Medics and paramedics from Cuba pose upon arrival at the Malpensa airport of Milan, Italy, Sunday, March 22, 2020. Fifty-three doctors and paramedics from Cuba arrived in Milan to help with coronavirus treatment. © 2020 AP Photo/Antonio Calanni.

The Cuban government imposes draconian rules on doctors deployed in medical missions globally that violate their fundamental rights, Human Rights Watch said today. Governments seeking support from Cuban health workers to respond to the Covid-19 pandemic should press Cuban authorities to modify applicable regulations and laws that violate the right to privacy, freedom of expression and association, liberty, and movement, among others.

Since March, Cuba has sent roughly 1,500 medical professionals across the world to help fight the Covid-19 pandemic, joining approximately 30,000 Cuban health workers already deployed abroad. Cuban government regulations provide that workers may be disciplined for being “friends” with people who hold “hostile or contrary views to the Cuban revolution.” Health workers may also face criminal penalties if they “abandon” their jobs.

“Cuban doctors deployed to respond to the Covid-19 pandemic provide valuable services to many communities, but at the expense of their most basic freedoms,” said José Miguel Vivanco, Americas director at Human Rights Watch. “Governments interested in receiving support from Cuban doctors should press the Cuban government to overhaul this Orwellian system that dictates with whom doctors can live, fall in love, or talk.”

According to the Cuban government, over the past nearly 60 years, Cuba has deployed over 400,000 health workers across 164 countries to help tackle short-term crises, natural disasters, and, currently, the Covid-19 pandemic. Since March 2020, the Cuban government has sent several contingents of medical personnel to support local healthcare systems in over 20 countries, including several in Latin America.

Since its first medical mission to Algeria in 1963, Cuba has crafted repressive norms that regulate the lives of those deployed abroad. The rules severely restrict health workers’ freedom of expression, association, movement, and privacy.

Cuba regulates even the most mundane aspects of the lives of Cuban medical personnel on missions, in ways that violate their rights to freedom of association. Under Resolution 168 of 2010, issued by the Ministry of External Commerce and Foreign Investment, it is considered a “disciplinary offense” to have “relationships” with anyone whose “actions are not consistent with the principles and values of the Cuban society,” as well as to be “friends or establish any other links” with Cuban dissidents, people who have “hostile or contrary views to the Cuban revolution,” or who are “promoters of a way of life contrary to the principles that a Cuban collaborator abroad must represent.” Living with “unauthorized” people is also a disciplinary offense. Deployed personnel are required to disclose all “romantic relationships” to their immediate supervisors.

Vague provisions in Resolution 168 restrict health workers’ freedom of movement. The resolution makes it an offense to “frequently visit places that damage [the doctor’s] prestige,” as well as to “visit places that, given their characteristics, are prone to public order disturbances.” Health workers also need “authorization” to “participate in public acts of a political or social nature.”

Their freedom of expression is also severely limited by broad, vague regulations that are unnecessary and disproportionate to any legitimate government aim. Under Resolution 168, doctors need “authorization and instructions” to “express opinions” to the media about “internal situations in the workplace” or that “put the Cuban collaboration at risk.” It is also an offense to “disseminate or propagate opinions or rumors that undermine the morals or prestige of the group or any of its members.”

Sanctions for violating the rules range from withholding wages to recalling the person to Cuba. Under Cuba’s Penal Code, medical staff who “abandon” their jobs may face criminal charges and imprisonment for up to eight years – a punishment that is grossly disproportionate, implicating the workers’ right to liberty.

Human Rights Watch has not been able to determine the extent to which Cuban health workers have broken the rules and law, or whether the Cuban government has enforced criminal or disciplinary sanctions against them. While criminal penalties appear to have been applied rarely, doctors’ statements reviewed by Human Rights Watch suggest that disciplinary sanctions are more common.

Cuban law severely restricts the right of doctors and other Cubans to leave their own country. It also restricts access to regular passports, and health workers in missions are granted so-called “official” passports that are only valid during time of deployment.

Health workers are considered a “regulated” population and need to obtain special authorization to leave the country before receiving a passport, even if they resign from their positions in the National Health System. Cuban law purports to justify such restrictions in the need to “preserve the skilled workforce for the economic, social, technical and scientific development of the country,” but such harsh restrictions, which apply indefinitely, are disproportionate to that aim.

A 2012 decree gives broad powers to authorities to grant or deny health workers an authorization to leave the country. Under the decree, authorities will take “no more than five years” to process a request by a health worker to live abroad. Under Cuban law, the long wait is allegedly justified by the need to “train the replacement [of the health worker].”

Cuban health workers have also reported that those who “abandon” the missions are subject to a de facto entry ban to Cuba of eight years. The ban is not clearly established in Cuban legislation. However, the immigration law bars the entry of people who have been declared “undesirable” or who have “organized, stimulated, carried out or participated in hostile actions against the political, economic, and social basis of the Cuban state.” The provision, which violates the right to enter one’s own country, is applicable to “anyone,” including Cuban nationals.

In November 2019, the UN special rapporteurs on contemporary forms of slavery, including its causes and consequences, and on trafficking in persons, especially in women and children, requested information from the Cuban government on the working conditions of Cuban medical missions. The rapporteurs said the working conditions reported to them, including from first-hand sources, “could amount to forced labor.”

They reported that many doctors feel pressured to participate in the missions and fear retaliation if they do not, and that doctors have “excessive work hours,” limited access to vacations and to salaries, and face official threats as well as restrictions on the rights to privacy and freedom of expression. In a January 2020 response, which Human Rights Watch reviewed, the Cuban government denied the allegations, saying that rapporteurs had been “used to foment spurious campaigns … by the US government.”

The rights group Prisoners Defenders gathered statements, which Human Rights Watch reviewed, by dozens of health workers who participated in missions prior to the Covid-19 pandemic, between 2001 and 2018. Many said they joined the program because they feared retaliation by Cuban authorities. Others said they joined in the hope of leaving the country or of obtaining access to food, such as meat, which they cannot buy with their salaries in Cuba.

The rights to privacy, freedom of expression and association, liberty, and movement are protected the International Covenant on Civil and Political Rights (ICCPR), other treaties, and customary international law. The vast majority of countries hosting Cuban doctors have ratified the ICCPR. Cuba has signed, but not ratified, the covenant. Forced labor is also forbidden under Conventions 29 and 105 of the International Labour Organization, which Cuba and most host states have ratified. Several host states have ratified the International Covenant on Economic and Social Rights, which recognizes the right to just and favorable conditions of work and to an adequate standard of living. The Universal Declaration of Human Rights also provides that everyone has “the right to leave any country,” including their own, “and to return” to their country.

Host countries have human rights obligations to all people in their territory, which would include Cuban health workers, and should ensure that their agreements with the Cuban government include effective protections for workers’ rights, said Human Rights Watch.

“Governments that accept Cuban assistance that includes the abusive conditions imposed by Cuba risk becoming complicit in human rights violations,” said Vivanco. “Cuba may not be willing to protect its health workers, but other governments should avoid furthering their exploitation.”