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The American Association of World Health released an extensive study in March 1997 of the impact of the U.S. government’s embargo on public health and nutrition in Cuba. Through hundreds of examples, the study provides an abundance of evidence that the embargo has a widespread, penetrating, and cruel affect on the people of Cuba. As if this weren’t enough, the study also documents ways in which the embargo violates a number of international human rights agreements, including several which bear the signature of the United States.

According to the study, "...Since 1992, the number of unmet medical needs—patients going without essential drugs or doctors performing medical procedures without adequate equipment—has sharply accelerated.... A humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventive health care to all of its citizens."

Among numerous alarming situations, the research team observed the following:

• Thirty-five children in a pediatric ward were vomiting an average of twenty-eight to thirty times per day because they were on their twent-second day without metoclopramide HCI, a drug used in combination with others to relieve nausea in pediatric chemotherapy.
• A heart attack patient with a ventricular arrhythmia required an implantable defibrillator to survive. The U.S. firm CPI, which then held a virtual monopoly on the device, was willing to make the sale, but the U.S. government denied a license. Two months later, the patient died.
• A European organization donated 59 U.S.-manufactured Cobe kidney dialysis machines to Cuba. All 59 were in need of repair, but only 29 could be placed in working order because the necessary parts to repair the remaining 30 could not be obtained. The loss of these 30 machines alone meant that 150 patients had inadequate access to kidney dialysis in 1996, lessening their chances for kidney transplants, and therefore, for survival. At least another 180 patients had only partial access to dialysis that same year.
• The library of Havana’s medical sciences campus and those of most hospitals are stocked with textbooks and journals (the majority of which are in deteriorating condition) only up to 1991. Subscriptions to vital U.S. publications cost 50-100 percent more through European distributors. Spanish translations of textbooks available in Latin America usually run about five years behind original English texts.

The study is an impressive, exhaustive, and meticulously referenced work of research conducted by a multi-disciplinary team over a 12-month period in 1995 and 1996. Not only does it examine the current situation, but it also presents highlights of the history of the embargo, including periods in time when some aspects of the embargo were loosened. The overall trend has been to tighten the embargo, particularly with the Torricelli Act (Cuban Democracy Act) of 1992 and the Helms-Burton Act (Cuban Liberty Act) of 1996.

The American Association of World Health (AAWH) argues that these measures were passed precisely because Cuba faced an economic crisis in 1989 after the fall of the Soviet Union. The U.S. embargo not only left Cuba with nowhere to turn for trade but the Soviet Union in the 1960s, but also, when the Soviet Union collapsed, the embargo meant Cuba had nowhere at all to turn. Practically overnight, Cuba lost 80 percent of its imports. Within 2 years, the Cuban economy contracted by 35 percent. President Castro declared the beginning of the "Special Period in Time of Peace," which continues today. The likes of Jesse Helms wanted to give the struggling island a fatal blow by further tightening the noose.

Aside from human suffering, the strongest objection the study presents to the embargo is the lack of precedent, either legal or practical, for depriving people of food and medicine. "...The AAWH wishes to emphasize the stringent nature of the U.S. trade embargo against Cuba. Few other embargoes in recent history—including those targeting Iran, Libya, South Africa, Southern Rhodesia, Chile or Iraq—have included an outright ban on the sale of food. Few other embargoes have so restricted medical commerce as to deny the availability of life-saving medicines to ordinary citizens. Such an embargo appears to violate the most basic international charters and conventions governing human rights, including the United Nations charter, the charter of the Organization of American States, and the articles of the Geneva Convention governing the treatment of civilians during wartime." (The Geneva Convention requires free passage of all medical supplies intended for civilians.)

The study made an impact on Washington. On May 14, 1997, the U.S. State Department issued a press release refuting many of the study’s claims. While the AAWH report is dense and methodical, the State Department release offers entertaining twists on reality such as: "The U.S. embargo does NOT deny medicines and medical supplies to the Cuban people," "The U.S. embargo on Cuba affects only U.S. companies and their subsidiaries. Other nations and companies are free to trade with Cuba," and, "Third country transactions only cost an estimated 2-3 percent more than purchases from the U.S. as a result of higher shipping costs." The truth, as documented by the study, is that shipping from third countries costs two to three times more.

The State Department may not be aware that the Cuban Democracy Act (1992) prevents the docking at a U.S. port of any ship that has docked in Cuba six months before or that plans to visit Cuba within six months after. The Cuban Democracy Act does allow medicines and medical supplies to be shipped, but only after complicated, ambiguous licensing requirements are fulfilled for both the sale and the shipping. For sales, not donations, of medicines and medical supplies the seller must guarantee that the U.S. government can make "on-site verification" of the "end use" of the products. The study provides detailed documentation of the ways in which these restrictions make both the sale and gift of medicines and medical supplies from the U.S. to Cuba almost entirely unfeasible. "For all practical purposes an absolute ban exists on sale of medicines and medical equipment to Cuba by U.S. companies and their foreign subsidiaries....Under no circumstance is the sale of food authorized."

What tops off the complications and delays is the study’s proof that the U.S. government’s real policy is to deny licenses. Authorizing sales of medicines and medical supplies to Cuba falls under the Treasury Department, while authorizing the shipment thereof comes under the Commerce Department. According to the report, "...Both of these departments openly state that it is their general policy to deny all applications." Quotes from Department publications and Congressional testimony are cited.

The research team also found that there was a 30 percent drop in the number of surgeries performed from 1990 to 1995. "Surgical services face shortages of most modern anesthetics and related equipment, specialized catheters, third generation antibiotics and other key drugs, sutures, instruments, fabric for surgical greens, air conditioning equipment and disposable supplies." People with HIV and AIDS have been severely affected: "The embargo was directly responsible for up to six month delays in AZT treatment for a total of 176 HIV patients.... As one AIDS professional told the AAWH, ‘The problem is that our patients don’t have the time to wait’."

In addition, the study provides examples of ways in which the U.S. is hurt by the embargo. Cuba is the only country with a vaccine for Meningitis B, a disease which recently afflicted a number of children in southern states. The embargo also denies U.S. citizens access to cheaply produced interferon and streptokinase and an AIDS vaccine currently undergoing clinical trials with human volunteers. Complications and delays of scientific and medical information exchanges and of the ability of professionals to participate in conferences in each other’s country are examples of losses to both sides.

Factors responsible for Cuba’s economic crisis other than the embargo are mentioned: the fall of the Soviet Union and inefficiencies within the Cuban government and economy. The AAWH investigation does not attempt to quantify to what extent Cuba’s problems are caused by the embargo as opposed to these other factors, nor could any study do so. However, the study does give the impression that all of its examples of suffering and denial of food, medicines, and medical equipment are due to the embargo. Some health professionals in Cuba agree with this point of view, while others point more strongly to inefficiencies within the Cuban government.

Another area the study does not address is that some minor improvements in public health resulted, not by choice, from the Special Period. The transportation crisis compelled Cuba to turn to bicycles on a massive scale. The result has been cleaner air and more exercise for citizens, some of whom were struggling with obesity during the 1970s and 1980s. While caloric intake was slightly deficient for a period of time, shortages of meat products and cooking oil led to a diet lower in fat. U.S. currency shortages forced Cuba to supplement chemical pesticides with biological controls and to produce fertilizers and methane gas from sugar cane waste.

Deaths due to heart disease, cancer, cerebral vascular disease, diabetes, bronchitis, emphysema, asthma, liver disease, all of which increased during the 1980s, showed slight decreases from 1990 to 1995. The flexibility of the Cuban health system (which continues to serve all Cubans free of charge) and the dedication of its highly trained medical staff undoubtedly played a role. Yet, the consumption of less fat and fewer cigarettes coupled with more exercise might have helped reduce deaths due to these diseases.

Where food shortages had a negative impact on the health of the Cuban population is evident in the most sensitive indicators: infant mortality, maternal mortality, low birth weight, and mortality in children under five years of age. The Cuban health system was able to prioritize these sectors of the population such that today these indicators are similar or superior to what they were in 1989—and are comparable to those of the "first world." Sharp declines in food imports and agricultural inputs also contributed to the 1993 neuropathy epidemic that temporarily blinded over 50,000 people.

Deaths due to accidents, particularly bicycle accidents, increased from 1990 to 1995. In terms of infectious diseases, the Special Period brought about increases in typhoid fever, tuberculosis, hepatitis, and parasitic diseases, due in part to the country’s inability to purify drinking water in many areas.

It will probably never be possible to know the extent of either the human suffering and the economic damage to Cuba as a result of the U.S. embargo. The AAWH study leaves no doubt that there are many actions Cuba cannot take—because of U.S. laws—to emerge from its economic crisis and to provide food security and health care for its citizens. Where the problem might be only a question of not having enough U.S. dollars, the study argues that the embargo limits Cuba’s access to hard currency.

The embargo does not seem to have any benefits, except perhaps for the political appearances of a reactionary minority. Even many who oppose Castro feel that the embargo should be lifted, either because it is inhumane or because it provides the Cuban government a convenient rationale for inefficient practices. Legislation is pending in the U.S. Congress to exempt food, medicines, and medical supplies from the embargo. The study contains numerous detailed sections including: legal aspects of the embargo, donations, food, women’s health, children’s health, water resources, medical testing, research, the pharmaceutical industry, oncology, cardiology, HIV/AIDS, nephrology, ophthalmology, and treatment of foreign patients.

Copies of the full report are available for $25 including postage from the AAWH, 1825 K Street, NW, Suite 1208, Washington, DC 20006, Tel: 202-466-5883, Fax: 202-466-5896, The well-written Executive Summary is available free of charge.

 

Genevieve Howe is a political activist from New Hampshire.