The Trump administration is expanding its effort to isolate Cuba by offering incentives to other countries to kick out Cuban doctors whose services help fund Havana’s communist leadership, according to State Department documents obtained by POLITICO.
In a Feb. 23 memo to Secretary of State Marco Rubio, department officials detailed a comprehensive strategy to coax Western Hemisphere countries — some of whom rely heavily on Cuban medical assistance — away from using the program. The memo says the State Department is offering countries that agree to stop employing Cuban doctors support for “infrastructure modernization,” like telemedicine and virtual training, as well as offering countries help in turning to “ethical third-country recruitment” of medical workers.
The move highlights the diverse strategies the U.S. is using to topple the Cuban regime without resorting to military action. And it shows that the U.S. is intensifying that economic and diplomatic pressure campaign.
While the U.S. targeting of Cuban medical missions has been reported, the memo and the details of the strategy it lays out have not.
President Donald Trump has said the Cuban regime is on his list of adversaries to subdue alongside those in Venezuela and Iran, although he has cast it as a “friendly takeover” rather than threatening a military operation. In recent months, the U.S. has moved on multiple fronts — from tightening sanctions to blocking oil imports — to diminish Cuba’s links to other countries.
To Havana’s dismay, a growing number of countries are choosing the U.S. over Cuba, including by saying no to Cuban doctors. Some countries are caving to the American pressure, while others appear to be acting on their own initiative to gain U.S. favor.
“It’s difficult to find partners in the conditions that our economy is working [through] under the U.S. blockade,” Cuba’s de facto ambassador to the United States, Lianys Torres Rivera, said in an interview. “The main world superpower is trying to strangle a tiny economy, a tiny country, an island that is not a threat for the United States.”
Cuba has for decades sent tens of thousands of physicians and other health care workers around the world, often to countries that have limited resources to fund their health care systems. Cuban physicians are required to go on such missions as part of their medical training, which is free in Cuba. Critics argue that the Cuban regime is essentially trafficking and profiting off its health care workers, and there have been reports of the workers being exploited. Cuba’s government says it uses the revenue from medical missions to fund its own health care system.
In the memo, marked sensitive but unclassified, two senior State Department officials said their bureaus were implementing a plan to effectively eliminate Cuba’s medical missions program in the Western Hemisphere over a period of two to four years.
Some 19,000 Cuban health care professionals work in 16 Western Hemisphere countries, the memo estimates, adding that in some countries they make up more than 20 percent of medical personnel.
Tearing down the program “denies the Cuban regime critical revenue and regional influence,” wrote the two officials, Michael Kozak, the senior official in the Western Hemisphere bureau, and Jeff Graham, the senior official in the Bureau of Global Health Security and Diplomacy.
The Trump administration believes it has an unusual opportunity to dramatically reshape if not outright end the Cuban government, which has been in power for nearly 70 years.
The “general sense is that we can remove the regime without having to bomb anything. We’re squeezing them economically and diplomatically quite effectively,” said a person close to the White House, granted anonymity to discuss sensitive plans.
The White House declined to provide immediate comment.
The State Department’s Jeremy Lewin, a senior official who deals with foreign assistance and launched the administration’s America First Global Health Strategy, said the pressure campaign is about both cutting off the Cuban regime and defending human rights.
“Cuban medical brigades are a key source of hard cash for the failing regime, and one of the most pernicious examples of modern-day slavery and forced labor,” Lewin said.
The U.S. has long imposed economic sanctions on Cuba, and past presidents have also targeted the medical missions program. But Washington has significantly upped the pressure on multiple fronts since Trump returned to office.
That includes everything from reinstating Cuba on the State Sponsors of Terrorism list on Trump’s first day back as president to refusing visas for some of its athletic officials to expanding the list of Cuban entities with which Americans are forbidden to do business.
Rubio, the U.S.-born son of Cuban immigrants who has long sought to topple the Havana regime, has led much of the effort.
The Trump administration pressure reached new heights this year. After the U.S. captured Venezuelan President Nicolás Maduro in January, it convinced the Caracas regime to end oil shipments to Cuba that had supplied most of its energy needs. Through tariffs and other threats, the Trump team has led other countries to reduce their oil shipments to Cuba as well.
While some countries are providing Havana with humanitarian aid, and even the U.S. is allowing some oil imports if they go to Cuba’s private sector, the country of 10 million is essentially running on fumes. Its citizens must endure severe power outages and long waits for gasoline.
The U.S. campaign has also included assistance with police actions. Days after the U.S. launched a March 3 joint operation with Ecuador’s military against a major gang in the country, Quito broke diplomatic relations with Havana and expelled Cuban diplomats from the country. While Ecuador has not given a clear reason for its decision, analysts say it appeared to be a way to gain favor with the Trump administration.
Rubio has also been engaged in private talks with Cuban representatives about political and economic reforms. The hope among some critics of the Cuban government is that continued pressure on Cuba’s economy will spur the regime to make changes like allowing for multiparty elections or ease repression on the island, which lies some 90 miles off the Florida coast.
Cuban President Miguel Díaz-Canel confirmed Friday for the first time that the U.S. and Cuba are engaged in negotiations.
The State Department memo on the Cuban doctors calls the plan to cut off the program the “Freedom Framework for Self-Sufficient Healthcare in the Americas.” It goes far beyond earlier efforts to revoke visas from officials the U.S. determines are complicit in the mistreatment of Cuban medical workers.
Cuba has been making several billion dollars a year off of the medical missions program, proceeds it claims to reinvest in its own health system. What it charges countries per worker varies; Cuba does not charge poorer countries as much as it charges wealthier countries, as the rate often depends on the local wage for doctors.
Already, two countries with longstanding medical partnerships with Havana suddenly ended their programs under pressure from the U.S.
Honduras nixed its program earlier this month, days before the country’s president, Nasry Asfura, joined Trump at a summit of right-leaning Western Hemisphere leaders in Doral, Florida. Also in March, Jamaica ended its decades-old medical partnership with Cuba.
Some countries are still working with Cuba’s medical missions but modifying the terms of the arrangements to avoid running afoul of U.S. complaints that doctors are being mistreated. A senior Caribbean official, granted anonymity to discuss the sensitive situation, pointed to efforts in the Bahamas to negotiate employment contracts directly with Cuban health workers, as opposed to the Cuban state.
Caribbean states in particular are caught in a tough spot, the senior Caribbean official said. Many are reluctant to ditch medical programs that have aided their health systems and are relied upon by many people in the region, or to turn their back on a long-time partner, but they also don’t want to anger their super-power neighbor.
“Honestly, there’s a lot of fear,” the senior official said, adding that the pressure “has never been this open. This is unprecedented.”
The documents obtained by POLITICO state that several countries in the region “claim” they pay the Cuban workers directly, circumventing the regime. That list includes Mexico, where more than 3,600 Cuban medical professionals work, according to the documents. Still, U.S. officials appear intent on those countries fully severing ties to the program.
With 14,000 Cuban medical professionals, Venezuela appears to be by far the biggest user of the program regionally. But the documents list Venezuela as a “quick win,” noting that the U.S. will not be allowing what’s left of the Venezuelan regime to use oil funds to pay Havana and that Cuba has already pulled out many of its medical workers from the country.
At the same time, a bumper crop of right-leaning or centrist governments in the Western Hemisphere — from Trinidad and Tobago to Chile — have little sympathy for the communist government in Havana, making it somewhat easier for the Trump message to get through.
Torres Rivera insisted that Cuba will continue to “engage with any country on Earth” that wants to trade or otherwise engage with the island, despite the challenges.
Some countries are still on the fence. Mexico initially offered to sell oil to Cuba, but it is not expected to fill the gap left behind by the collapse of Venezuelan support. Mexico has faced considerable pressure to not give Cuba oil from the United States.
John Kavulich, president of the U.S.-Cuba Trade and Economic Council, said the Trump administration’s game plan appears to be succeeding.
Countries under pressure calculate that doing what Trump wants costs them little domestically and “gains them far more with Washington than they lose in Havana,” Kavulich said.
Diana Nerozzi contributed to this report.
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