The Algerian government pays Cuba $70 million a year for the services of nearly 900 doctors. Still, the island's government has not paid their salaries since March, several Cuban doctors in that country told el Nuevo Herald.
The allegations come just after Algeria made public the agreement with the Cuban government to hire doctors. The export of medical services has become Cuba's primary source of foreign exchange.
"We are eating from what they give us at the hospitals. It is a desperate situation. Cuba says it has no money to pay us," said a doctor who works in the African country and asked not to be identified for fear of retaliation.
According to the agreement published in Algeria's official gazette last week, the government pays around 72,000 euros ($79,000) annually for each of the 890 doctors Cuba has sent to the African country.
But the Cuban government keeps most of it and pays doctors about $900 a month. Of that, $350 is deposited in a bank account on the island. According to three doctors who talked to the Herald, the rest is paid directly to them in Algerian dinars.
"Algeria pays with hard currency and for a specific time. Cuba uses all that money and then has no way to pay us," said another doctor. "The explanation is that the country needs that money to invest in health and education, but every time I return (to the island), things are getting worse.
"We live in crowded conditions, many of us sharing the same place," he added. "Conditions are bad, security worse. We do this for our families."
The conditions described by doctors in Algeria are common in the so-called Cuban "medical missions."
Documents published in Brazil, where thousands of Cuban health professionals worked through the Mais Medicos program, show that the Brazilian government paid $4,000 per month for each specialist. Still, the island government only gave them $1,000 per month as a stipend. And almost half of it stayed in a Cuban bank account to which the doctors did not have access until they returned to the island after finishing their contract.
Human rights organizations have documented that Cuban authorities also restrict doctors' movements abroad and punish those who decide to escape from the missions. Abandoning them entails the prohibition of entry to Cuba for a maximum of eight years.
A doctor who recently worked on the medical "mission" in Algeria said Cuban officials withheld his passport upon arrival in the African country.
"When you arrived in Algiers, they take it away from you, and they don't return it to you until you go (back to Cuba) on vacation," he said.
The doctor said that some Cuban professionals buy merchandise in Algeria and resell it in Cuba to supplement the salary paid by the Cuban government.
"The stipend was enough for me because they gave me food in the hospital. Cuba says that what they give you in Algeria is not a salary, but a stipend for food and communication," he said.
"We never knew how much Algeria paid for our work. I looked it up in the press of that country," he added. "It was secret."
According to the agreement between Cuba and Algeria, first reported by the Cuban independent outlet 14ymedio, the Algerian government pays for medical services in four areas: ophthalmology, maternal and child health, oncology and urology.
The largest amount, 31,100,264 euros, about $34 million, goes to ophthalmology. In total, the Algerian government allocated 64,228,823 euros, or just over $70 million, to pay for Cuba's medical services.
All payments are made in euros to a bank account designated by the Cuban government, the document says.
Algeria is also responsible for the doctors' accommodations and repatriations in the event of illness or death.
For its part, Cuba pays for the flight tickets of the workers who go back to the island on vacation and ensures that it has a list of specialists available in case any vacancy needs to be filled.
The agreement also includes a confidentiality clause that can only be waived if required by each country's law.
It is not clear why the Algerian government, which has received Cuban doctors since the 1960s, has now decided to publish the agreement in its official gazette. After 20 years in power, and amid strong protests, Algerian leader Abdelaziz Bouteflika resigned in April last year.
The U.S. State Department has carried out a loud diplomatic campaign to denounce Cuban medical missions and has asked countries that hire doctors to pay them directly and make the terms of the agreement with Cuba public.
"We urge host countries to protect Cuban medical workers by making all agreements transparent, paying doctors directly, and not allowing anyone to confiscate their passports," Michael Kozak, acting assistant secretary for the Western Hemisphere, wrote on Twitter last week.
