Trafficking of doctors in the Caribbean: The story of five Cuban Women

In March, during his first official visit to Jamaica, U.S. Secretary of State, Marco Rubio reaffirmed Washington’s position on the Cuban medical brigades: “They basically operate as forced labor,” Rubio said at a press conference, and mentioned that “the doctors are not paid” for their services directly, but “the Cuban government decides how much of anything to give them”, and “take away their passports.” The strong accusations, although publicly rejected by the authorities of Jamaica, Cuba, and other countries in the region, had an immediate effect on the Jamaican medical mission: the Cuban side—which had indeed confiscated the passports—gave the order to return them to the doctors. 

In this report, five women working in the healthcare system reveal a pattern of expropriation and extreme control within the Cuban professional brigades in the Caribbean, a claim that the host governments insist on denying. Their experiences, backed by official documentation, paint a clear picture of the violations of international labour standards in medical missions.

***

For Yaniset* joining the “Cuban Medical Brigade in Jamaica” was never a matter of choice, nor of solidarity: few things are more compelling than a hungry daughter and a salary that can’t fill her plate. That’s why she couldn’t refuse to provide medical services in Kingston, as “a white coat heroine” under the orders of Cuba’s Ministry of Public Health (MINSAP). But, more than saving the lives of others, she ended up rescuing her own family from the misery that threatened to engulf them.

In 2015, Yaniset only had one purpose: to give a better life to her daughter. “I had to leave her behind,” she tells CubaNet, referring to the ban imposed by the Cuban regime on traveling to internationalization missions in the company of one’s family. And adds:

“It was the only way I could fix up my house because with my salary…, I could either feed (badly feed) or else dress my daughter .” She was aware that the Cuban Medical Services, a MINSAP company that manages the recruitment of Cuban personnel with the local government, would keep a portion of her wages, nevertheless, she thought that working abroad would be worth the sacrifice. 

About seven years later, it was Mirta’s* turn. She landed in the same Jamaican city looking to work to save money, also leaving her daughter in Cuba in the care of her own elderly mother. All the stamps in her passport—there are plenty—show the many back-and-forth journeys with the medical brigades. In all this time, the Cuban authorities have not found a solution for the thousands of mothers who must split from their children to fulfill an “internationalist mission.”

The reason for this is to maintain the family hostage on the island so that the professional is forced to return to Cuba and continue serving the system, says researcher Maria Werlau, executive director of the NGO Archivo Cuba, based in Miami, United States. 

It is the mothers—and the Cuban children, and grandmothers—who bear the weight of failed social and health policies on an island from which they must escape to support those left behind. The human cost is incalculable and the family is most impacted.

“As a mother, I missed out on many things during my daughter’s transition from childhood to adolescence. It is what has hit me the most; I am still coming to terms with it”, she laments; while pointing at the obstacles imposed by Cuban officials in cases of family emergencies. “They make it difficult for the collaborator to go to Cuba to say goodbye to a loved one in their final stage of life and even attend their wake or funeral,” she adds.

One by one, Yaniset’s and Mirta’s plans fell apart. No matter how many overtime hours they worked, they could not save enough money due to the leonine conditions of their employment. Since at least 2015, a Cuban doctor’s salary in the Jamaica mission has been replaced with a monthly stipend. Half of their income must be transferred, subject to threats, to the account of the Cuban Medical Brigade in the southern island, explains Mirta. What remains for the collaborator is less than 50% of what a Jamaican colleague earns. This scheme qualifies as extortion—a form of modern slavery that the authorities of this and other countries in the region insist on denying.  

“Thanks to Marco Rubio, we got our passports back”

On February 25, the State Department announced that the United States may revoke the visas of foreign officials whose countries employ Cuban professionals in the so-called “medical missions”, formally known as Cuban Medical Brigades (CMB). The measure, which seeks to combat forced labor practices in international cooperation programs and to hold the enabling governments to account, was received with concern and rejection by the Latin American and Caribbean leaders, whose communities rely heavily on Cuban health personnel to keep their services afloat. 

In the Caribbean Basin alone, Cuba has deployed approximately “19,000 health collaborators, which accounts for more than 75%” of all such workers worldwide, and generates billions of dollars each year for the Cuban regime, said Maria Werlau, executive director of the NGO Archivo Cuba based in Miami. The researcher has been documenting the export of Cuban professional services since 2010.

In addition to the important financial gains—Werlau adds—the cooperation program serves “as propaganda and to gather followers” ​​because “it creates loyalties that ensure votes in international organizations, as well as international support.” 

During an official visit to Jamaica on March 25th, the U.S. Secretary of State, Marco Rubio, stated that his government is not against the medical assistance or the work of Cuban doctors. However, the objection stems from the violations of international labor standards associated with the Cuban government’s cooperation program.

“I’m talking about this program in general…And how it is operated around the world is that, basically, the doctors are not paid…”, he said, adding that only the Cuban government shall decide what portion of the salary the workers can get. The Cuban-American official specified that the confiscation of the salary, as well as the withholding of ID documents, are patterns of forced labor present in these medical brigades. 

In response, Jamaican Prime Minister Andrew Holness and Health and Welfare Minister Christopher Tufton have insisted that Cuban medical personnel “provide a valuable service in the health system” in their country and are not exploited. Jamaica faces a significant healthcare workforce shortage, aggravated by COVID-19, with a deficit of around 50% of doctors and nurses; a common problem which Cuba has been taking advantage of in the region. Other countries of the Caribbean Community (CARICOM) had already denied human trafficking accusations in the Cuban medical missions operating in their territories. 

“We ensure they are treated within our labor laws and benefit like any other worker. Therefore, any characterization of the program by others would certainly not be applicable to Jamaica,” underlined Holness. Likewise, the health minister explained that his country is involved in the hiring of Cuban personnel and guarantees corresponding remuneration, which was shared by the Cuban government.

The head of the CMB in Jamaica, Katia Ochoa, thanked the support of the authorities in the face of what she considered “attacks on health missions by the US Secretary of State.” According to Michael Cabrera, director of the Central Medical Cooperation Unit—another MINSAP entity that since 1984 has coordinated the sending of health missions abroad—more than 24,500 Cuban professionals provide services in 56 countries, something that, he assures, “the US government or anyone who tries will not be able to change.”

However, Rubio’s statements had two immediate effects: The Government of Jamaica announced that it “coincidentally” started a revision of the terms of the bilateral deal with Cuba (which establishes salary payment to the CMB bank account as opposed to the Cuban worker directly), which will allow “clarifying issues” and “adjusting elements of the agreement,” declared Tufton. Also, the Cuban side—led by Ochoa—gave the order to the brigade leaders to return the ID documents to the collaborators. 

“Thanks to Marco Rubio, they returned the passports to all the collaborators; at least it is progress,” a health worker from Jamaica told CubaNet, who requested anonymity for fear of reprisals. 

Three sources consulted by CubaNet assure that, upon arriving in Jamaica, the mission leadership removes the identification documents of its subordinates to prevent them from abandoning the mission. “Under the excuse that they are going to stamp your work permit in your passport, they take it away from you,” says Yaniset. If the collaborators need to carry out any procedure, they must request permission from the brigade leader, and, at the same time, such leader must have the authorization of the head of the mission. 

Jamaica

More than 400 Cuban healthcare professionals provide services in Jamaica. Of them, a third will soon return to Cuba, according to statements from its Minister of Health and Welfare, who clarified that the withdrawal is not due to the recent controversy over forced labor in the CMB but rather coincides with a personnel renewal process. Other doctors and nurses who have already been interviewed will come in their place, he assured. 

Data from Archivo Cuba places Jamaica’s CMB as the fourth most numerous (and lucrative) location in the region for the Havana regime, after Venezuela, Mexico, and Guatemala.

The expropriation pattern and control mechanisms used by Cuban officials in other medical missions, although with certain differences, are also present on the English-speaking island.

On the 10th of each month, Jamaica deposits the salaries of Cuban health workers into the CMB account, and the CMB then pays a stipend to each worker. According to testimonies and official documents from the Mission reviewed by CubaNet, the monthly payments range between 1,400 and 2,100 USD. Of this amount, Cuba retains 50%, while the other 50% is allocated to the worker. Additionally, Jamaica guarantees an extra 200 USD to cover housing expenses. As a result, the highest basic income—after returning what the CMB requires and paying rent—is that of doctors, amounting to 1,050 USD per month or 6.06 USD per hour. The full payment from government to government is unknown, although the salary of an independently hired doctor can easily double such earnings. 

A key element of agreements of this nature is the inclusion of a confidentiality clause. This lack of transparency can enable abusive practices to flourish in the CMB, making them difficult to detect, which was condemned by the Office of Western Hemisphere Affairs at the State Department, making it clear that such actions will not go unchallenged.

Jamaica also pays for overtime hours worked, but the Cuban professional must also reimburse a significant portion to Cuba, after deducting supplements for “meal” and “taxi”, that cover food costs and transportation expenses. These, and other related allowances, are considered by the mission management as non-reimbursable income, as they are essential for the fulfillment of duties of the Cuban professional in Jamaica. “The rest must be divided by two,” says Yaniset.

To mask the appropriation of workers’ earnings, Cuban authorities refer to the mandatory 50% repayment as a “remittance”—a term that adds a personal touch to the bank transfer, as if it were money sent to a loved one or a voluntary gift.

“The payslips reflect the payment that the hospital makes on the 25th day, for overtime hours worked. From there one also remits 50%,” says Yaniset. The additional remuneration is by direct payment from the hospital to the Cuban doctor (in Jamaican dollars). The Cuban mission imposes an exchange rate of 154 x 1 USD, according to official documents leaked to CubaNet.

Transfers of their income are made at the end of the month “to an account in the name of the medical mission at NCB [National Commercial Bank],” explains Yaniset. “It is frustrating to see on the 25th of each month how the employees feel. You can see the discontent in their faces. Many say that they are not going to work overtime…What for, since they have to give half of it back? It is very humiliating,” she laments.

To confirm the correct amount was deducted, health workers must give their payslip to the brigade chief and show deposit receipts after returning 50% of their salary to the Medical Brigade (CMB), the source explains. The Cuban authorities also send emails and Telegram messages with detailed instructions on how to return the money to the State.

Next, the collaborator must send the CMB management a signed sworn statement confirming the amount due to the mission’s account, as required by the employment contract. According to health workers, their contract is not given to them but is only presented for signature shortly before leaving Cuba, without enough time to read it.

“That money goes to no-one-knows-where because you go to Cuba and you see that the same misery continues,” she comments. Cuba’s ongoing crisis also reflects a significant imbalance in public investment, with a clear preference for the tourism sector at the expense of public health and social services, which receive less than 2% of the national revenue, according to data from the National Office of Statistics and Information (ONEI).

“The collaborator in Jamaica is like a kidnapped person. It’s horrible; one accepts the contract because really, who can live in Cuba with a 50 USD salary?” she questions. 

Another controversial aspect of the Cuban Medical Brigades (CMB) is the politicization of healthcare. Mission leadership instructs collaborators to take photos of themselves while working, which are then shared on official social media accounts for propaganda purposes. However, according to Yaniset, “some have encountered issues.” In certain workplaces, health workers have been warned that taking photos with patients violates local privacy policies and protocols. Cuban professionals who comply with Jamaican regulations and decline to engage in political promotion have reportedly been threatened by mission authorities for failing to follow directives “from above.”

The regime’s control within the medical missions extends beyond professional duties to regulate personal interactions. Collaborators are prohibited from engaging with independently contracted Cuban colleagues, a restriction previously reported by doctors who served in Venezuela and Angola. According to Yaniset, “one cannot speak freely,” and mission leaders threaten to revoke contracts if these rules are not followed.

These strict conditions are codified in Resolution 368 of 2020, titled Disciplinary Regulations for Employees Working Abroad, which outlines sanctions ranging from warnings to expulsion. The resolution, along with the employment contract, functions as a legal mechanism to reinforce state control over Cuban workers, severely restricting their freedom of choice, expression, and even the right to form a family.

Frustrated by these coercive measures, some collaborators resist demands to reimburse the government. When they do, they are subject to harassment. “The supervisors threaten to send them back to Cuba and warn them that they have ways to track whether they worked overtime,” Yaniset explains. CubaNet has documented similar cases in Dominica.

Dominica

Iliana* was summoned to a disciplinary council because “she refuses to contribute her remittance to the country,” reads an official document signed by the leadership of the CMB of Dominica, to which CubaNet had access. The healthcare worker, as the letter states, “violates the Employment Contract for the provision of services… especially section 6.1 related to the obligation to remit to Cuba,” as well as the Disciplinary Regulations for collaborators.

According to a source in Dominica, the wage expropriation method used by the Cuban Medical Brigade there is carried out in cash, as “the banks are American and no funds can be transferred to Cuba by any means.” In this context, collaborators are instructed to withdraw the required amount under the guise of a “family remittance” and hand it directly to the brigade leader.

One doctor estimates that the Cuban government’s share amounts to “thousands of dollars.” “I could earn a significant amount from overtime and on-call hours, but I was only allowed to keep about 200 USD,” she explains.

From the base salary, doctors like Iliana receive approximately 800 USD, bringing their maximum earnings to around 1,000 USD. “The rest is withdrawn from the bank and handed over in cash,” she adds. The doctor also notes that the amount paid by the host government per physician is substantially higher, as it includes various additional costs beyond the salary.

In the CMB in Dominica, it is believed that the receiving country incurs expenses of 11,000 USD per Cuban doctor per month, although the professional said she did not know exactly how much it amounts. For the same reason, it is not possible to calculate Cuba’s gains from this practice in the Caribbean nation. 

The Cuban government has established a sophisticated system of salary appropriation, while outwardly conforming to the regulations and expectations of host countries. In nations where the regime wields significant influence—such as Angola and Venezuela—legal entities act as intermediaries between the host government and Cuban professionals, primarily doctors, teachers, and engineers. One prominent example is ANTEX S.A., which withholds between 76% and 91% of the salaries of subcontracted workers. Similarly, Cuban Medical Services and the Central Medical Collaboration Unit retain at least 50% of the net income earned by their personnel.

On the other hand, in countries where such intermediaries are not permitted—such as Saudi Arabia and Qatar—salaries are paid directly to the Cuban workers, creating the illusion that they are receiving full compensation. Nevertheless, even in these cases, mission leadership requires workers to transfer between 80% and 90% of their income each month to an account held by the Cuban government.

This mechanism represents the fundamental model for the mass deployment of Cuban professionals under bilateral agreements. “Only independently negotiated contracts ensure the protection of individual freedoms and labor rights,” states the executive director of Archivo Cuba, emphasizing the need for host countries that rely on foreign health professionals to offer vacant positions through open and direct hiring processes.

This is the golden rule regarding mass employment of Cuban professionals derived from bilateral agreements. “Only independently negotiated contracts ensure the protection of individual freedoms and labor rights,” states the executive director of Archivo Cuba, emphasizing the need for host countries that rely on foreign health professionals to offer vacant positions through open and direct hiring processes. 

Another critical issue is the role of financial interests: the export of Cuban professional services—particularly in the medical sector—represents the primary source of revenue for the Cuban State. This economic dependency makes it untenable for the state-run companies managing these missions to allow workers to retain their full salaries. If they did, how could the government generate between 4 billion and 6 billion annually from these programs?

If the working conditions within the brigades were equitable, why have more than 10,000** collaborators been labeled “deserters” simply for terminating their contracts early or refusing to return to Cuba once their assignments end? Why does the legal status of “regulated” (a restriction preventing professionals from leaving the country due to their designation as essential personnel) do not apply to those deployed abroad under state control? And why do Cuban doctors and other professionals continue to face an eight-year ban from re-entering the country if they abandon these international missions?

Moreover, the mission in Dominica not only pressures its participants to relinquish a substantial portion of their income but also compels them to engage in political and propaganda activities—mirroring practices observed in Jamaica. These conditions reinforce a long-standing pattern of exploitation that has become entrenched over decades of state-run international cooperation programs.

Saint Lucia

Carmen* lived through hell in Saint Lucia ten years ago, under a contract with Cuba’s Central Medical Cooperation Unit. She recounts being persecuted and left virtually homeless—an ordeal she says she will share in full when the time is right.

“Mine is a long story, but similar to that of many others on these missions. A corrupt, arrogant supervisor, and a group of silent slaves… until one day. I’m actually grateful for being pushed to the limit—it opened my eyes. I secured an independent contract, returned to the same country, and now I’m free. Still, without cause, my name was added to a blacklist, and I am forbidden from returning to Cuba,” she explains.

It was only after obtaining an independent contract that Carmen realized her income, free from Cuban state intermediation, more than doubled what she had previously earned on the mission. From the already modest stipend she received through the state program, she was required—like her colleagues in Jamaica and Dominica—to transfer 50% of her income to an account belonging to the Cuban Medical Brigade. This requirement was written directly into her employment contract, effectively reducing her take-home pay to just 25% of what she should have earned as a medical professional.

By signing the contract, Carmen agreed to surrender her passport to her superiors, in accordance with the terms outlined in the document. She was also required to grant the brigade chief “broad and sufficient powers to act on her behalf” before the Saint Lucian authorities.

“The reality is that when you’re in Cuba, starving, with two children you can’t support, you’ll sign anything,” she explains.

“We’ve been through a great deal; we’ve suffered immensely. The conditions we endured under the Cuban medical missions were extremely difficult,” Carmen reflects.

Carmen had to deliver the payment receipts to the mission headquarters because the Cuban doctor’s word was not enough in Santa Lucía either.

According to the Cooperation Agreement between Cuba’s Ministry of Public Health (MINSAP) and the Ministry of Health, Wellness, Human Services, and Gender Relations of Saint Lucia, the host country is responsible for ensuring adequate living conditions for Cuban medical personnel. This includes covering the costs of rent, gas, internet access, and any other expenses necessary for the upkeep of the property and its equipment.

The agreement also obligates the Saint Lucian government to provide free medical and dental care to the personnel, daily transportation to and from the workplace, and to cover the costs of international airfare, visas, and any required permits. Additionally, the government must guarantee the payment of a financial allowance intended to cover both personal and food-related expenses for the Cuban specialists assigned to the mission.

“For Saint Lucia, it is a great business to have a group of doctors who are only paid half of what they pay national doctors. And for Cuba it is a great business because, of this money that its workers are going to receive, it takes half,” adds Carmen.

According to Maria Werlau, “with a minimal investment of resources,” the Havana regime manages to “exert significant influence in host countries” by fostering dependence on its medical and professional services. At the same time, it appropriates the labor of those it sends abroad and expands its commercial reach beyond service exports, venturing into the selling of medicines and medical supplies made-in-Cuba. 

Such is the case of the infiltration of the Jacden Group —a conglomerate of Jamaican companies that operates in various sectors, including pharmaceutical and medical services—whose absolute partners are the Cuban companies COMBIOMED, ​​BioCubaFarma, the Finlay Vaccine Institute and the La Pradera clinic. 

Another avenue of interference by Cuban medical diplomacy is the provision of scholarships to foreign students, who upon graduation become pivotal in the promotion of Cuban medicine and the advancement of the regime’s efforts to “sell” medical missions to the world.

The expansion of the regime’s services and companies in other countries contributes to the internationalization of human trafficking and forced labor practices. The above, Werlau warns, “results in the systematic violation of the rights of all health workers in Cuba, prisoners of a system that exploits them and does not allow them alternative independent avenues of employment.” 

Only a few manage to secure independent contracts in third countries. Each doctor who resigns from the Cuban Health Ministry translates into thousands of dollars in losses, and less staff availability in future international collaboration agreements. For the ones that still remain on the island, the options are limited. Salary policies in Cuba have consistently fallen short in addressing the needs of workers. As a result, many of them spend the best years of their lives going from mission to mission, away from family.

Belize and other complaints

Tatiana Carballo Gómez provided services in three different countries (Belize, Venezuela and Brazil) from 2006 to 2017. Regarding her time in Belize, she remembers the persecution and control of the Cuban authorities; She lived in an overcrowded house with her colleagues, unable to go out, and had to attend political events.

“Our movements were restricted from home to the clinic and vice versa. It was driving me crazy. I was there the first year and when I returned to Cuba on vacation, I didn’t want to go back. They took away the 50 USD monthly I was entitled to because I didn’t complete the years of work,” she told CubaNet.

The stipend she received in the three countries never exceeded 25% of what their governments paid per doctor to Cuba. 

In almost 11 years of providing services, she was never authorized to have her young children with her. Both were left in the care of the family in Cuba. Although Tatiana later managed to reunite with her son, in Brazil, and then with her daughter, in the United States—where she currently resides—she feels that she lost an important part of their lives that she will not be able to recover. 

“All those years I was separated from my children, my mother and my father (who fell ill in 2009 and who I barely managed to see alive); I missed all the milestones of my children, their successes and failures, and when I did see them, I barely knew them,” she said in a testimony published in Hypermedia Magazine. 

Since her time in Venezuela, Tatiana has suffered from insomnia, which has made her dependent on drugs. It all started when she was threatened at gunpoint by “malandros” (gang members), she recounted in a 2021 program of the digital platform CiberCuba. It all happened at the community health center where she worked, commonly known as CDI, which underscored the dangers to personal safety that Cuban doctors face while on these missions. 

“I was never able to sleep well again. The sleep disorder and hypertension that I suffer from originated in Venezuela,” she said. 

Finally, she was able to escape under the protection of the Cuban Medical Parole Program (CMPP, 2006 to 2017) which allowed Cuban doctors to apply for legal residency in the United States after abandoning medical missions.

In 2017 she joined the initiative No Somos Desertores (We are not Deserters) which demands the lifting of sanctions by the Cuban regime against professionals who abandon missions and settle abroad. In 2018 she started a legal demand against the Pan American Health Organization, which she accuses of having facilitated a “human trafficking network” and “slavery” in the Mais Médicos program in Brazil. 

Tatiana is the only one of those interviewed who agreed to publish her real name. The rest of the health workers live in fear of reprisals against them and their families in Cuba. Other women do not even dare to report it.

Some 50 million people are exploited around the world, estimates the NGO’s Global Slavery Index Walk Free which has noted an accelerated pace in the increase in modern slavery practices. From 2016 to 2021 alone, victims increased by 10 million. 54% of them are women. 

In Cuba, WF has quantified more than 60,000 victims of modern slavery and has made recommendations for the authorities to criminalize forced labor and human trafficking according to international legislation.

For these practices to proliferate, they need facilitators in the host countries and decision-making officials willing to look the other way because they somehow benefit from the extractive scheme or because they are unaware of other less controversial options to meet the demand for personnel.

In The Bahamas, for instance, Cuban medical brigades were initially deployed to mitigate the effects of the pandemic and have since become integral to programs such as ophthalmology. Official sources indicate plans to triple their presence in the islands, despite mounting concerns regarding reports of forced labor imposed by the Cuban government. Contractual documents obtained by Archivo Cuba reveal that Cuban medical personnel stationed in The Bahamas receive a stipend of 990 USD, from which they are required to reimburse the same percentage to the Cuban Medical Brigade as their counterparts in Jamaica, Dominica, and Saint Lucia.

Based on the testimonies gathered, official documentation, and the criteria used in the development of Walk Free‘s Global Slavery Index, there is a strong basis for concluding that workers in the Cuban medical brigades are exposed to practices consistent with modern slavery. 

Three independent alternatives to the Cuban medical brigades

Julio César Alfonso, president of Solidarity Without Borders—a Miami-based NGO supporting foreign healthcare professionals in the United States—is working together with American legislators to address immigration irregularities affecting newly arrived healthcare graduates and to push for the reactivation of the parole program for Cuban doctors.

“The reactivation of the CMPP is crucial, as it represents the most effective tool to combat human trafficking and modern slavery embedded in the Cuban internationalist missions,” Alfonso told CubaNet. According to him, reopening the CMPP would establish “a legal and organized pathway” for professionals fleeing the regime’s control.

Beyond advocating for policy changes, Alfonso proposes an alternative to the Cuban Medical Brigades: the creation of independent medical assistance programs in underserved communities across Latin America and beyond. “This is something we have already implemented in countries like Honduras and Haiti through Cruz Verde Internacional’s ‘Green Teams,’” he explained.

Under these independent collaborations, healthcare professionals would be employed through “completely legal agreements ensuring full salaries in accordance with international labor standards and regulations,” he said. Alfonso views this approach as “a highly effective alternative in the fight against exploitative labor contracts, modern slavery, and debt bondage.”

Another initiative to independently recruit Cuban doctors is Free Cuban Doctors, a project led by Archivo Cuba through its Cuba Salud program, in partnership with No Somos Desertores. 

Emerging during the COVID-19 pandemic in 2020, this initiative seeks to  connect Cuban doctors with international entities aiming to bolster their healthcare systems with foreign personnel. The hiring process would be conducted directly, without intermediaries linked to the Havana government, ensuring healthcare professionals receive their full remuneration along with travel, accommodation, medical insurance, and other benefits.

An alternative to the Cuban Medical Brigades (CMB) is  Doctor’s Reserve, a private, non-profit organization with no governmental, political, or religious affiliations. According to its website, the project aims to “create a global network of Cuban health professionals abroad.”

On April 4, the European Parliament approved an amendment to its annual foreign policy report condemning modern slavery and forced labor within Cuban medical brigades. The measure, championed by Spanish MEP Antonio López-Istúriz White, follows the historic EP vote in 2021 and delivers a firm message to Havana’s government. With this resolution, the European Union aligns its stance with that of Washington, which has maintained Cuba at Tier 3—the most severe classification—for countries failing to combat human trafficking since 2019.

Over the past decade, reports of repressive labour conditions within Cuban international medical missions have multiplied, with both victims and international organizations raising concerns. Since 2014, rapporteurs on modern slavery and human trafficking have uncovered evidence of forced labor in these brigades. The United Nations has since called on Cuba to address allegations of unsanitary working conditions, passport confiscation, and the forced separation of Cuban families—especially children—a concern flagged by the UN Committee on the Rights of the Child in 2022.

Amid the rising international concerns, the hiring of Cuban professional services has declined by almost 30% in the last 18 years, according to data collected by Archivo Cuba, and by more than 62% since its peak in 2014. 

Despite this downward trend, thousands of healthcare workers deployed through Cuban medical brigades continue to participate in the system, seeking better opportunities abroad. However, they remain trapped in an extractive framework that offers little prospects for advancement and denies them the ability to assert their rights.

“The mission is a scam, and a form of slavery whichever way you look at it,” says Yaniset.

*Yaniset, Mirta, Iliana and Carmen are pseudonyms of health workers who asked to protect their real names and omit any details that could identify them, for fear of reprisals from the Cuban regime. 

**Calculations by the author based on 2,500 doctors who refused to return to Cuba after the Mais Médicos program was repealed in Brazil in 2018 and the 8,000 health workers who between 2006 and 2017 fled missions and took refuge in the United States, covered by the extinct Cuban Professional Medical Parole.