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When the Journal of the American Medical Association (JAMA) recently published a preliminary clinical evaluation of health problems suffered by US embassy personnel in Havana, the State Department seized the opportunity to reiterate a countrywide “health alert” on Cuba. “Discuss the JAMA article with a doctor if you have concerns prior to travel,” the department advised on February 14. “We encourage private U.S. citizens who have traveled to Cuba and are concerned about their symptoms to share this article with their doctor.” Ad Policy

The alert reflects an ongoing effort by President Trump’s State Department to frighten US travelers away from Cuba. Last September, when the administration announced a drastic 60 percent embassy staff reduction in Havana in response to the mysterious health maladies, the department issued a categorical warning to US citizens “not to travel to Cuba.” In early January, when the State Department issued a new safety ranking system for all nations, Cuba received a “level 3” designation—“Reconsider Travel: Avoid travel due to serious risks to safety and security.” In late January, a spokesperson for the Bureau of Western Hemisphere Affairs told The Miami Herald that, following the September alert, 19 US citizens had called to report health problems after traveling to Cuba—out of close to 620,000 travelers who visited the island in 2017—even though officials at the Bureau of Consular Affairs who fielded those calls readily admit that they took no steps to determine when, where, and how those illnesses occurred, and simply passed the callers on to the FBI. And last week, when the State Department determined that the embassy would not be restaffed and will “continue to operate with the minimum personnel necessary to perform core diplomatic and consular functions,” the department posted a long list of warnings for anyone thinking about traveling to Cuba—even though the island remains among the safest countries anywhere in the world for US citizens to visit. Trump’s Non-Sonic Attack on Cuba Trump’s Non-Sonic Attack on Cuba Peter Kornbluh

The highly technical JAMA study, titled “Neurological Manifestations Among US Government Personnel Reporting Directional Audible and Sensory Phenomena in Havana, Cuba,” certainly sounds scary. The article summarizes initial medical findings on 21 of the 24 members of the US embassy community in Havana—diplomats, family members, and intelligence agents—who suffered a range of neurological-related symptoms from a still-unidentified source between late 2016 and August 2017. “Persistent cognitive, vestibular, and oculomotor dysfunction, as well as sleep impairment and headaches, were observed among US government personnel in Havana, Cuba, associated with reports of directional audible and/or sensory phenomena of unclear origin,” a team of doctors from the University of Pennsylvania’s Center for Brain Injury and Repair reported. “These individuals appeared to have sustained injury to widespread brain networks without an associated history of head trauma.” “At this point, a unifying explanation for the symptoms…remains elusive and the effect of possible exposure to audible phenomena is unclear.” —JAMA editorial

The report, however, was accompanied by an editorial warning that the findings remain preliminary and incomplete. “At this point, a unifying explanation for the symptoms experienced by the US government officials described in this case series remains elusive and the effect of possible exposure to audible phenomena is unclear,” states the JAMA editorial. “Before reaching any definitive conclusions, additional evidence must be obtained and rigorously and objectively evaluated.”

Nevertheless, the JAMA study has helped to clarify the murky and misrepresented events that the Trump administration has characterized as “sonic attacks” against US personnel in Havana—and a potential threat to US travelers. The journal article contains several important takeaways:

The “sonic attack” meme has been scientifically laid to rest. The doctors determined that the sounds heard by those who were hurt—described as a “high-pitched sound,” “buzzing,” “grinding metal,” “piercing squeals,” and “humming”—could not have caused the symptoms they experienced. “We actually don’t think it was the audible sound that was the problem,” says Dr. Douglas Smith, MD, a co-author of the study who directs the Center for Brain Injury and Repair. “We think the audible sound was a consequence of the exposure, because audible sound is not known to cause brain injury.” At the same time, the JAMA study casts doubt on viral or chemical sources of the symptoms. While the JAMA editorial alludes to “mass psychogenic illness” as a possible explanation—a theory that Cuban investigators have also advanced—after a year of serious investigation by multiple US agencies, the cause of the health problems remains unidentified.

Sensational reports of brain damage turn out to be fake news. Based on leaks by anonymous US officials briefed on the medical-study findings, the Associated Press circulated a seemingly explosive scoop in December that the doctors had “discovered brain abnormalities” among the US embassy personnel. “Medical testing has revealed the embassy workers developed changes to the white matter tracts that let different parts of the brain communicate,” the AP reported. But now those claims have been revealed to be incorrect at best—and malicious spin at worst. According to the JAMA study, all 21 patients underwent MRI testing, and “most patients had conventional imaging findings.” Only three showed “multiple T2-bright white matter foci”; of those, two were “mild in degree and 1 with moderate changes.” The study made it clear that there was no way to know if those few cases had anything to do with events in Havana or “could perhaps be attributed to other preexisting disease processes or risk factors.”

Those who experienced health problems in Havana hotel rooms were US personnel. The JAMA study refers to government patients who experienced an “onset of symptoms in their homes and hotel rooms,” offering official, if inadvertent, confirmation that reported incidents in the Hotel Nacional and the Hotel Capri involved US employees, not tourists. Other than the names of the hotels, the State Department has refused to provide any details about three incidents that took place at the Nacional and Capri. But when the administration announced the virtual shutdown of the embassy last September, the State Department pointed to the hotels as evidence of a potential threat to US tourists and categorically warned them not to travel to the island. “Because our personnel’s safety is at risk, and we are unable to identify the source of the attacks,” the travel warning stated, “we believe U.S. citizens may also be at risk and warn them not to travel to Cuba. Attacks have occurred in U.S. diplomatic residences and hotels frequented by U.S. citizens.” An updated travel advisory posted on the State Department’s website last week specifically instructs US travelers to “avoid Hotel Nacional and Hotel Capri.”

Predictably, these travel warnings have led to significant cancellations at the Capri and the Nacional, as well as a significant drop-off in overall US visitors to the island. That might not have been the case if the Trump administration had been transparent, and honest, about what happened in Cuba, instead of exploiting this troubling situation to sabotage normalized relations. “Leaks of intentionally misleading and false information by US government officials have distorted the truth and made it harder to get to the bottom of the mystery,” points out Collin Laverty, who runs Cuba Educational Travel (CET) and tracks the impact of Trump’s policies on tourism and the tourist sector in Cuba. The administration, he suggests, is “hiding many of the facts.” “The first four Americans to report being struck by the phenomenon were all CIA officers working under diplomatic cover, as were two others affected later on.” —ProPublica report

CIA: The Elephant in the Embassy

The JAMA study evaluated 11 women and 10 men who were vaguely identified as “US government personnel serving on diplomatic assignment in Havana, Cuba.” The mainstream press has often referred to those who reported injuries as “diplomats,” while US officials have referred to them as “members of the Embassy community.” Not a single member of this “community” has been named, let alone stepped forward and publicly identified themselves. It has fallen to intrepid investigative reporters at CNN, the AP, and most recently ProPublica to reveal the missing link in this mystery: A critical number of those affected were members of the CIA station in Cuba. Current Issue View our current issue

The ProPublica article, based on a lengthy investigation by reporters Tim Golden and Sebastian Rotella, appeared on February 14, the same day the JAMA study was published. While the JAMA article was picked up by major news outlets such as The New York Times and The Washington Post, the revelations of the lengthy ProPublica story have received little mainstream circulation. The article, “The Sound and the Fury: Inside the Mystery of the Havana Embassy,” offers the first credible and comprehensive time line on how the health crisis unfolded and, most importantly, breaks through the Trump administration’s cover-up of who was initially affected. “The first four Americans to report being struck by the phenomenon,” according to Golden and Rotella, “were all CIA officers working under diplomatic cover, as were two others affected later on.” (The latter two are widely rumored to include an agency doctor who was sent to Havana to evaluate what was happening to CIA colleagues and reported acoustic-related injuries while staying in one of the hotels.) CIA officers saw “a pattern that was anything but coincidental.”

Indeed, the article makes clear that both senior embassy and intelligence officials believed that the acoustic episodes were part of a long, nasty history of “spy vs. spy” in Cuba. Between late December 2016, when the first CIA operative reported his symptoms, and late March 2017, when the health problems were shared with the embassy community, “both the intelligence officials and senior diplomats guessed that the noises were ‘just another form of harassment’ by the Cuban government,” ProPublica reported. In March, the de facto US ambassador, Jeff DeLaurentis, told a diplomatic colleague who wanted a full embassy meeting on the issue that “he and others who knew about the incidents believed they were confined to a ‘small universe of people’ whom the Cubans probably suspected of doing intelligence work, whether they were CIA officers or not.” Top CIA officials became so convinced that their agents were under attack, The Nation has learned, that they apparently ordered the closure of the CIA station in Havana—a move that contributed to Secretary of State Rex Tillerson’s decision in September to effectively shutter the consulate and reduce embassy operations to a skeleton staff.

Only after DeLaurentis briefed the entire diplomatic corps at the Havana embassy in late March 2017 did something akin to mass hysteria break out. Some 80 members of the US diplomatic community, including family and non-diplomatic personnel, took a leave to Miami to be tested for symptoms. Of those, about a dozen were found to have traumatic experiences similar to the more serious cases of the initial four CIA personnel. Between April and August, another eight cases were reported, including the three at the Capri and Nacional hotels, at least one of which involved a CIA employee. In total, 24 cases have been identified as part of this health mystery. None involve US tourists.

“Duty to Inform”

The fact that a “small universe” of CIA personnel is at the center of what has evolved into a major impasse in US-Cuban relations explains the secrecy surrounding this mystery; to publicly admit that a “CIA station” exists anywhere in the world is taboo for US officials. The Top Secret nature of CIA operations restricts the release of information by the administration, and by senators and representatives who have received multiple classified briefings on the situation. It limits access to information that both scientists and doctors need to fully evaluate what could have created this mysterious situation.

Indeed, the sensitivity around spy-vs.-spy technologies at use in Cuba may also impede a much-needed consultation between the US and Cuban intelligence communities over whether espionage-related equipment may have inadvertently combined to create these health conditions. A comprehensive acoustical study released last week by a team of computer scientists and engineers from the University of Michigan and Zhejiang University in China concluded that the metallic grinding noises experienced by US personnel in Cuba might have been caused by an accidental combination of ultrasound waves, raising the possibility that multiple ultrasonic carriers, including eavesdropping and jamming technologies, collided to create the conditions for harm. “If ultrasound played a role in harming diplomats in Cuba,” the study states, “then a plausible cause is intermodulation distortion between ultrasonic signals that unintentionally synthesize audible tones. In other words, acoustic interference without malicious intent to cause harm could have led to the audible sensations in Cuba.” It is hard to imagine how this potentially promising theory can be tested without a formal, and candid, dialogue between the appropriate US and Cuban authorities.

By hiding this part of the story, however, the Trump administration has created a false impression that a broader threat to travelers exists in Cuba, when the threat, if there was one, appears to have evolved around a specific group of US personnel. Without this context, the official travel alert—mandated by the State Department’s “duty to inform” procedures when there is a drawdown of embassy staff—is grossly misleading for the traveling public.

Indeed, if the administration fulfilled its “duty to inform” honestly, it would advise potential tourists that the health problems have been specific to US government personnel, that no cases have been reported since August 2017, and that overall, Cuba remains one of the most secure nations in the world to visit. An honest travel advisory would note that in January the International Travel Fair in Madrid voted to give Cuba an excellence award as the “safest country for tourism.” A recent survey by the Center for Responsible Travel (CREST) of 42 agencies that arrange travel to Cuba found that not a single one of the travelers they hosted in 2017 had reported any health issues related to those of the embassy community. “We have brought more than 10,000 Americans to Cuba over the last few years—including thousands in 2017 and 2018—and not one has reported any similar health issues during or after their visit,” notes Laverty of CET, who also handles The Nation’s trips to Cuba. “On the contrary, a leading response on post-trip surveys is how safe travelers feel in that country.”

CREST and CET are among almost three dozen travel agencies and educational groups calling for Secretary Tillerson to change the travel advisory and begin to restaff the embassy. Similar requests have come from senators and congressional representatives, including Vermont Senator Patrick Leahy and Florida Representative Kathy Castor, who visited Cuba in late February and met with Cuban officials to discuss how to move US-Cuban relations forward. In a February 28 letter to Secretary Tillerson, Congresswoman Castor urged him to “return consular officials and diplomatic personnel to the embassy as soon as possible” so that the United States could advance its political, cultural, and economic interests at a time of major leadership transition in Cuba, as well as to support the growing Cuban private sector, which depends on commercial interaction and US tourism. “It is also time to reverse the overreaching travel warning by the State Department that it is unsafe to travel to Cuba,” her letter continued. “There is nothing in recent history to show that Cuba is unsafe for American visitors.”

On March 5, however, the State Department began implementing a new staffing plan that will keep the embassy community at minimum levels—transforming a temporary reduction into an indefinite one. The embassy “will operate as an unaccompanied post, defined as a post at which no family members are permitted to reside,” the department declared last week. The decision was accompanied by yet another lengthy warning against traveling to Cuba.

But at time when the Trump administration seems determined to undermine better US relations with Cuba, travel to the island has become all the more important. If the State Department is unwilling to engage in the mission of diplomacy, it will be left to the citizen-diplomats to fill the void and, at the people-to-people level, advance the cause of positive relations.