The COVID-AM blog is a partnership between the UMI 3157 iGLOBES and the Institut des Amériques, coordinated by François-Michel Le Tourneau, Deputy Director and Marion Magnan, researcher at the Institute. About the blog.

by Mélanie Moreau-Lebert, Professor in Latin-American Civilization at the Université Bordeaux Montaigne representative for the Institut des Amérique at the Université.

After the historic reconciliation between Cuba and the United States in 2014, under President Barack Obama, the Trump era started with a return to aggressive politics and a reinforcement of the economic and financial embargo that has weighed on Cuba since 1962.

The brigades' most glaring visibility also brought to light their long history in the fight against global medical emergencies. The media seemed surprised at the presence of these Cuban doctors overseas, and unhinged by the out of sync images showing men and women coming down from a plane with Cuban flags, to the sounds of the national anthem, as can be seen in the francetvinfo.fr on March 24, 2020 as 52 doctors arrive in Lombardie: "These last few days, Cuban doctors arrived in Italy to lend a helping hand to their colleagues. An information that can seem surprising, but that isn't (...). We thought that Cuba, a poor island, had enough to do with its own problems, but no..." (Source FranceTVinfo).

Even France, at first reticent at the thought of calling on Cuba, wound up "accepting" the presence of Cuban doctors in Martinique, Guadeloupe, French Guiana and Saint Pierre and Miquelon. The senator from Martinique, Catherine Conconne, was happy for this measure which she had been saying for a long time "was taken to reinforce our hospitals. We are missing a few medical specialists and we have a hard time getting doctors from Europe. This amendment will allow us to dip into our Cuban brotherly resources. So, for me, it's a victory, a great joy. That this decree arrives during the coronavirus crisis, that's just fine". (RFI.fr, 31/03/2020).

So, on June 26, a Cuban "brigade" disembarked in Martinique, composed of "a pulmonologist, two specialists in internal medicine, an infectious disease specialist, two anesthetists, three radiologists, two nephrologists, one hematologist." (Huffington post).

"MEDICAL INTERNATIONALISM", A CUBAN ASSET SINCE 1959

Medical internationalism has been a feature of Cuba since 1959, especially in Africa, in Latin America, and in the most isolated regions, to the most vulnerable populations. In 2005, the Henry Reeve brigade (the name of a young American who had fought alongside the Cubans in the war of independence against Spain) was created as a group of doctors specialized in fighting against public health disasters and epidemics. In fact, it was involved in the 2005 earthquake in Pakistan, in Haiti in 2010, to fight against the cholera epidemic after the earthquake that devastated the country, and in West Africa in 2014 when close to 250 Cuban doctors played a major role in the fight against the Ebola virus. Cuba even responded to the call for help sent by Louisiana's governor, Kathleen Babineaux, after hurricane Katrina went through in August 2005, proposing 1 600 specialized doctors, as well as equipment and medicaiton that could arrive in under 48h. George Bush refused, with the resulting consequences that are known.

Today, in a large portion of the world, respect seems to have replaced distrust and caution. Over forty European organizations uphold the proposal of giving the Nobel peace prize to the Cuban medical brigades of the Henry Reeves contingent, for their contribution against the global fight against COVID-19.

This acknowledgment and the return of Cuba on the international scene during a health crisis cristallizes the tensions with the United States, who seem, on their end, incapable of controlling the pandemic. Trump's reacton is not long in coming since in April the State Secretary Mike Pompeo declares:  "We’ve noticed how the regime in Havana has taken advantage of the COVID-19 pandemic.  Governments accepting Cuban doctors must pay them directly. Otherwise, when they pay the regime, they are helping the Cuban Government turn a profit on human trafficking". This accusation against Cuba had already been made in 2018, supported by the Brazilian president Jair Bolsonaro, who was lashing out at the thousands of Cuban doctors present in the country, putting in doubt their competence and accusing the Cuban government of slavery.

The "Mais médicos" (more doctors) program was in fact one of the most important from a numeric standpoint for Cuban medical assistance. Put in place in 2013 under the direction of Dilma Rousseff, it consisted in sending over 8000 doctors to Brazil to work in clinics and public hospitals, especially in underprivileged areas. In return, Cuba received money which only a small portion was given to the doctors, feeding into the criticisms from the conservative right in Brazil. However, the Cuban doctors quickly became an essential cog in the health system and when they left, the national association of mayors of Brazil sounded the alarm, calling to mind that close to 80% of the country's towns "totally depended on the program for medical care and 90% of the indigenous population was treated by Cuban professionals".

This skirmish with Brazil illustrates the two-sided aspect of the Cuban medical assistance. Though it is a geopolitical asset with respect to developping countries, it is also a source of economic revenu inasmuch as the Cuban government, when countries can pay for it, charges for the presence of the doctors and keeps a large portion of their salary.

WHY EXPEND SO MUCH ENERGY CONDEMNING THE CUBAN DOCTORS' SITUATION?

While the controversy concerning the status, indeed questionable, of Cuban doctors overseas is rekindled and after the director of the World Health Organization, making reference to the danger of the new coronavirus, asked that "politics be put in quarantine", President Trump reinforced the measures aiming at asphyxiating Cuba in the beginning of April, forbidding the delivery of respirators, equipment and medicine which partners, of which China, had sent. This did not fail to stun public opinion internationally and impact all the more so the American president's image, whose excessive dislike for the medical brigades "victims of human trafficking" does not fool anyone.

Why so much hate from a president who at first glance has more urgent matters to deal with? Cuba's economic system rests on three pillars, of which the first one is precisely medical internationalism, which earns between 8 to 10 billion dollars a year, followed by the remesas (money sent by families overseas) and tourism. The last two are deeply impacted by the health and economic crisis caused by Covid-19, and are throwing Cuba in a new "special period".

Denying Cuba influx of money generated by the medical aid programs would allow the United States to continue undermining the regime by asphyxiating its economy. Ending the Castro era and imposing a new government has been an undisguised strategy of the American administration for a long time. 

To that end, Rick Scott, Marco Rubio and Ted Cruz, Republican senators from Florida and Texas submitted a legislative proposal to the American State Department in the beginning of June which would sanction countries that called on Cuban doctors. The legislative proposal, named the Cut Profits to the Cuban Regime Act stipulates that the State Department will publish the list of countries who have signed contracts with the Cuban government for its medical missions program, and demands that it be considered a factor when classifying countries that deal with human trafficking. (Cubadebate.cu, 06/18/2020).

American threats however seem to be falling flat in the current situation (which the Cuban president did not hesitate to point out in a tweet) because Cuba, despite the controversies, has shown its effectiveness in managing the health crisis, by anticipating and taking drastic preventative measures of treatment, isolation and information, demonstrating that the Cuban health system is operational, efficient, high performance and fair.

The Ministry of Health, which publishes an information bulletin daily, announced on the first of July a count of 2 348 cases of which 2 218 healed and 86 deaths. Among the measures taken to control the epidemic, of note are the systemic door to door done by 28 000 medical students who visited and found the Coronavirus cases in each family, six laboratories put to use for making and doing tests, the set-up of units specifically dedicated to the sick with coronavirus in 20 hospitals, the set up of efficient treatments and protocols thanks to innovative products coming from Cuban biotechnology and biopharmaceutical (notably Interferon Alpha 2-B, retroviral that has proven itself)...

On Wednesday July 2nd, Cuba celebrates the return of some of its brigades, such as the one from Andorra and Lobardie, while others, in Martinique for example, lend a hand to the teams and the population. Without a doubt, it is not all rosy, far from it, and some things are questionable in the way Cuban doctors are treated and paid. It remains that politically the Covid-19 pandemic has intensified tensions between Cuba and the United States and led the giant in the North to adopt new intimidation strategies toward Cuba and its allies. It remains to be seen whether the effectiveness of Cuban medicine will be more attractive than the risk of upsetting a United States that is bending under the pressure of the disease.