Denial of Food and Medicine

Dorothy Guellec

The embargo is driving Cuba toward crisis and is causing significant suffering and death. Obtaining licenses from the departments of Commerce and Treasury to sell goods to Cuba (Cuban Democracy Act of 1992) on a contract-by-contract basis is a laborious process. The Geneva Conventions, to which some 165 countries including the U.S. are party, require free passage of all medical supplies and food intended for civilian use during wartime. The U.S. and Cuba are not at war. Nevertheless the AAWH (American Association for World Health) findings suggest that the embargo’s restrictions amount to the purposeful impending of foods and medicines in peacetime.

Last week I spoke with Dr. Anthony Kirkpatrick a renowned U.S. anesthesiologist and currently on the faculty at the University of South Florida and the Director for research for a national medical association dedicated to a life-threatening disease called reflex sympathetic dystrophy. I called him because he had reviewed a recent book “A developmental analysis of Cuba’s health care system since 1959” by Theodore H. MacDonald in the April 1st edition of the Lancet.

He told me “Cuba’s GNP is less than 1/20 of the US. It is a very poor country indeed.” According to the U.N. and the World Bank, as the GNP increases so do survival rates and Outcomes.

“Cuba has other priorities” he said, “They nurture their children and educate them. The mind set is different, so are the values. Cubans value a sense of community over money. Under Battista corruption was rampant and during the first few months of Castro’s administration senior faculty members at the Medical schools left in droves and came to Miami”.

The AAWH study for the WHO was conducted over a yearlong period between 1995 & 1996, and then published in 1997. A multi-disciplinary research team traced the implications of the embargo restrictions on health care delivery and food security in Cuba. The team reviewed key U.S. regulations and their implementation, conducted a survey of 12 American medical and pharmaceutical companies and documented the experience of Cuban import firms with the embargo.  The team assessed the impact of U.S. sanctions on health in Cuba through on-site visits to 46 treatment centers and related facilities; it conducted 160 interviews with medical professionals and other specialists, government officials, representatives of non-governmental organizations, churches and international aid agencies. In October 1996, the AAWH sent a delegation of distinguished medical experts to Cuba to validate the findings of the draft report through first-hand observation. The full report of more than 300 pages is the first comprehensive study of its kind.

The embargo is very stringent, and most other countries would have had a major catastrophe, but this has been averted because the Cuban government has maintained a high level of budgetary support for a system designed to deliver primary and preventive care for all citizens. The Cuban constitution makes health care a right of every citizen and the government’s responsibility. The infant mortality rate is roughly half that in Washington, D.C. There are 440 polyclinics and secondary and tertiary facilities include 284 hospitals and 11 national institutes with impatient and research capacities. The 1992 Cuban Democracy Act (CDA) outlawed subsidiary trade with Cuba and imposed severe restrictions on foreign ships that visit Cuba before attempting to enter U.S. ports. The CDA gave the Treasury Dep’t for the first time the authority to levy civil fines up to $50,000 for violations of the embargo.

The report states that “ four factors have dangerously exacerbated the human effects of this 37-year-old trade embargo” All four stem from the little-understood provisions of the U.S. Congress’ 1992 CDA.

(1)  A Ban on Subsidiary Trade “beginning in 1992, the CDA imposed a ban on subsidiary trade. This restriction has severely constrained Cuba’s ability to import medicines and medical supplies from third country sources. Moreover, recent corporate buy-outs and mergers between U.S. and European pharmaceutical companies have further reduced the number of companies permitted to do business with Cuba”.

(2)  Licensing “under the CDA the U.S. Treasury and Commerce Departments are allowed in principle to license individual sales of medicines and medical supplies, ostensibly for humanitarian reasons to mitigate the embargo’s impact on health care delivery”. In practice, according to U.S.corporate executives, the licensing provisions actively discourage any medical commerce. The number of such licenses granted or even applied for since 1992 is minuscule.  Numerous licenses for medical equipment and medicines have been denied on the grounds that these experts “would be detrimental to U.S. foreign policy interests.”

(3)  Shipping “Since 1992 the embargo has prohibited ships loading or unloading cargo in U.S. ports for 180 days after delivering cargo to Cuba.”  Shipping costs have risen dramatically. From 1993-1996 Cuban companies spent an additional $8.7 million on shipping medical imports from Asia, Europe and South America.

(4)  Humanitarian Aid. Charity is an inadequate alternative to free trade. The level of donations pales in comparison to import needs. Donations are inconsistent; contributions only reach a part of the population, benefiting those with relatives in the U.S.

Taken together, these four factors have placed severe strains on the Cuban health system. The embargo has “closed so many windows that in some instances Cuban physicians have found it impossible to obtain life-saving medicines from any source, under any circumstances. Patients have died.” In general, a relatively sophisticated and comprehensive public health system is being stripped of essential resources.

The cost of the embargo in human terms can be calculated both statistically and anecdotally.

Here are some highlights from this extensive 300-page report from the Association for World Health. Waterborne disease rates have more than doubled, making diarrhea the second most common reason to visit a physician. The country’s mammography program is crippled by a shortage of film and spare parts. Surgical rates are down because of a lack of supplies and equipment, including anesthetics. Drugs for leukemia patients and children with heart disease are not available, since the embargo effectively bans Cuba from purchasing half of the new world-class drugs on the market. The U.S. is directly responsible for the delays in AZT treatment for AIDS patients. The patients do not have time to wait. Heart disease is the number one cause of death in Cuba and mortality rates have increased since 1989. In one instance reported by the delegation Cuban cardiologists diagnosed a heart attack patient with a ventricular arrhythmia. He required an implantable defibrillator to survive. Though the U.S. firm CPI, which then held “a virtual monopoly on the device, expressed a willingness to make the sale, the U.S. government denied a license for it. Two months later the patient died.” The AAAWH team visited a pediatric ward then on its 22nd day without metoclopramide HCI, a drug used in combination with others such as “betamethasone for pediatric chemotherapy. Without this drug’s nausea-preventing effects, the 35 children in the ward were vomiting an average of 28-to-30 times a day.”

As we all know the embargo has been in place for 30 years, but during the 1990’s the sanctions against trade with Cuba have “become tighter and more wide reaching.” In 1996 the Lancet Editorial for November 30th described the Helms-Burton-Act as the “harshest economic action yet taken by the USA against Cuba. Under domestic political pressure, President Clinton reversed his initial opposition to a new piece of legislation and signed it into law in March. The law strengthens the existing embargo and allows US citizens whose property in Cuba was seized as a result of the 1959 revolution there to sue foreign companies who have invested in those properties. The law also requires that persons closely involved in these investments, including company executives and their families, be denied entry to the USA.” Dr. Kirkpatrick in the same 1996 Lancet characterizes this Act as “having an inhibiting effect on non-US medical companies.”

In four consecutive sessions the United Nations General Assembly passed resolutions condemning the U.S. embargo against Cuba and called on the nation to rescind those aspects of the statutes that violate principles of international law and the United Nations Charter. Of course we all know the tortured relationship of the U.S. and the United Nations. In 1994 the U.N. Commission on Human Rights characterized unilateral coercive measures such as trade embargoes as a “clear contradiction of international law,” and noted that “such unilateral coercive economic measures create obstacles to trade relations among states, adversely affecting the socio-humanitarian activities of developing countries, and hinder the full realization of human rights by the people subject to those measures.” The UN in my humble opinion was too generous and vastly understated the harshness of the US position. Why can’t we tolerate a country just 90 miles from our shores where the literacy rate is about 96%, where money is not at issue?

Dorothy Guellec
Member Foreign Press Ass’n
guellec@purvid.purchase.edu
914 271 5644