In a recent interview on the program Democracy Now!, Cuban Deputy Foreign Minister Carlos Fernández de Cossío sought to dismantle the allegations of forced labor in Cuba's international medical missions, claiming that the state program “is very similar” to those of American, European, or even United Nations agencies.
"The terms of this cooperation [...] are completely in line with what the United Nations practices and what many countries do when providing assistance," said the official in response to statements made by U.S. Secretary of State Marco Rubio, who has repeatedly denounced that "the Cuban regime does not pay these doctors. It takes away their passports, and in many ways, it is forced labor."
In his statements, Fernández de Cossío accused Rubio of lying: “He knows very well [...] that these doctors receive their full salary in Cuba while providing services in another country, [and that] they receive a decent, substantial stipend that increases their standard of living and is better than what their colleagues have in Cuba.”
The deputy minister defended the program as a gesture of solidarity and international cooperation, stating that “it has received praise from governments and several United Nations secretaries-general for its ability to provide medical assistance to millions of people”.
However, his speech omits the essential point: that the Cuban government takes the majority of the salary paid by the receiving countries for these services, and that many doctors cannot refuse to participate without facing repercussions, ranging from job sanctions to restrictions on leaving the country.
Although Fernández de Cossío insists that the missions are based on "bilateral agreements with each country," the regime does not allow doctors to negotiate their conditions or to practice their profession freely outside of state supervision.
Various reports, including those from Human Rights Watch and testimonies collected by independent media, document a consistent pattern: passport confiscation, salary withholding, monitoring in destination countries, and punishments for those who desert or refuse to undertake a second mission.
The statement that doctors are “better paid” and “treated with dignity” contradicts what the Cuban doctors themselves have denounced for years. Many of them flee during missions, breaking ties with their families and facing the punishment of not being able to return to the island for at least eight years.
Fernández de Cossío also tried to justify the system of medical missions within the official discourse of "economic aggression" by the U.S.: "The objective [of the embargo] is to encircle Cuba and isolate it from the international economy. [...] This impacts the lives of the Cuban people," he said.
What the Deputy Foreign Minister does not mention is that while denouncing an “unprecedented economic blockade,” medical missions represent one of the main sources of income for the regime, which raises billions in hard currency every year at the expense of healthcare professionals' labor.
The human impact: between vocation and forced sacrifice
Beyond the diplomatic discourse, medical missions are, for many Cubans, an ambivalent experience: the opportunity to temporarily improve their living conditions, but also a tool for political control, family isolation, and exploitation.
The comparison with the UN, far from clarifying, seeks to depoliticize a model designed to benefit the state, not its workers. In the words of the Vice Minister himself: “Rubio [...] must have lied. First, he accused them of being agents of the Cuban government, intelligence agents [...]. Now he has changed his narrative and says it is forced labor, that they are slaves, that they are not paid. All of which is a fallacy.”
For Cuban doctors, however, those "fallacies" describe a reality that many have experienced firsthand. And for thousands of Cubans both on and off the island, the debate is not about diplomacy, but about rights, dignity, and freedom.
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