The Organization of American States has launched a formal investigation into Cuba’s international medical missions amid growing claims that the program amounts to forced labor. The move comes as the US escalates pressure on countries that host the missions, revoking visas for government officials tied to the controversial scheme.

In late May, the Inter-American Commission on Human Rights sent a letter to all 34 OAS member countries demanding detailed information on every Cuban medical mission, including contracts, complaints, union rights and lists of doctors who abandoned their posts.

The request, timed shortly after US Secretary of State Marco Rubio imposed visa bans on officials tied to the programs, has sparked sharp criticism.

Some Caribbean leaders briskly defended the missions. Trinidad and Tobago’s Prime Minister Keith Rowley said banning Cuban doctors would “jeopardize our sovereignty” and he would rather lose his US visa than cut off vital services.

Similarly, Saint Vincent and the Grenadines’ Prime Minister Ralph Gonsalves provided US officials assurances that Cuban doctors in his country are treated fairly. “International labor conventions have not been breached and will not be breached,” he said.

For decades, Cuba has deployed tens of thousands of doctors and nurses to provide care in underserved regions of the globe, calling its medical brigades “missions of solidarity.” 

The country has about 24,000 doctors working in 54 countries, including in the Caribbean and the Americas, according to its government. A breakdown for the region was not available, but many impoverished nations in the Caribbean rely heavily on those medical professionals.

But many doctors who have participated in the missions complain about labor conditions.

One Cuban gynecologist, who asked not to be named for fear of retaliation, joined a mission to Seychelles in 2018, drawn by the promise of a better income. In Cuba, she earned just $40 a month, far from being enough to survive. The overseas contract offered a lifeline: housing, utilities and 700 euros (around $800) in cash each month. But once there, she discovered that half her salary was withheld by the Cuban government, and that her daily life — from her social interactions to her romantic relationships — was under constant scrutiny.

“My own colleagues were the ones watching me,” she said. “They would report what I bought, where I went, even who I was talking to.”

Things got worse after she started dating a man outside the mission with political views different from that of the Cuban government. When she decided to marry him, she was told her contract was terminated and she needed to return to Cuba. When she didn’t, she was labeled a defector.

Defecting a mission is a criminal offense

Under Cuban law, abandoning an official mission is considered a criminal offense. The punishment: a ban on entering one’s own country for eight years, sometimes accompanied by prosecution or loss of a number of rights back home.

Arisleydi López, a nurse who worked in Venezuela, described being threatened at gunpoint by gang members demanding medical care.

“If their friend died, I’d be next,” she said.

Meanwhile, her local pay was rendered worthless by hyperinflation and, although the Cuban government deposited $50 a month into her account, she was warned she would lose it if she left the mission.

“It was the biggest fraud of my life — what the Cuban government did to us,” López said.

After being caught talking to human rights activists abroad, she was threatened with being returned to Cuba and facing consequences, so she fled to neighboring Colombia. She was later granted asylum in the US and now lives in Illinois. She hasn’t seen her 10-year-old daughter in four years.

Elba Rosa, another Cuban doctor, also worked in Venezuela in 2003. She said her passport was confiscated the day she arrived on her mission and that she didn’t see it for years.

“We had to be reachable at any hour,” she said. “We couldn’t move without being questioned.”

She described being instructed to conduct house-to-house surveys and promote then-President Hugo Chávez’s socialist policies.

“It was part medical work, part political outreach,” she said.

Human rights groups have long raised concerns about the missions. Javier Larrondo, president of Prisoners Defenders, said the organization has collected testimony from over 1,400 Cuban medical professionals.

“The Cuban government separates these doctors from their children for years, they withhold their wages and they control their movements,” he said. “This isn’t humanitarian work. It’s modern slavery.”

Larrondo estimates that the Cuban government retains between 85% and 95% of the salaries host countries pay. The revenue, while opaque, is believed to be one of Cuba’s most important sources of income.

A study by the Miami-based human rights group Cuba Archive estimates that Cuba generates over $4 billion annually by sending professionals abroad — including doctors, construction workers, teachers and other skilled laborers. The findings were prepared for the US State Department’s annual report on human trafficking.

Cuban officials have strongly rejected the accusations. In an April interview with Spanish journalists, President Miguel Díaz-Canel defended the missions, calling them “a profoundly human, altruistic and solidary effort.” He dismissed the criticism as “a perverse political campaign” and said the money supports Cuba’s domestic health system.

Earlier this year, Cuba’s health minister acknowledged that some missions had confiscated participants’ passports in the past but said the practice no longer occurs.

Not all doctors see the missions as coercive. A woman currently working in Mexico told The World that her experience has been positive.

“It’s made me more sensitive, more human,” she said.

She accepts that the government takes a portion of her salary.

“It’s a way to give back to my country after studying medicine for free,” she said, adding that she feels lucky to travel and serve abroad.

Cuba says it currently has 24,000 health professionals deployed in 54 countries — fewer than at the program’s 2014 peak. It has declined over the past decade because of disputes with Brazil and cutbacks in Venezuela.

The Bahamas is the latest country to distance itself from the program. Under pressure from the US, it quietly opted to cancel its contracts with Cuban doctors and will begin hiring medical personnel directly. According to the country’s health minister, Cuban staff have been given a transition period to wind down their work.

Guyana’s foreign minister, Hugh Todd, told The Associated Press on Friday that the government plans to amend its payment and recruitment system involving Cuban medical professionals.