MIAMI _ In a harshly worded report published Thursday, the United States described the international medical missions managed by the Cuban government as an example of "forced labor," and kept Cuba on the blacklist of countries that do not do enough to fight human trafficking.
The official declaration comes after an intense campaign by the U.S. government, activists and international organizations to denounce alleged abuses in these medical brigades.
In 2019, "there was a government policy or government pattern to profit from labor export programs with strong indications of forced labor," says the State Department in its annual Trafficking in Persons report.
In its 20th edition this year, the report was presented Thursday by State Secretary Mike Pompeo and presidential adviser Ivanka Trump.
"Up to 50,000 Cuban doctors have been forced by the Castro regime into human trafficking situations in more than 60 countries," Pompeo said in his remarks. "They are the regime's number one source of income."
Speaking of the medical missions coordinated by the Cuban Health Ministry and the Unidad Central de Cooperacion Medica, the report states that the island's government "has not taken action to address the exploitative and coercive policies in these missions, which are clear indicators of human trafficking."
The Cuban government has about 34,000 health workers, mostly doctors, in more than 60 countries. The government reported more than $6 billion in revenue from medical services abroad in 2018.
More than 20 nations have hired nearly 2,000 health care workers in response to the coronavirus crisis "under unclear financial arrangements," the report added.
Among the labor violations cited, the State Department says the island's government does not inform participants of the conditions of their contracts, withholds their passports and pays them only a small fraction of the funds disbursed by the host countries.
"Many Cuban medical personnel claim they work long hours without rest and face substandard and dangerous working and living conditions in some countries, including a lack of hygienic conditions and privacy, and are forced to falsify medical records," the department says.
The report also refers to complaints about retaliation suffered by those who leave the missions, who cannot return to Cuba for eight years.
Ambassador John C. Richmond, the head of the office in charge of publishing the annual report, said the U.S. government is closely tracking the concerns about the Cuban medical missions and has interviewed several former participants.
In 2019, two Cuban doctors who were on a mission in Kenya were kidnapped and believed to be in neighboring Somalia. According to the State Department report, six other doctors in the official brigades died in 2019, and an undetermined number have suffered sexual assaults.
According to the methodology for preparing the annual report, countries such as Cuba and Venezuela that ranked in Tier 3, the worst rating, do not meet the minimum standards of protection against forced labor and human trafficking.
The report is the most "authoritative" assessment of the situation of human trafficking in the world and what governments are doing to tackle it, Richmond said.
It also includes recommendations to improve each country's record, and "it has made a difference; it has been a critical tool to bring governments to the table," he said.
For the first time, Richmond said, the report also takes into account criteria for state-sanctioned human trafficking, and 10 countries, including Cuba, Russia and North Korea, were placed on Tier 3 because of "patterns of governments acting as human traffickers."
Last week, three Republican senators _ Rick Scott and Marco Rubio, both of Florida, and Ted Cruz of Texas _ introduced a bill that would penalize countries that hire Cuban doctors through the government missions. The bill proposes that this be considered as a factor in the country's ranking in the State Department's annual report on human trafficking.
The initiative was quickly criticized by several Caribbean countries that have received Cuban doctors to treat patients with COVID-19, and whose health care system heavily relied on Cuban doctors hired long-term through official missions.
An example of how the State Department could use the claims about the Cuban medical brigades to downgrade the ranking of other countries can be found in the same report published Thursday.
Among the violations cited to justify the placement of Venezuela at the bottom of the list, the report indicates that the government of Nicolas Maduro "did not make any efforts to screen Cuban medical professionals for trafficking indicators."
Richmond said the U.S. has called upon countries that hire the Cuban doctors "to make sure that anyone on their countries who is part of the Cuban medical mission is screened for indicators of trafficking, and to make sure they do their part."
The classification of the Cuban medical brigades as forced labor may become problematic for the World Health Organization and its regional branches, already facing criticism for their involvement in some of these programs.
Recently, Pompeo questioned the Pan American Health Organization for its role as an intermediary in hiring thousands of Cuban doctors in Brazil, through a "potentially illegal" agreement, he said.
The Cuban government has vehemently denied criticism of its medical brigades, saying they represent examples of solidarity and cooperation.
"When U.S. and Cuba authorities don't talk about Trafficking in Persons, Narcotics, Alien Smuggling, Terrorism and other international crimes, traffickers, and criminals celebrate," the Cuban ambassador to Washington, Jose Ramon Cabanas, wrote on Twitter on Wednesday. "Why is this State Department so keen on helping mobsters?"
Despite some initiatives to educate people about these crimes and help the victims, the State Department also concludes that the Cuban government has made "minimal" efforts to prevent sex trafficking.
According to information offered by Cuba and cited in the report, the island's authorities investigated 15 cases of human trafficking, dismantled eight criminal networks involved in the sexual exploitation of people, and arrested a Turkish citizen and 12 Cubans.
Cuban authorities also arrested five foreigners for paying for sex with minors.
Last year, the administration downgraded Cuba's rating. The Barack Obama administration first took the island out of Tier 3 in 2015, after top State Department officials interfered to inflate assessments of several countries, including Cuba.
On Wednesday, the State Department also released its annual report on terrorism, in which it says that Cuba is "not cooperating fully" with U.S. counterterrorism efforts.
The report also highlights that Cuba maintains close relations with states that are considered sponsors of terrorism (Iran, North Korea); refuses to extradite to Colombia members of the National Liberation Army, and provides refuge to fugitives from American justice.
