The Trump administration announced Tuesday it will expel 15 Cuban diplomats from the U.S. in response to months of “health attacks” that have affected American personnel in Havana.

The move comes days after the U.S. pulled roughly 60 percent of its embassy staff from the Cuban capital and is the latest sign of the worsening ties between the two former Cold War foes under President Trump.

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A State Department official said the expulsions will ensure “we have equitable staffing levels” while still allowing the embassies to operate. The official would not confirm whether the percentage of Cubans expelled matches the U.S. staff cut in Havana.

The Cuban officials were given seven days to leave Washington.

The diplomatic tit-for-tat is a further blow to former President Obama’s effort to re-establish ties with Cuba after decades of isolation.

The State Department official said the U.S. is maintaining diplomatic ties with Cuba, but warned Havana it will need its “full assurances” that U.S. diplomats will be protected in order to restore a full presence there.

“We have underscored repeatedly to the Cuban government its responsibility for the security, safety, [and] well-being” of our diplomats, the official said.

The move will likely please Cuban-American lawmakers in Washington, who have urged the Trump administration to expel Cuban diplomats over the attacks. But the emissaries are not being declared persona non grata, meaning they will avoid the most serious punishment for foreign diplomats.

The State Department said Tuesday that at least 22 U.S. embassy employees have been injured in the attacks. The affected diplomats have reportedly suffered loss of hearing, headaches and other symptoms.

The Cuban government has denied it was behind any attack and has pledged to investigate the incidents. But so far, no culprit has been named. The Trump administration has not blamed the Castro government, but has repeatedly stated it bears responsibility for stopping them.

In addition to the embassy drawdown, the Trump administration has stopped issuing visas for Cubans seeking to visit the U.S. and issued a travel warning for Americans who want to visit Cuba. The U.S. also expelled two other Cuban diplomats in May over the attacks.

Tensions between Washington and Havana have repeatedly flared under Trump.

The president over the summer rolled back part of Obama’s Cuba policy, which he criticized as a “one-sided deal.”

Cuban officials warned the move would damage relations between the two nations.