What began in the 1960s as a cooperative medical initiative has evolved into a critical source of revenue for the Cuban government, according to a report by the Inter-American Commission on Human Rights (IACHR). Cuba’s international medical missions, which started in 1963 with the dispatch of a permanent brigade to Algeria, now deploy thousands of doctors around the world, serving as a lucrative export for the island nation. A recent IACHR report highlights widespread labor violations within these programs, including claims of modern slavery, denial of fair wages, excessive working hours, and punitive measures against healthcare personnel and their families.
The 200-page report expresses “concern over the working conditions faced by Cuban personnel participating in medical missions,” detailing allegations that include unpaid or partially retained wages, coercion into participation without access to employment contracts, and reprisals against medical workers who fail to comply with imposed conditions. The commission warns of serious human rights violations, particularly regarding forced labor and trafficking of Cuban health professionals. Cuba’s government has publicly denied these allegations.
Officially, the missions are framed as cooperative arrangements, designed to provide medical assistance to countries requesting support through bilateral agreements. According to data referenced in the IACHR report, at least 165 countries have hosted Cuban medical personnel across Latin America, Africa, Asia, and Europe. Over six decades, more than 600,000 Cuban health professionals have been mobilized for international assignments. The IACHR notes that “this practice has experienced sustained growth, now constituting what is estimated as the main source of revenue for the Cuban state.” In addition to generating income, the missions are sometimes seen by host countries as expressions of international solidarity, contributing to the strengthening of public health systems.
The objectives of these agreements, as outlined by the IACHR, include enhancing medical training, improving continuing education in health, delivering quality care to local populations, facilitating technical assistance, and promoting research and capacity-building. Yet interviews conducted by the commission with Cuban medical personnel reveal starkly different realities: substandard working conditions, discriminatory treatment relative to local staff, and instances of labor exploitation.
A particularly controversial allegation involves the confiscation of wages by the Cuban state. The report details the precariousness of working conditions “motivated by the retention of a significant portion of salaries by the Cuban government, severe restrictions on fundamental freedoms, and widespread lack of legal protection.” Mechanisms of control reportedly extend into the personal lives of staff, including prohibitions on forming personal relationships with local citizens and restrictions on speaking to the media without prior authorization. Those who abandon missions face serious reprisals, including permanent prohibition from returning to Cuba, forced family separations, and pressure on relatives remaining on the island.
Human Rights Watch has also criticized the Cuban government for its strict control over these brigades. HRW described the working conditions as “draconian” and has called on recipient countries to demand reforms from Havana, urging a review of contractual terms and protections for medical personnel.
The IACHR report underscores that the information it received suggests “situations compatible with contemporary forms of slavery or forced labor, including contract fraud, retention of identity documents, wage confiscation, and monitoring and control of private life.” The report also highlights the impact of geopolitical pressures, with the administration of then-US President Donald Trump demanding a shift in Cuban leadership. Some countries, including Guatemala, Honduras, and El Salvador, have expelled Cuban medical personnel. Even allies of Havana, such as Nicaragua under Daniel Ortega, have canceled contracts with Cuban doctors. These developments unfold against a backdrop of deep socio-economic crisis in Cuba, marked by shortages of essential goods, persistent inflation, declining public services, and reduced purchasing power.
The IACHR is calling on both Cuba and host nations to reform the international medical mission model to ensure compliance with human rights standards. The commission emphasizes that participation must be voluntary, wages must be paid fully and directly, freedom of movement must be respected, and all forms of forced labor, retaliation, and union restrictions must be eliminated. It further recommends the establishment of independent inspection mechanisms and legal frameworks that guarantee dignified, safe, and transparent working conditions aligned with international human rights standards.
Analysts note that the dual narrative of the missions—as humanitarian aid and as an economic engine—has complicated efforts to hold Cuba accountable. While the missions are recognized in some countries for strengthening local healthcare systems, reports of coercion, surveillance, and wage control raise serious ethical and legal concerns. The report suggests that the Cuban state has institutionalized oversight mechanisms that extend far beyond standard employment practices, encompassing both professional and personal spheres, thereby creating conditions akin to forced labor.
The IACHR findings have significant implications for global health cooperation, raising questions about the ethics of sourcing labor under coercive conditions while maintaining the appearance of humanitarian solidarity. The situation also presents legal challenges for host countries, which may unwittingly participate in programs that violate labor and human rights conventions. International human rights organizations are urging transparency, enforcement of labor protections, and reforms to ensure that medical personnel are treated fairly and can exercise their rights without fear of retaliation.
