Michael Abrahams | The complexity of the Cuban doctor crisis

The recent decision by the Jamaican Government to terminate its arrangement with the Cuban Government regarding its Medical Brigade has created a furore. However, the complexity of this multifaceted issue is unappreciated by many.

After the Cuban Revolution ended in 1959, the US instituted an embargo which has been in place for the last 66 years, the longest in its history. The embargo includes restrictions on travel and on all commercial, economic, and financial activity, contributing to shortages of food, medicine, electricity, water and essential machinery and equipment in the country. A major component of Cuba’s plan to mitigate the economically stifling effects of the embargo is to export skilled workers, mainly health care professionals, to other countries, and the medical missions have become the country’s largest source of foreign income.

However, there are legitimate concerns. Several international organisations and countries have flagged the use of exploitative practices and repressive measures within the programme, reporting human rights violations from trafficking and forced labour to what some perceive as modern slavery. For instance, the Cuban Government keeps most of the salaries paid to its health workers in its missions overseas, between 75 per cent and more. The doctors still take home significantly more than they would have in Cuba, but other issues remain.

Personnel often have their passports confiscated by Cuban officials upon arrival in host countries. Many also report being watched by Cuban security officials while on their missions and claim that they did not volunteer to join the missions but were coerced. They are also not allowed to take their families to the host nations with them. The doctors can choose to be paid directly, but if they defect from the programme, they are punished by being banned from entering Cuba for eight years.

In 2018, Brazil became the first major country to terminate its agreement with Cuba. Far-right president-elect Jair Bolsonaro requested that the doctors be paid their full salaries directly, that their families be allowed to join them, and that their credentials be validated in Brazil. The Cuban Government refused to comply, and they called the doctors home.

Since President Trump returned to office last year, the pressure on countries to discontinue current arrangements with Cuba regarding medical professionals has intensified. In February last year, U.S. Secretary of State Marco Rubio announced that Washington would restrict visas, targeting “forced labour” linked to the Cuban labour export programme. In August, the U.S. announced that it was revoking the visas of Brazilian, African and Caribbean officials over their ties to the programme. This year, Trump has further escalated the pressure, cutting off oil shipments from Venezuela to the country, pressuring Mexico to do the same, and threatening to slap tariffs on any country that delivers oil there while declaring Cuba “an unusual and extraordinary threat” to U.S. national security.

And since Trump’s return, multiple countries have re-visited their arrangements with Cuba. In June 2025, the Bahamas cancelled contracts with Cuban healthcare professionals after discussions with the U.S. Government, and since late 2025, Paraguay, Antigua and Barbuda, St Vincent and the Grenadines, Guatemala, Guyana, Dominica and Honduras have either terminated their arrangements with Cuba or are in the process of doing so. Jamaica discontinued its arrangement in March after requests that the doctors be paid their salaries directly and be allowed to retain possession of their passports were not granted by the Cuban Government.

Does the US have the right to call out Cuba for its human rights violations and oppressive practices? Yes, it does. Cuba’s communist regime is indeed guilty of many human rights offences. Some observers also accuse the Government of mismanagement. For example, a Miami Herald investigation found that the Cuban military has as much as $18 billion in its coffers and the investigators suggested that the embargo should not be blamed for all the country’s economic woes.

But America is more tolerant of other states that have similar issues. For instance, it trades with China and sells weapons to Saudi Arabia, two authoritarian regimes with well-documented human rights violations. The US also maintains a very close relationship with Israel, a country accused of multiple human rights violations involving Palestinians. Recently, in February, over 80 United Nations (UN) member states condemned Israel’s de facto annexation of the West Bank.

The US is doing all it can to terminate Cuba’s Medical Brigade programme under the guise of concern for human rights, while simultaneously orchestrating a humanitarian crisis in the country. Not only has the embargo, which has been condemned by the UN General Assembly for 33 consecutive years, affected the country economically, but the fuel blockade has precipitated its worst electricity crisis in nearly 70 years, plunging it into darkness repeatedly and increasing the suffering of its people. Perishable foods and drugs that require refrigeration are spoiling, garbage is piling up as garbage trucks lack fuel, surgeries and other medical procedures have been interrupted, running water, which requires electric pumps to be delivered, has been cut off for many residents, and numerous flights have been suspended due to the shortage of jet fuel.

So, the Cuban Medical Brigade has assisted our country immensely, but there are aspects of the programme that impinge on the rights of its workers. Pressure from the US is definitely a factor contributing to the exodus of Cuban medical personnel from the Caribbean and from Central and South America, but with the nature of the balance of power between the US and the countries in the region, failure to comply with the wishes of the US has the potential to adversely affect the citizens of these nations. It is also apparent that regime change is a greater priority for the US than the wellbeing of the Cuban people. The cessation of the programme will hurt us, but it is the Cuban citizenry who are the ultimate victims, caught between the oppression of their regime and the collective punishment they are being subjected to by the US.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams