Those economic reforms? Some have failed to materialize, while the most successful — the issuing of licenses to start small businesses — has all but stalled as the state deliberates how to move forward. The rapprochement with the United States? President Trump all but torpedoed it, at least in tone. Even the island’s historic escape valves — visas and undocumented migration to the United States — have been turned off.

In the most recent blow, the United States Embassy in Havana vastly reduced its staff and stopped issuing visas to Cubans after dozens of its personnel were mysteriously sickened in what the State Department has described as attacks of unknown origin.

That happened after the immigration pipeline of Cubans trying to reach the United States had already been abruptly squeezed by the Obama administration. Before leaving office, President Barack Obama put an end to the longstanding policy known as wet-foot-dry-foot, which allowed Cubans who made it to American soil or border crossings without a visa to stay in the United States.

Now the Trump administration’s decision to shut down many of the functions of the Havana embassy is making it even harder for Cubans to head north.

Without an operating consular office, Cubans had to travel to Colombia earlier this year to even apply for their visas, a costly endeavor considering that their average salaries amount to about $1 a day. Today, that pipeline has been blocked, too. Visa issuance for Cubans hoping to visit their families in the United States is now being done from Guyana.

“There are thousands of parents who have children in the U.S. and who are not going to be able to visit them,” said one Cuban doctor, who spoke on condition of anonymity because she and her partner are trying to leave the country without permission. “With Obama, there was a big step forward because relations were reestablished. And now just because of Trump’s whim, things have become worse than ever.”