Ramona Matos, who had been a doctor in Cuba and recently obtained U.S. citizenship, didn’t hesitate to make her voting decision last year. She chose Donald Trump, the candidate who promised to take a hard stance against the communist Cuban government.
Matos hoped that Trump would help free the Cuban people and, in particular, put an end to a practice that Havana has used to improve its global image, something Matos found especially repulsive for personal reasons. For decades, the Cuban government has sent thousands of healthcare professionals to work in remote towns and cities across the world, where they are paid only a fraction of what these countries pay Cuba for their services.
“These doctors are slaves to the Cuban dictatorship,” said Matos, 63, who, after working in Cuban medical missions in Bolivia and Brazil, now works in a factory in South Florida.
Since taking office, Trump has ramped up pressure on Cuba, including its global medical program. With a Cuban-American Secretary of State and a Latin American envoy known for his hardline stance on Cuba, the Trump administration quickly imposed tougher measures. This shift marks the latest turn in the U.S. policy toward Cuba, which has swung between aggression and détente depending on who occupies the White House.
The Trump administration rolled back measures put in place by the Biden administration, reinstating Cuba on the list of state sponsors of terrorism, which limits its ability to do business globally. It also restored the right of U.S. citizens to file lawsuits over properties seized from them in Cuba decades ago. Additionally, visas were revoked for Cuban officials, and business transactions with Cuban companies controlled by the military, intelligence, and security services—who manage key industries such as tourism and imports—were banned.
While previous Republican administrations had attempted to target Cuba’s medical missions, Trump has taken a harder line. In February, for the first time, the U.S. government announced it would revoke travel visas for officials from countries that host Cuban medical brigades. This measure threatens one of Cuba’s major sources of foreign currency, just as the nation faces a massive wave of migration, widespread power outages, and severe food shortages.
It is difficult to pinpoint exactly how much revenue the medical program generates for Cuba, as experts note that government figures are often unclear due to frequent changes in the way payments are described. However, it is estimated that Cuba earns more than $4 billion annually by exporting workers in fields like health, construction, education, and other skilled professions, according to a study by Archivo Cuba, a human rights organization based in Miami. The study was prepared for the U.S. State Department’s annual Trafficking in Persons report.
So far, four government officials—two from Venezuela and two from Cuba—have had their U.S. visas revoked as a result of the new U.S. policy, according to the State Department.
“I don’t agree with everything Trump does, but on Cuba, I think it’s wonderful,” Matos said.
Cuban medical brigades operate in dozens of countries, from Africa to Latin America and the Caribbean. Although they are often described as humanitarian missions for nations in need of medical care, the countries pay Cuba for the services of doctors, nurses, technicians, and other professionals, helping the Cuban government fund its healthcare system.
Currently, Cuba has about 24,000 workers deployed in 56 countries, according to the Cuban government. The program peaked in 2014 but has declined in the past decade due to disputes with Brazil and cutbacks in Venezuela.
While Cuban healthcare workers receive free medical education in Cuba, many choose to participate in the program because they earn far more than they would at home. However, they only receive a fraction—between 2% and 15%, according to human rights activists—of what governments pay Cuba for their services. Half of their wages are deposited in a local currency account in Cuba, which is devalued, and they can only withdraw the funds after returning home from their missions.
Doctors who have worked abroad report that their passports were taken, they were not allowed to interact with the local population, and, in some communities, they had to adhere to a 6 p.m. curfew. They were also not allowed to bring their families. Under President George W. Bush, doctors who deserted the program were offered a fast track to enter the U.S., leading many to flee.
Leydy, a doctor who escaped the program in 2019, said the salary she received in Venezuelan currency was enough to buy only a loaf of bread and a soda. She worked 48-hour shifts, often without electricity, and lived with three other Cuban doctors.
“It’s literally a business for the Cuban government. The truth is, it’s exploitation,” Leydy said, now studying to become an advanced practice nurse in Florida. Since she never returned to Havana, the Cuban government kept the $10,000 she earned in Venezuela over 15 months.
Maria Werlau, executive director of Archivo Cuba, described the program as a “forced labor scheme.” Governments have paid Cuba between $900 and $5,000 per doctor, depending on the country. For example, in Equatorial Guinea, doctors received only $1,000 out of the $10,000 the government paid for their services.
Werlau pointed out that U.S. federal law mandates sanctions against countries involved in human trafficking. While the State Department has long accused Cuba of labor trafficking, Werlau believes the U.S. should also sanction governments that participate in the program.
The Cuban government insists that the medical program does not qualify as labor trafficking because the workers are not deceived and know where they are going. They receive a salary, a pension, and “decent” benefits in the host country, where their accommodation, transportation, and often food expenses are covered, explained Carlos Fernández de Cossío, Cuba’s Deputy Foreign Minister.
The Cuban government also defends that its professionals have “complete freedom of movement,” a claim that has been questioned by many doctors who have left the program. However, Fernández de Cossío stated that no country has withdrawn from the program due to the new U.S. policy.
Trump’s policy of canceling visas for officials from countries participating in the program “is aimed at strangling the Cuban economy through threats and coercion of third-country governments and entities,” Fernández de Cossío said, adding that it has significantly impacted the standard of living in Cuba, restricting income and undermining essential services like electricity, water, transportation, and healthcare.
Leaders from several Caribbean nations have expressed reluctance toward the new visa policy and stated that they would gladly forgo traveling to the U.S. While Jamaica has up to 400 Cubans, mostly nurses, who have filled significant gaps in the country’s healthcare system, Health Minister Christopher Tufton denied that human trafficking is occurring. In Trinidad and Tobago, where 87 nurses and 9 Cuban doctors work, authorities have ensured that the program complies with labor standards, according to Prime Minister Stuart Young.
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