nursing homes. In 2019, all Cuban health professionals received raises financed in part by the revenue from international missions. So it is a win-win for the volunteers and the Cuban people who benefit from universal healthcare.
Flawed use of sources
In three successive paragraphs, the Human Rights Watch report cites sources that do not correspond to their claims or are flatly inaccurate. For example, it links to a Granma article about an online dialogue between the Cuban Ministry of Health and health professionals seeking clarification about a 2012 rule that requires travel permits for certain medical professionals to leave the country. HRW uses that link to support its false claim that the rule applies “even if [the medical professionals] resign from their positions in the National Health System.” Yet the article cited says the exact opposite: “Upon retiring one is exempt from having to apply for a travel permit.”
In the very next paragraph, HRW says that it can take no more than five years “to process a request by a health worker to live abroad” and decries the “long wait,” claiming that it is “allegedly justified” by the need to train a replacement medical professional. However, in the same article previously cited by HRW, the Cuban Ministry of Health states that the entire process, “from the request made by the professional until the corresponding response can last up to 50 days.” It hardly seems repressive to ask an active medical professional to wait up to fifty days to ensure that their travel abroad will not affect the ability of the Cuban health care system to provide services, especially considering that the education of Cuban medical professionals takes sixe years and is provided at no cost.
The paragraph after that links to a website that is misleading in that it cites a question posed in the Granma article as a declaration of fact, as seen in the image below. HRW goes on to claim that Cuban medical personnel who abandon their posts face an 8-year ban from re-entering the country. However, no mention is made that Cuba has – since 2015 – offered such personnel the opportunity to return to Cuba with their jobs intact.
On the left, a question posed by a Cuban doctor to a Health Ministry official as quoted in Granma. On the right, the same text as a declaration rather than question, in a source cited by HRW.
Again, Cuba is responding to a serious concern over the emigration of highly trained specialists to other countries, considering the investment made by the state in their education. It is common for developing countries to place hurdles to prevent “brain drain” and even developed countries understand this. For example, the United States requires that foreign specialists, including physicians, obtain a “no objection statement” from their home country in order to seek permanent residency in the U.S.
Another source cited by the HRW report is Prisoners Defenders, an NGO based in Spain that is led by Javier Larrondo, a strident anti-Castro activist. Larrondo has a history of making wild claims about Cuba, including that “it is an island full of slaves that serve a dynasty.” HRW claims that it reviewed dozens of statements from Cuban health care professionals collected by Prisoners Defenders between 2001 and 2018. During that same period, tens of thousands of Cubans volunteered for medical missions abroad. The statements of a few dozen doctors are hardly representative of the experiences of the vast majority of Cuba’s volunteers.
The HRW report also cites a letter sent in November 2019 by the UN Special Rapporteurs on Contemporary Forms of Slavery and on Trafficking in Persons. The rapporteurs raise questions about Cuba’s medical missions but provide no mention of the sources of the allegations. At no point have these rapporteurs visited Cuba in any official capacity, nor have they conducted a survey of the volunteers. This letter is in no way a report, yet HRW claims the rapporteurs “reported… that doctors have excessive work hours.” In fact, the rapporteurs expressed concern over allegations that doctors can work between 48 and 64 hours a week; they did not establish that these allegations are true. The report mentions a Cuban government response that denies the allegations, but fails to provide any details from the Cuban government perspective.
Additionally, in the United States, according to the American Medical Association, “most physicians work between 40 and 60 hours per week, but nearly one-quarter of physicians work between 61 and 80 hours per week.” It is unlikely that HRW will issue a report denouncing the human rights violations of U.S. doctors.
It is shameful that HRW is attacking a medical program that is saving lives throughout the world during a pandemic, particularly as it is doing so in a seemingly coordinated manner with the Trump administration and right-wing senators like Ted Cruz, Marco Rubio and Rick Scott. The latter three recently introduced legislation in the U.S. Senate to include nations who accept Cuban medical assistance in the State Department’s annual Trafficking in Persons Report.
In response to this legislation, Sir Ronald Sanders, Ambassador of Antigua and Barbuda to the United States, wrote the following: “For many countries of the Caribbean, the presence of Cuban medical personnel has made a huge and beneficial difference to their capacity to manage COVID-19 and its spread. It is no exaggeration to say that, without the Cuban medical personnel, the medical system of several Caribbean countries would have collapsed.” By characterizing Cuba’s medical missions as repressive, Human Rights Watch is contributing to the Trump administration’s ongoing attacks against the island nation, while doing a disservice to the many thousands of people who depend on these volunteers for life-saving medical care.
Since 1959, Cuban doctors have helped millions of people in 164 countries. John Kirk, professor and author of “Healthcare without Borders: Understanding Cuban Medical Internationalism,” explains the sentiment behind their work: “The Cuban overseas medical program generates funding to maintain Cuba’s excellent health care system—in many ways on par with those in the Global North. But there is also a strong element of altruism, of the need to collaborate and share Cuba’s impressive human capital—something which is clearly stated in the preamble to the national constitution. We in the Global North are not used to seeing altruism to this degree, but it is in the Cuban DNA.” This altruism explains why Cubans are willing to risk their own lives to save lives, as they did fighting Ebola in Africa, cholera in Haiti and now coronavirus all over the world. HRW not only ignores this altruism, it frames its entire report around individual rights, disregarding the collective rights guaranteed by Cuba’s healthcare and education systems, as well as the rights of patients overseas who receive treatment.
Human Rights Watch concludes that governments seeking support from Cuban health workers should “press Cuban authorities to modify applicable regulations and laws that violate the right to privacy, freedom of expression and association, liberty, and movement.” A more relevant request, however, would be to ask the U.S. government to lift the sanctions on Cuba that violate international law and the right of the Cuban people to their basic needs, including food and medicine, during a pandemic.