The American Association of World Health released an
extensive study in March 1997 of the impact of the U.S.
government’s embargo on public health and nutrition in
Cuba. Through hundreds of examples, the study provides an
abundance of evidence that the embargo has a widespread,
penetrating, and cruel affect on the people of Cuba. As if
this weren’t enough, the study also documents ways in
which the embargo violates a number of international human
rights agreements, including several which bear the signature
of the United States.

According to the study, "…Since 1992, the number of
unmet medical needs—patients going without essential
drugs or doctors performing medical procedures without
adequate equipment—has sharply accelerated…. 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."

Among numerous alarming situations, the research team
observed the following:

  • Thirty-five children in a pediatric ward were
    vomiting an average of twenty-eight to thirty times
    per day because they were on their twent-second day
    without metoclopramide HCI, a drug used in
    combination with others to relieve nausea in
    pediatric chemotherapy.
  • A heart attack patient with a ventricular arrhythmia
    required an implantable defibrillator to survive. The
    U.S. firm CPI, which then held a virtual monopoly on
    the device, was willing to make the sale, but the
    U.S. government denied a license. Two months later,
    the patient died.
  • A European organization donated 59 U.S.-manufactured
    Cobe kidney dialysis machines to Cuba. All 59 were in
    need of repair, but only 29 could be placed in
    working order because the necessary parts to repair
    the remaining 30 could not be obtained. The loss of
    these 30 machines alone meant that 150 patients had
    inadequate access to kidney dialysis in 1996,
    lessening their chances for kidney transplants, and
    therefore, for survival. At least another 180
    patients had only partial access to dialysis that
    same year.
  • The library of Havana’s medical sciences campus
    and those of most hospitals are stocked with
    textbooks and journals (the majority of which are in
    deteriorating condition) only up to 1991.
    Subscriptions to vital U.S. publications cost 50-100
    percent more through European distributors. Spanish
    translations of textbooks available in Latin America
    usually run about five years behind original English

The study is an impressive, exhaustive, and meticulously
referenced work of research conducted by a multi-disciplinary
team over a 12-month period in 1995 and 1996. Not only does
it examine the current situation, but it also presents
highlights of the history of the embargo, including periods
in time when some aspects of the embargo were loosened. The
overall trend has been to tighten the embargo, particularly
with the Torricelli Act (Cuban Democracy Act) of 1992 and the
Helms-Burton Act (Cuban Liberty Act) of 1996.

The American Association of World Health (AAWH) argues
that these measures were passed precisely because Cuba faced
an economic crisis in 1989 after the fall of the Soviet
Union. The U.S. embargo not only left Cuba with nowhere to
turn for trade but the Soviet Union in the 1960s, but also,
when the Soviet Union collapsed, the embargo meant Cuba had
nowhere at all to turn. Practically overnight, Cuba lost 80
percent of its imports. Within 2 years, the Cuban economy
contracted by 35 percent. President Castro declared the
beginning of the "Special Period in Time of Peace,"
which continues today. The likes of Jesse Helms wanted to
give the struggling island a fatal blow by further tightening
the noose.

Aside from human suffering, the strongest objection the
study presents to the embargo is the lack of precedent,
either legal or practical, for depriving people of food and
medicine. "…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 during
wartime." (The Geneva Convention requires free passage
of all medical supplies intended for civilians.)

The study made an impact on Washington. On May 14, 1997,
the U.S. State Department issued a press release refuting
many of the study’s claims. While the AAWH report is
dense and methodical, the State Department release offers
entertaining twists on reality such as: "The U.S.
embargo does NOT deny medicines and medical supplies to the
Cuban people," "The U.S. embargo on Cuba affects
only U.S. companies and their subsidiaries. Other nations and
companies are free to trade with Cuba," and, "Third
country transactions only cost an estimated 2-3 percent more
than purchases from the U.S. as a result of higher shipping
costs." The truth, as documented by the study, is that
shipping from third countries costs two to three times more.

The State Department may not be aware that the Cuban
Democracy Act (1992) prevents the docking at a U.S. port of
any ship that has docked in Cuba six months before or that
plans to visit Cuba within six months after. The Cuban
Democracy Act does allow medicines and medical supplies to be
shipped, but only after complicated, ambiguous licensing
requirements are fulfilled for both the sale and the
shipping. For sales, not donations, of medicines and medical
supplies the seller must guarantee that the U.S. government
can make "on-site verification" of the "end
use" of the products. The study provides detailed
documentation of the ways in which these restrictions make
both the sale and gift of medicines and medical supplies from
the U.S. to Cuba almost entirely unfeasible. "For all
practical purposes an absolute ban exists on sale of
medicines and medical equipment to Cuba by U.S. companies and
their foreign subsidiaries….Under no circumstance is the
sale of food authorized."

What tops off the complications and delays is the
study’s proof that the U.S. government’s real
policy is to deny licenses. Authorizing sales of medicines
and medical supplies to Cuba falls under the Treasury
Department, while authorizing the shipment thereof comes
under the Commerce Department. According to the report,
"…Both of these departments openly state that it is
their general policy to deny all applications." Quotes
from Department publications and Congressional testimony are

The research team also found that there was a 30 percent
drop in the number of surgeries performed from 1990 to 1995.
"Surgical services face shortages of most modern
anesthetics and related equipment, specialized catheters,
third generation antibiotics and other key drugs, sutures,
instruments, fabric for surgical greens, air conditioning
equipment and disposable supplies." People with HIV and
AIDS have been severely affected: "The embargo was
directly responsible for up to six month delays in AZT
treatment for a total of 176 HIV patients…. As one AIDS
professional told the AAWH, ‘The problem is that our
patients don’t have the time to wait’."

In addition, the study provides examples of ways in which
the U.S. is hurt by the embargo. Cuba is the only country
with a vaccine for Meningitis B, a disease which recently
afflicted a number of children in southern states. The
embargo also denies U.S. citizens access to cheaply produced
interferon and streptokinase and an AIDS vaccine currently
undergoing clinical trials with human volunteers.
Complications and delays of scientific and medical
information exchanges and of the ability of professionals to
participate in conferences in each other’s country are
examples of losses to both sides.

Factors responsible for Cuba’s economic crisis other
than the embargo are mentioned: the fall of the Soviet Union
and inefficiencies within the Cuban government and economy.
The AAWH investigation does not attempt to quantify to what
extent Cuba’s problems are caused by the embargo as
opposed to these other factors, nor could any study do so.
However, the study does give the impression that all of its
examples of suffering and denial of food, medicines, and
medical equipment are due to the embargo. Some health
professionals in Cuba agree with this point of view, while
others point more strongly to inefficiencies within the Cuban

Another area the study does not address is that some minor
improvements in public health resulted, not by choice, from
the Special Period. The transportation crisis compelled Cuba
to turn to bicycles on a massive scale. The result has been
cleaner air and more exercise for citizens, some of whom were
struggling with obesity during the 1970s and 1980s. While
caloric intake was slightly deficient for a period of time,
shortages of meat products and cooking oil led to a diet
lower in fat. U.S. currency shortages forced Cuba to
supplement chemical pesticides with biological controls and
to produce fertilizers and methane gas from sugar cane waste.

Deaths due to heart disease, cancer, cerebral vascular
disease, diabetes, bronchitis, emphysema, asthma, liver
disease, all of which increased during the 1980s, showed
slight decreases from 1990 to 1995. The flexibility of the
Cuban health system (which continues to serve all Cubans free
of charge) and the dedication of its highly trained medical
staff undoubtedly played a role. Yet, the consumption of less
fat and fewer cigarettes coupled with more exercise might
have helped reduce deaths due to these diseases.

Where food shortages had a negative impact on the health
of the Cuban population is evident in the most sensitive
indicators: infant mortality, maternal mortality, low birth
weight, and mortality in children under five years of age.
The Cuban health system was able to prioritize these sectors
of the population such that today these indicators are
similar or superior to what they were in 1989—and are
comparable to those of the "first world." Sharp
declines in food imports and agricultural inputs also
contributed to the 1993 neuropathy epidemic that temporarily
blinded over 50,000 people.

Deaths due to accidents, particularly bicycle accidents,
increased from 1990 to 1995. In terms of infectious diseases,
the Special Period brought about increases in typhoid fever,
tuberculosis, hepatitis, and parasitic diseases, due in part
to the country’s inability to purify drinking water in
many areas.

It will probably never be possible to know the extent of
either the human suffering and the economic damage to Cuba as
a result of the U.S. embargo. The AAWH study leaves no doubt
that there are many actions Cuba cannot take—because of
U.S. laws—to emerge from its economic crisis and to
provide food security and health care for its citizens. Where
the problem might be only a question of not having enough
U.S. dollars, the study argues that the embargo limits
Cuba’s access to hard currency.

The embargo does not seem to have any benefits, except
perhaps for the political appearances of a reactionary
minority. Even many who oppose Castro feel that the embargo
should be lifted, either because it is inhumane or because it
provides the Cuban government a convenient rationale for
inefficient practices. Legislation is pending in the U.S.
Congress to exempt food, medicines, and medical supplies from
the embargo. The study contains numerous detailed sections
including: legal aspects of the embargo, donations, food,
women’s health, children’s health, water resources,
medical testing, research, the pharmaceutical industry,
oncology, cardiology, HIV/AIDS, nephrology, ophthalmology,
and treatment of foreign patients.

Copies of the full report are available for $25 including
postage from the AAWH, 1825 K Street, NW, Suite 1208,
Washington, DC 20006, Tel: 202-466-5883, Fax: 202-466-5896,
The well-written Executive Summary is available free of


Genevieve Howe is a political activist from New