Doctors, not bombs: Cuba’s strategic medical missions

During the ongoing COVID-19 pandemic, the island state of Cuba is sending hundreds of doctors around the world to combat the virus. According to the Cuban government this is an act of solidarity in line with the ideology of the Cuban revolution. The Cuban medical missions have been praised widely and civil society organizations have started petitions calling for the Nobel Peace Prize to go to the doctors. However, opponents of Cuba’s medical missions claim that the doctors are victims of exploitation by their government, a view that is held by the United States and its allies. Ever since the Cuban Revolution in 1959, the US maintained a hostile policy and an economic blockade against the island. Brazilian president Jair Bolsonaro also recently expelled several Cuban doctors working in the country, and the same thing happened in Bolivia. Despite this pressure, Cuba keeps sending doctors abroad. It could be argued that these medical missions are a strategic political tool, which may help to push for a relaxation of the US sanctions. So what exactly is the purpose of Cuba’s medical missions, and what is the history behind the country’s very well-trained medical professionals? 

The history of Cuban medical internationalism

Even though Cuban doctors have only recently received global attention because of the pandemic, it is not the first time they are sent abroad to places in need. Cuba has a long history of medical internationalism. One of the biggest accomplishments of the Cuban Revolution was the implementation of a wide, public, and free healthcare system spanning the entire island. The first time Cuba sent doctors to another country was to Chile after the earthquake in 1960. Shortly after, Cuban doctors also went to Algeria, which at the time was a newly independent country. In the 1980’s, Cuba decided to start training doctors for the purpose of exporting healthcare as Fidel Castro was committed to make the country a medical superpower. 

With the fall of the Soviet Union in the early 1990’s, Cuba lost its most important trade partner. This led to the so-called Special Period in Cuba, an economic crisis that lasted almost a decade. The Special Period was characterized by shortages in everything, and even though the healthcare system never lost its place on the list of priorities for the government, the crisis also affected the availability of medicine and medical equipment. The situation led to a search for new sources of hard currency to access much needed imports and to reduce the isolating effects of the US economic blockade. A dual-currency system was implemented, and tourism became the main source of income, which also led to the emergence of inequalities based on access to hard currency. 

Regional integration and expansion of international cooperation

In 1999, close relations were established with newly elected Hugo Chávez in Venezuela, whose country received Cuban doctors in exchange for oil. This helped Cuba to relieve the fuel shortages the island had suffered since the fall of the Soviet Union. Cuban doctors were key in Chávez’s social programmes, the so called misiones. A well-known example of such a mission or programme is Barrio Adentro, which provided healthcare for Venezuelans living in slums where doctors did not usually go. Another programme is Operación Milagro, in which Cuban doctors perform free eye surgeries and have restored the sight on three million people in poverty all over Latin America. Ironically, the soldier who shot Che Guevara in Bolivia received eye surgery through this programme.

The Cuban state has also financed the education of many international students to study medicine on the island. Fidel Castro inaugurated ELAM, the Latin American Medical School, in Havana in 1999, despite the critical situation during the Special Period. Ever since its founding, the school has received thousands of students from Third World countries. It has also welcomed students from low-income areas in the US, whose enrolment is coordinated by the organization Interreligious Foundation for Community Organization and its program Pastors for Peace. The only obligation for US students is to practice medicine in their neighbourhoods after returning home. Both the ELAM and the international medical missions are characterized by a form of “revolutionary medicine”, traced back to the Cuban revolution and its vision of healthcare as a fundamental human right. 

In 2003, Fidel Castro held a famous speech at the University of Buenos Aires, in which he spoke of the missions. “Doctors, not bombs!” he shouted, criticizing the US who had just invaded Iraq at the time. Since 2003, the amount of Cuban medical missions abroad increased drastically. The Henry Reeve Brigade, a team of doctors specialized in disaster medicine and infectious disease containment, was established in 2005. Cuba had this brigade ready to go to the US during Hurricane Katrina in 2006. However, instead of accepting this offer for help, George W. Bush created the program CMPP (Cuban Medical Professional Parole), which encouraged Cuban doctors to defect from medical missions by offering quick asylum in the US. 

Why do Cuban doctors want to go abroad?

By 2020, Cuban doctors have worked in over 60 countries. It is voluntary for doctors to sign up for an international medical mission, and there are different reasons why many do it. Many cite the plain morality and the obligation to help people as the strongest reason to go and there are also significant economic advantages. While doctors work abroad, they receive several times as much as their salary in Cuba. The government also sends money to the doctors’ families every month and places hard currency in a savings account for when the doctor returns home. Cuba only charges host countries with the financial ability to pay, such as South Africa or Qatar. Cuba is paid per doctor and most of it goes back into the country’s national healthcare system. Further, many doctors who get to work abroad are Afro-Cubans and women, social groups who generally take less part in the tourist industry and therefore have less access to hard currency. US academic Sarah A. Blue has written about this in more detail put into a wider context within Cuban society.

In sum, the Cuban medical missions can be seen to serve several purposes. Providing help in times of need out of ideological commitment is one, but these missions also help Cuba to gain political legitimacy internationally, as well as providing hard currency for its public healthcare system and its citizens. During the COVID-19 pandemic, countries around the world have expressed gratitude for the Cuban doctors, including European countries like Italy and Spain. Cuba has called for global cooperation to combat the pandemic, and regardless of critical debates concerning underlying intentions, Cuba is showing that they are turning these words into actions.

Julian Dannefjord