Denial of Food and Medicine
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 embargos restrictions amount to the purposeful impending of foods
and medicines in peacetime.
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 Cubas health care
system since 1959 by Theodore H. MacDonald in the April 1st edition of the
told me Cubas 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.
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 Castros administration senior faculty members at the Medical
schools left in droves and came to Miami.
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.
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 governments 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 Dept for the first time the authority to
levy civil fines up to $50,000 for violations of the embargo.
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 Cubas 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 embargos 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.
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
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.
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
The cost of the embargo in human terms can be calculated both statistically and anecdotally.
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 countrys 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 drugs
nausea-preventing effects, the 35 children in the ward were vomiting an average
of 28-to-30 times a day.
we all know the embargo has been in place for 30 years, but during the 1990s
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
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 cant we tolerate a country just 90
miles from our shores where the literacy rate is about 96%, where money is not
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