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Yahoo
06-05-2025
- Health
- Yahoo
Leaked contract shows how Cuba pockets money Bahamas pays for medical services
The Bahamian government appears to have signed off on a contract that directs most of the money paid for the services of four Cuban health professionals to a Cuban government entity while giving away its legal authority on key issues to the communist-ruled island, according to a copy obtained by a group monitoring Havana's medical missions abroad. Bolstering the United States' allegations of unfair labor practices in Cuba's government-run medical missions, the 2023 contract required the Bahamian Ministry of Health and Wellness to pay $22,000 in monthly fees for the four workers' services directly to the Cuban state company Comercializadora de Servicios Médicos Cubanos, or Trading Company of Cuba's Medical Services. But the four workers themselves — two medical specialists advisers, one computer sciences engineer and a health data specialist— only received a monthly allowance between $990 and $1,200, for a total cost of $4,380, paid directly to them by Bahamian health authorities. Those stipends hover around the country's minimum salary of $250 per week and were deemed enough to cover rent in the expensive islands, which The Bahamas did not provide for the Cuban workers. The leaked contract was published by Cuba Archive, a Miami-based non-profit group that monitors Cuba's medical missions. The U.S. State Department has used the group's work to put together its annual human trafficking report. Last year, the State Department celebrated the group's director, María Werlau, as one of 'outstanding individuals around the world who are fighting to end human trafficking.' The Miami Herald has not independently verified the contents of the contract, which appeared to bear the signature of Bahamian Health Minister Michael Darville. The one-year contract appeared to have been signed in Havana in 2023, but the month and day were left blank in the copy obtained by Cuba Archive, which Werlau believes indicates the agreement is still in place. Four copies of the documents were signed. While Cuba has promoted the medical brigades as a show of solidarity with other nations, the health workers have become a major source of foreign revenue in recent years. The purported agreement with The Bahamas had Cuba receiving between 84% and 92% of the money the Bahamas paid for the services of the Cuban workers. The Cuban state company also collected 50% of the overtime and bonuses paid by The Bahamas to the Cuban staffers. Since 2020, the State Department has kept Cuba on the blacklist of countries that do not do enough to fight human trafficking and has cited the Cuban medical missions as an example of 'forced labor.' Defectors from those missions have said their Cuban handlers confiscate their passports, limit their movements and pressure them to do political work on behalf of the Cuban government. Recently, Secretary of State Marco Rubio expanded visa restrictions on Cuban officials involved with the medical missions to also apply to third-country officials contracting those services. That measure has created friction between U.S. and Caribbean leaders, many of whom have come to rely on Cuban doctors to fill critical gaps in their healthcare systems. Giménez calls for sanctions against countries that do not pay Cuban doctors directly The leaked document has added even more tensions ahead of a visit by Bahamas Prime Minister Philip Davis to Washington. He is expected to be among seven Caribbean leaders meeting with State Department officials on Tuesday, and the Cuban medical brigade is among the topics expected to come up alongside discussions about countering illegal immigration, drugs and firearm trafficking, disaster relief and border security. Bahamian officials have not disputed the contract's authenticity. Davis, who previously acknowledged that 'a portion' of the salaries of the Cuban doctors is sent to a Cuban agency, told reporters last month after the leak that he was speaking to the Cuban government about the 'concerns.' Bahamian Foreign Minister Fred Mitchell, responded by questioning the motivations behind the leak of the contract, which he said could be part of a broader effort to influence Bahamian public policy and undermine national sovereignty. 'The Bahamas government does not engage in any practice contrary to international labor norms. Let's make that abundantly clear,' Mitchell said. He told lawmakers the government must resist forming policy based on 'subjective interpretations of untested material.' The Herald reached out to Darville and Mitchell. Mitchell said his comments were in the public domain and he had nothing more to add. Darville did not respond to a request for comment about whether Cuban professionals were indeed getting less than 20% of the funds the government was paying on their behalf and other legal details in the leaked contract. In March, Darville told the Nassau Guardian newspaper that two ophthalmologists, one retina specialist, one cataract specialist and one optometrist from Cuba are in the country. He also said there are three nurses and other support staff from Cuba. At the time, Darville said The Bahamas' Foreign Affairs Ministry was involved in ongoing negotiations with the U.S. over its concerns about the medical brigade, which some Caribbean leaders think were settled during Rubio's recent visit to Jamaica when the matter was raised with others in the region. 'The services they provide in the country [are] needed, and so the Ministry of Foreign Affairs is presently back and forth with their counterparts in the United States ... because they want more clarity on what we are doing with these workers, because it seems as if there is this cloud that [there] is forced labor, and we don't believe so,' Darville told the paper. A month later, he traveled to Havana, where he met with Cuban Public Health Minister José Angel Portal to discuss their 20-year cooperation and the expansion of Cuba's medical services in The Bahamas. 'During the dialogue, the ministers will discuss new strategies to expand specialized care in priority areas such as ophthalmology, orthopedics, cardiology and oncology, identified as sectors with growing demand,' Cuban state outlet Cubadebate reported about the April 19 meeting. The Trading Company of Cuba's Medical Services is the Health Ministry's firm in charge of exporting medical services and selling health tourism packages. Its affiliation with the ministry is public knowledge. While Caribbean governments have pushed back on Rubio's assertion that the medical brigade program is a form of 'force labor,' the contract signed by The Bahamas reinforces the notion and shows that the relationship is lopsided and favors Cuba. Not only did Bahamian authorities sign away rights to discipline the professionals, leaving it in the hands of the Cuban state agency. They also let Cuba off the hook if any legal disagreement arises, according to a contract provision giving the Cuban government discretion about whether to comply with Bahamian laws. In case of disagreement, the law applicable to the contract is that of The Bahamas, the document says, but with a big caveat: 'provided that such legislation and its effects do not contravene the principles of the social, economic and political system of the Republic of Cuba.' The Cuban entity also had the power to withdraw the doctors at any time, the document shows. And if The Bahamas were to agree to U.S. requests to move away from the current contract to negotiate better terms for the Cuban doctors, the language in the document would still make The Bahamas liable for payments to the Cuban government. The Cuban government seems to have planned specifically for this scenario. The document includes language that would make the Bahamian government still liable for its obligations under the agreement in the face of 'any provisions, regulations, proclamations, orders or actions... of foreign governments to the parties or others that in any way prevent or attempt to prevent... the complete performance of this agreement.' At least two other Caribbean governments that employ Cuban medical professionals say they do not have the same terms as the ones in The Bahamas' contract. However, because contracts are not made public, the claims cannot be independently verified. The Bahamas agreement includes a confidentiality provision prohibiting the disclosure of its details for two years after its completion. Werlau told the Herald that it is not enough for governments to arrange to pay doctors in these missions directly, because Cuban authorities have concocted other schemes to confiscate most of the money. For example, in 2012, the head of a Cuban official educational mission in The Bahamas, another type of service offered by the Cuban government to other countries, sent an email detailing how the Cuban teachers were supposed to collect the salaries paid directly by Bahamian authorities and wire most of it back to Cuban authorities on the island. Werlau said his organization had developed screening guidelines for foreign officials and human rights groups to discern whether Cuban doctors have been trafficked and urged foreign officials to publish the contracts. If other nations need Cuban doctors, she said, 'they should hire them directly, as they do with any other foreign doctor who comes to practice in their country. They should pay them directly. The doctors should be able to bring their families. They should not be subject to all these restrictions through an intermediary that is a dictatorship.'
Miami Herald
06-05-2025
- Health
- Miami Herald
Leaked contract shows how Cuba pockets money Bahamas pays for medical services
The Bahamian government appears to have signed off on a contract that directs most of the money paid for the services of four Cuban health professionals to a Cuban government entity while giving away its legal authority on key issues to the communist-ruled island, according to a copy obtained by a group monitoring Havana's medical missions abroad. Bolstering the United States' allegations of unfair labor practices in Cuba's government-run medical missions, the 2023 contract required the Bahamian Ministry of Health and Wellness to pay $22,000 in monthly fees for the four workers' services directly to the Cuban state company Comercializadora de Servicios Médicos Cubanos, or Trading Company of Cuba's Medical Services. But the four workers themselves — two medical specialists advisers, one computer sciences engineer and a health data specialist— only received a monthly allowance between $990 and $1,200, for a total cost of $4,380, paid directly to them by Bahamian health authorities. Those stipends hover around the country's minimum salary of $250 per week and were deemed enough to cover rent in the expensive islands, which The Bahamas did not provide for the Cuban workers. The leaked contract was published by Cuba Archive, a Miami-based non-profit group that monitors Cuba's medical missions. The U.S. State Department has used the group's work to put together its annual human trafficking report. Last year, the State Department celebrated the group's director, María Werlau, as one of 'outstanding individuals around the world who are fighting to end human trafficking.' 'Forced labor' The Miami Herald has not independently verified the contents of the contract, which appeared to bear the signature of Bahamian Health Minister Michael Darville. The one-year contract appeared to have been signed in Havana in 2023, but the month and day were left blank in the copy obtained by Cuba Archive, which Werlau believes indicates the agreement is still in place. Four copies of the documents were signed. While Cuba has promoted the medical brigades as a show of solidarity with other nations, the health workers have become a major source of foreign revenue in recent years. The purported agreement with The Bahamas had Cuba receiving between 84% and 92% of the money the Bahamas paid for the services of the Cuban workers. The Cuban state company also collected 50% of the overtime and bonuses paid by The Bahamas to the Cuban staffers. Since 2020, the State Department has kept Cuba on the blacklist of countries that do not do enough to fight human trafficking and has cited the Cuban medical missions as an example of 'forced labor.' Defectors from those missions have said their Cuban handlers confiscate their passports, limit their movements and pressure them to do political work on behalf of the Cuban government. Recently, Secretary of State Marco Rubio expanded visa restrictions on Cuban officials involved with the medical missions to also apply to third-country officials contracting those services. That measure has created friction between U.S. and Caribbean leaders, many of whom have come to rely on Cuban doctors to fill critical gaps in their healthcare systems. 'Concerns' The leaked document has added even more tensions ahead of a visit by Bahamas Prime Minister Philip Davis to Washington. He is expected to be among seven Caribbean leaders meeting with State Department officials on Tuesday, and the Cuban medical brigade is among the topics expected to come up alongside discussions about countering illegal immigration, drugs and firearm trafficking, disaster relief and border security. Bahamian officials have not disputed the contract's authenticity. Davis, who previously acknowledged that 'a portion' of the salaries of the Cuban doctors is sent to a Cuban agency, told reporters last month after the leak that he was speaking to the Cuban government about the 'concerns.' Bahamian Foreign Minister Fred Mitchell, responded by questioning the motivations behind the leak of the contract, which he said could be part of a broader effort to influence Bahamian public policy and undermine national sovereignty. 'The Bahamas government does not engage in any practice contrary to international labor norms. Let's make that abundantly clear,' Mitchell said. He told lawmakers the government must resist forming policy based on 'subjective interpretations of untested material.' The Herald reached out to Darville and Mitchell. Mitchell said his comments were in the public domain and he had nothing more to add. Darville did not respond to a request for comment about whether Cuban professionals were indeed getting less than 20% of the funds the government was paying on their behalf and other legal details in the leaked contract. In March, Darville told the Nassau Guardian newspaper that two ophthalmologists, one retina specialist, one cataract specialist and one optometrist from Cuba are in the country. He also said there are three nurses and other support staff from Cuba. At the time, Darville said The Bahamas' Foreign Affairs Ministry was involved in ongoing negotiations with the U.S. over its concerns about the medical brigade, which some Caribbean leaders think were settled during Rubio's recent visit to Jamaica when the matter was raised with others in the region. 'The services they provide in the country [are] needed, and so the Ministry of Foreign Affairs is presently back and forth with their counterparts in the United States ... because they want more clarity on what we are doing with these workers, because it seems as if there is this cloud that [there] is forced labor, and we don't believe so,' Darville told the paper. A month later, he traveled to Havana, where he met with Cuban Public Health Minister José Angel Portal to discuss their 20-year cooperation and the expansion of Cuba's medical services in The Bahamas. 'During the dialogue, the ministers will discuss new strategies to expand specialized care in priority areas such as ophthalmology, orthopedics, cardiology and oncology, identified as sectors with growing demand,' Cuban state outlet Cubadebate reported about the April 19 meeting. The Trading Company of Cuba's Medical Services is the Health Ministry's firm in charge of exporting medical services and selling health tourism packages. Its affiliation with the ministry is public knowledge. While Caribbean governments have pushed back on Rubio's assertion that the medical brigade program is a form of 'force labor,' the contract signed by The Bahamas reinforces the notion and shows that the relationship is lopsided and favors Cuba. Withdrawing doctors Not only did Bahamian authorities sign away rights to discipline the professionals, leaving it in the hands of the Cuban state agency. They also let Cuba off the hook if any legal disagreement arises, according to a contract provision giving the Cuban government discretion about whether to comply with Bahamian laws. In case of disagreement, the law applicable to the contract is that of The Bahamas, the document says, but with a big caveat: 'provided that such legislation and its effects do not contravene the principles of the social, economic and political system of the Republic of Cuba.' The Cuban entity also had the power to withdraw the doctors at any time, the document shows. And if The Bahamas were to agree to U.S. requests to move away from the current contract to negotiate better terms for the Cuban doctors, the language in the document would still make The Bahamas liable for payments to the Cuban government. The Cuban government seems to have planned specifically for this scenario. The document includes language that would make the Bahamian government still liable for its obligations under the agreement in the face of 'any provisions, regulations, proclamations, orders or actions... of foreign governments to the parties or others that in any way prevent or attempt to prevent... the complete performance of this agreement.' At least two other Caribbean governments that employ Cuban medical professionals say they do not have the same terms as the ones in The Bahamas' contract. However, because contracts are not made public, the claims cannot be independently verified. The Bahamas agreement includes a confidentiality provision prohibiting the disclosure of its details for two years after its completion. Werlau told the Herald that it is not enough for governments to arrange to pay doctors in these missions directly, because Cuban authorities have concocted other schemes to confiscate most of the money. For example, in 2012, the head of a Cuban official educational mission in The Bahamas, another type of service offered by the Cuban government to other countries, sent an email detailing how the Cuban teachers were supposed to collect the salaries paid directly by Bahamian authorities and wire most of it back to Cuban authorities on the island. Werlau said his organization had developed screening guidelines for foreign officials and human rights groups to discern whether Cuban doctors have been trafficked and urged foreign officials to publish the contracts. If other nations need Cuban doctors, she said, 'they should hire them directly, as they do with any other foreign doctor who comes to practice in their country. They should pay them directly. The doctors should be able to bring their families. They should not be subject to all these restrictions through an intermediary that is a dictatorship.'
New York Times
14-04-2025
- Business
- New York Times
Trump Takes Aim at a Key Cuban Export: Its Worldwide Medical Missions
As a newly minted U.S. citizen, Ramona Matos, once a doctor in Cuba, did not hesitate when deciding whom to vote for last year. She chose Donald J. Trump, the candidate who promised to be tough on Cuba's communist government. She hoped he would help free the Cuban people and, in particular, put an end to a tool the government in Havana has used to soften its image around the world — one that Ms. Matos found particularly repugnant for personal reasons. For decades, the Cuban government has sent thousands of health professionals to work in remote villages and cities in dozens of countries, where they get just a fraction of what the countries pay Cuba for their services. 'Those doctors are slaves to the Cuban dictatorship,' said Ms. Matos, 63, who, after posts at Cuban medical missions in Bolivia and Brazil, is a factory worker in South Florida. Beginning on his first day in office, Mr. Trump has started tightening the screws on Cuba, including on its global medical program. With a Cuban American secretary of state and an envoy to Latin America known as a longtime hawk on Cuba policy, the Trump administration quickly imposed tougher measures. It was the latest twist in the back-and-forth approach toward Cuba, which shifts from aggression to softening, depending on who occupies the White House. The Trump administration reversed moves made by the Biden administration, returning Cuba to the list of state sponsors of terrorism, which limits its ability to do business around the world, and restoring the right of Americans to sue over property confiscated on the island decades ago. Cuban officials have had their visas yanked and the administration has prohibited business transactions with companies controlled by Cuba's military, intelligence and security services, which manage vital interests such as tourism and imports. Republican administrations have tried to target Cuba's medical missions before, but Mr. Trump is taking a harder line: In February, for the first time, the U.S. government said it would withdraw the travel visas of officials in countries that host the medical brigades. The measure threatens one of Cuba's main sources of currency, just as the nation grapples with a huge wave of migration, widespread power outages and food shortages. It's difficult to figure out exactly how much the medical program generates for Cuba — experts note that the government's figures are often unclear, because it frequently changes the descriptions of the payments and lumps together different kinds of services. Overall, Cuba earns more than $4 billion a year by exporting health care employees, construction workers, educators and other types of skilled workers, according to a study by Cuba Archive, a Miami-based human rights organization, which produced the findings for the State Department's annual Trafficking in Persons report. Four government officials, two from Venezuela and two from Cuba, have lost their travel visas to the United States over the new medical brigade policy, the U.S. State Department said. 'I don't agree with everything Trump does, but on the subject of Cuba, I find it wonderful,' Ms. Matos said. Cuba's medical brigades work in dozens of countries from Africa to South America and the Caribbean. Though they are often depicted as humanitarian missions for nations in need of health care, the countries pay Cuba for doctors, nurses, technicians and other service providers, helping the Cuban government fund its own health care system. Cuban officials say the country currently has 24,000 people posted in 56 countries. The program peaked in 2014 but has declined over the past decade because of disputes with Brazil and cutbacks in Venezuela. The health workers, who study medicine for free in Cuba, generally participate in the program willingly because they earn far more than they would at home. But they only receive a portion — human rights activists say 2 to 15 percent — of what governments pay Cuba for their services. Half of the workers' pay is held in a devalued local currency account in Cuba, from which they can withdraw only after returning home from their assignments. Doctors who served overseas say their passports were taken from them, they were not allowed to socialize with locals and, in some communities, had to keep a 6 p.m. curfew. They also could not bring their families. Under the administration of President George W. Bush, doctors who fled the program were offered fast-track entry into the United States, and many deserted. One doctor who fled in 2019 said the monthly salary she received in Venezuela's local currency during a period of hyperinflation was enough to buy just a loaf of bread and a can of soda. She worked 48-hour shifts, often without electricity, and bunked with three other Cuban doctors. 'It's a Cuban government business, literally,' said the doctor, who asked that she only be identified by her first name, Leydy, because the government sometimes harasses her family at home. 'The truth is, it's exploitation.' Leydy is now studying to be a nurse practitioner in Florida. Because she never returned to Havana, the Cuban government kept the $10,000 she earned in Venezuela over 15 months, she said. Maria Werlau, the executive director of Cuba Archive, the Miami-based human rights group, described the program as 'a scheme for forced labor.' The amount governments have paid Cuba per doctor varies, ranging from $900 in Guatemala to $5,000 in Kenya. In Equatorial Guinea, doctors received $1,000 of the $10,000 the government paid for them, Cuba Archive's report said. Ms. Werlau noted that U.S. federal law calls for sanctions against countries that participate in trafficking. While the State Department has accused Cuba of labor trafficking for years, Ms. Werlau believes the United States should also penalize governments that participate in the program. The Cuban government insists that the medical program does not meet the international legal definition of labor trafficking because employees are not tricked and know where they are going. The employees receive a salary, pension and a 'decent' stipend in the destination country, where their lodging, transportation and often food expenses are covered, Cuba's deputy foreign minister, Carlos F. de Cossío, said in an emailed response to questions. 'The Cuban professionals who participate do so voluntarily,' he said. Mr. de Cossío said they have 'complete freedom of movement,' an assertion human rights activists say hundreds of doctors who have left the program have disputed. No countries have withdrawn from the program because of the new policy, Mr. de Cossío said. Mr. Trump's policy to cancel visas from officials of countries that participate in the program 'is aimed at strangling the Cuban economy by means of threats and coercion on governments and entities of third countries, thus reinforcing the siege they have imposed for decades,' he said. 'Predictably,'' Mr. de Cossío added, 'it has affected our people's standard of living, restricting income, damaging essential services such as electricity, water, transportation and health care.' Leaders of several Caribbean countries have balked at the new visa rule and said they'd happily forfeit trips to the United States. Jamaica has up to 400 Cubans, mostly nurses, who have filled important gaps in the nation's medical care, said Christopher Tufton, Jamaica's minister of health and wellness. 'We don't have any evidence that there is trafficking taking place,' Mr. Tufton said in an interview. In Trinidad and Tobago, where 87 nurses and nine doctors from Cuba work, the authorities have ensured that the program meets labor standards, Prime Minister Stuart Young said. 'We remain grateful to Cuban health care providers who provide service in key areas to people of Trinidad and Tobago in conditions that they and we can be proud of,' said Amery Brown, a medical doctor who serves as minister of foreign affairs. 'The conditions are actually excellent.'' But a Cuban doctor who had been posted in Port of Spain, the capital of Trinidad and Tobago, and who spoke on the condition her name not be published because she fears reprisals, said so much of her $3,500 monthly payment was kept in a Cuban account that it was difficult to survive. Mauricio Claver Carone, Mr. Trump's envoy for Latin America and a longtime advocate for tough sanctions on Cuba, said more countries needed to use a model like the one in Barbados, where the government hires doctors directly. 'We want to basically have a united voice against indentured servitude, against human trafficking,' he said. In 2018, Ms. Matos sued the PanAmerican Health Organization, a U.N. agency that had a role in managing the program in Brazil. She considers it 'modern slavery.' 'Isn't that a slave, that you restrict a person from going wherever they want, talking to whoever they want?' she said. 'Not to mention the salaries.'
