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The Health System in Cuba: Origin, Doctrine and Results

Salim Lamrani
Cet article est une traduction de :
Le système de santé à Cuba : origine, doctrine et résultats [fr]
Autre(s) traduction(s) de cet article :
El sistema de salud en Cuba: origen, doctrina y resultados [es]

Résumés

Depuis l’avènement de la Révolution cubaine en 1959, Cuba a fait de la santé une priorité nationale et a construit un système public, universel et gratuit, en plaçant le patient au centre du projet médical. Basé sur la prévention et le concept de “médecin de famille”, il a permis à la population de bénéficier d’un niveau de protection sanitaire unique pour un pays du Tiers-monde, et d’atteindre des indicateurs comparables à ceux des nations les plus développées. Reconnu par les institutions internationales comme étant le modèle prééminent pour les pays en voie de développement, le système de santé cubain est considéré par certains observateurs comme une potentielle source d’inspiration pour les nations les plus riches, notamment grâce à son modèle préventif. En plus de soigner ses propres citoyens, Cuba propose depuis plus d’un demi-siècle son expertise médicale à travers le monde et soigne les populations de tous les continents, faisant de ce service sa première source de revenus.

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Introduction

1Since 1959, Cuba has made health a national priority by establishing a public, universal and free system, subordinating economic considerations to the imperative of public health, with an annual investment representing the largest share of the national budget. Based on prevention and the concept of the “family doctor”, it has enabled the population of the island to enjoy a level of health protection unique in the Third World, comparable to that of the most developed countries. The World Health Organization (WHO), the Pan American Health Organization (PAHO), the World Bank, among others, as well as the medical journals The Lancet, Science and The New England Journal of Medicine have praised this system and present it as the model to follow for developing countries, as well as a path to be explored for the richest nations.

2Despite limited resources and a complex geopolitical context – the country having been under US sanctions since 1960 – how has Cuba managed to become a global benchmark in the field of public health? What are the characteristics of the island’s health system that enable it to provide the entire population with high quality care? How did a nation representing 0.001% of the world’s population become the leader of international medical solidarity?

3Three axes structure this study. The first part will be devoted to the genesis of the Cuban health system based on the doctrine “prevent before you heal” and the formation of an abundant human capital. Secondly, the effectiveness of this model will be considered in the light of statistical results and opinions issued by international institutions on the health policy of the Caribbean island. Finally, the reasons which led Cuba to export its medical services, to make health solidarity a pillar of its foreign policy and to make this sector the first source of income for the country will be analyzed.

1. The Cuban health system: formation and human capital

  • 1 Francisco Rojas Ochoa, “El número de médicos en Cuba”, Revista Cubana de Salud Pública, January-Mar (...)

4In 1959, Cuba had only 6,286 physicians for a total population of 6 million, a ratio of one doctor to 1,064 people. Within three years, 1,402 of them chose to leave the country for the United States, attracted by better professional opportunities and a favorable migration policy put in place by Washington for Cuban executives from all sectors in the framework of the ideological war against the Cuban Revolution. With a ratio of one doctor to 1,268 inhabitants, the island was facing a serious health crisis.1

5Faced with this, Cuba therefore decided to make the development of a public, universal and free health system a national priority. Founded in 1961, the National Health System (SNS), an entity dependent on the Ministry of Public Health, is structured around seven principles:

  1. Health is a people’s right.

  2. The health of the population is the responsibility of the state.

  3. Health services are equally accessible to the population.

  4. Health practices have a solid scientific basis.

  5. Health actions have a preventive orientation.

  6. Social participation is inherent in the use and development of health services.

    • 2 Benito A. Pérez Maza, “La equidad en los servicios de salud”, Revista Cubana de Salud PúblicaJuly-S (...)

    International solidarity will be a practice of the health services.2

6The entire Cuban health system is based on the model called “the family doctor and nurse”, developed in 1984. This model, where the basic unit is the family nucleus, with a clinical, epidemiological and social approach of health problems, has seven characteristics that ratify the principles set out by the SNS:

  • state and social character of medicine

  • accessibility and free services

  • prophylactic (preventive) orientation

  • community and intersectoral participation

  • international collaboration

  • normative centralization and executive decentralization

    • 3 Pedro Mujica Pérez, “El sistema de salud cubano”, Revista de Ciencias Médicas de Pinar del Río, Sep (...)

    adequate application of advances in science and technology.3

  • 4 Organisation mondiale de la santé, “La revolución a la atención primaria en Cuba cumple 30 años”, V (...)

7The 436 community polyclinics and 15,000 consultation centers scattered throughout the country constitute the backbone of the health system in Cuba. Each polyclinic caters to a population of 30,000 to 60,000 people and works closely with 20 to 40 consultation centers. A polyclinic offers an average of twenty different services: rehabilitation, radiology, ultrasound, optometry, endoscopy, emergency services, traumatology, clinical laboratory, family planning, thrombolysis, medical and dental emergencies, maternal and child care, immunization and attention to people with diabetes, geriatrics, dermatology, psychiatry, cardiology, family medicine and internal medicine, pediatrics, obstetrics and gynecology.4

  • 5 Nidia E. Márquez Morales, “Modelo : el Médico y la Enfermera de familia en Cuba”, in Ministerio de (...)

8Within these entities, health professionals are responsible for the primary medical attention of the population and more specifically deal with the most vulnerable categories of people, namely children, the elderly and pregnant women. The emphasis is on preventive medicine, hygiene, diet, sports and the fight against risk factors. Prevention is “the cornerstone” of the Cuban health system. Thus, each Cuban family nucleus – regardless of their state of health – receives a regular visit from the doctor considered to be “the guardian of health”. This model has notably shown its effectiveness in the areas of epidemiological surveillance and epidemic disease control.5

9This model adapts to its environment and to the biological, psychological and social characteristics of the community and its health situation. Thus, if a territorial area has a population particularly prone to allergies, the polyclinic will open a dedicated service in order to respond to this type of problem. Likewise, if a significant percentage of a community has hypertension, the institution will take the necessary steps to adjust to that reality. Another example, if a sector has a large number of smokers, an awareness campaign on the harmfulness of tobacco will be carried out at regular intervals.

  • 6 Organisation mondiale de la santé, “La revolución a la atención primaria en Cuba cumple 30 años”, o (...)
  • 7 Ministère chargé de la Santé, « Les chiffres clés de l’offre de soins”, 2017. https://solidarites-s (...)

10Cuba also has 284 hospitals with an average of 5.2 hospital beds per 1,000 inhabitants. According to the World Health Organization, it is the best-endowed Latin American country in this sector.6 By way of comparison, France has 6.1 beds per 1,000 inhabitants in the entire health sector, namely public establishments, private establishments of collective interest and private for-profit establishments. If only public hospitals are considered, the average drops to 3.8 beds per 1,000 inhabitants.7

1.1. Formation and human capital

  • 8 Clarivel Presno Labrador, “El médico de familia en Cuba”, Revista Cubana de Medicina General Integr (...)

11Cuba has 24 faculties of medicine and 40 formation centers for nurses in all provinces of the country and trains an average of 10,000 doctors and nearly 30,000 health professionals per year. At the level of the university course, the specialty “family medicine” is an obligation for all future doctors. After completing their studies, doctors must systematically complete one year as interns and two years as residents in a consultation center or polyclinic, in order to complete and validate their formation.8

  • 9 Elizabeth Newhouse, “Disaster Medicine : U.S. Doctors Examine Cuba’s Approach”, Center for Internat (...)

12All specialties are taught in Cuba, including disaster medicine, which is an integral part of the medical curriculum. The population is also trained from elementary school on the attitude to adopt in the face of a natural disaster. Regular exercises are carried out and involve all categories of the population, from children to the elderly. The entire population is also trained in first aid and survival skills. In this regard, the Washington Center for International Policy (CIP) notes in a report that “the result is an ingrained culture of prevention and preparation second to none”. The CIP also stresses that “that the system is effective is beyond doubt. Only a handful of Cubans died in the 16 major storms that battered the island over the last decade—and the likelihood of being killed by a hurricane in the United States is 15 times greater than in Cuba”.9

  • 10 Juventud Rebelde, “Cuba alcanza la cifra de 9 médicos por cada mil habitantes”, 22 June 2019. http: (...)
  • 11 OCDE, “Statistiques de l’OCDE sur la santé. Données. Médecins”, 2018. https://data.oecd.org/fr/heal (...)
  • 12 Juventud Rebelde, “Cuba alcanza la cifra de 9 médicos por cada mil habitantes”, op. cit.

13Cuba thus has nearly 50,000 medical professors, more than 100,000 doctors and around 100,000 nurses. With an average of 9 doctors and 9 nurses per 1,000 inhabitants, Cuba is today one of the best-endowed nations in the sector.10 For comparison, according to the Organization for Economic Co-operation and Development (OECD), France has 3.4 doctors per 1,000 inhabitants and Austria, the best-endowed European country, has 5.2 doctors per 1,000 inhabitants. As for the United States, the figure is 2.6 doctors per 1,000 inhabitants.11 The island also has nearly 20,000 dentists and dental surgeons as well as more than 15,000 pharmacists. In total, according to the Cuban Ministry of Public Health, the National Health System employs nearly half a million professionals, or 13% of the working population, in the 13,000 health institutions in the nation.12

1.2. The biotechnology industry

14Cuba has also invested in the biotechnology sector by creating a leading industry with the following characteristics:

  • The state is the main investor.

  • The scientific and technical preparation of professionals trained in Cuban universities aims for excellence.

  • Significant investment in education and training of human resources.

  • Close relationship between the health system and the health needs of the population: the products developed are primarily focused on the health needs of the country.

  • Product development to substitute for imports and be self-sufficient for national demand and national health programs.

  • The national market is the highest priority.

  • “Closed cycle” and complete policy within the biotechnology centers: research, development, production, marketing, after-sales service.

  • Synergy between research and development institutions and production, free from any individual competition. Each institution contributes with its strengths to the common need to create new products. The products are thus obtained thanks to the collaboration of all the institutions.

  • Gain in international competitiveness in terms of quality, production volume, costs and novelty.

    • 13 Organización Panamericana de la Salud & Organización Mundial de la Salud, “Biotecnología para la sa (...)

    Collaboration with developing countries for the research, development, production and commercialization of biotechnological products.13

  • 14 Ibid.

15In 1992, in the midst of a Special Period marked by severe material shortages, Cuba created the West Havana Science Pole. It is the coordinating and strategic structure of Cuban biotechnology which brings together a total of 38 institutions belonging to 13 state bodies. Among these are the Center for Genetic Engineering and Biotechnology (CIGB), the Center for Immunoassay (CIE), the Center for Molecular Immunology (CIM), the Cuban Neuroscience Center (CNEURO), the Center for Biomolecular Chemistry (CQB), the International Center for Neurological Restoration (CIREN), the National Center for Bio-Prepared Products (BIOCEN), the National Center for Scientific Research (CNIC), the Finlay Institute, the “Pedro Kourí” Institute of Tropical Medicine (IPK), the Center for the State Control of Drugs, Equipment and Medical Devices (CECMED) which is the national regulatory authority for drugs and medical equipment, and the National Coordinating Center for Clinical Trials (CENCEC). In 2012, these institutions were grouped into the BioCubaFarma Biotechnology and Pharmaceutical Industries Group, whose mission is to “produce high-tech drugs, equipment and services aimed at improving the health of the population and creating exportable goods and services”.14

  • 15 Organización Panamericana de la Salud & Organización Mundial de la Salud, “Vacunas cubanas registra (...)

16Thanks to its advanced biotechnology industry, Cuba manages to produce nearly 65% of the drugs necessary for the health of the population. The island has been able to develop thirteen vaccines with efficacy recognized by the World Health Organization, in particular against meningitis B and leptospirosis, cholera, whooping cough, diabetes and hepatitis B, which are exported to dozens of countries.15

17A report published jointly by the European Commission, the World Health Organization and the Pan American Health Organization hails Havana’s results:

  • 16 Comisión Europea, Organización Panamericana de la Salud, Organización Mundial de la Salud, “Experie (...)

Over the years, Cuba has successfully developed its capacity to produce health technologies to maintain its health system, recognized worldwide for having achieved universal coverage. This reality is illustrated by the health indicators obtained, comparable to those of highly developed countries. The level of this success prompts other countries attempting to establish a sustainable and competitive national pharmaceutical sector to emulate the model. Cuba has therefore become a world leader in South-South technology transfer, helping low-income countries to develop their own national biotechnology capacities, providing technical capacity and facilitating access to life-saving medicines at low cost for fight diseases such as meningitis B and hepatitis B.16

  • 17 Edward W. Campion & Stephen Morrissey, “A Different Model: Medical Care in Cuba”, New England Journ (...)
  • 18 The Lancet, “Ebola Control: the Cuban Approach”, 6 December 2013. http://www.thelancet.com/journals (...)

18The New England Journal of Medicine notes that “Cuba has developed its own pharmaceutical industry and now not only manufactures most of the medications in its basic pharmacopeia, but also fuels an export industry. Resources have been invested in developing biotechnology expertise to become competitive with advanced countries”.17 According to the medical journal The Lancet, “If the accomplishments of Cuba could be reproduced across a broad range of poor and middle-income countries the health of the world's population would be transformed”.18 The results obtained by the Caribbean island are indeed remarkable.

2. Results and international recognition

  • 19 Ministerio de Relaciones Exteriores de la República de Cuba, “Cuba destinará a Salud y Educación má (...)
  • 20 Organización Panamericana de la Salud & Organización Mundial de la Salud, Espacio fiscal para la sa (...)
  • 21 Ministère des Solidarités et de la Santé, “Les dépenses de santé en 2018 – Résultats des comptes de (...)
  • 22 Banco Mundial, “Esperanza de vida al nacer”, 2017. https://datos.bancomundial.org/indicador/SP.DYN. (...)
  • 23 Geo, “Pourquoi les Cubains peuvent-ils espérer vivre jusqu’à 120 ans”, 5 July 2019. https://www.geo (...)

19Cuba allocates 27.5% of its national budget to the health sector,19 just over 6% of its GDP. This is the nation’s primary budget. According to the Pan American Health Organization, Cuba is one of five countries in Latin America and the Caribbean that allocate more than 6% of their GDP to health.20 By way of comparison, France allocates 11.3% and the United States 17.1%.21 This investment has enabled the island to achieve remarkable results. Thus, life expectancy is 79 years, similar to that of the richest countries.22 Cuba is one of the countries with the highest number of centenarians per million inhabitants, according to the World Health Organization.23

  • 24 Banco Mundial, “Tasa de mortalidad, bebés (por cada mil nacidos vivos)”, 2018. https://datos.bancom (...)
  • 25 Organización Mundial de la Salud, “La OMS valida la eliminación de Cuba de la transmisión de madre (...)

20Prenatal care exceeds 95% and the institutional delivery rate is 99.9%. This explains why the infant mortality rate is so low. According to the World Bank, it is 4 per thousand and it is the lowest rate on the continent, lower even than that of the United States and similar to that of Canada. Latin America has an infant mortality rate of 14 per thousand.24 Meanwhile, according to the World Health Organization, in 2015 Cuba became “the first country in the world” to eliminate mother-to-child transmission of HIV and syphilis. “Eliminating the transmission of a virus is one of the greatest possible successes in public health”, notes the UN institution. “This is a triumph for Cuba and a triumph for children and families around the world”, according to the WHO.25

  • 26 O. Fonticoba Gener, “Mantiene Cuba alto índice de desarrollo humano”, Granma, 1 October 2011. http: (...)

21According to the Human Development Index Office of the United Nations Development Program, Cuba is the only Latin American and Third World country that is among the top ten nations in the world with the best Human Development Index. on the three criteria of “life expectancy”, “education” and “standard of living” during the last decade.26

  • 27 Organización Panamericana de la Salud & Organización Mundial de la Salud, “Lanzan por primera vez e (...)

22Cuba has succeeded in eradicating many diseases that still plague the underdeveloped countries. Thus, polio was eliminated in 1962, malaria in 1967, neonatal tetanus in 1972, diphtheria in 1979, meningoencephalitis and congenital rubella syndrome in 1989, measles in 1993, whooping cough in 1994 and rubella in 1995. All Cuban children are vaccinated very early against thirteen infectious diseases. According to the Pan American Health Organization, “Immunization is one of the most powerful tools science has offered us to prevent disease and save lives”. The World Health Organization points out that “Cuba not only enjoys universal vaccine coverage, it also manufactures and exports these products”. Indeed, of the eleven vaccines applied to all children in Cuba, eight are produced in the country.27

  • 28 José A. De la Osa, “Cuba es ejemplo en la protección a la infancia”, Granma, 12 April 2008.
  • 29 Fernando Ravsberg, “UNICEF : Cuba sin desnutrición infantil”, BBC, 26 January 2010.
  • 30 Organización de las Naciones Unidas para la Alimentación y la Agricultura, “UNICEF: Cuba, único paí (...)

23According to UNICEF, “Cuba is an example in child protection”.28 Juan José Ortiz, representative of the institution in Havana, notes that “severe malnutrition does not exist in Cuba [because] there is a political will” to eliminate it. “There are no children in the streets here. In Cuba, children are always a priority and that is why they do not suffer from the shortages that affect millions of children in Latin America, who work, who are exploited or who find themselves in prostitution networks”, he underlines.29 Likewise, UNICEF recalls that Cuba is the only country in Latin America – and the Third World – to have eradicated child malnutrition.30

24The non-governmental organization Save the Children, founded in 1919 in the United Kingdom, ranks Cuba first among developing countries for the conditions for prospective mothers, ahead of Argentina, Israel or South Korea. In this study, several criteria were considered, such as the health and education system, assistance by qualified personnel during childbirth, the distribution of contraceptive methods, the level of education of women. and children, and political and economic equality between men and women, i.e. the participation of women in political life and equal pay.31

  • 32 Ricardo López Hevia, “En fotos, Ban Ki-moon visita la Escuela Latinoamericana de Medicina (ELAM)”, (...)

25The United Nations cited Cuba as an example: “Cuba has a lot to teach the world about its preventive health system, which has achieved important results such as low mortality, long life expectancy and universal coverage”. The organization appealed to follow the example offered by the island: “Health must cease to be a privilege for the few and become a right for all”.32

  • 33 Gail Reed, “ La revolución de la atención primaria en Cuba cumple 30 años”, Organisation mondiale d (...)

26The WHO has praised the Cuban health model and set it up as an example for the rest of the world. “With the community-based polyclinic as a fundamental pillar, the primary care system has yielded enviable results and continues to respond to new challenges”. It is “one of the most effective and unique systems in the world” and the “extraordinary health indicators of the country” are due to “the importance given over the past four decades to primary attention. These indicators, close or comparable to those of developed countries, speak for themselves”.33

  • 34 Prensa Latina, “Directora de OMS reconoció labor de Cuba en materia de salud”, 16 July 2014.
  • 35 Agencia Cubana de Noticias, “World Health Organization Praises Cuba’s Achievements”, 14 July 2014.

27WHO has highlighted successes in this area: “Cuba is the only country that has a health system closely linked to research and development in a closed cycle. This is the path to follow, because human health can only improve through innovation”. It praised “the efforts of the leadership of this country to make health an essential pillar of development”.34 According to the institution, the world must follow the island’s path in this area and replace the curative model, which is less effective and more expensive, with a system based on prevention: “We sincerely hope that all the inhabitants of the planet can have access to quality medical services, as in Cuba”.35

  • 36 Edward W. Campion & Stephen Morrissey, “A Different Model: Medical Care in Cuba”, New England Journ (...)

28According to the New England Journal of Medicine, “the Cuban health care system also seems unreal. There are too many doctors. Everybody has a family physician. Everything is free, totally free […]. Although Cuba has limited economic resources, its health care system has solved some problems that ours [that of the United States] has not yet managed to address”.36

29The specialist journal adds:

This highly structured, prevention-oriented system has produced positive results. Vaccination rates in Cuba are among the highest in the world. The life expectancy of 78 years from birth is virtually identical to that in the United States. The infant mortality rate in Cuba has fallen from more than 80 per 1000 live births in the 1950s to less than 5 per 1000 — lower than the U.S. rate. […]

  • 37 Ibid.

Without doubt, the improved health outcomes are largely the result of improvements in nutrition and education, which address the social determinants of health. Cuba's literacy rate is 99%, and health education is part of the mandatory school curriculum.37 […]

  • 38 Fitzhugh Mullan, “Affirmative Action, Cuba Style”, New England Journal of Medecine, 23 December 200 (...)

The Cuban health care system […] is exceptional for a poor country and represents an important political accomplishment of the Castro government. Since 1959, Cuba has invested heavily in health care and now has twice as many physicians per capita as the United States and health indicators on a par with those in the most developed nations — despite the U.S. embargo that severely reduces the availability of medications and medical technology.38

  • 39 American Association for World Health, “Denial of Food and Medicine: The Impact of the U.S. Embargo (...)
  • 40 Diane Kuntz, “Statement from American Public Health Association”, American Public Health Associatio (...)

30The American Association for World Health, whose honorary president is Jimmy Carter, notes that Cuba’s health system is “uniformly considered the preeminent model in the Third World”.39 According to the American Public Health Association, in Cuba, “there is no racial barrier that prevents access to health” and emphasizes “the example Cuba offers – an example of a country with the political will to provide good health care to all its citizens”.40

  • 41 Agencia Cubana de Noticias, “Un expert des Etats-Unis se déclare intéressé par une collaboration av (...)

31US biologist Peter Agre, Nobel Prize in Chemistry, praised the island’s public health system. According to him, Cuba “is an example for the Western world. It has a lot to learn about solving problems that persist in other parts of our planet”.41

32The World Bank also praised the island’s health system:

Cuba has become internationally recognized for its achievements in the areas of education and health, with social service delivery outcomes that surpass most countries in the developing world and in some areas match first-world standards. Since the Cuban revolution in 1959, […], the country has created a social service system that guarantees universal access to education and health care provided by the state. This model has enabled Cuba to achieve near universal literacy, the eradication of certain diseases, widespread access to potable water and basic sanitation, and among the lowest infant mortality rates and longest life expectancies in the region.

  • 42 Dan Erikson, Annie Lord & Peter Wolf, Cuba’s Social Services : A Review of Education, Health, and S (...)

A review of Cuba’s social indicators reveals a pattern of almost continuous improvement from the 1960s through the end of the 1980s. Several major indices, such as life expectancy and infant mortality, continued to improve during the country’s economic crisis of the 1990s, […]. Today, Cuba’s social performance is among the best in the developing world, as documented by numerous international sources including the World Health Organization, the United Nations Development Programme and other U.N. agencies, and the World Bank. […] Cuba far outranks both Latin America and the Caribbean and other lower-middle income countries in major indices of education, health, and sanitation.42

  • 43 Raquel Marrero Yanes, “Cuba muestra indicadores sociales y demográficos de países desarrollados”, G (...)

33For its part, the United Nations Population Fund notes that Cuba “adopted more than half a century ago very advanced social programs, which have enabled the country to achieve social and demographic indicators comparable to those of developed countries”. The organization adds that “Cuba demonstrates that the limits of developing economies do not necessarily constitute an insurmountable obstacle to the progress of health status, demographic change and well-being”.43

  • 44 Adam Taylor, “In the medical response to Ebola, Cuba is punching far above its weigh”, The Washingt (...)
  • 45 Conner Gorry, “Cuba Calling: What This Small Island Can Teach the World About Disease Control”, The (...)

34The conservative daily The Washington Post also recognized the excellence of Cuba’s health system: “The results have been widely praised”.44 The Guardian, for its part, notes that “Cuba, a country of just 11.2 million inhabitants, has achieved a health picture on par with the world’s most developed nations”.45

  • 46 Barack Obama, “Remarks by President Obama and President Raul Castro of Cuba in a Joint Press Confer (...)

35President Barack Obama, during his historic visit to Cuba in March 2016, praised the island's successes in education and health: “The United States recognizes progress that Cuba has made as a nation, its enormous achievements in education and in health care”.46

36This expertise in the field of health has enabled the island to cope with the global Covid-19 pandemic.

2.1. The fight against the Covid-19 pandemic

  • 47 Organización Panamericana de la Salud / Organización Mundial de la Salud, “Cuba frente a la Covid-1 (...)
  • 48 Nuria Barbosa León, “Las universidades participan y toman medidas ante Covid-19”, Granma, 20 March (...)

37Faced with the global Covid-19 pandemic, Cuba has provided a health response in accordance with its medical doctrine based on prevention. The first cases in the territory were confirmed on March 11, 2020 in three Italian tourists. However, as a report by the Pan American Health Organization points out, the Cuban Ministry of Public Health had drawn up an “intersectoral response plan two months previously with Civil Defense, approved by central government authorities at the end of January”. The Covid-19 Confrontation Plan has based its action on national epidemiological surveillance in order to rapidly identify cases.47 Since March 17, 2020, the more than 28,000 medical students on the island have been carrying out a weekly door-to-door survey across the country to detect possible cases of contamination, commonly known as active finding of suspected cases”, thus making it possible to control nearly four million people per day.48

  • 49 Reuters, “Cuba suspende llegada de vuelos al país y retira embarcaciones de sus aguas por coronavir (...)
  • 50 Ibid.

38Strict monitoring of positive cases and their contacts has been put in place in hospitals and isolation centers. As of March 25, 2020, commercial and tourist flights were suspended and a strict health control was carried out in all ports and airports in the country, with the establishment of a strict quarantine for all citizens and residents returning to Cuba.49 Tourists on the island have been urged to return home.50

  • 51 Ibid.

39Authorities have decided to close recreation centers and cancel social events, and all face-to-face classes have been suspended to be replaced by distance learning classes. Physical distancing measures were recommended, as was the reduction of trips to what was strictly necessary. The wearing of masks was imposed in all public places from the start and hygiene measures were tightened.51

  • 52 Ibid.

40From April 9, 2020 and the start of the indigenous transmission phase (unrelated to an imported case), the authorities adopted new measures. Public transport has been suspended and major markets have been closed in favor of decentralization of the sale of basic necessities. In areas of open circulation of the virus, social containment measures have been adopted with a restriction of movement.52

  • 53 Ibid.

41PAHO notes that “the isolation of all contacts, travelers and suspected cases, for 14 days, in centers authorized for this, with a performance of a PCR test for the diagnosis of SARS-Cov-2, even if they showed no symptoms, was very effective”. Positive patients, once recovered and discharged from the hospital, remain under home surveillance and isolation for an additional 14 days, and are retested at the end of this period. In addition, they all receive preventive treatment with nasal Interferon Alfa 2B. PAHO stresses that “this had an influence on the low rate of contamination among health professionals, who have had no deaths”.53

  • 54 Domitille Piron, “Covid-19 : l’OMS confirme la bonne gestion de l’épidémie par Cuba”, Radio France (...)
  • 55 Johns Hopkins University, “Coronavirus Resource Center. World Countries”, 1 February 2021. https:// (...)

42This strategy has enabled Cuba to control the pandemic. The island is an exception in Latin America. Indeed, according to the World Health Organization, among the 12 countries most affected by Covid-19, six are in the Americas.54 According to Johns Hopkins University of Washington, which offers a daily count that has become a global benchmark, as of February 1, 2021, Cuba, with a population of 11.3 million, has 25,674 cases for 213 deaths. By comparison, the Dominican Republic, with 10.7 million inhabitants, has 212,553 cases and 2,646 deaths. Haiti (11.4 million) has recorded 11,460 cases and 245 deaths. El Salvador (6.5 million) has recorded 53,989 cases and 1,614 deaths. Bolivia (11.6 million) has recorded 215,397 cases and 10,330 deaths. Honduras (9.9 million) has recorded 147,000 cases and 3,592 deaths. Paraguay (7.1 million) has recorded 132,548 cases and 2,704 deaths. Nicaragua (6.6 million) has recorded 6,253 cases and 169 deaths. Costa Rica (5 million) has recorded 193,276 cases and 2,604 deaths. Panama (4.3 million inhabitants) has recorded 319,453 cases and 5,244 deaths.55

  • 56 Ibid.

43In Europe, countries with a demographics similar to that of the Caribbean island have experienced various pandemic situations. Belgium, for example, with a population of 11.4 million, has recorded 707,837 cases and 21,066 deaths. Greece (10.7 million) has recorded 156,473 cases and 7,779 deaths. Hungary (9.7 million) recorded 366,279 cases and 12,463 deaths. Austria (8.9 million) has recorded 413,208 cases and 7,703 deaths. Portugal (10.2 million) has recorded 711,018 cases and 12,179 deaths. Sweden (10.3) has recorded 566,957 cases and 11,591 deaths. Switzerland (8.6 million) has recorded 521,320 cases and 9,370 deaths.56

  • 57 Escambray, “Iniciará este sábado en Cuba la primera etapa de la vacunación masiva”, 21 April 2021. (...)
  • 58 Miguel Febles Hernández, “Cuba alista 100 millones de dosis de vacuna anti-Covid-19”, Granma, 21 Ja (...)

44Cuba is also working on the development of five candidate vaccines against Covid-19: Soberana 1, Soberana 2, Soberana Plus, Abdalá and Mambisa. The first four are given through an injection and the last through a nasal spray. The most advanced research concerns the Abdalá and Soberana 2 vaccines which began the second phase of the clinical trial in January 2021 and which included a sample of 900 people aged 19 to 80 years. In February 2021, the trial also involved the pediatric population so that the vaccine can be administered to children. The Carlos Finlay Institute launched phase III in March 2021 in collaboration with the Pasteur Institute of Iran which included 150,000 vulnerable people and residents of high-risk areas. On April 24, 2021, Cuba launched a massive vaccination campaign in Havana with the Abdalá and Soberana 2 vaccines, which were respectively effective at 92.2% (three doses) and 62% (two doses).57 The goal is to vaccinate the entire Cuban population during the first half of 2021 and the island is developing the capacity to produce 100 million doses for Third World countries. Cuba, according to the World Health Organization, “was the first candidate from Latin America and the Caribbean to put its vaccine into the clinical phase”. The Cuban vaccine has already been “prequalified” by the Pan American Health Organization (PAHO).58

  • 59 Organización Panamericana de la Salud / Organización Mundial de la Salud, “Cuba frente a la Covid-1 (...)

45PAHO also stresses that “information and communication” have been “two key dimensions” of the Cuban response to the pandemic. The island’s health system has provided an effective response to this unprecedented global crisis.59

46In addition, it allows the island to establish international cooperation with many countries around the world.

3. International cooperation

  • 60 Roberto Morales, “África está urgida de la solidaridad internacional”, Cuba Debate, 12 September 20 (...)
  • 61 Ricardo López Hevia, “En fotos, Ban Ki-moon visita la Escuela Latinoamericana de Medicina (ELAM)”, (...)

47Since 1959, Cuba has made international solidarity a fundamental pillar of its foreign policy. Thus, as early as 1960, even before the development of its health system, Cuba offered its aid to Chile following the earthquake that had devastated the country. In 1963, the Havana government sent its first medical brigade of 55 professionals to Algeria to help the young independent nation cope with a serious health crisis. Since that date, Cuba has extended its solidarity to the rest of the world, especially Latin America, Africa and Asia.60 The United Nations highlighted this contribution: “Saving lives: this is what Cuba is doing in the world”. According to the institution, the island “has a long history of cooperation” with Third World countries. During natural disasters, “Cuban doctors are the first to arrive and the last to leave”, notes the institution.61

  • 62 Rosa Muñoz Lima, “‘Misiones médicas’ cubanas: ¿cuántas, dónde y por qué?”, Deutsche Welle, 20 April (...)
  • 63 U.S. Department of State, “A Call to Action: First-Hand Accounts of Abuses in Cuba’s Overseas Medic (...)

48Cuban medical cooperation is free for low-income countries. On the other hand, those with intermediate incomes pay for the services offered by Cuban professionals under bilateral agreements. For example, the doctors who worked in Brazil in the Mais Médicos program, set up by President Dilma Rousseff in 2013 to meet the health needs of the population, cost the Brazilian state the sum of 3,000 dollars per month and per doctor paid directly to the Cuban Ministry of Public Health. The mission doctors, whose living expenses are covered by the authorities (accommodation and food) receives part of this sum – about 900 dollars per month, a salary almost ten times higher than that received by a doctor practicing in Cuba. The remainder of the amount, about two-thirds, goes to finance the island’s health system as well as medical missions in low-income countries.62 Today, international medical cooperation is Cuba’s primary source of income – over $ 7 billion a year – ahead of family remittances and tourism.63

  • 64 Roberto Morales, “África está urgida de la solidaridad internacional”, op.cit.; Liz Caridad Conde S (...)

49From 1959 to 2020, Cuba carried out nearly 600,000 missions in 158 countries, with the participation of a total of 326,000 health professionals. Doctors have performed more than 1.998 billion medical consultations, 4.3 million deliveries, 14.5 million surgeries and have vaccinated more than 12 million pregnant women and children.64

50According to the United Nations Development Program (UNDP), Cuban humanitarian aid represents a percentage of GDP higher than the average of the 18 most developed nations. UNDP notes in a report that

  • 65 Programme des Nations unies pour le Développement, Investigación sobre ciencia, tecnología y desarr (...)

The cooperation offered by Cuba takes place in a context of South-South cooperation. It does not pursue a lucrative objective, but on the contrary is offered as the expression of a principle of solidarity and, as far as possible, on the basis of shared costs. Nevertheless, for years Cuba has provided aid in the form of grants to the poorest countries, and has been very flexible in the form or structure of collaboration […]. In almost all cases, Cuban aid has been free, although from 1977 onwards, with certain high-income countries, mainly oil-producing, cooperation in the form of compensation developed. The high development achieved in Cuba in the fields of health, education and sport has meant that cooperation has concerned these sectors, although there has been participation in other branches such as construction, fishing. and agriculture.65

  • 66 Programme des Nations unies pour le Développement, Investigación sobre ciencia, tecnología y desarr (...)

51According to the UNDP, “one of the most successful examples of Cuban cooperation with the Third World has been the Comprehensive Health Program for Central America, the Caribbean and Africa”, developed in 1998 following Hurricane Mitch.66 The organization notes an improvement in all health indicators, including a notable drop in the infant mortality rate, in the regions where it is applied. It is currently in force in three continents and is founded on three basic principles:

  • the free dispatch of health workers for a period of two years after which a new team replaces the existing staff;

  • the presence of medical brigades who provide their services in rural areas and medical deserts, so that their work does not interfere with that of national doctors;

    • 67 Ibid.

    the training of medical personnel at the Latin American School of Medicine in Havana, or in universities created there under the direction of Cuban professors.67

3.1. The Latin American School of Medicine in Havana

  • 68 Nuria Barbosa León, “La Escuela Latinoamericana de Medicina: un proyecto visionario y humanista”, J (...)
  • 69 Cuba debate, “El sueño de Fidel : Reciben su título 500 médicos extranjeros”, 24 july 2019.

52In 1998, following Hurricane Mitch which ravaged Central America and the Caribbean, with a terrible death toll of 10,000 dead and missing and more than a million homeless, Cuba decided to create the Latin-American School of Medicine of Havana (ELAM) – inaugurated on November 15, 1999 – to train future Third World doctors in Cuba.68 Since its founding, ELAM has trained 37,333 healthcare professionals from 141 different countries, 96% of whom are doctors.69

53The World Health Organization paid tribute to the work of ELAM:

[In terms of recruitment], preference is given to financially disadvantaged applicants who would otherwise not be able to afford medical school. As a result, 75% [of] students come from communities in need of doctors and ethnic minorities, as well as indigenous peoples, are well represented […]. New doctors work in most countries of the Americas, including the United States, various African countries, and many English-speaking countries in the Caribbean region.

  • 70 Organisation mondiale de la santé, “Cuba répond à la demande de Médecins”, May 2010, Volume 88. htt (...)

At the same time, schools like ELAM challenge medical education around the world to have more social concerns. […] This notion of social responsibility must be considered everywhere in the world, even in traditional medical circles […]. The world urgently needs these kinds of dedicated builders of new paradigms in medical education.70

  • 71 Salim Lamrani, “Cuba’s Health Care System: A Model for the World”, The Huffington Post, 8 August 20 (...)

54According to the United Nations, “ELAM is the most advanced medical school in the world”.71 WHO leadership praised the work of ELAM and praised Cuban policy and its commitment to South-South cooperation:

  • 72 Dr. Margaret Chan, “Remarks at the Latin American School of Medicine”, World Health Organization, 2 (...)

I know of no other medical school that offers students so much, at no charge. I know of no other medical school with an admissions policy that gives first priority to candidates who come from poor communities and know, first-hand, what it means to live without access to essential medical care. For once, if you are poor, female, or from an indigenous population you have a distinct advantage. This is an institutional ethic that makes this medical school unique.72

55According to UNESCO, ELAM has become the preferred institution for Latin American students, drawn by the high-quality education offered in Cuba. “Cuba is one of the most popular destinations for students in Latin America”.73

56In addition to training foreign students, Cuba also assisted victims of the Chernobyl nuclear disaster.

3.2. The children of Chernobyl

  • 74 Ministerio de Relaciones Exteriores de la República de Cuba, “Más de 18 mil niños de Chernobyl aten (...)
  • 75 Reuters, “Chernobyl Victims Treated in Cuba”, 23 March 2010 ; Yissel Rodríguez Milán, “Cuba sola at (...)

57Cuba’s role with the victims of the Chernobyl nuclear disaster of April 26, 1986, in Ukraine, which claimed the lives of 40,000 people and infected millions, is unique.74 Since the creation of the Program of Comprehensive Attention to Children Victims of Disasters in 1990, within the Institute of Hematology of Havana and the Oncology Department of the Juan Manuel Márquez University Pediatric Hospital, in response to the most important nuclear accident in history, more than 26,000 children aged 5 to 15 received free treatment in Cuba.75

58The British daily The Guardian notes in this regard:

Despite the isolation and the economic slump, Cuba still takes care of them. The difference between this programme and others – such as the exchange of Cuban medical expertise for Venezuelan oil – is that there is no economic gain. The programme even survived Cuba’s economic crisis of the early 90s, the so-called "special period" after the fall of the Soviet bloc. […]

  • 76 Andrés Schipani, “Revolutionary Care : Castro’s Doctors Give Hope to the Children of Chernobyl”, Th (...)

Dr Julio Medina, general co-ordinator of the programme, recently told […]: “It is simple: we do not give what we have in excess; we share all that we have”.76

  • 77 Ibid.

59The children are being treated at Tarará Hospital, 20 kilometers east of Havana, in an area that enjoys an exceptional microclimate favorable to healing. Most suffer from cancers, especially of the skin and thyroid, leukemia, birth defects, alopecia and vitiligo. In addition, thanks to this program, Cuba has created a database unique in the world on nuclear contamination and has successfully developed techniques to study its effects on DNA.77

  • 78 Ministerio de Relaciones Exteriores de la República de Cuba, “Más de 18 mil niños de Chernobyl aten (...)
  • 79 El Nuevo Herald, “Atendidos 18,000 niños de Chernóbil”, 31 March 2005.
  • 80 Ministerio de Relaciones Exteriores de la República de Cuba, “Más de 18 mil niños de Chernobyl aten (...)
  • 81 China Daily, “Ukraine Thanks Cuba for Helping Chernobyl Victims”, 24 December 2010. http://www.chin (...)

60Svetlana Zaslavskaya, whose child was treated on the island, testified: “For many mothers, Cuba was the only hope”.78 Nikola Efimovich Polischuk, former Ukrainian health minister, said no nation in the world has done as much for the child victims of the Chernobyl nuclear disaster as Cuba.79 He expressed his gratitude to health professionals: “In difficult times for the Ukrainian people, Cuba was one of the first countries to reach out for the health of affected children”.80 Konstantin Grishenko, former Ukrainian foreign minister, also expressed his gratitude to the Havana government: “We will never forget what Cuba has done for us”.81

61As part of its international medical cooperation, Cuba established Operation Miracle in 2004.

3.3 Operation Miracle

  • 82 Organisation mondiale de la santé, “Cécité et déficience visuelle”, Aide-Mémoire n°282, October 201 (...)

62According to the World Health Organization, nearly 285 million people are visually impaired worldwide, including 39 million who are blind and 246 million who have reduced visual acuity. Almost 90% of them live in Third World countries. The main causes of visual impairment are uncorrected refractive errors (myopia, hyperopia or astigmatism, 43%), cataracts (33%) and glaucoma (2%). Almost 80% of all visual impairments are curable. The WHO notes that “cataracts remain the leading cause of blindness”. These eye diseases primarily affect people over 50 (65%), who represent 20% of the world’s population, a percentage that increases with the aging of the population, but also 19 million children.82

  • 83 Ministerio de Relaciones Exteriores, “Celebra Operación Milagro cubana en Guatemala”, República de (...)
  • 84 Iris Armas Padrino, “Misión Milagro: 15 años en combate contra la ceguera”, Agencia Cubana de Notic (...)
  • 85 Ricardo López Hevia, “En fotos, Ban Ki-moon visita la Escuela Latinoamericana de Medicina (ELAM)”, (...)

63Faced with this observation, in the framework of the Bolivarian Alliance for the Peoples of Our America, Cuba and Venezuela decided in July 2004 to launch a vast continental humanitarian campaign under the name of Operation Miracle. It involves operating for free on poor Latin Americans with cataracts and other eye diseases, who are unable to finance an operation that costs between $ 5,000 and $ 10,000 depending on the country. This humanitarian mission has since been extended to other latitudes (Africa, Asia). Operation Miracle includes the participation of 165 Cuban institutions. It has 49 eye centers and 82 operating theaters in 15 countries in Latin America and the Caribbean.83 In fifteen years, nearly 4 million people from more than 35 countries have been treated by Cuban doctors.84 The United Nations hailed Cuba’s humanitarian commitment: “Operation Miracle, in addition to restoring sight, has given us a new worldview of generosity and solidarity”.85

3.4. Henry Reeve Medical Brigades

  • 86 The New York Times, “Cuba’s Impressive Role on Ebola”, 19 October 2014.
  • 87 Roberto Morales, “África está urgida de la solidaridad internacional”, op. cit.

64Following Hurricane Katrina which devastated the city of New Orleans in September 2005, Cuba set up the “Henry Reeve International Contingent of Doctors Specialized in Disasters and Major Epidemics”, – in tribute to an American citizen who participated in the first Cuban War of Independence in the 19th century, – made up of 10,000 doctors. The island, despite the historic conflict with the United States, offered to help Washington. According to the New York Times, “the Cuban government created a quick-reaction medical corps and offered to send doctors to New Orleans. The United States, unsurprisingly, didn’t take Havana up on that offer”.86 From this contingent, Cuba created 39 international medical brigades which have worked in more than 20 countries.87

  • 88 Ibid.
  • 89 Nina Lakhani, “Cuban Medics in Haiti Put the World to Shame”, The Independent, 26 December 2010.
  • 90 Conner Gorry, “Cuba Calling: What This Small Island Can Teach the World About Disease Control”, The (...)

65The Henry Reeve Brigades notably intervened on several continents. Thus, following the earthquake that devastated Pakistan in November 2005, 2,564 doctors went to the scene and assisted the victims for more than eight months. Thirty-two field hospitals were set up and were subsequently donated to the country's health authorities. Over 1,800,000 patients have been treated and 2,086 lives have been saved. By way of comparison, the United States, then Islamabad’s main ally, established two field hospitals and remained there for eight weeks.88 The British newspaper The Independent highlighted the fact that the Cuban medical brigade was the first to arrive at the scene and the last to leave the country.89 The Guardian recalls the following on this subject: “It was a story of unprecedented medical solidarity by a developing country which few media outlets picked up – until now”.90

  • 91 Tom Fawthrop, “Impoverished Cuba Sends Doctors Around the Globe to Help the Poor”, The Syndney Morn (...)

66Likewise, after the earthquake in May 2006 in Java, Indonesia, Cuba sent several medical missions. Ronny Rockito, Indonesian regional health coordinator, praised the efforts of 135 Cuban professionals who set up two field hospitals. According to him, their work had a greater impact than that of any other country. “I appreciate the Cuban medical team; their style is very friendly and their medical standard very high. Everything is free and [there is] no support from my government. We give thanks to [Cuban President] Fidel Castro. Many villagers begged the Cuban doctors to stay”, he said.91

  • 92 Institut national de sciences de l’univers, “Séïsme de Haïti du 12 janvier 2010”, Centre national d (...)
  • 93 Radio Canada, “Le bilan grimpe à 230 000 morts”, 10 February 2010. http://www.radio-canada.ca/nouve (...)
  • 94 Nina Lakhani, “Cuban Medics in Haiti Put the World to Shame”, The Independent, 26 December 2010. ht (...)

67One of the most emblematic cases of Cuban medical cooperation concerns Haiti. The magnitude 7 earthquake of January 2010 caused dramatic human and material damage.92 According to Haitian authorities, the extremely heavy toll was at least 230,000 dead, 300,000 injured and 1.2 million homeless.93 Cuban doctors, present in the country since 1998, were the first to bring aid and treated nearly 40% of the victims.94

  • 95 Andrés Martínez Casares, “Cuba Tales Lead Role in Haiti’s Cholera Fight”, The New York Times, 7 Nov (...)

68In addition, in October 2010, Nepalese United Nations soldiers accidentally introduced the cholera virus into Haiti. According to the UN, the epidemic was discovered by the Cuban medical team of Dr Jorge Luis Quiñones. It claimed the lives of 6,600 people and infected 476,000 others, which represents nearly 5% of the Haitian population (10 million inhabitants). It was the highest cholera rate in the world according to the United Nations. The New York Times underlined in a report the key role of Cuban doctors: “The Cuban medical mission that played an important role in detecting it presses on in Haiti, winning accolades from donors and diplomats for staying on the front lines and undertaking a broader effort to remake this country’s shattered health care system”.95

  • 96 Ibid. See also Cuba Debate, “Brigada Médica Cubana en Haití alcanza records mínimos de tasa de leta (...)

69For his part, Paul Farmer, UN special envoy, noted that in December 2010, when the epidemic reached its peak with an unprecedented death rate and the world had its eyes riveted elsewhere, “half of the NGOs are already gone, and the Cubans are still there”. According to the Haitian Ministry of Health, Cuban doctors have saved more than 76,000 people in the 67 medical units under their responsibility, with only 272 deaths, i.e. a mortality rate of 0.36%, against a rate of 1.4% in the rest of the country.96

70According to José Di Fabio, WHO representative,

  • 97 Diario do Centro de Mundo, “Entrevista: ‘é incrível o que Cuba pode fazer’, diz OMS sobre ajuda con (...)

Cuba is a special case because of its rapid response capacity, its political will and the experience of doctors. What Cuba is capable of achieving is incredible. There is both the political will [of the authorities] and the human will of the population. When there was an earthquake in Pakistan, 2,000 doctors were dispatched within 48 hours. They were the first to arrive in Pakistan and the last to leave the country. They stayed for almost six months. It was the same in Haiti.97

71In Africa, Cuba has also played a notable role in the fight against epidemics.

3.5. The fight against meningitis, malaria and Ebola in Africa

  • 98 Halla Thirsteinsdóttir & Tirso W. Sáenz, “Tackling Meningitis in Africa”, Science, 21 December 2012 (...)

72In 2006, the World Health Organization issued an urgent appeal to the international community to come to the aid of Africa. The UN body was in dire need of polysaccharide vaccines to fight against meningitis A and C which struck 23 countries of the continent located in the so-called “meningitis belt, from Senegal to Ethiopia”. The epidemic affected nearly 100,000 people and caused more than 5,000 deaths per year. This antidote had to be produced on a massive scale to help the 430 million people in the region.98

73The institution therefore called on all laboratories, both public and private, to produce this type of vaccine. Only two Third World public laboratories responded to this call: the Carlos Finlay Institute in Cuba and the Bio-Manguinhos Institute in Brazil.99 The two entities teamed up and created the vax-MEN-AC vaccine at the exceptional price of $ 0.95 per dose, which is twenty times lower than that produced by multinational pharmaceutical companies. A total of 19 million vaccines have been manufactured and distributed in Africa by WHO, UNICEF, Doctors Without Borders and the International Red Cross, saving tens of thousands of lives.100 The US scientific journal Science hailed this example of “South-South cooperation” and called for this model to be extended to the rest of the world.101

  • 102 Agencia Cubana de Noticias, “Cuba’s LABIOFARM Launches Malaria Campaign in Western Africa”, 30 May (...)
  • 103 Organisation mondiale de la santé, “World Malaria Report 2013”, 2013, p. v. http://www.who.int/mala (...)

74In 2014, Cuba launched a malaria vaccination campaign in West Africa, in no less than 15 countries.102 According to the WHO, the virus, which predominantly affects children, claims the lives of as many as 630,000 people a year, “mostly those of children under five years of age in Africa. This means 1300 young lives lost to malaria every day”.103

  • 104 Granma, “Cuba responde al llamado de la ONU para combatir el ébola”, 11 September 2014. http://www. (...)

75The same year, according to the United Nations, the epidemic of Zaire-type Ebola, a hemorrhagic fever that struck part of West Africa, in particular Sierra Leone, was one of the most serious health crises of recent times. Within weeks, the virus spread at high speed. It was the “longest, most severe and most complex” Ebola crisis ever observed since the disease was discovered in 1976. Highly contagious, the virus is transmitted through direct contact with blood and bodily fluids. The World Health Organization launched an urgent appeal to the international community to come to the aid of the African populations abandoned to their fate.104

  • 105 Cuba Debate, “Apoyo de Cuba a la lucha contra el ébola responde a la solidaridad de su Revolución”, (...)
  • 106 Cuba Debate, “Apoyo de Cuba a la lucha contra el ébola responde a la solidaridad de su Revolución”, (...)
  • 107 Ibid.

76Cuba immediately responded to the UN and WHO request, dispatching 165 health workers to Sierra Leone, Guinea and Liberia. This was the largest medical contingent dispatched to the affected region.105 WHO praised Cuba’s gesture: “What we need most are medical personnel. The most important thing to prevent the transmission of Ebola is to have the right people, the right specialists, properly trained, "to deal with this type of humanitarian crisis. The entity recalled that “Cuba is world famous for its ability to train excellent doctors and nurses. It is also famous for its generosity and solidarity with countries on the road to progress”.106 WHO urged the rest of the world, especially the developed countries, to follow Cuba’s path and express the same solidarity with Africa: “Cuba is an example […]. This is the largest contingent of doctors, nurses and specialists in infectious and epidemiological disease control”.107

  • 108 Kai Kupferschmidt, “Cuba to Commit Large Health Corps to Ebola Fight”, Science, 12 September 2014. (...)
  • 109 Cuba Debate, “Apoyo de Cuba a la lucha contra el ébola responde a la solidaridad de su Revolución”, (...)

77The journal Science in turn hailed the example offered by the island: “It is the biggest contribution of health care staff by any single country so far to help control the epidemic […] This will make a significant difference in Sierra Leone”.108 Until the Cubans arrived, the international medical presence in West Africa stood at 170 professionals according to the WHO. Thus, Cuba provided aid equal to the sum of aid from all the nations of the world combined.109

  • 110 Barack Obama, “Remarks by President Obama and President Raul Castro of Cuba in a Joint Press Confer (...)
  • 111 Barack Obama, “Remarks by President Obama to the People of Cuba”, The White House, 22 March 2016. h (...)
  • 112 Le Figaro, “Ebola : John Kerry remercie Cuba”, 17 October 2014.

78The United States, through President Barack Obama, hailed Cuba’s humanitarian commitment in the fight against Ebola: “I want to give a special commendation to Cuban doctors who volunteered and took on some very tough assignments to save lives in West Africa in partnership with us and other nations.  We very much appreciate the work that they did”.110 He added that “no one should deny the service that thousands of Cuban doctors have delivered for the poor and suffering”.111 Secretary of State John Kerry also thanked Havana for its contribution to the fight against the epidemic: “Cuba, a country of barely 11 million inhabitants, has dispatched 165 health professionals and plans to do more, send almost 300 more”.112

  • 113 Adam Taylor, “In the medical response to Ebola, Cuba is punching far above its weight”, The Washing (...)
  • 114 Drew Hinshaw & Betsy McKay, “Island Nation Outpaces Larger Countries in Sending Medical Staff; Unli (...)
  • 115 The New York Times, “Cuba’s Impressive Role on Ebola”, 19 October 2014.

79The Washington Post praised the role played by Cuba: “While the international community has been accused of dragging its feet on the Ebola crisis, Cuba […] has emerged as a crucial provider of medical expertise in the West African nations hit by Ebola”.113 For its part, the Wall Street Journal notes that Cuba is the only country to have responded “with force” to the call of the WHO and the UN. The financial daily notes that Cuba has sent nearly 10 times more medical personnel than the United States. The newspaper also compares the two lifestyles: “While consultants from the American Center for Disease Control and Prevention stay at the Radisson Blu hotel, at more than $ 200 a night, the 165 Cuban doctors live at three per room. in one of the cheap hotels in Freetown. The hotel toilets are out of order. Flies swarm around the dirty tablecloths in cafeterias where Cubans eat”.114 The New York Times has highlighted Cuba’s “impressive role on Ebola” and notes that it is “the most robust role among the nations seeking to contain the virus”. According to the daily, the Cuban contribution “should be lauded and emulated” because “only Cuba and a few nongovernmental organizations are offering what is most needed: medical professionals in the field”. The newspaper also paid tribute to the courage of Cuban doctors, recalling that they were “among the most exposed” to the virus.115

80Cuban solidarity was also expressed during the Covid-19 pandemic that hit the entire planet.

3.6. The Covid-19 pandemic

  • 116 France Info Outre-mer la 1ère, “Coronavirus : Cuba envoie en Italie des médecins ayant combattu la (...)
  • 117 Prensa Latina, “Ayuda de Cuba a Italia fue solidaria y gratuita, dice canciller”, 18 July 2020.

81Following the Covid-19 pandemic, several countries, including Italy, have requested medical help from Cuba. For the first time, Cuban doctors intervened in Western Europe. Havana sent a brigade of 52 doctors and nurses to Lombardy, hard hit by the virus, thirty of whom had fought the Ebola epidemic.116 After two months of hard work, the members of the Henry Reeve contingent returned to Cuba. Bruno Rodríguez Parilla, Cuban Minister of Foreign Affairs, stressed that Cuban aid had been “solidary and free” and that Cuba was satisfied with “the gratitude of citizens and local and national authorities”.117

82Stefania Bonaldi, mayor of the municipality of Crema, where the Cuban-operated hospital was located, paid tribute to the medical staff on the island:

I will be really brief because better than my words, our immense gratitude is already visible on the faces of the authorities present here, whom I thank from the bottom of my heart. I have a particular emotion for the fellow mayors and the administrators of Crema, who represent so many faces, those of all the inhabitants of Crema, without exception, who embrace you with affection and sincerity, fogged with nostalgia because we are certain that you will be missed, as if you were brothers.

We know this well, because we Italians have been a people of migrants and we know what feelings accompany those who leave.

We will miss you but you will not disappear, because our consciences will preserve your gift and strengthen us in our conviction that in Crema no one should ever be considered a stranger again. And henceforth we will have a decisive argument to oppose to anyone who wishes to limit or interfere with our sacred duty of hospitality.

Your reassuring presence will be missed as it was an effective remedy in a time of unprecedented uncertainty and imminent danger.

What you have represented silently during these weeks, starting with the certainty that our planet can fight and overcome inequalities, injustices and emergencies, if all peoples fraternize, will be missed.

When you came here, you said that your homeland was the world. Therefore, from now on, you will always be our compatriots, in this vast world often abused by the absence of the supreme value of solidarity.

We were shipwrecked and you rescued us, without asking us our name or our origin. After months of struggle, anguish, doubts, we now see the light, but only because we have come together.

Women and men of our Lombard health system, Institutions, leaders and administrators at all levels, we have stood together with you, dear doctors and nurses of the “Henry Reeve” Brigade and with your generous people, drawing from your competence and from your passion the oxygen necessary to keep alive the confidence essential in the fight.

Without you, everything would have been more difficult.

In our city and in our territory, during these months, gestures of solidarity and generosity have multiplied. We have seen the reappearance of feelings of closeness that were habitually drowsy, worn out by everyday life.

You have also fueled these feelings of humanity and brotherhood by your presence here, discreet but effective, respectful but determined, gentle but reliable.

You have arrived at the most dramatic moment and you fought in our company to transform “the complaint into dance”, a collective dance, proving once again that great battles are not won by lone heroes, but by communities, and what has happened on our earth is the proof, the demonstration.

We have been a community and that is why we have triumphed. We have been, thanks to you once again, a remedy for individualism, the favorite ally of adversity. We have of course been a multicultural and very human community. A deployment that did not admit defeat and we did not indeed lose.

We fought like a passionate people with a project, refusing the risk of being a chaotic and hesitant crowd, driven only by fear.

We have become intelligent adversaries of a killer pathogen […].

With you, everything was easier.

  • 118 Stefania Bonaldi, “Covid: medici Cuba terminano missione a Crema con tanti ringraziamenti”, Giornal (...)

Thank you, on behalf of all the citizens of Crema, our territory, Lombardy and all of Italy!118

  • 119 Giusi Spica, “Emergenza Covid, la Sicilia chiede a Cuba una task force di 60 medici e infermieri”, (...)

83In November 2020, faced with the resurgence of Covid-19 cases, Sicily launched an urgent appeal to Cuba to receive help from 60 health professionals and relieve regional hospitals structurally lacking in human and material resources. The Italian press highlighted the vital contribution of Cuban doctors: “This is a race against time to capture professionals from overseas, before other regions do”. Renato Costa, the Covid-19 emergency commissioner in Palermo behind the initiative, explained his decision: “The Cuban government has teams of doctors and nurses willing to travel. We asked for their help. We are aware that other regions have followed suit and we hope we were the first. I am in close contact with the Embassy, which seems to have welcomed our S.O.S.”.119

  • 120 France 24/AFP, “Médicos cubanos van a Andorra, su segundo destino europeo contra el COvid-19”, 29 M (...)
  • 121 Adrià Esteban & Lidia Pérez, “Defensa de la sobirania davant dels EUA”, Diari d’Andorra, 31 March 2 (...)
  • 122 Diari d’Andorra, “Tornen a casa un grup de 13 sanitaris Cubans”, 25 May 2020. https://www.diariando (...)

84Andorra also received the help of a contingent of 39 Cuban professionals.120 The pressure exerted by Washington on the small European principality forced María Ubach, Minister of Foreign Affairs, to give an energetic response: “I am aware of the position of the United States, but we are a sovereign country and we can choose the partners with whom we wish to collaborate”.121 After a two-month mission, Cuban medical personnel returned to the island with all the gratitude of the government and people of Andorra.122

  • 123 Alizé Boissin, “Des médecins cubains au chevet de l’Outre-mer”, Public Sénat, 31 March 2020. https: (...)
  • 124 Sophie Lonette, “Après 3 mois d’attente, quinze professionnels cubains sont arrivés en Martinique”, (...)
  • 125 France Antilles, “Avant de regagner Cuba, les médecins cubains reçus par la CTM”, 7 October 2020. h (...)

85France has also authorized the overseas departments of Martinique, Guadeloupe, Guyana and Saint-Pierre-et-Miquelon to seek the help of Cuban doctors to deal with the health emergency due to Covid-19.123 Thus, a team of fifteen doctors carried out a three-month mission in Martinique from June to September 2020 to strengthen the medical teams in place in the fight against the pandemic, at the request of Alfred Marie-Jeanne, President of the Executive Council of the Territorial Collectivity of Martinique.124 According to Professor François Roch, president of the medical commission of the Martinique CHU, “the overall results are positive [...]. Now the decrees are there to allow us to start on a stable basis and to maintain a lasting cooperation”.125

  • 126 Granma, “Brigada médica cubana parte a Jamaica”, 21 March 2020. http://www.granma.cu/cuba-covid-19/ (...)
  • 127 Telesur, “Médicos cubanos viajan a Lombardía, Italia, por coronavirus”, 21 March 2020. https://www. (...)
  • 128 Resumen Latinoamericano, “Argentina. Cuba envía brigada de 500 médicos a la provincia de Buenos Air (...)
  • 129 José Antonio Abadía, “Médicos cubanos contra la Covid-19, solidaridad para el mundo”, Prensa Latina(...)

86Likewise, a brigade of 140 health professionals was dispatched to Jamaica.126 Other brigades also visited Nicaragua, Venezuela, Suriname and the island of Grenada.127 Following a request from Argentina, Cuba sent 500 doctors to the province of Buenos Aires to deal with the Covid-19 pandemic.128 In total, according to the Cuban Ministry of Public Health, 28 brigades made up of a total of 2,579 health workers are working in 24 countries to fight Covid-19. To these must be added the more than 28,000 health professionals who were already present in 59 countries before the outbreak of the pandemic.129

  • 130 Saimi Reyes Carmona, “Interferón Alfa 2B: entre los más empleados para combatir la Covid-19”, Agenc (...)
  • 131 EFE, “Cuba reserva suficiente antiviral para tratar el Covid-19 en otros países”, 13 March 2020. ht (...)

87In addition, the antiviral drug Interferon Alfa 2B Recombinant developed with Cuban technology has been widely used in China against Covid-19.130 Almost 50 countries in Europe, Latin America, Africa and Asia have ordered the product in its Cuban version.131

  • 132 The New York Times, “Cuban Doctors Head to Italy to Battle Coronavirus”, 22 March 2020.

88The New York Times praised the aid given by Havana: “The Caribbean island has sent its “armies of white robes” to disaster sites around the world largely in poor countries since its 1959 revolution. […] Yet with the 52-strong brigade, this is the first time Cuba has sent an emergency contingent to Italy, one of the world’s richest countries, demonstrating the reach of its medical diplomacy”. Christopher Tufton, Jamaican Minister of Health, thanked the Cuban authorities for their support: “In a time of crisis, the Cuban government, the Cuban people ... have risen to the occasion, they have heard our appeal and they have responded”.132

  • 133 Ibid.

89The United Kingdom also expressed gratitude to Cuba for agreeing to host a cruise ship of over 1,000, mostly British, with cases of Covid-19 on board, which was wandering the Caribbean after suffering rejection from all quarters, including from member countries of the British Commonwealth and the United States.133 Ambassador Anthony Stokes thanked the Cuban health workers who handled the transfer in an open letter:

I wish to express my immense gratitude and that of my country to the 43 Cubans who have completed the quarantine period today, after their incalculable contribution to the success of the operation carried out by Cuba to help the passengers and part of the crew of the Braemer cruise ship to return to the UK on March 18th.

I highly appreciate the courage and humanism of those who decided to be on the front line knowing that it was a complex and delicate operation and that they should be separated for two weeks from their families and people who are dear to them. […]

During Operation Braemer, I witnessed the many qualities of the Cuban people, their humanitarian principles, their friendliness, their commitment to work; facets of Cuban character that I have discovered and come to love since arriving on this island. […]

  • 134 Jon Stone, “UK Thanks Cuba for ‘Great Gesture of Solidarity’ in Rescuing Passengers From Coronaviru (...)

Your great gesture of solidarity will last in the memory of the passengers and crew of the Braemer, their families and friends, who are together today thanks to your effort.134

  • 135 United Nations, “Cuba : U.N. Members Overwhelmingly Support End of U.S. Embargo, as Brazil Backs Wa (...)

90International medical cooperation has enabled Cuba to develop an influential health diplomacy that has led the island to have many allies in international forums, especially among the countries of the South. Thus, Havana regularly enjoys the support of most developing nations, especially the United Nations where its resolutions – against sanctions imposed by the United States, for example – are generally supported by the majority of members.135

Conclusion

91As early as 1959, Cuba made the choice to create a public, universal and free health care system, making the health of the population a national priority and dedicating the largest part of the national budget to this sector. By focusing its health philosophy on prevention and on the “family doctor” model and relegating commercial considerations to the background, the island has obtained remarkable results, unprecedented for a Third World country with limited resources and under economic sanctions for more than half a century.

92The excellence achieved in the field of health has thus enabled the island to form an abundant human capital whose expertise is now in demand around the world, to the point of making international medical cooperation the first source of income for Cuba. This contribution to emergencies that occur across the planet and its capacity to respond to epidemics and natural disasters has led Havana to develop a health diplomacy unparalleled in the world and to strengthen the prestige of its health system.

93By making health a state monopoly not subject to budgetary constraints, Cuba has been able to put in place a strategy of prevention and fight against emerging diseases such as Covid-19, which has proved to be highly effective, thus allowing the competent authorities to provide quality protection to citizens and to have one of the lowest rates of infection and lethality in the world. By placing the patient at the center of the health project, Havana has shown that it is possible to provide top quality services to the population, despite the structural constraints linked to its low income.

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Haut de page

Notes

1 Francisco Rojas Ochoa, “El número de médicos en Cuba”, Revista Cubana de Salud Pública, January-March 2015. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-34662015000100013 (Accessed 23 March 2020).

2 Benito A. Pérez Maza, “La equidad en los servicios de salud”, Revista Cubana de Salud PúblicaJuly-September 2007, volume 33, n°3. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-34662007000300007 (Accessed 23 March 2020).

3 Pedro Mujica Pérez, “El sistema de salud cubano”, Revista de Ciencias Médicas de Pinar del Río, September-December 2004, volume 8, number 3. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1561-31942004000300001 (Accessed 23 March 2020).

4 Organisation mondiale de la santé, “La revolución a la atención primaria en Cuba cumple 30 años”, Volume 86, May 2008. http://www.who.int/bulletin/volumes/86/5/08-030508/es/ (Accessed 23 March 2020).

5 Nidia E. Márquez Morales, “Modelo : el Médico y la Enfermera de familia en Cuba”, in Ministerio de Salud Pública, Organización Panamericana de la Salud, Organización Mundial de la Salud, “Revista Especial. La OPS/OMS reconoce los logros de la salud pública cubana”, May 2009, p. 37-39. https://www.paho.org/cub/index.php?option=com_docman&view=download&category_slug=documentacion-tecnica&alias=208-revista-especial-por-los-100-anos-del-minsap-2009&Itemid=226 (Accessed 24 March 2020).

6 Organisation mondiale de la santé, “La revolución a la atención primaria en Cuba cumple 30 años”, op. cit.

7 Ministère chargé de la Santé, « Les chiffres clés de l’offre de soins”, 2017. https://solidarites-sante.gouv.fr/IMG/pdf/dgos_cc_2018_02_16_a_web_pages_hd.pdf (Accessed 19 November 2020).

8 Clarivel Presno Labrador, “El médico de familia en Cuba”, Revista Cubana de Medicina General Integral, January-March 2006, volume 22, n°1. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21252006000100015 (Accessed 23 March 2020).

9 Elizabeth Newhouse, “Disaster Medicine : U.S. Doctors Examine Cuba’s Approach”, Center for International Policy, 9 July 2012. https://reliefweb.int/sites/reliefweb.int/files/resources/0712_Delegation_ReportCuba.pdf (Accessed 24 March 2020).

10 Juventud Rebelde, “Cuba alcanza la cifra de 9 médicos por cada mil habitantes”, 22 June 2019. http://www.juventudrebelde.cu/cuba/2019-07-22/cuba-alcanza-la-cifra-de-nueve-medicos-por-cada-mil-habitantes (Accessed 24 March 2020).

11 OCDE, “Statistiques de l’OCDE sur la santé. Données. Médecins”, 2018. https://data.oecd.org/fr/healthres/medecins.htm#indicator-chart (Accessed 24 March 2020).

12 Juventud Rebelde, “Cuba alcanza la cifra de 9 médicos por cada mil habitantes”, op. cit.

13 Organización Panamericana de la Salud & Organización Mundial de la Salud, “Biotecnología para la salud”. https://www.paho.org/cub/index.php?option=com_content&view=article&id=213:informacion-general&Itemid=277#1.1 (Accessed 25 March 2020).

14 Ibid.

15 Organización Panamericana de la Salud & Organización Mundial de la Salud, “Vacunas cubanas registradas”. https://www.paho.org/cub/index.php?option=com_docman&view=download&category_slug=centro-de-ingenieria-genetica-y-biotecnologia&alias=882-vacunas-cubanas-registradas&Itemid=226 (Accessed 25 March 2020) ; Comisión Europea, Organización Panamericana de la Salud, Organización Mundial de la Salud, “Experiencia cubana en la producción local de medicamentos, transferencia de tecnología y mejoramiento en el acceso a la salud”, 2015. https://www.who.int/phi/publications/Cuba_case_studySP.pdf (Accessed 25 March 2020), p. 4.

16 Comisión Europea, Organización Panamericana de la Salud, Organización Mundial de la Salud, “Experiencia cubana en la producción local de medicamentos, transferencia de tecnología y mejoramiento en el acceso a la salud”, op. cit., p. 3.

17 Edward W. Campion & Stephen Morrissey, “A Different Model: Medical Care in Cuba”, New England Journal of Medecine, 23 January 2013. https://www.nejm.org/doi/full/10.1056/NEJMp1215226 (Accessed 24 March 2020).

18 The Lancet, “Ebola Control: the Cuban Approach”, 6 December 2013. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2962329-1/fulltext

(Accessed 24 March 2020).

19 Ministerio de Relaciones Exteriores de la República de Cuba, “Cuba destinará a Salud y Educación más del 50% del presupuesto del 2019”, 22 December 2018. http://misiones.minrex.gob.cu/es/articulo/cuba-destinara-salud-y-educacion-mas-del-50-del-presupuesto-del-2019 (Accessed 23 March 2020).

20 Organización Panamericana de la Salud & Organización Mundial de la Salud, Espacio fiscal para la salud en América Latina y el Caribe, Washington, 2018. https://iris.paho.org/bitstream/handle/10665.2/34947/9789275320006_spa.pdf?sequence=1&isAllowed=y (Accessed 14 December 2020).

21 Ministère des Solidarités et de la Santé, “Les dépenses de santé en 2018 – Résultats des comptes de la santé – Editions 2019”, 2019. https://drees.solidarites-sante.gouv.fr/etudes-et-statistiques/publications/panoramas-de-la-drees/article/les-depenses-de-sante-en-2018-resultats-des-comptes-de-la-sante-edition-2019 (Accessed 23 March 2020).

22 Banco Mundial, “Esperanza de vida al nacer”, 2017. https://datos.bancomundial.org/indicador/SP.DYN.LE00.IN?end=2017&start=2017 (Accessed 24 March 2020).

23 Geo, “Pourquoi les Cubains peuvent-ils espérer vivre jusqu’à 120 ans”, 5 July 2019. https://www.geo.fr/voyage/pourquoi-les-cubains-peuvent-ils-esperer-vivre-jusqua-120-ans-196428 (Accessed 24 March 2020) ; Le Figaro, “Cuba : centenaires grâce au système”, 22 May 2009. https://www.lefigaro.fr/flash-actu/2009/05/22/01011-20090522FILWWW00280-cuba-centenaires-grace-au-systeme.php (Accessed 24 March 2020).

24 Banco Mundial, “Tasa de mortalidad, bebés (por cada mil nacidos vivos)”, 2018. https://datos.bancomundial.org/indicador/SP.DYN.IMRT.IN?view=chart (Accessed 23 March 2020).

25 Organización Mundial de la Salud, “La OMS valida la eliminación de Cuba de la transmisión de madre a hijo del VIH y de la sífilis”, 30 June 2015. https://www.who.int/mediacentre/news/releases/2015/mtct-hiv-cuba/es/ (Accessed 26 March 2020).

26 O. Fonticoba Gener, “Mantiene Cuba alto índice de desarrollo humano”, Granma, 1 October 2011. http://www.granma.cu/granmad/2011/10/01/nacional/artic02.html (Accessed 24 March 2020).

27 Organización Panamericana de la Salud & Organización Mundial de la Salud, “Lanzan por primera vez en Cuba la Semana de Vacunación en las Américas”, 23 April 2018. https://www.paho.org/hq/index.php?option=com_content&view=article&id=14271:lanzan-por-primera-vez-en-cuba-la-semana-de-vacunacion-en-las-americas&Itemid=1926&lang=es (Accessed 23 March 2020).

28 José A. De la Osa, “Cuba es ejemplo en la protección a la infancia”, Granma, 12 April 2008.

29 Fernando Ravsberg, “UNICEF : Cuba sin desnutrición infantil”, BBC, 26 January 2010.

30 Organización de las Naciones Unidas para la Alimentación y la Agricultura, “UNICEF: Cuba, único país en América Latina sin desnutrición infantil”, 21 September 2011. http://www.fao.org/in-action/agronoticias/detail/es/c/508233/ (Accessed 24 March 2020). UNICEF, Progreso para la infancia. Un balance sobre la nutrición, 2011.

31 Save the Children, « Informe Estado Mundial de las madres 2011 », 2012. https://www.savethechildren.es/sites/default/files/imce/docs/estado_mundial_madres_2011_esp_web.pdf (Accessed 24 March 2020).

32 Ricardo López Hevia, “En fotos, Ban Ki-moon visita la Escuela Latinoamericana de Medicina (ELAM)”, Cubadebate, 28 January 2014. http://www.cubadebate.cu/fotorreportajes/2014/01/28/en-fotos-ban-ki-moon-visita-la-escuela-latinamericana-de-medicina-elam/#.VvuEKkbj8x4 (Accessed 24 March 2020).

33 Gail Reed, “ La revolución de la atención primaria en Cuba cumple 30 años”, Organisation mondiale de la Santé, 3 May 2008. http://www.who.int/bulletin/volumes/86/5/08-030508/es/ (Accessed 24 March 2020).

34 Prensa Latina, “Directora de OMS reconoció labor de Cuba en materia de salud”, 16 July 2014.

35 Agencia Cubana de Noticias, “World Health Organization Praises Cuba’s Achievements”, 14 July 2014.

36 Edward W. Campion & Stephen Morrissey, “A Different Model: Medical Care in Cuba”, New England Journal of Medecine, op. cit., p. 297-99.

37 Ibid.

38 Fitzhugh Mullan, “Affirmative Action, Cuba Style”, New England Journal of Medecine, 23 December 2004, p. 2682.

39 American Association for World Health, “Denial of Food and Medicine: The Impact of the U.S. Embargo on the Health and Nutrition in Cuba”, March 1997.

40 Diane Kuntz, “Statement from American Public Health Association”, American Public Health Association, 2 May 1996.

41 Agencia Cubana de Noticias, “Un expert des Etats-Unis se déclare intéressé par une collaboration avec Cuba”, 13 December 2011.

42 Dan Erikson, Annie Lord & Peter Wolf, Cuba’s Social Services : A Review of Education, Health, and Sanitation (Washington : World Bank, 2002), p. 3.

43 Raquel Marrero Yanes, “Cuba muestra indicadores sociales y demográficos de países desarrollados”, Granma, 12 July 2012.

44 Adam Taylor, “In the medical response to Ebola, Cuba is punching far above its weigh”, The Washington Post, 4 October 2014. http://www.washingtonpost.com/blogs/worldviews/wp/2014/10/04/in-the-medical-response-to-ebola-cuba-is-punching-far-above-its-weight/ (Accessed 24 March 2020).

45 Conner Gorry, “Cuba Calling: What This Small Island Can Teach the World About Disease Control”, The Guardian, 23 October 2014. http://www.theguardian.com/global-development-professionals-network/2014/oct/23/cuba-healthcare-lessons-ebola-sierra-leone-guinea-liberia (Accessed 24 March 2020).

46 Barack Obama, “Remarks by President Obama and President Raul Castro of Cuba in a Joint Press Conference”, The White House, 21 March 2016. https://www.whitehouse.gov/the-press-office/2016/03/21/remarks-president-obama-and-president-raul-castro-cuba-joint-press (Accessed 24 March 2020).

47 Organización Panamericana de la Salud / Organización Mundial de la Salud, “Cuba frente a la Covid-19”, volume 24, n°2, May-June 2020, p. 2. https://iris.paho.org/bitstream/handle/10665.2/52514/v24n2.pdf.pdf?sequence=1&isAllowed=y (Accessed 20 November 2020).

48 Nuria Barbosa León, “Las universidades participan y toman medidas ante Covid-19”, Granma, 20 March 2020. http://www.granma.cu/cuba-covid-19/2020-03-20/mas-de-28-mil-estudiantes-de-medicina-en-cuba-realizan-pesquisa-activa-contra-el-coronavirus (Accessed 20 November 2020) ; Mario J. Pentón, “Cuba: estudiantes hacen pesquisias en hogares por Covid-19”, El Nuevo Herald, 20 March 2020. https://www.elnuevoherald.com/noticias/mundo/america-latina/cuba-es/article241373596.html (Accessed 20 November 2020).

49 Reuters, “Cuba suspende llegada de vuelos al país y retira embarcaciones de sus aguas por coronavirus”, 1 April 2020.

50 Ibid.

51 Ibid.

52 Ibid.

53 Ibid.

54 Domitille Piron, “Covid-19 : l’OMS confirme la bonne gestion de l’épidémie par Cuba”, Radio France Internationale, 18 November 2020.

55 Johns Hopkins University, “Coronavirus Resource Center. World Countries”, 1 February 2021. https://coronavirus.jhu.edu/region/cuba (Accessed 1 February 2021).

56 Ibid.

57 Escambray, “Iniciará este sábado en Cuba la primera etapa de la vacunación masiva”, 21 April 2021. http://www.escambray.cu/2021/iniciara-este-sabado-en-cuba-la-primera-etapa-de-vacunacion-masiva/ (Accessed 22 April 2021); Mauricio Vicent, “Cuba logra la primera vacuna latinoamericana con datos de efectividad al nivel de Pfizer y Moderna”, El País, 22 June 2021.

58 Miguel Febles Hernández, “Cuba alista 100 millones de dosis de vacuna anti-Covid-19”, Granma, 21 January 2021. http://www.granma.cu/cuba-covid-19/2021-01-21/cuba-alista-cien-millones-de-dosis-de-vacuna-anti-covid-19-21-01-2021-00-01-26 (Accessed 1 February 2021) ; France 24, “Cuba apuesta por crear primera vacuna en América Latina contra el Covid-19”, 21 January 2021. https://www.france24.com/es/minuto-a-minuto/20210121-cuba-apuesta-por-crear-primera-vacuna-de-am%C3%A9rica-latina-contra-el-covid-19 (Accessed 1 February 2021).

59 Organización Panamericana de la Salud / Organización Mundial de la Salud, “Cuba frente a la Covid-19”, op. cit., p. 29.

60 Roberto Morales, “África está urgida de la solidaridad internacional”, Cuba Debate, 12 September 2014. http://www.cubadebate.cu/especiales/2014/09/13/africa-esta-urgida-de-la-solidaridad-internacional/ (Accessed 24 March 2020).

61 Ricardo López Hevia, “En fotos, Ban Ki-moon visita la Escuela Latinoamericana de Medicina (ELAM)”, op. cit.

62 Rosa Muñoz Lima, “‘Misiones médicas’ cubanas: ¿cuántas, dónde y por qué?”, Deutsche Welle, 20 April 2020. https://www.dw.com/es/misiones-m%C3%A9dicas-cubanas-cu%C3%A1ntas-d%C3%B3nde-y-por-qu%C3%A9/a-53054180 (Accessed 12 December 2020)

63 U.S. Department of State, “A Call to Action: First-Hand Accounts of Abuses in Cuba’s Overseas Medical Missions”, 26 September 2019. https://www.state.gov/a-call-to-action-first-hand-accounts-of-abuses-in-cubas-overseas-medical-missions/ (Accessed 31 December 2019) ; Laydis Milanés, “Claves para entender la colaboración médica cubana”, Cubahora, 8 October 2019. https://www.cubahora.cu/politica/claves-para-entender-la-colaboracion-medica-cubana (Accessed 20 November 2020).

64 Roberto Morales, “África está urgida de la solidaridad internacional”, op.cit.; Liz Caridad Conde Sánchez, “La solidaridad médica cubana ha llegado a casi un tercio de la humanidad”, Granma, 23 February 2021. http://www.granma.cu/cuba/2021-02-23/la-solidaridad-medica-cubana-ha-llegado-a-casi-un-tercio-de-la-humanidad-23-02-2021-14-02-09 (Accessed 26 February 2021).

65 Programme des Nations unies pour le Développement, Investigación sobre ciencia, tecnología y desarrollo humano en Cuba, 2003, p.117-119. http://hdr.undp.org/en/content/investigaci%C3%B3n-sobre-ciencia-tecnolog%C3%ADa-y-desarrollo-humano-en-cuba-2003 (Accessed 24 March 2020).

66 Programme des Nations unies pour le Développement, Investigación sobre ciencia, tecnología y desarrollo humano en Cuba, 2003, p.117-119, op. cit.

67 Ibid.

68 Nuria Barbosa León, “La Escuela Latinoamericana de Medicina: un proyecto visionario y humanista”, Juventud Rebelde, 21 November 2014. http://www.granma.cu/cuba/2014-11-21/la-escuela-latinoamericana-de-medicina-un-proyecto-visionario-y-humanista (Accessed 24 March 2020).

69 Cuba debate, “El sueño de Fidel : Reciben su título 500 médicos extranjeros”, 24 july 2019.

70 Organisation mondiale de la santé, “Cuba répond à la demande de Médecins”, May 2010, Volume 88. http://www9.who.int/bulletin/volumes/88/5/10-010510/fr/ (Accessed 24 March 2020).

71 Salim Lamrani, “Cuba’s Health Care System: A Model for the World”, The Huffington Post, 8 August 2014. http://www.huffingtonpost.com/salim-lamrani/cubas-health-care-system-_b_5649968.html (Accessed 24 March 2020).

72 Dr. Margaret Chan, “Remarks at the Latin American School of Medicine”, World Health Organization, 27 October 2019. http://www.who.int/dg/speeches/2009/cuba_medical_20091027/en/ (Accessed 24 March 2020).

73 UNESCO, UNESCO Science Report: Toward 2030, Paris, 2015, p. 181. http://unesdoc.unesco.org/images/0023/002354/235406e.pdf (Accessed 24 March 2020).

74 Ministerio de Relaciones Exteriores de la República de Cuba, “Más de 18 mil niños de Chernobyl atendidos en Cuba”, March 2005. http://www.cubaminrex.cu/CDH/61cdh/M%E1s%20de%2018%20mil%20ni%F1os.htm (Accessed 13 January 2013).

75 Reuters, “Chernobyl Victims Treated in Cuba”, 23 March 2010 ; Yissel Rodríguez Milán, “Cuba sola atendió más niños de Chernobyl que todo el mundo”, Granma, 27 April 2018. http://www.granma.cu/ciencia/2018-04-27/cuba-sola-atendio-mas-ninos-de-chernobil-que-todo-el-mundo-27-04-2018-22-04-53 (Accessed 24 March 2020).

76 Andrés Schipani, “Revolutionary Care : Castro’s Doctors Give Hope to the Children of Chernobyl”, The Guardian, 2 July 2009.

77 Ibid.

78 Ministerio de Relaciones Exteriores de la República de Cuba, “Más de 18 mil niños de Chernobyl atendidos en Cuba”, op. cit.

79 El Nuevo Herald, “Atendidos 18,000 niños de Chernóbil”, 31 March 2005.

80 Ministerio de Relaciones Exteriores de la República de Cuba, “Más de 18 mil niños de Chernobyl atendidos en Cuba”, op. cit.

81 China Daily, “Ukraine Thanks Cuba for Helping Chernobyl Victims”, 24 December 2010. http://www.chinadaily.com.cn/world/2010-12/24/content_11751208.htm (Accessed 24 March 2020).

82 Organisation mondiale de la santé, “Cécité et déficience visuelle”, Aide-Mémoire n°282, October 2011. http://www.who.int/mediacentre/factsheets/fs282/fr/index.html (Accessed 24 March 2020).

83 Ministerio de Relaciones Exteriores, “Celebra Operación Milagro cubana en Guatemala”, República de Cuba, 15 November 2010. http://www.cubaminrex.cu/Cooperacion/2010/celebra1.html (Accessed 13 November 2011) ; Operación Milagro, “¿Qué es la Operación Milagro?”. http://www.operacionmilagro.org.ar/ (Accessed 15 November 2011).

84 Iris Armas Padrino, “Misión Milagro: 15 años en combate contra la ceguera”, Agencia Cubana de Noticias, 10 july 2019. http://www.acn.cu/especiales-acn/46949-mision-milagro-15-anos-en-combate-contra-la-ceguera-fotos (Accessed 25 March 2020).

85 Ricardo López Hevia, “En fotos, Ban Ki-moon visita la Escuela Latinoamericana de Medicina (ELAM)”, op. cit.

86 The New York Times, “Cuba’s Impressive Role on Ebola”, 19 October 2014.

87 Roberto Morales, “África está urgida de la solidaridad internacional”, op. cit.

88 Ibid.

89 Nina Lakhani, “Cuban Medics in Haiti Put the World to Shame”, The Independent, 26 December 2010.

90 Conner Gorry, “Cuba Calling: What This Small Island Can Teach the World About Disease Control”, The Guardian, 23 October 2014. https://www.theguardian.com/global-development-professionals-network/2014/oct/23/cuba-healthcare-lessons-ebola-sierra-leone-guinea-liberia (Accessed 24 March 2020).

91 Tom Fawthrop, “Impoverished Cuba Sends Doctors Around the Globe to Help the Poor”, The Syndney Morning Herald, 28 October 2006.

92 Institut national de sciences de l’univers, “Séïsme de Haïti du 12 janvier 2010”, Centre national de la recherche scientifique, 19 January 2010. http://www.insu.cnrs.fr/co/terre-solide/catastrophes-et-risques/seismes/seisme-de-haiti-du-12-janvier-2010 (Accessed 12 November 2011).

93 Radio Canada, “Le bilan grimpe à 230 000 morts”, 10 February 2010. http://www.radio-canada.ca/nouvelles/International/2010/02/10/004-haiti_bilan.shtml (Accessed 12 November 2011).

94 Nina Lakhani, “Cuban Medics in Haiti Put the World to Shame”, The Independent, 26 December 2010. https://www.independent.co.uk/life-style/health-and-families/health-news/cuban-medics-in-haiti-put-the-world-to-shame-2169415.html (Accessed 24 March 2020).

95 Andrés Martínez Casares, “Cuba Tales Lead Role in Haiti’s Cholera Fight”, The New York Times, 7 November 2011.

96 Ibid. See also Cuba Debate, “Brigada Médica Cubana en Haití alcanza records mínimos de tasa de letalidad por cólera”, 5 March 2011.

97 Diario do Centro de Mundo, “Entrevista: ‘é incrível o que Cuba pode fazer’, diz OMS sobre ajuda contra ebola”, October 2014. http://www.diariodocentrodomundo.com.br/entrevista-e-incrivel-o-que-cuba-pode-fazer-diz-oms-sobre-ajuda-contra-ebola/ (Accessed 24 March 2020).

98 Halla Thirsteinsdóttir & Tirso W. Sáenz, “Tackling Meningitis in Africa”, Science, 21 December 2012, p. 1546-47 ; Jorge Manzaneda, “Vacunas de Cuba y Brasil salvan miles de vidas en Africa”, Trabajadores, 10 January 2013.

99 Ibid.

100 Ibid.

101 Halla Thorsteinsdóttir & Tirso W. Sáenz, “Tackling Meningitis in Africa”, Science, 21 December 2012, p. 1546-47.

102 Agencia Cubana de Noticias, “Cuba’s LABIOFARM Launches Malaria Campaign in Western Africa”, 30 May 2014.

103 Organisation mondiale de la santé, “World Malaria Report 2013”, 2013, p. v. http://www.who.int/malaria/publications/world_malaria_report_2013/report/en/ (Accessed 24 March 2020).

104 Granma, “Cuba responde al llamado de la ONU para combatir el ébola”, 11 September 2014. http://www.granma.cu/mundo/2014-09-11/cuba-responde-al-llamado-de-la-onu-para-combatir-el-ebola (Accessed 24 March 2020).

105 Cuba Debate, “Apoyo de Cuba a la lucha contra el ébola responde a la solidaridad de su Revolución”, 13 september 2014. http://www.cubadebate.cu/noticias/2014/09/13/apoyo-de-cuba-a-la-lucha-contra-el-ebola-responde-a-la-solidaridad-de-su-revolucion/#.VBSAxVd42So (Accessed 24 March 2020).

106 Cuba Debate, “Apoyo de Cuba a la lucha contra el ébola responde a la solidaridad de su Revolución”, op. cit.

107 Ibid.

108 Kai Kupferschmidt, “Cuba to Commit Large Health Corps to Ebola Fight”, Science, 12 September 2014. http://news.sciencemag.org/africa/2014/09/cuba-commit-large-health-corps-ebola-fight (Accessed 24 March 2020).

109 Cuba Debate, “Apoyo de Cuba a la lucha contra el ébola responde a la solidaridad de su Revolución”, 13 September 2014, op. cit.

110 Barack Obama, “Remarks by President Obama and President Raul Castro of Cuba in a Joint Press Conference”, op. cit.

111 Barack Obama, “Remarks by President Obama to the People of Cuba”, The White House, 22 March 2016. https://www.whitehouse.gov/the-press-office/2016/03/22/remarks-president-obama-people-cuba (Accessed 24 March 2020).

112 Le Figaro, “Ebola : John Kerry remercie Cuba”, 17 October 2014.

113 Adam Taylor, “In the medical response to Ebola, Cuba is punching far above its weight”, The Washington Post, 4 October 2014, op. cit.

114 Drew Hinshaw & Betsy McKay, “Island Nation Outpaces Larger Countries in Sending Medical Staff; Unlikely Partner for U.S.”, The Wall Street Journal, 9 October 2014. http://online.wsj.com/articles/cuba-stands-at-forefront-of-ebola-battle-in-africa-1412904212 (Accessed 24 March 2020).

115 The New York Times, “Cuba’s Impressive Role on Ebola”, 19 October 2014.

116 France Info Outre-mer la 1ère, “Coronavirus : Cuba envoie en Italie des médecins ayant combattu la fièvre Ebola”, 22 March 2020. https://la1ere.francetvinfo.fr/coronavirus-cuba-envoie-italie-medecins-ayant-combattu-fievre-ebola-814946.html (Accessed 22 March 2020).

117 Prensa Latina, “Ayuda de Cuba a Italia fue solidaria y gratuita, dice canciller”, 18 July 2020.

118 Stefania Bonaldi, “Covid: medici Cuba terminano missione a Crema con tanti ringraziamenti”, Giornale Diplomatico, 23 May 2020. https://www.giornalediplomatico.it/Covid-medici-Cuba-terminano-missione-a-Crema-con-tanti-ringraziamenti.htm (Accessed 30 May 2020).

119 Giusi Spica, “Emergenza Covid, la Sicilia chiede a Cuba una task force di 60 medici e infermieri”, La Repubblica, 23 November 2020. https://palermo.repubblica.it/cronaca/2020/11/23/news/emergenza_covid_la_sicilia_chiede_a_cub_una_task_force_di_60_medici_e_infermieri-275474742/ (Accessed 14 December 2020).

120 France 24/AFP, “Médicos cubanos van a Andorra, su segundo destino europeo contra el COvid-19”, 29 March 2020. https://www.france24.com/es/20200329-m%C3%A9dicos-cubanos-van-a-andorra-su-segundo-destino-europeo-contra-la-covid-19 (Accessed 30 March 2020).

121 Adrià Esteban & Lidia Pérez, “Defensa de la sobirania davant dels EUA”, Diari d’Andorra, 31 March 2020. https://www.diariandorra.ad/noticies/nacional/2020/03/31/cuba_els_eua_enfronten_per_ajuda_dels_metges_les_infermeres_159179_1125.html (Accessed 1 April 2020).

122 Diari d’Andorra, “Tornen a casa un grup de 13 sanitaris Cubans”, 25 May 2020. https://www.diariandorra.ad/noticies/nacional/2020/05/25/acte_reconeixement_comiat_als_sanitaris_cubans_161481_1125.html (Accessed 30 May 2020).

123 Alizé Boissin, “Des médecins cubains au chevet de l’Outre-mer”, Public Sénat, 31 March 2020. https://www.publicsenat.fr/article/societe/des-medecins-cubains-au-chevet-de-l-outre-mer-181672?amp (Accessed 1 April 2020).

124 Sophie Lonette, “Après 3 mois d’attente, quinze professionnels cubains sont arrivés en Martinique”, Martinique la 1ère, 26 June 2020. https://la1ere.francetvinfo.fr/martinique/apres-3-mois-attente-15-professionnels-cubains-sont-arrives-martinique-847206.html (Accessed 19 November 2020) ; Martinique la 1ère, “Des médecins cubains étaient en renfort pour 3 mois en Martinique. Des renforts globalement salués en raison des besoins urgents dans les hôpitaux Martiniquais”, 30 September 2020. https://la1ere.francetvinfo.fr/martinique/le-sejour-des-medecins-cubains-est-plutot-salue-en-martinique-876242.html (Accessed 19 November 2020).

125 France Antilles, “Avant de regagner Cuba, les médecins cubains reçus par la CTM”, 7 October 2020. https://www.martinique.franceantilles.fr/actualite/sante/avant-de-regagner-cuba-les-medecins-cubains-recus-par-la-ctm-562012.php (Accessed 19 November 2020).

126 Granma, “Brigada médica cubana parte a Jamaica”, 21 March 2020. http://www.granma.cu/cuba-covid-19/2020-03-21/brigada-medica-cubana-parte-a-jamaica-para-combatir-el-covid-19-video-21-03-2020-15-03-48 (Accessed 22 March 2020).

127 Telesur, “Médicos cubanos viajan a Lombardía, Italia, por coronavirus”, 21 March 2020. https://www.telesurtv.net/news/cuba-medicos-cooperacion-coronavirus--20200321-0010.html (Accessed 22 March 2020).

128 Resumen Latinoamericano, “Argentina. Cuba envía brigada de 500 médicos a la provincia de Buenos Aires”, 24 March 2020. http://www.resumenlatinoamericano.org/2020/03/24/argentina-cuba-envia-brigada-de-500-medicos-a-la-provincia-de-buenos-aires/?fbclid=IwAR1fUn4z4ws8w8IbYtmjrPKElfTXfP3IVaVNMrtCHvSgaCcBg3bIdFGXFOE Accessed 25 March 2020).

129 José Antonio Abadía, “Médicos cubanos contra la Covid-19, solidaridad para el mundo”, Prensa Latina, 26 May 2020.

130 Saimi Reyes Carmona, “Interferón Alfa 2B: entre los más empleados para combatir la Covid-19”, Agencia Cubana de Noticias, 19 March 2020. http://www.acn.cu/salud/62273-interferon-alfa-2b-entre-los-mas-empleados-para-combatir-la-covid-19-video (Accessed 22 March 2020) ; Yaditza del Sol González, “El Interferón que ayuda a tratar el Covid-19: de su origen hasta hoy”, Granma, 19 March 2020. http://www.granma.cu/cuba-covid-19/2020-03-19/el-interferon-que-ayuda-a-tratar-la-covid-19-de-su-origen-hasta-hoy-19-03-2020-23-03-09 (Accessed 22 March 2020).

131 EFE, “Cuba reserva suficiente antiviral para tratar el Covid-19 en otros países”, 13 March 2020. https://www.efe.com/efe/america/sociedad/cuba-reserva-suficiente-antiviral-para-tratar-el-covid-19-en-otros-paises/20000013-4195541 (Accessed 22 March 2020) ; Orfilio Peláez, “Más de 45 países solicitan el interferón contra la COVID-19”, Granma, 27 March 2020. http://www.granma.cu/cuba-covid-19/2020-03-27/mas-de-45-paises-solicitan-el-interferon-contra-la-covid-19-27-03-2020-01-03-21 (Accessed 28 March 2020).

132 The New York Times, “Cuban Doctors Head to Italy to Battle Coronavirus”, 22 March 2020.

133 Ibid.

134 Jon Stone, “UK Thanks Cuba for ‘Great Gesture of Solidarity’ in Rescuing Passengers From Coronavirus Cruise Ship”, The Independent, 7 April 2020. https://www.independent.co.uk/news/world/americas/coronavirus-cruise-ship-cuba-rescue-ms-braemar-havana-cases-a9451741.html (Accessed 19 November 2020).

135 United Nations, “Cuba : U.N. Members Overwhelmingly Support End of U.S. Embargo, as Brazil Backs Washington”, 19 November 2019. https://news.un.org/en/story/2019/11/1050891 (Accessed 21 November 2020).

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Salim Lamrani, « The Health System in Cuba: Origin, Doctrine and Results »Études caribéennes [En ligne], 7 | Juillet 2021, mis en ligne le , consulté le 11 février 2025. URL : http://journals.openedition.org/etudescaribeennes/24110 ; DOI : https://doi.org/10.4000/etudescaribeennes.24110

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Salim Lamrani

Maître de conférences HDR, Université de La Réunion, salim.lamrani@univ-reunion.fr

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