Denial of Food and Medicine

Dorothy Guellec


embargo is driving Cuba toward crisis and is causing significant suffering and

death. Obtaining licenses from the departments of Commerce and Treasury to sell

goods to Cuba (Cuban Democracy Act of 1992) on a contract-by-contract basis is a

laborious process. The Geneva Conventions, to which some 165 countries including

the U.S. are party, require free passage of all medical supplies and food

intended for civilian use during wartime. The U.S. and Cuba are not at war.

Nevertheless the AAWH (American Association for World Health) findings suggest

that the embargo’s restrictions amount to the purposeful impending of foods

and medicines in peacetime.


week I spoke with Dr. Anthony Kirkpatrick a renowned U.S. anesthesiologist and

currently on the faculty at the University of South Florida and the Director for

research for a national medical association dedicated to a life-threatening

disease called reflex sympathetic dystrophy. I called him because he had

reviewed a recent book “A developmental analysis of Cuba’s health care

system since 1959” by Theodore H. MacDonald in the April 1st edition of the



told me “Cuba’s GNP is less than 1/20 of the US. It is a very poor country

indeed.” According to the U.N. and the World Bank, as the GNP increases so do

survival rates and Outcomes.


has other priorities” he said, “They nurture their children and educate

them. The mind set is different, so are the values. Cubans value a sense of

community over money. Under Battista corruption was rampant and during the first

few months of Castro’s administration senior faculty members at the Medical

schools left in droves and came to Miami”.


AAWH study for the WHO was conducted over a yearlong period between 1995 &

1996, and then published in 1997. A multi-disciplinary research team traced the

implications of the embargo restrictions on health care delivery and food

security in Cuba. The team reviewed key U.S. regulations and their

implementation, conducted a survey of 12 American medical and pharmaceutical

companies and documented the experience of Cuban import firms with the embargo. 

The team assessed the impact of U.S. sanctions on health in Cuba through on-site

visits to 46 treatment centers and related facilities; it conducted 160

interviews with medical professionals and other specialists, government

officials, representatives of non-governmental organizations, churches and

international aid agencies. In October 1996, the AAWH sent a delegation of

distinguished medical experts to Cuba to validate the findings of the draft

report through first-hand observation. The full report of more than 300 pages is

the first comprehensive study of its kind.


embargo is very stringent, and most other countries would have had a major

catastrophe, but this has been averted because the Cuban government has

maintained a high level of budgetary support for a system designed to deliver

primary and preventive care for all citizens. The Cuban constitution makes

health care a right of every citizen and the government’s responsibility. The

infant mortality rate is roughly half that in Washington, D.C. There are 440

polyclinics and secondary and tertiary facilities include 284 hospitals and 11

national institutes with impatient and research capacities. The 1992 Cuban

Democracy Act (CDA) outlawed subsidiary trade with Cuba and imposed severe

restrictions on foreign ships that visit Cuba before attempting to enter U.S.

ports. The CDA gave the Treasury Dep’t for the first time the authority to

levy civil fines up to $50,000 for violations of the embargo.


report states that “ four factors have dangerously exacerbated the human

effects of this 37-year-old trade embargo” All four stem from the

little-understood provisions of the U.S. Congress’ 1992 CDA.


A Ban on Subsidiary Trade “beginning in 1992, the CDA imposed a ban on

subsidiary trade. This restriction has severely constrained Cuba’s ability to

import medicines and medical supplies from third country sources. Moreover,

recent corporate buy-outs and mergers between U.S. and European pharmaceutical

companies have further reduced the number of companies permitted to do business

with Cuba”.


Licensing “under the CDA 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 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 experts “would be detrimental to U.S. foreign policy



Shipping “Since 1992 the embargo has prohibited ships loading or unloading

cargo in U.S. ports for 180 days after delivering cargo to Cuba.” 

Shipping costs have risen dramatically. From 1993-1996 Cuban companies spent an

additional $8.7 million on shipping medical imports from Asia, Europe and South



Humanitarian Aid. Charity is an inadequate alternative to free trade. The level

of donations pales in comparison to import needs. Donations are inconsistent;

contributions only reach a part of the population, benefiting those with

relatives in the U.S.


together, these four factors have placed severe strains on the Cuban health

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 stripped of

essential resources.


cost of the embargo in human terms can be calculated both statistically and



are some highlights from this extensive 300-page report from the Association for

World Health. Waterborne disease rates have more than doubled, making diarrhea

the second most common reason to visit a physician. The country’s mammography

program is crippled by a shortage of film and spare parts. Surgical rates are

down because of a lack of supplies and equipment, including anesthetics. Drugs

for leukemia patients and children with heart disease are not available, since

the embargo effectively bans Cuba from purchasing half of the new world-class

drugs on the market. The U.S. is directly responsible for the delays in AZT

treatment for AIDS patients. The patients do not have time to wait. Heart

disease is the number one cause of death in Cuba and mortality rates have

increased since 1989. In one instance reported by the delegation Cuban

cardiologists diagnosed a heart attack patient with a ventricular arrhythmia. He

required an implantable defibrillator to survive. Though the U.S. firm CPI,

which then held “a virtual monopoly on the device, expressed a willingness to

make the sale, the U.S. government denied a license for it. Two months later the

patient died.” The AAAWH team visited a pediatric ward then on its 22nd day

without metoclopramide HCI, a drug used in combination with others such as

“betamethasone for pediatric 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.”


we all know the embargo has been in place for 30 years, but during the 1990’s

the sanctions against trade with Cuba have “become tighter and more wide

reaching.” In 1996 the Lancet Editorial for November 30th described the

Helms-Burton-Act as the “harshest economic action yet taken by the USA against

Cuba. Under domestic political pressure, President Clinton reversed his initial

opposition to a new piece of legislation and signed it into law in March. The

law strengthens the existing embargo and allows US citizens whose property in

Cuba was seized as a result of the 1959 revolution there to sue foreign

companies who have invested in those properties. The law also requires that

persons closely involved in these investments, including company executives and

their families, be denied entry to the USA.” Dr. Kirkpatrick in the same 1996

Lancet characterizes this Act as “having an inhibiting effect on non-US

medical companies.”


four consecutive sessions the United Nations General Assembly passed resolutions

condemning the U.S. embargo against Cuba and called on the nation to rescind

those aspects of the statutes that violate principles of international law and

the United Nations Charter. Of course we all know the tortured relationship of

the U.S. and the United Nations. In 1994 the U.N. Commission on Human Rights

characterized unilateral coercive measures such as trade embargoes as a “clear

contradiction of international law,” and noted that “such unilateral

coercive economic measures create obstacles to trade relations among states,

adversely affecting the socio-humanitarian activities of developing countries,

and hinder the full realization of human rights by the people subject to those

measures.” The UN in my humble opinion was too generous and vastly understated

the harshness of the US position. Why can’t we tolerate a country just 90

miles from our shores where the literacy rate is about 96%, where money is not

at issue?



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