In the middle of the covid-19 pandemic one Cuban asset was in high demand from all corners of the world: its exported doctors. For decades Cuba has sent them abroad to burnish its international reputation and fill its coffers. Although the number of its medical professionals working abroad has fallen by more than half in the past decade, around 24,000 still work in more than 50 countries, including as many as 1,500 in the Caribbean.
Now Marco Rubio, the US secretary of state, says that the doctors work abroad as “forced labour” and that any officials complicit in such activity will have their visas to the United States revoked. Cuba blames this attack on the “personal agenda” of Mr Rubio, the son of Cuban migrants. Yet this latest decision reflects Donald Trump’s disdain for the small communist island. During his first presidency he imposed sanctions on Cuban officials involved in the medical programme.
But the latest policy goes even further, targeting not just foreign officials but also their family members. It ratchets up pressure on Caricom, the 15-strong group of Caribbean countries, which have long seen unity as their only means of international leverage. They are in a bind: they need Cuban doctors to prop up their fragile health-care systems but cannot afford to antagonise the United States.
Cuban and Caribbean leaders deny the accusation of forced labour and challenge the White House to prove it. Mia Mottley, the prime minister of Barbados, says Cuban doctors receive the same wages as local Barbadians. Official figures for Cuban doctors’ salaries are not widely known; it is estimated Cuba’s government pays its medical workers about 10-15% of what it receives from host governments, then pockets the difference. The doctors’ take-home pay varies widely, from $200 a month for those working in Guyana to $1,000 a month in Qatar. Both sums are a fortune compared with the average pay of $50-75 a month back home.
No Caribbean health-care system could survive without medical staff from Cuba, says Dominica’s prime minister, Roosevelt Skerrit. The 1,500 or so Cuban medical professionals that work in the Caribbean are regarded as some of the islands’ best staff. Some Caribbean leaders, including the prime ministers of Barbados and Trinidad & Tobago, have tried to call Mr Rubio’s bluff by saying they would forgo their visas to the United States if need be. Ralph Gonsalves, prime minister of St Vincent & the Grenadines, says: “I would prefer to lose my visa than to have 60 poor and working people die.”
Caricom and Cuba have long enjoyed close relations, much to the annoyance of Uncle Sam. Frank Mora, an ambassador to the Organisation of American States under Joe Biden, says Caribbean countries pushed back “very, very hard” in regional settings whenever Cuba came up.
Some Caribbean islands are more vulnerable to Trumpian pressure than others. In Guyana some 240 Cuban doctors and nurses paper over staff shortages. Cuban doctors go to remote rural areas, says Kadasi Ceres of the University of Guyana. “You can’t put a price on that.” But the small state needs American security backing to protect its oil and gas off the coast of Essequibo from Venezuelan claims to it. Caribbean countries are feeling the sticky heat of Mr Trump’s policies. They hope things will cool down soon. ■
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