Forced labor designation for Cuban doctors highlights rift over sanctions

The Biden administration formally accused Cuba of profiting from forced labor on Monday, two months after President Biden signed a spending bill that requires the State Department to impose sanctions on third-country officials who hire Cuban work brigades.

That determination sets up a clash between Cuba hawks in Congress who want it to immediately translate to sanctions against third parties — including key U.S. allies — and the State Department, which views Havana as the main culprit.

'Just wimping out'

“Now, when there's some actual teeth on this aspect of human trafficking, for some reason, the Department of State and the administration is, frankly, just wimping out. I mean, it's amazing,” said Rep. Mario Díaz-Balart (R-Fla.), chair of the House Appropriations State, Foreign Operations, and Related Programs Subcommittee.

That frustration comes despite the State Department adding language to the 2024 Trafficking in Persons Report (TIP) directly accusing Cuba of implementing “a government policy or pattern to profit from forced labor in Cuba’s labor export program, which included foreign medical missions.”

That language is a step up from previous iterations of the report, including the 2023 TIP, which alleged “strong indications of forced labor, particularly in the foreign medical missions’ program.”

The TIP is an annual report published by the State Department with global assessments of different types of human trafficking, from sex trafficking to forced labor.

Groups such as the Foundation for Human Rights in Cuba (FHRC) lauded the direct allegation of forced labor in TIP, but called on State to take immediate action, including defunding the Pan American Health Organization (PAHO), which was sued by Cuban doctors in 2020 for its role in paying for Cuban missions in Brazil.

“The FHRC commends the Department of State for its vigilance and commitment to uncovering these abuses. However, we emphasize that recognizing these violations is only the first step. Tangible actions must be taken to hold the perpetrators accountable,” FHRC representatives said in a statement.

“This is now a tremendous opportunity for the United States to prove it is indeed a beacon of justice and do just that. As the biggest funder of the Pan American Health Organization, we as a country cannot look the other way in the face of PAHO's egregious lapses of judgment at best and outright criminal activity at worst.”

A second State report delivered to Congress last week detailed the department’s assessment of Cuba’s medical work brigades, specifically the Henry Reeve Brigades, a project set up in 2005 for Cuban medical professionals to deploy to third countries in emergency situations.

The report, mandated by Congress in the $1.2 trillion spending bill signed by President Biden in March, lists 74 countries — ranging from NATO allies including the United Kingdom to U.S. rivals like China — which may have hosted Cuban government-affiliated workers over the past five years.

Cuba hawks included language in the spending bill directing State to impose sanctions against third-country officials who “are directly paying the Government of Cuba for coerced and trafficked labor of Cuban medical professionals.”

But the State Department avoided singling out specific third-country officials in its report to Congress, in part because payment schemes between Cuba and host countries vary from mission to mission.

“The Department does not have sufficient information at this time to assess the involvement of specific host government officials in gross violations of human rights or significant corruption,” reads the report.

“In some cases, contracts signed between Cuba and a receiving country include provisions to ensure working conditions are consistent with international labor standards. However, because Cuba signs a separate, secret contract with each worker, Cuban government officials are primarily responsible for the fraudulent and coercive practices under which these workers serve.”

That rationale landed flat with the Cuba hawks.

“This is pretty routine, as they'll make determinations based on the facts that they have. And the fact that they are reluctant to do it here tells you everything that you need to know about the attitude of this administration that is consistently trying to figure out ways how to excuse and appease this anti-American terrorist regime,” said Díaz-Balart.

A lose-lose

President Biden has been between a rock and a hard place on Cuba policy from day one.

Many progressives wanted a return to the Obama administration’s rapprochement policy, and Cuban officials opened the door wide for its return.

But Biden faced serious headwinds to loosen any sanctions, not just from Republicans, but from allies such as Sen. Bob Menéndez (N.J.), who until his corruption indictment in September was the top Democrat on the Senate Foreign Relations Committee.

And the outgoing Trump administration left a hot potato, adding Cuba to the State Sponsor of Terrorism list a week before Biden took office.

In essence, former President Trump dared Biden to make a major pro-Havana move or face the migratory consequences of further tightening the economic squeeze on the island.

The Biden administration has refused to discuss Cuba’s presence on the list, but it has made some moves to ease restrictions in other areas like small enterprise and removed Cuba off a separate list of countries that do not fully collaborate with the United States in combatting terrorism.

That has angered hawks, but most sanctions remain in place, vexing progressives, strategic international partners including Mexican President Andrés Manuel López Obrador, as well as the Cuban government.

“The coercive measures that the United States calls ‘sanctions’ are held up only by the brute force of the United States. They have no legitimacy or moral authority. It’s the resort of the powerful against the less powerful,” said Cuban Deputy Foreign Minister Carlos Fernández de Cossío.

The new language in the 2024 TIP is unlikely to change the Cuba equation for the Biden administration, but State Department officials say it will arm U.S. diplomats to engage host countries on the issue.

“We did modify the language in how we described it a little bit, and it wasn't so much as the result of a change in what Cuba was doing, but more a reflection of the fact that we had spent more time understanding the issue, talking with survivors of the Cuban medical missions, and we made the decision that we wanted to be a little stronger, to promote accountability and awareness about this problem,” a State Department official told The Hill.

The brigades

“The missions are a Cuban government scam where you don’t know how much you’ll get paid, but one is so desperate to leave Cuba and to get some money that one leaves for whatever reason,” said Rotceh Rios Molina, a Cuban doctor who defected in 2020 from a brigade assigned to fight COVID-19 in Mexico.

Human rights advocates and defectors say the program is an illicit cash cow for the Cuban government, where Cuba charges host countries a certain amount for medical services and only pays a tiny fraction of that amount to the medical professionals doing the work.

According to the sanctions report, Venezuela pays the Cuban government $60,000 per year per worker, but the workers only get between $1,224 to $1,296 per year, plus a $480 bonus upon their return to Cuba.

Similarly, the report cited sources claiming that the approximately 475 Cuban staff at a hospital in Qatar receive $1,000 a month, but Qatar pays Cuba $5,000 to $10,000 a month for each worker.

“There's a model for these brigades, which is: Cuba sends these brigades, and Cuba keeps like between 95 percent to 80 percent of what Cuba is paid for each worker,” said Maria Werlau, founder of the Cuba Archives, a group that’s spent years documenting the missions in Latin America.

“They're sent with handlers. They have to sign, you know, these regulations that they have to keep. You know, they're kept in certain conditions. There's a lot of arbitrary rules there if you defect.”

Werlau was included in the TIP as one of the report’s 10 heroes, a group described by Secretary of State Antony Blinken as “remarkably courageous individuals who are driving change, driving change in the face of daunting obstacles — often at great personal risk.”

But Cuban officials say advocates such as Werlau and defectors like Rios are biased, and they defend the program as a successful humanitarian initiative, citing international praise.

“The Cuban medical brigades that operate in other countries do so under absolutely legitimate bilateral agreements, consistent with United Nations practices,” said Fernández de Cossío.

“The United States government knows that, but it uses scarce sources, almost always among immigrants or those aspiring to migrate to the United States, to try to denigrate Cuba and to attack a cooperation that has been recognized and praised by the international community.”

Cuba hawks in Congress share Rios’s position that the brigades are a “scam,” and are seeking to sanction both Cuba and host countries.

“The criminal Cuban regime has always used the so-called medical brigades to enrich its pockets and any country partaking in this scheme must be held accountable,” said Sen. Marco Rubio (R-Fla), who is reportedly on the short list to be Trump’s running mate in 2024.

“The State Department’s annual Trafficking in Persons Report continues cites Cuba as a Tier 3 country due to its failure to fully comply with the minimum standards against human trafficking, the country remains a state sponsor of human trafficking.”

International support

While few in the United States defend the brigades, the Cuban program has gained some international praise.

In March, Italian online newspaper Il Post quoted Calabrian doctors calling the Cuban mission “a breath of fresh air.”

 According to the publication, 270 Cuban medical professionals remain in Calabria. Controversy over potential forced labor conditions was overshadowed by local concerns that the mission is just a stopgap measure rather than a fix for the local health care system.

State Department officials say that’s part of the challenge in engaging host countries, notwithstanding the official U.S. determination that some of the missions constitute forced labor.

“We really are trying to find the best way to make sure that these workers are not exploited, but that also, you know, that medical services are available in places that don't have access to them. You know, we're sympathetic to that,” said the State official.

State’s sanctions report to Congress provided some details regarding Cuban work missions in 72 countries, but did not list specific third-country officials for the sanctions delineated in the March spending bill.

And the Biden administration is stopping short of calling the entire medical brigade program forced labor, both because some host countries can and do provide worker protections to the Cuban professionals, and because some are in dire need of any medical aid they can get.

“I do want to be clear that the U.S. does not have a blanket prohibition, telling countries that they should not, cannot utilize these workers. We haven't gone that far. We recognize that countries have extreme medical needs they're needing to get addressed,” said the State Department official.

“But what we have done, and we have even increased this in the past year, is given very clear information to every single country that we know of who hosts these governments about what our concerns are and specifically things that they should do to make sure that the Cuban workers that are coming, if they are coming, are not subject to forced labor.”

And unbridled sanctions could upend U.S. diplomacy, particularly with U.S. partners and allies who agree with Cuba’s view of the brigades as a humanitarian initiative.

Mexican President-elect Claudia Sheinbaum, for instance, brushed off attacks from the right in 2021 over her hiring of Cuban brigades as mayor of Mexico City.

“There’s absolutely nothing to hide, they were different health care professionals who came to Mexico to support — there were two periods in which they were mainly in Mexico City,” she said at the time.

A rift with Mexico is a worst-case scenario for the Biden administration on issues like migration and trade, but relations with other key global partners such as Italy or Brazil could also be strained in that scenario.

“I’ve previously condemned host countries worldwide who’ve violated the labor and human rights of Cuban medical personnel and will continue to do so. Anyone who's been complicit in this scheme must be held accountable,” said Rubio.