"Denial of Food and Medicine:
The Impact Of The U.S. Embargo
On The Health And Nutrition In Cuba"
-An Executive Summary-
American Association for World Health Report
Summary of Findings
After a year-long investigation, the American Association for
World Health has determined that the U.S. embargo of Cuba has
dramatically harmed the health and nutrition of large numbers
of ordinary Cuban citizens. As documented by the attached report,
it is our expert medical opinion that the U.S. embargo has caused
a significant rise in suffering-and even deaths-in Cuba. For several
decades the U.S. embargo has imposed significant financial burdens
on the Cuban health care system. But since 1992 the number of
unmet medical needs patients going without essential drugs or
doctors performing medical procedures without adequate equipment-has
sharply accelerated. This trend is directly linked to the fact
that in 1992 the U.S. trade embargo-one of the most stringent
embargoes of its kind, prohibiting the sale of food and sharply
restricting the sale of medicines and medical equipment-was further
tightened by the 1992 Cuban Democracy Act.
A humanitarian catastrophe has been averted only because the
Cuban government has maintained a high level of budgetary support
for a health care system designed to deliver primary and preventive
health care to all of its citizens. Cuba still has an infant mortality
rate half that of the city of Washington, D.C.. Even so, the U.S.
embargo of food and the de facto embargo on medical supplies has
wreaked havoc with the island's model primary health care system.
The crisis has been compounded by the country's generally weak
economic resources and by the loss of trade with the Soviet bloc.
Recently four factors have dangerously exacerbated the human
effects of this 37-year-old trade embargo. All four factors stem
from little-understood provisions of the U.S. Congress' 1992 Cuban
Democracy Act (CDA):
- A Ban on Subsidiary Trade: Beginning in
1992, the Cuban Democracy Act imposed a ban on subsidiary trade
with Cuba. This ban has severely constrained Cuba's ability to
import medicines and medical supplies from third country sources.
Moreover, recent corporate buyouts and mergers between major
U.S. and European pharmaceutical companies have further reduced
the number of companies permitted to do business with Cuba.
- Licensing Under the Cuban Democracy Act:
The U.S. Treasury and Commerce Departments are allowed in principle
to license individual sales of medicines and medical supplies,
ostensibly for humanitarian reasons to mitigate the embargo's
impact on health care delivery. In practice, according to U.S.
corporate executives, the licensing provisions are so arduous
as to have had the opposite effect. As implemented, the licensing
provisions actively discourage any medical commerce. The number
of such licenses granted-or even applied for since 1992-is minuscule.
Numerous licenses for medical equipment and medicines have been
denied on the grounds that these exports "would be detrimental
to U.S. foreign policy interests."
- Shipping Since 1992:The embargo has prohibited
ships from loading or unloading cargo in U.S. ports for 180 days
after delivering cargo to Cuba. This provision has strongly discouraged
shippers from delivering medical equipment to Cuba. Consequently
shipping costs have risen dramatically and further constricted
the flow of food, medicines, medical supplies and even gasoline
for ambulances. From 1993 to 1996, Cuban companies spent an additional
$8.7 million on shipping medical imports from Asia, Europe and
South America rather than from the neighboring United States.
- Humanitarian Aid: Charity is an inadequate
alternative to free trade in medicines, medical supplies and
food. Donations from U.S. non-governmental organizations and
international agencies do not begin to compensate for the hardships
inflicted by the embargo on the Cuban public health system. In
any case, delays in licensing and other restrictions have severely
discouraged charitable contributions from the U.S.
Taken together, these four factors have placed severe strains
on the Cuban health system. The declining availability of food
stuffs, medicines and such basic medical supplies as replacement
parts for thirty-year-old X-ray machines is taking a tragic human
toll. The embargo has closed so many windows that in some instances
Cuban physicians have found it impossible to obtain life-saving
medicines from any source, under any circumstances. Patients have
died. In general, a relatively sophisticated and comprehensive
public health system is being systematically stripped of essential
resources. High-technology hospital wards devoted to cardiology
and nephrology are particularly under siege. But so too are such
basic aspects of the health system as water quality and food security.
Specifically, the AAWH's team of nine medical experts identified
the following health problems affected by the embargo:
- Malnutrition: The outright ban on the sale
of American foodstuffs has contributed to serious nutritional
deficits, particularly among pregnant women, leading to an increase
in low birth-weight babies. In addition, food shortages were
linked to a devastating outbreak of neuropathy numbering in the
tens of thousands. By one estimate, daily caloric intake dropped
33 percent between 1989 and 1993.
- Water Quality: The embargo is severely restricting
Cuba's access to water treatment chemicals and spare-parts for
the island's water supply system. This has led to serious cutbacks
in supplies of safe drinking water, which in turn has become
a factor in the rising incidence of morbidity and mortality rates
from water-borne diseases.
- Medicines & Equipment: Of the 1,297
medications available in Cuba in 1991, physicians now have access
to only 889 of these same medicines - and many of these are available
only intermittently. Because most major new drugs are developed
by U.S. pharmaceuticals, Cuban physicians have access to less
than 50 percent of the new medicines available on the world market.
Due to the direct or indirect effects of the embargo, the most
routine medical supplies are in short supply or entirely absent
from some Cuban clinics.
- Medical Information: Though information
materials have been exempt from the U.S. trade embargo since
1 988, the AAWH study concludes that in practice very little
such information goes into Cuba or comes out of the island due
to travel restrictions, currency regulations and shipping difficulties.
Scientists and citizens of both countries suffer as a result.
Paradoxically, the embargo harms some U.S. citizens by denying
them access to the latest advances in Cuban medical research,
including such products as Meningitis B vaccine, cheaply produced
interferon and streptokinase, and an AIDS vaccine currently under-going
clinical trials with human volunteers.
Finally, the AAWH wishes to emphasize the stringent
nature of the U.S. trade embargo against Cuba. Few other
embargoes in recent history - including those targeting Iran,
Libya, South Africa, Southern Rhodesia, Chile or Iraq - have included
an outright ban on the sale of food. Few other embargoes have
so restricted medical commerce as to deny the availability of
life-saving medicines to ordinary citizens. Such an embargo appears
to violate the most basic international charters and conventions
governing human rights, including the United Nations charter,
the charter of the Organization of American States, and the articles
of the Geneva Convention governing the treatment of civilians
American Association for World Health
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