Feature

Cuba: time to take an ethical stand

A new report on the health effects of US policy toward Cuba makes disturbing reading. John Waller reports

Five years ago a group of Sheffield health workers visited Cuba to study its heathcare system. We returned immensely inspired by Cuba’s achievements but deeply angered by the sustained efforts of the US government to destroy them.

During our visit US president George Bush, supported by Bill Clinton, signed the Cuban Democracy Act, more commonly known as the ‘Torricelli Law’ after its congressional author. For the previous 30 years the US government had banned all trade with Cuba, including food and pharmaceuticals. The new law extended the ban to any subsidiary of a US company, anywhere in the world. Almost overnight $750m worth of trade, mostly in food and medicines, ceased.

In October 1996 a prestigious group of US doctors representing the American Association for World Health visited Cuba to verify, through first hand observation, the findings of the association’s year long study of the embargo. The report of the results, Denial of food and medicine: the impact of the US embargo on health & nutrition in Cuba, was published in March 1997. Written in measured tones, it provides 300 pages of damning evidence of the brutality of US policy towards Cuba. The introductory summary to the report is worth quoting at length.

‘The American Association for World Health has determined that the US embargo of Cuba has dramatically harmed the health and nutrition of large numbers of ordinary Cuban citizens.

‘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 DC. Even so, the US embargo of food and the de facto embargo on medical supplies has wreaked havoc with the island’s model primary health care system.

‘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.

‘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… By one estimate, daily caloric intake dropped 33 per cent between 1989 and 1993.

‘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…Mortality rates from acute diarrhoeal disease, for instance, increased from 2.7 per 100,000 inhabitants in 1989 to 6.7 per 100,000 inhabitants in 1994.

‘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 US pharmaceuticals, Cuban physicians have access to less than 50 per cent 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.

‘Surgeries dropped from 885,790 in 1990 to 536,547 in 1995, a glaring indicator of the decline in hospital resources. Surgical services face shortages of most modern anaesthetics and related equipment, specialised catheters, third generation antibiotics and other key drugs, sutures, instruments, fabric for surgical greens, air conditioning equipment and disposable supplies.

‘AAWH visited a paediatric ward then on its 22nd day without metoclopramide HCL, a drug used in combination with others such as betamethasone for paediatric chemotherapy. Without this drug’s nausea-preventing effects, the 35 children in the ward were vomiting an average of 28 to 30 times a day.

‘In one instance Cuban cardiologists diagnosed a heart attack patient with a ventricular arrhythmia. He required an implantable defibrillator to survive. Though the US firm CPI, which then held a virtual monopoly on the device, expressed a willingness to make the sale, the US government denied a license for it. Two months later the patient died.

‘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.’

In November 1996, the British government joined almost the entire world in condemning the US blockade in a UN General Assembly vote, and British trade with Cuba is slowly growing. The Cuba Solidarity Campaign raises funds and materials to send direct medical aid to Cuba as a gesture of solidarity. But though important, this is only a drop in the ocean. We would like to see Britain show much more active political opposition to US policy towards Cuba and demonstrate greater willingness to break the blockade with trade and investment. Without this, the innocent citizens of Cuba will continue to suffer unnecessarily.

Cuba Solidarity Campaign, 129 Seven Sisters Road, London N7 7QG. 0171 263 6452.