Cuba sends doctors on medical missions. The U.S. isn’t a fan : NPR

Cuban doctors wave their national flag as they arrive in Honduras for a medical mission in February 2024. They are now leaving Honduras as the United States urges countries to reconsider their agreements with Cuba.

Orlando Sierra/AFP/via Getty Images

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Orlando Sierra/AFP/via Getty Images

Is this a laudable humanitarian effort or an affront to human rights?

This is the debate that revolves around a Cuban program that sends tens of thousands of doctors and other health professionals abroad to treat people.

Cuba proudly asserts that these “medical brigades” demonstrate solidarity with their compatriots in the South. But the program is not only altruistic. It is also one of the largest sources of foreign funds for the island, as the countries that receive the small army of health workers pay Cuba for these services.

The U.S. State Department has long criticized the system, saying participants are coerced and underpaid by the government. In a statement to NPR, the State Department calls it “forced labor” and “human trafficking.”

Now the Trump administration is increasing pressure on countries to withdraw from these agreements with Cuba. A number of them in Latin America and the Caribbean are lining up. Countries yielding to this pressure include Guatemala, Guyana, Jamaica, Saint Vincent and the Grenadines, Paraguay and Honduras. They are phasing out programs, reevaluating the payment model, and sometimes canceling them altogether.

Here’s how it works and why it’s so controversial.

The backstory

The program began more than 60 years ago and typically provides medical assistance to poor communities and underserved rural areas – often in low-resource countries like Angola, Guatemala and Venezuela, but also in some high-income countries. For example, a Cuban team traveled to Italy to help during the early years of the COVID crisis.

The numbers are impressive: in 2024, more than 20,000 Cuban medical personnel were serving in more than 50 countries, according to grandmotherthe official newspaper of the Communist Party in Cuba.

Under agreements with different countries, the Cuban government often receives a large sum for each doctor, but the doctors themselves receive only a small percentage of this money.

When Dr. Leyani Perez Gonzalez was a doctor in Cuba in the early 2000s, she says it was difficult to make ends meet. “At the time, a doctor’s salary in Cuba was about $20 a month,” she says. “With $20 in Cuba at that time, I could only buy a pair of shoes.”

Financial difficulties led Gonzalez to apply to be part of a Cuban medical mission abroad. She says she could get paid about four times as much working on board. In 2008, Cuba sent Gonzalez to Venezuela. “I was in a primary care setting, seeing people with different chronic illnesses, children and pregnant women,” she recalls.

The American point of view

Gonzalez loved working with patients, but she says the rest of the experience was miserable and scary. She was placed in a poor and very violent neighborhood. Additionally, she said, the Cuban government was constantly monitoring her and taking steps to ensure she couldn’t escape. She had to return to Cuba. “They took away our passports,” she said.

She describes medical missions as a form of slavery.

She ultimately decided to flee, even though she had no passport, no idea where to go and what her future held.

Fortunately for her, she soon learned that the United States shared her concerns about Cuban medical missions. During the presidency of George W. Bush, the State Department created a system allowing Cuban medical professionals stationed abroad to seek refuge in the United States and obtain residency. It was called the Cuban Medical Professional Parole Program and ended under President Barack Obama, when he restored diplomatic relations with Cuba.

But now – under the leadership of President Trump and Secretary of State Marco Rubio, a longtime critic of the Cuban regime – the United States is returning to its contradictory approach to the program. This adds up to a punishment oil blockade the United States imposes.

In August 2025, the Trump administration decided to revoke visas and impose visa restrictions on government officials from Brazil, Grenada, and other countries. a little African country because they worked with Cuba on these programs. “Our action sends an unequivocal message that the United States encourages accountability for those who enable the Cuban regime’s forced labor export program,” Rubio said in a statement at the time. press release.

The United States has also recently passed a law allowing it to impose sanctions on countries that work with Cuban doctors.

“The countries that have broken these contracts are afraid. They are afraid of retaliation from the United States,” explains William LeoGrande, professor of government at the School of Public Affairs at American University. “It’s typical of Donald Trump’s foreign policy, which is essentially based on coercive diplomacy: ‘Do it our way, or else.’ So: ‘Get rid of the Cuban doctors, or else.’

It’s complicated

Not everyone agrees with the U.S. position on Cuban medical missions. It’s “really extreme,” LeoGrande says.

Stephanie Panichelli-Batallaprofessor of global sustainability at the University of Warwick in the United Kingdom, says this program “is, in fact, much more complex” than the United States claims.

She acknowledges that Cuba has a strong financial incentive for the program: “It is the highest income of foreign funds for Cuba. Cuban doctors are in a way a commodity used by the country to survive economically.”

However, she is quick to add that some consider this system “extremely intelligent”, helping Cuba “in its economic context, while doing good in the world.” She also points out that although doctors are not well paid, they earn much more than in Cuba. And they volunteer for these missions. “They then go back to Cuba and manage to renovate their apartments, or buy this or have this, and they have a standard of living that the average Cuban people don’t have,” she says.

The other long-standing problem, she said, is Cuba’s confiscation of participants’ passports. According to her, from Cuba’s point of view, the country has invested in free training of doctors and does not want to lose them. Given the difficulty for Cubans to leave the island and the severity of the economic crisis, “they have never communicated precise figures, but[thenumberofdoctorswhodesertwouldexplodeiftheygavethempassportsSotheywouldneveracceptthatIt’snotasurprise”shesaid[thenumberofdoctorswhodesertwouldexplodeifyougivethempassportsSotheywouldneveragreetothatThat’snosurprise”shesays[lenombredemédecinsquidésertentexploseraitsionleurdonnaitdespasseportsIlsn’accepteraientdoncjamaiscelaCen’estpasunesurprise”dit-elle[thenumberofdoctorswhodesertwouldexplodeifyougivethempassportsSotheywouldneveragreetothatThat’snosurprise”shesays

When a special rapporteur looked into the system for Office of the United Nations High Commissioner for Human Rightsthey reported several issues, including the working and living conditions of participants and the sanctions imposed on their family members in Cuba if their loved one abandons their post abroad.

What is happening to health care?

As countries withdraw from their agreements with Cuba and doctors pack their bags, a big question arises.

“If we start canceling all of these programs, what is going to happen to these vulnerable communities who will lose access to health care? » asks Panichelli-Batalla. NPR asked the State Department about U.S. plans to fill this role, but did not receive a response to that question.

Some countries, the Bahamas for example, hope to pay Cuban doctors directly. The possibility thrills Dr. Gonzalez, who now lives in Florida and has retrained to work as a nurse practitioner in the United States.

“I’m very happy because they offer doctors the power to get paid and have freedom,” she says.