60 years of Cuban medical cooperation.
In May 1963, a group of Cuban health workers arrived in Algeria to support the country’s efforts to rebuild after liberation from France. As the team was assembled, none of its members knew what to expect. “Now when you say that you have been on a mission people understand what you mean; there is a history, a tradition. Back then there wasn’t any. We were taking a first step; we were launching into the unknown,” said Pablo Resik Habib, one of the doctors who traveled in this contingent, to Cuban journalist Edelberto López Blanch.
Sixty years later, Cuban medical solidarity is one of the few shining points in global health. Hundreds of thousands of people have survived outbreaks of infectious diseases, and millions more were guaranteed access to basic care, thanks to Cuba’s dedication to supporting sister countries.
The wars waged by the United States after 2001 killed—directly—at least 906,000 people. Many more died as an indirect result of the conflicts, and even more are still suffering from their consequences. Meanwhile, since the establishment of the international health brigades, Cuban health workers have participated in the delivery of more than two million children all over the world. Sending doctors, not soldiers, as Fidel Castro implied in the aftermath of the 2010 Haiti earthquake, makes all the difference.
Building public health systems together
The first group that traveled to Algeria counted some 60 health workers, including doctors, nurses, and dentists. By May 2022, 605,000 health workers had served in 165 countries. Their involvement ranges from participating in emergency programs for the response to infectious disease outbreaks and the aftermath of hurricanes and earthquakes to the provision of primary health care.
In addition to sending health workers to other countries, Cuba also offers medical training to people from other countries of the Global South. Between 2005 and 2016, some 25,000 students went through training at the Latin American School of Medicine (ELAM). The number climbs even higher if we consider students from high income countries, including the US. In that case, more than 27,000 students received training at ELAM. Differently from most medical schools, ELAM prioritizes the enrollment of women and students from peasant, working class, and Indigenous backgrounds. This ensures that the health workers who graduate from the school understand, at a very personal level, the conditions in which their patients live.
Students at ELAM are not only trained in medical sciences, but are also exposed to the idea of health heralded by the revolution. After initial training, the students are sent to work together with one of the nurse-physician teams distributed around the country. As Helen Yaffe, an economic historian specializing in Latin America, points out in her book We are Cuba!, these students are taught to work in a very different way than medical students in the Global North—with little reliance on high-tech equipment, and in a spirit of comradeship with the community and traditional healers.
They are also taught the revolutionary potential of medicine and the importance of health workers’ participation in anti-colonial and anti-imperialist movements. For example, this year the students of ELAM marked the 75th anniversary of the Nakba. As of today, 163 Palestinian students graduated from ELAM. 50 more are still enrolled in undergraduate or postgraduate courses, according to the Cuban Ministry of Public Health.
Health for all in practice
Medical training for foreign students is conducted in parallel to local efforts to build and strengthen the health workforce. In 2022, Cuba had nine doctors to 1,000 patients, while the US had 2.5 to 1,000. The distribution of health workers in Cuba is also organized in a very different manner than in most high income countries. A network of clinics and polyclinics, based on the principles of primary health care and scattered around the island, ensures that care is easily accessible to everyone who needs it, regardless of where they live. In contrast, high income countries—again including the US—are increasingly facing the problem of medical deserts, where rural communities or specific populations are cut off from essential health care because of the health workers’ shortage.
In fact, in a period marked by an acute global shortage of health workers, Cuba’s experience of building its own health workforce and sharing it with others should be heralded as a way forward for everyone. Yet, in the Global North it is rarely acknowledged outside of the context of the COVID-19 pandemic response in Italy.
But it is wrong to reduce Cuban health internationalism to technical assistance during moments of crises. As the efforts put into educating nurses, doctors, and other health workers coming from other parts of the world show, Cuba’s international health programs give a glimpse into a different health landscape than the one dominating the discussion: care available to everyone, no matter how poor, provided by expert workers trained through a public education system.
As José Angel Portal Miranda, Cuba’s Minister of Public Health, said at the 76th World Health Assembly, Cuba “has succeeded in complying with the principle of ‘health for all.’” Cuba is one of the very few members of the World Health Organization who can say that. What he did not explicitly say in the speech is that, thanks to the international solidarity heralded by the island’s health workers, Cuba also reminds others that health for all is much more than a talking point.