Is it a praiseworthy humanitarian effort or an affront to human rights?
That's the debate swirling around a Cuban program that sends tens of thousands of doctors and other medical professionals abroad to care for people.
Cuba proudly says these "medical brigades" show solidarity with their fellow countries in the Global South. But the program is not solely altruistic. It's also one of the largest sources of foreign money for the island as the countries receiving the small army of health workers pay Cuba for them.
The U.S. State Department has long been critical of this system, alleging that the participants are coerced and underpaid by the government. In a statement to NPR, the State Department calls it "forced labor" and "human trafficking."
Now, the Trump administration is ratcheting up the pressure on countries to pull out of these arrangements with Cuba. A number in Latin America and the Caribbean are falling into line. Among the nations yielding to this pressure are Guatemala, Guyana, Jamaica, St. Vincent and the Grenadines, Paraguay and Honduras. They're phasing out the programs, reevaluating the payment model and sometimes canceling altogether.
Here's how it works — and why it's so controversial.
The backstory
The program began more than 60 years ago and typically provides medical aid to impoverished communities and rural, underserved areas — often in lower-resource countries like Angola, Guatemala and Venezuela but in some high-income countries as well. For example, a Cuban team went to Italy to help out during the early years of the COVID crisis.
The numbers are impressive: In 2024, more than 20,000 Cuban medical personnel were serving in more than 50 countries, according to Granma, the official paper of the communist party in Cuba.
Under the agreements made with individual countries, the Cuban government often gets paid a hefty sum for each medical practitioner but the doctors themselves see only a small percentage of that money.
When Dr. Leyani Perez Gonzalez was a doctor in Cuba in the early 2000s, she says it was hard to make ends meet. "The payment for a doctor in Cuba, at that time, was about $20 monthly," she says. "With $20 in Cuba at that time, I can only buy — like one pair of shoes."
The financial challenges drove Gonzalez to apply to become part of a Cuban medical mission abroad. She says she could get paid roughly four times more working aboard. In 2008, Cuba sent Gonzalez to Venezuela. "I was in a primary care setting, seeing people with different chronic diseases, children, pregnant women," she remembers.
The U.S. perspective
Gonzalez liked working with the patients but she says the rest of the experience was miserable — and scary. She was placed in an impoverished neighborhood with a lot of violence. Plus, she says, the Cuban government was watching her constantly and took steps to make sure she couldn't escape. She had to return to Cuba. "They removed our passports," she says.
She describes the medical missions as a form of slavery.
She ended up deciding to flee, even though she had no passport, no idea where to go and no idea what her future held.
Luckily for her, she soon learned that the U.S. shared her concerns about Cuba's medical missions. During George W. Bush's presidency, the State Department created a system that allowed Cuban medical professionals serving abroad to seek refuge in the U.S. and get residency. It was called the Cuban Medical Professional Parole Program and ended under President Barack Obama, when he reinstated diplomatic relations with Cuba.
But now — under President Trump and Secretary of State Marco Rubio, a long-time critic of the Cuban regime — the U.S. is returning to its adversarial approach to the program. That comes on top of a punishing oil blockade the U.S. is imposing.
In August 2025, the Trump Administration moved to revoke visas and impose visa restrictions on government officials in Brazil, Grenada and some African countries because they worked with Cuba on these programs. "Our action sends an unmistakable message that the United States promotes accountability for those who enable the Cuban regime's forced labor export scheme," Rubio said at the time in a press statement.
The U.S. also recently passed a law allowing it to impose sanctions on countries that work with Cuban doctors.
"The countries that have broken off these contracts are afraid. They are afraid of retaliation by the United States," says William LeoGrande, a professor of government in the School of Public Affairs at American University. "This is typical of Donald Trump's foreign policy, which is based essentially on coercive diplomacy: 'Do it our way, or else.' So: 'Get rid of the Cuban doctors, or else.' "
It's complicated
Not everyone agrees with the U.S. position on Cuban medical missions. It's "really extreme," says LeoGrande.
Stephanie Panichelli-Batalla, a professor of global sustainable development at the University of Warwick in the U.K., says this program "is, in fact, much more complex" than the U.S. makes it out to be.
She acknowledges that Cuba has a strong financial incentive for the program: "It is the highest income of foreign funds for Cuba. The Cuban doctors are kind of a commodity that is being used by the country to survive economically."
However, she is quick to add that some see this system as "extremely smart," helping Cuba "with their economic context, while doing good in the world." She also points out that, while the doctors aren't paid well, they earn significantly more than they'd make in Cuba. And they volunteer for these missions. "They then go back to Cuba, and they manage to renovate their apartments, or buy this or have this, and they have a standard of living that the common Cuban people don't have," she says.
She says the other long-standing issue is Cuba's confiscation of the participants' passports. She says, from Cuba's perspective, it has invested in training the doctors for free and doesn't want to lose them. Given how hard it is for Cubans to leave the island and how bad the economic crisis is, "there are no exact figures they've ever shared, but [the number of doctors who desert would explode, if you give them passports. So they would never agree to that. That's no surprise," she says.
When a special rapporteur looked into the system for the Office of the United Nations High Commissioner for Human Rights, they flagged several issues, including working and living conditions for the participants and punishment for family members in Cuba if their relative abandons their post abroad.
What happens to health care?
As countries pull out of their agreements with Cuba and doctors pack their bags, a big question looms.
"If we start canceling all those programs, what is going to happen with those vulnerable communities that will lose access to health care?" Panichelli-Batalla asks. NPR asked the State Department about any plans for the U.S. to fill this role but did not receive a response to that question.
Some countries — the Bahamas, for example — hope to pay the Cuban doctors directly. That possibility thrills Dr. Gonzalez, who now lives in Florida and has retrained to work as a nurse practitioner in the U.S.
"I'm very happy because they are offering to the doctors the power to be paid and to have freedom," she says.
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