Mexico City – Mexico confirmed that it will maintain the hiring of Cuban doctors despite pressure from Washington and questions about possible labor abuses. The decision comes while other Latin American nations cancel similar agreements with this type of missions, which Cuba defends as "solidarity." The case is triangulated between the urgency to fill gaps in the health system, geopolitical implications and a debate that is planned on the commercial issue.

First modification: 04/24/2026 - 03:16

“You feel imprisoned, without freedom,” says Alicia*, whose real name she prefers to omit out of fear. The Cuban specialist explains that while she participated in the doctors abroad program, she could not process an ordinary passport in Cuba and that, upon arriving at the assigned destinations, the authorities retained her documents. That loss of control over his identity marked, he says, the beginning of a dynamic that limited his autonomy inside and outside of work.

Alicia served in Venezuela and East Timor, a remote destination in Southeast Asia. In her daily life as a doctor in such a distant place, she remembers precarious conditions: shared housing with up to ten people, no privacy, long working hours and a lack of resources in health centers. He assures that, in addition, there was pressure to report inflated medical figures.

“If you operate on five patients, you have to enter ten for the Government to obtain its statistics,” he told France 24.

The woman participated in the forum “Modern slavery and Cuban medical missions in Mexico”, held in Mexico City and organized by the Foundation for Human Rights in Cuba, an NGO based in Miami that tries to make visible the situation of around 24,000 professionals deployed in 56 countries.

Read alsoIn a Cuba hit by the crisis, doctors make "very difficult" decisions in a children's heart center

The doctor also denounces that the Cuban State withheld close to 75% of her salary and that her mobility was restricted, even outside of working hours. This set of conditions, added to the impossibility of leading a social life or making her own decisions, led her to leave the program. The decision involved a high personal cost: not being able to return to Cuba for years or reunite with his family, while he tries to rebuild his life in Mexico in an immigration limbo that prevents him from practicing his profession.

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According to current Cuban legislation, abandoning missions abroad can be punished with sentences of up to eight years in prison, in addition to leading to administrative and immigration measures that classify these professionals as “not admissible” in their own country.

“We have to work on whatever appears, except in health, in anything particular, private,” says the woman, who has been in the process for more than a year and a half to obtain asylum that would allow her to try to resume her life as a doctor in Mexico.

"We do not have access to public health yet until we have a residency. After the residency, if they give it to us, we can revalidate and we can integrate into the system. In the meantime, we cannot do it," he says.

Read alsoCuba rejects accusations about its participation in health fraud in the US.

“It is very helpful for Mexico”

Faced with criticism, the Mexican Government has defended the agreement as a necessary response to the shortcomings of the local health system.

At the end of March, President Claudia Sheinbaum maintained that medical cooperation with Cuba is the result of a “very good bilateral agreement of a lot of help for Mexico” and reiterated the decision to maintain it despite external pressure and the cancellation of similar agreements in countries such as Honduras, Guatemala or Jamaica.

The president framed the program within a logic of cooperation and health coverage. He recalled that the first Cuban doctors arrived during the pandemic and stressed that their presence responds to the lack of specialists in certain regions of the country.

Faced with accusations from US officials - such as the Secretary of State, Marco Rubio, who has described these brigades as forced labor -, Sheinbaum rejected that there are irregularities in remuneration:

"They are paid what they have to be paid. They receive their salary. It is not that 'come here and the Cuban Government will pay you whatever it wants there', no. They are paid a salary. And it is part, obviously, of a bilateral agreement," he commented.

Along the same lines, the Mexican Embassy in the United States responded to the accusations of Republican Congressman Mario Díaz-Balart, who pointed out possible links to human trafficking. The diplomatic representation maintained that alliances in the health sector “guarantee direct remuneration for medical professionals and decent working conditions,” and assured that foreign workers receive the same conditions as Mexican workers, in accordance with national legislation.

Read alsoThe withdrawal of Cuban doctors from Guatemala advances after the closure of medical missions

Mexico does not give up its support for Cuba

The continuity of the program on behalf of Mexico also occurs in a delicate economic context for Cuba. The island faces a deep energy crisis, aggravated by external restrictions and the tightening of sanctions promoted by the Donald Trump Administration, which seek to limit its sources of financing. In this scenario, Mexico has remained one of the few allies that supports active support, not only through medical cooperation, but also by sending humanitarian aid and fuel.

"They are paid what they have to be paid. They receive their salary.

But, for Oscar Grandío, a specialist in Cuban history, keeping the program in Mexico responds more to an ideological issue. "It is not a humanitarian issue, it is not an issue to benefit the Mexican population, but it is evidently an issue of a financial scheme that seeks to extract resources from the Mexican Government to Cuba."

Read alsoCuban doctors: 'heroes of socialism' or 'slaves of the dictatorship'?

Criticism of "modern slavery"

Criticisms of the program are not limited to the ethical level, but escalate to the legal field. Grandío maintains that Mexico's participation in this scheme could imply non-compliance with international commitments regarding forced labor. “The Mexican State violates, let's say, all international conventions on forced labor and modern slavery, of which Mexico is a signatory,” he assured.

The expert specifically points to instruments such as Convention 29 of the International Labor Organization and its protocol on modern slavery, as well as Convention 105, which absolutely prohibits forced labor. “Mexico, by being a signatory of these international agreements and applying a medical program that violates these agreements that Mexico has signed, becomes a violator of international treaties,” he maintains.

The central argument, according to the specialist, lies in the very structure of the program. Unlike a direct contracting scheme, in the Cuban case, he explains, the employment relationship is not established between the doctor and the receiving State, but through an entity of the Cuban Government that intermediates the contracts and administers the payments. "These salaries are not delivered to Cuban doctors. These salaries are withheld [...] and only between 20% and 10% are paid," he states, while describing mobility restrictions and control over the professionals' personal lives.

For Grandío, this design not only raises labor questions, but also opens a commercial front. It points out that Mexico, where there are around 3,000 Cuban doctors, as part of the North American free trade agreement, T-MEC, could be failing to comply with provisions related to the prohibition of forced labor.

Read alsoThe last Cuban doctors leave Honduras amid pressure from Trump

"Cuban doctors are the pride of the nation"

Although US legislation contemplates possible sanctions for officials involved in these schemes, Grandío considers that Washington has opted for a containment strategy. “The United States […] is trying to maneuver politically with the Mexican government, trying to pause these sanctions,” he says. In this context, the case becomes a potential point of friction within a bilateral relationship already strained by other issues.

For Eduardo Calderón, leader of the Fuerza Comunitaria collective, defining missions as “slavery” is based on an incomplete reading crossed by geopolitical interests. “Reducing them to concepts such as ‘forced labor’ is simplistic and closer to a tool of ideological attack than to a comprehensive analysis of the phenomenon,” he maintains, pointing out that these criticisms usually ignore the health impact of the brigades in crisis contexts.

From his perspective, the model does not respond to a traditional labor logic, but to agreements between States and explains that contracts are established at the government level and that the income generated is not conceived solely as an individual salary, but as a mechanism to sustain the Cuban health system.

"Reducing them (Cuban medical missions) to concepts such as 'forced labor' is simplistic and closer to a tool of ideological attack than to a comprehensive analysis of the phenomenon."

“There is a more collective logic in the organization of resources,” he says, in contrast to approaches that analyze the scheme solely from market parameters.

The Cuban president, Miguel Díaz-Canel, has vindicated the solidarity nature of the missions and their symbolic value for the country. “Cuban doctors are the pride of the nation and of many nations in the world,” he recently stated. Already in 2018, he had highlighted that same narrative by pointing out: “You assumed that dignity is not negotiated, you demonstrated that Cuban doctors do not work thinking about the money they can be paid.” Faced with accusations of exploitation, the president has been emphatic: “Calling a free man slaves is offensive, disrespectful,” he said.

"Mexico must not give in to imperial pressure and must extend its hand to a people that has been an example of resistance and dignity," Calderón states, in this sense, adding that, "although scenarios may arise in which the Mexican State is bound by economic or diplomatic pressures, it has also demonstrated the capacity to adapt to find support mechanisms beyond the limits imposed by the international context."

In January 2021, the Simón Bolívar Institute for Peace and Solidarity among Peoples even formalized in Caracas the nomination of the Henry Reeve contingent for the Nobel Peace Prize for its work during the Covid-19 pandemic. The candidacy, supported by medical organizations and international networks related to Cuba, highlighted its deployment in dozens of countries at times of health collapse.

Read alsoThe advance of an international convoy begins the delivery of medicines in Cuba

They sent us to "do propaganda"

But, the story of a Cuban nurse with two decades of experience introduces another angle to the program: its political dimension. During his missions in Venezuela – between 2016 and 2019, and then for another three years – he assures France 24 that his work was not limited to the health field. "They sent us from house to house to do propaganda in favor of Chavismo. You have to vote for that person. And that did take away some time because I didn't go to do politics, I went with the Hippocratic oath," he said.

“A CDI (Comprehensive Diagnostic Center) that looked like a cave,” he recalls, describing a place without electricity, without beds and without basic supplies, where—as he says—there were no real hospitalized patients. Even so, they had to record fictitious medical activity: “Ghosts were recorded in order to comply with the statistics […] if we did not treat any patients, they would take us out of there and send us to Cuba,” recalls another nurse under anonymity.

“Yes, it is slavery in the sense that you are not paid for what you have to do,” he maintains, referring to both salary withholding and working and control conditions.

Complaints about Cuban medical missions are not new. Already in 2018, a group of Cuban doctors filed a lawsuit in Miami against the Pan American Health Organization (PAHO), which they accused of having facilitated what they described as a “human trafficking” and “forced labor” scheme within the Mais Médicos program in Brazil. According to the plaintiffs, the agency's intermediation allowed the implementation of the agreement without guaranteeing fair working conditions or salaries for professionals.

Years later, the issue once again climbed onto the international agenda. In 2025, the United States Government announced sanctions against Brazilian officials and former representatives linked to the program, including Mozart Julio Tabosa Sales and Alberto Kleiman, whom it singled out for their role in the planning and execution of the scheme.

Read alsoThe IACHR denounces threats of prison and other human rights violations in medical missions in Cuba

An economic background?

The US Secretary of State, Marco Rubio, maintained that the program would have operated through PAHO as an intermediary with the Cuban Government, which - according to Washington - allowed sanctions to be avoided and payments to be channeled to Havana instead of to the doctors themselves.

Grandío also questions the opacity of the program in Mexico. He points out that the agreements signed with Cuba have been classified as reserved, which - in his opinion - limits the possibility of public scrutiny and independent audit.

For Cuba, he adds, the program represents a key source of foreign currency: one of the main income of the State, only behind tourism and remittances. An analysis by the independent Cuban magazine 'El Estornudo' estimates that these services generated more than 6 billion dollars in 2018, a figure that illustrates the structural weight of this model within the island's economy. Later official data reinforce this trend: in 2022, the export of medical services reached 4,882 million dollars, an increase of 12% compared to the previous year, according to the National Office of Statistics and Information.

“It is an ideological issue and it is an issue that the Mexican case in particular seeks to sustain the Cuban regime,” says Grandío. For his part, Calderón responds that "Mexico is not only its government, but also a people of solidarity that has expressed itself through donations, shipments of food and mobilizations in support of the Cuban people."

Read alsoTo Cuban doctors “we are not removing them” from Guatemala, President Bernardo Arévalo tells France 24

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