Images of Cuban doctors in virus-hit Italy have drawn attention, highlighting a tradition of medical internationalism.

As the world fights to stop COVID-19 claiming more lives, Cuba has dispatched 593 medical workers to 14 countries in their battles against the pandemic, its ministry of public health told Al Jazeera.

One of the first Cuban medical teams was sent to Italy on March 21 at the request of Lombardy, its worst-hit region.

According to Dr Jorge Delgado Bustillo, director of the Central Unit of Cooperation at the ministry, which is responsible for running the foreign missions, the other 13 countries are: Andorra, Venezuela, Nicaragua, Surinam, Jamaica, Haiti, Belice, Dominica, and the island nations of Saint Christopher and Nevis, Saint Vincent and the Grenadines, Grenada, St Lucia and Antigua and Barbuda.

Dozens of other countries across the world have also sent requests for medical help from Cuba, which the health ministry is currently reviewing and will respond to based on its capacities, Dr Bustillo said in an email to Al Jazeera.

“#Cuba has extended a hand many times, but never so many times in such a short time. In the past week, a Henry Reeve brigade has departed with each sunrise. There are already 11 in total. There is no precedent,” Jose Angel Portal Miranda, Cuba’s health minister, tweeted on March 28.

Since then, three more medical missions have been sent. According to a statement on the Cuban health ministry’s website, 179 doctors, 399 nurses and 15 health technologists have been dispatched as part of this initiative.

These medical workers belong to the Henry Reeve Emergency Medical Contingent, named after a US-born general who fought in the First Cuban War of Independence in the 19th century.

It was created in 2005 by the late Cuban leader Fidel Castro and specialises in rapid medical response to natural disasters and outbreaks.

They don't have this problem that Boris Johnson has and that Trump has, which is that the public healthcare response interferes with private interest and the process of profit-making. Helen Yaffe, lecturer in Economic and Social History at University of Glasgow

According to the Pan American Health Organization, between 2005 and 2017, the unit helped 3.5 million people in 21 countries affected by disasters, such as floods, earthquakes, hurricanes and epidemics, including the 2014 Ebola outbreak in West Africa.

On March 18, a British cruise ship carrying several passengers infected with COVID-19 was allowed to dock at a Cuban port, after it was turned away by other countries in the Caribbean. Some 680 passengers were then flown back to the UK on chartered flights from Havana.

So far, Cuba itself has 170 confirmed cases and four deaths, at least two of whom were foreign tourists. Like many other nations, it has barred foreigners from travelling to the country and advised the elderly and people with underlying conditions to stay at home.

But unlike other countries, it has not imposed a nationwide lockdown.

A history of Cuba’s medical internationalism

Cuba’s international medical outreach goes back decades, to the first years of the Cuban Revolution.

Experts say years of investment in free healthcare and a flourishing biotechnology sector have prepared its workforce to respond to emergencies.

In 1960, a year after Castro took power, Cuba sent a team of medics to Chile after a devastating earthquake hit the country. Three years later, Havana dispatched medical workers to help newly independent Algeria build its healthcare sector.

According to Helen Yaffe, a lecturer in Economic and Social History at University of Glasgow, free healthcare as a universal human right was a key tenet of the 1959 Cuban Revolution and laid the foundations of its medical internationalism – the idea and practice of sending medical teams to support other nations.

Cuba developed its public healthcare system, focusing on primary care and prevention, and built an international outreach programme which Yaffe says was based on solidarity and offered free of charge until the early 2000s.

After Hugo Chavez came to power in Venezuela, Cuba started sending medical staff and educators to help his Bolivarian revolution.

In return, Havana started purchasing Venezuelan oil at below-market prices. Some 30,000 Cuban medical workers were sent in the first 10 years of the “Oil for Doctors” programme.

“It was when Venezuela said, ‘We can pay for this’, that the possibility of Cuba using the export of medical professionals as a source of revenue for the country developed,” said Yaffe.

Cuba later set up permanent medical missions in a number of countries, including South Africa, Brazil, Ecuador, Qatar and others, which would pay in hard currency for them.

Over the past 50 years, it is estimated that between 135,000 and 400,000 Cuban doctors have been sent abroad.

Cuban doctors at the field hospital in Crema during the Coronavirus emergency lockdown in Italy, 23 March 2020 [Filippo Venezia/EPA]

Meanwhile, the Cuban government has invested heavily in the biotech industry, which today is another source for hard currency for the small country.

In the 1980s, faced with several outbreaks of infectious disease, such as dengue fever and meningitis, Cuban scientists worked hard to develop medicine and vaccines and support a prevention-oriented healthcare system.

“Biotech was one of two ‘revolutions within the revolution’ in Cuba’s health sector,” said Gail Reed, founder of Medical Education Cooperation with Cuba, a US non-profit promoting cooperation among US, Cuban and global health communities.

“Now, it is a powerhouse for health and also for the Cuban economy.”

According to Reed, Cuba’s biotech industry has developed successful drugs, including a therapeutic lung cancer vaccine and Heberprot-P, which reduces amputation risk in patients affected by diabetic foot ulcers.

Its signature drug, Interferon Alfa-2B Recombinant, has been used in the treatment of HIV and hepatitis and is now being given to COVID-19 patients, although its effectiveness is still not confirmed.

‘Not an example to follow any more’

But Cuba’s international health initiatives have also faced criticism, with some rights groups accusing Havana of exploiting its medical workers.

Former members of Cuban medical missions abroad have alleged that they had to work in unsafe environments and their movements were watched by government minders.

Medical staff working abroad in permanent medical missions reportedly receive between 10 and 25 percent of their salaries, paid by the host country. The rest is allegedly sent to the Cuban government. It is estimated that over 7,000 Cuban medical workers defected from such missions between 2006 and 2016.

The US, which has a strained relationship with Cuba and has imposed a trade embargo on it for decades, has characterised the Cuban medical missions as “human trafficking” and called on countries to stop accepting them.

In 2005, Washington rejected an offer by Castro to send Cuban doctors to US states devastated by Hurricane Katrina.

In 2019, Brazil, Ecuador and Bolivia ended their agreements for medical cooperation with Cuba. The number of Cuban medical professionals has dropped from 50,000 in 2016 to 28,000 today.

Asked about the US allegations, Dr Bustillo said they are “an insult” to Cuba’s bilateral and intergovernmental cooperation programmes, which have all been legitimately established based on guidelines of the United Nations regarding South-South cooperation.

“Access to health is a human right, and the United States commits a crime by pretending to deny or hinder it for political or aggression reasons,” he added.

According to Reed, Washington is trying to curb sources of hard currency for the Cuban government.

“[It] is outrageous that the US administration is strong-arming governments of poor countries not to accept medical teams from Cuba,” she said, adding that Cuban doctors volunteer for these missions out of solidarity and because they still make more money abroad than at home.

Critics have also raised concerns about the deteriorating state of some health infrastructure and services in Cuba.

They have argued that although the country has one of the highest doctor-to-patient ratios in the world, with 95,000 doctors providing care for its 11-million population, the quality of healthcare provision has declined – the result of a weak economy.

“[The] health infrastructure is ailing, and they have a chronic shortage of health inputs, both of medical equipment and drugs,” said Dr Octavio Gomez Dantes, a senior researcher at Mexico’s National Institute of Public Health. “Even the sanitary and water infrastructure is in poor conditions, and that will eventually create major health problems.”

Falling oil prices and economic and political crises in neighbouring Venezuela have affected Cuba, prompting the government to enforce strict price controls and energy rationing.

The US has also imposed additional sanctions in an attempt to pressure Havana into abandoning its support for Nicholas Maduro’s government in Caracas.

But according to Dantes, US sanctions alone cannot be blamed for healthcare woes and Cuba’s economic challenges. The international missions have led to complaints of medical staff shortages in the country.

“Cuba is not an example to follow any more. There are many health systems in the developing world, most of them financed with public resources, that are performing much better. The Costa Rican health system, for example,” he said.

Despite the difficulties it is experiencing, Dantes considers the Cuban healthcare system prepared for the COVID-19 outbreak.

“Cuba has had a very good epidemiologic surveillance system,” he said.

Yeffe is also convinced that Cuba can cope with the epidemic, because it has proved capable of mobilising national resources and its population during natural disasters and health emergencies.

“They don’t have this problem that [UK Prime Minister] Boris Johnson has and that [US Presdent Donald] Trump has,” she said, “which is that the public healthcare response interferes with private interest and the process of profit-making.”

This article has been updated to include comments from Dr Jorge Delgado Bustillo, a representative of Cuba’s health ministry.

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