Analysis: US pressure leads countries to break with Cuban medical missions

Hector Zelaya walks cautiously through an abandoned eye clinic in Honduras, with the slow pace of someone still relearning how to see.

The stout, middle-aged man was scheduled to undergo cataract surgery in April at the clinic in Catacamas, located on the lower slope of a wooded hill, about four hours east of Tegucigalpa, the country's capital.

But his surgery was abruptly canceled when the Honduran government in March terminated its contract with "Mission Miracle," a Cuban public health program that sends thousands of health workers to developing countries but which has also been criticized by the United States and other countries for involving forced labor.

The order came from Honduran President Nasry "Tito" Asfura, a conservative supported in last year's elections by US President Donald Trump, who said the sending of Cuban doctors, nurses and other medical specialists to Honduras did not comply with local regulations.

Honduras is among several countries in the Americas that have announced the cancellation of their contracts with Cuban medical missions - a pillar of foreign policy and an important source of foreign resources for the socialist island.

Jamaica, Guyana, Guatemala and even Venezuela - which has received by far the largest number of Cuban doctors in the last 20 years - have also terminated or are in the process of terminating their contracts with Cuban medical missions.

Havana criticized the decisions, claiming that they are "decrees from Washington", amid the Trump administration's intense diplomatic and economic pressure campaign on Cuba.

Last week, the US government indicted 94-year-old former Cuban president Raúl Castro, in a move that echoes steps taken before the ouster of former Venezuelan president Nicolás Maduro.

United States Secretary of State Marco Rubio, the son of Cuban immigrants, has been outspoken against the program, stating in February 2025 that the US would impose visa restrictions on third-party government employees responsible for Cuban medical missions.

The action was immediate: last year, he announced visa restrictions for officials from Central America, Africa, the Caribbean and Brazil.

The State Department "has taken steps to restrict the issuance of visas to Cuban and complicit third-country officials, as well as to individuals responsible for Cuba's exploitative labor export program. We will hold the Cuban regime accountable for the oppression of its people and those who profit from forced labor," said Rubio.

Cuban doctors wave paper Cuban flags as they arrive at Palmerola International Airport on February 27, 2024 - Orlando Sierra/AFP/Getty Images via CNN Newsource
But for many low-income farmworkers like himself, Zelaya said the Cuban program was their only chance to receive affordable health care.

Depending on the region, the average monthly salary in Honduras ranges from US$400 (approximately R$2,000) to US$800 (approximately R$4,000), and the Cuban clinic in Catacamas was the only public health option for eye surgery in the country's largest province.

Zelaya ended up spending US$2,250 (approximately R$11,300), paid with the help of his family, at a private clinic for the operation, he said.

"Most people here wouldn't be able to afford that," he said.

Cuban program is the subject of debate
Cuban medical missions have long been the subject of debate: on the one hand, the brigades - as these missions in Cuba are known - are seen as a means of expanding public health to remote locations such as Catacamas.

On the other hand, critics consider them a public relations tool in the service of an authoritarian dictatorship that dates back to the 1960s.

In April, an extensive report by the Inter-American Commission on Human Rights attempted to clarify the situation, recognizing the positive contribution of the brigades, but at the same time alleging forced labor practices and coercive methods on the part of the Cuban leadership.

Health workers are routinely underpaid and paid a fraction of what their host countries pay for their services, are not allowed to leave or establish relationships with the communities they are sent to, and are asked to deliver political messages in the name of the revolution or local governments, the report says.

Cuba has long denied similar accusations and the Cuban government did not respond to a series of questions from CNN related to the missions.

Members of the missions who speak openly about Cuba, where freedom of expression is limited, say they support the brigades as channels to foster international solidarity.

In 2022, the left-wing portal Breakthrough News interviewed a Cuban doctor who worked in Guatemala, Liberia, Italy and Portugal, European Union countries that hosted missions during the Covid-19 pandemic.

"Our philosophy is to help whoever we can", commented Dr. Juan Aleman, describing the history of the medical brigades since their creation in the 1950s as a selfless gesture by the late Cuban leader Fidel Castro.

Cuban doctors walk towards a bus as they arrive at Palmerola International Airport on February 27, 2024 - Orlando Sierra/AFP/Getty Images via CNN Newsource
However, the reality is more complex, as Cuba also uses the brigades to raise funds for the government.

A US State Department website estimates that Cuba brings in up to $4 billion a year, a figure disputed by Havana.

Last year, Cuban President Miguel Díaz-Canel defended his country's "right to use medical cooperation as a source of income."

Because Cuba is under US embargo and trade opportunities are limited, medical brigades have become an export like any other, he argued.

Doctors speak out
Two former Cuban medical professionals who worked in Venezuela confirmed the allegations made by the IACHR (Inter-American Commission on Human Rights) to CNN.

Asking to speak anonymously to protect their families, both said they joined the missions in search of economic opportunities unavailable in Cuba, but became disillusioned with exploitation by their superiors and the system.

One of them, a 35-year-old physiotherapist, served two different missions for the country between 2017 and 2024, before returning to Cuba at the end of his work period. He left the country permanently last year.

"In Cuba, we joke that your salary can cover your food, your clothes or your shoes, but not all three at the same time... Through the mission, I managed to save money, but then I decided to leave," he told CNN.

The physiotherapist was 26 years old when he traveled to Venezuela for the first time - it was the first time he had left Cuba. Venezuela was in an economic crisis in 2017, but it still had a profound impact.

"I remember the first time I went to a supermarket, I couldn't believe I could buy whatever I wanted on my own salary," he told CNN.

He managed to save more than US$6,000 during his first mission, a considerable amount for any Cuban.

He has since moved to Colombia, where, thanks to the training he received on missions, he got a job in a private clinic.

The brigades' medical skills are still relevant, but the idea of public health missions serving a country's geopolitical interests is outdated, he said.

"Cuba is like a bubble, and when you're in there, they say the rest of the world is bad. When in fact, it's only when you leave that you start to open your eyes," he said.

"My dream is to return one day, but to return, it needs to be a different Cuba," he added.

Who is Díaz-Canel, the Castro's successor president who sees Cuba under threat

Source: CNN