The Trump administration’s pressure campaign against Cuba’s Communist government is zeroing in on the island’s most valuable export and one of its few remaining sources of hard currency: the doctors and nurses it deploys abroad.
The U.S. has blocked fuel shipments , sanctioned and indicted its top officials and curbed money Cubans abroad send to relatives back home. Now, the effort to throttle Cuba’s decades-old medical missions—through which Havana gets payments to export doctors and nurses to more than 50 countries—threatens billions of dollars in revenue for a country already in economic free fall.
Trump administration officials have pressed countries that employ Cuban medical workers to end or scale back their contracts, threatening visa restrictions and other penalties for foreign officials who don’t comply. A State Department spokesman said the U.S. is sharing information about what it calls the program’s exploitative practices and urging governments that use Cuban doctors to hire and pay them directly instead of through Havana.
The campaign against Cuba’s medical program began just weeks after President Trump’s return to office last year. Several countries in Latin America and the Caribbean received inquiries from U.S. officials about the Cuban doctors deployed there, and Secretary of State Marco Rubio moved to bar foreign officials involved in the program from entering the U.S.
During a swing through the Caribbean this past March, Rubio lobbied political leaders to stop paying Cuba for doctors, saying its government was carrying out a forced-labor scheme disguised as humanitarian aid.
“The regime does not pay these doctors, takes away their passports, and basically it is in many ways forced labor,” Rubio said in Jamaica, standing next to the Prime Minister Andrew Holness .
Holness pushed back: “Let us be clear, the Cuban doctors in Jamaica have been incredibly helpful to us.”
But despite Holness’s public defense of the program, Jamaica ended its roughly 50-year partnership this winter. Others followed suit, suspending or restructuring their agreements with Cuba under U.S. pressure.
In Guatemala, 412 Cuban personnel—333 of them doctors—began leaving in April, with the last set to leave by year’s end. The Bahamas has also suspended its hiring of Cuban doctors.
Honduras President Nasry Asfura , a Trump ally, took office in January and sent home more than 150 Cuban medical workers. Videos circulated by local and pro-Cuba outlets showed a tearful send-off from residents who gave the departing Cuban staff an ovation as they left the ophthalmology clinics they had been operating.
Cuba currently has about 24,000 medical workers deployed globally, said Maria Werlau, director of Cuba Archive, which closely tracks labor abuses in the missions. They work in rural clinics and hospital wards across the world, from small Caribbean islands to as far away as Italy, where poor, rural communities rely on Cuban doctors to offer basic health services.
Rubio, who has targeted the program since his time in the Senate, has called the system “state-sponsored human-trafficking brigades.” In communities the doctors serve, people call them lifelines, offering patients free service.
In Honduras, José Enamorado, a plantain farmer, said his father received free cataract surgery from Cuban doctors last year, an operation that otherwise would have been unaffordable at $2,000.
“My dad could hardly see, but thank God his eye turned out well,” said Enamorado. “The Cuban doctors brought hope to a lot of people.”
Some governments are refusing to cut off ties with Cuba’s medical missions.
In St. Lucia, a tiny Caribbean island of 180,000 people where dramatic volcanic peaks draw hordes of tourists, Cuban doctors have been part of the healthcare system for more than 40 years.
“Our medical system would basically collapse without them,” St. Lucia Prime Minister Philip Pierre said after receiving the Trump administration’s inquiry last year.
Trevlyn Bonaparte, a St. Lucia teacher, said hospital wards are sometimes staffed by two Cuban nurses for every 20 patients. Many local doctors move outside the state-run health system into the more lucrative private sector or leave the country altogether for more money, she said.
“The shortfall is cushioned by Cubans,” Bonaparte said. “They come in and provide a vital service.”
Pierre, like some other leaders in the region, has said his government pays the Cuban doctors directly and treats them like local doctors. But U.S. officials have indicated that such assurances don’t resolve their broader concern that these doctors are being hired through the Cuban program, which could still receive the wages these countries pay them.
Cuba says it has sent medical workers abroad since 1963, the first to Algeria. Fidel Castro extolled the medics as an “army of white coats” who provided free health services for the poor. His government saw it as a key tool to boost international prestige for Cuba’s socialist model.
Havana also quickly realized that its “missionaries for the Cuban Revolution” were a financial lifeline, raking in about $8 billion a year at their peak just over a decade ago, according to Ricardo Torres, a Cuban economist at American University. In 2024, the last year for which official data is available, the missions generated about $5.3 billion, or half of total Cuban exports, said Torres.
“It’s not just the revenue they’re getting,” said Werlau of Cuba Archive. “It’s prestige, credibility, propaganda, influence.”
Prisoners Defenders, a Madrid-based human-rights group that works with Cuban dissidents, says Havana can make thousands of dollars a month from each doctor, from about $3,500 per doctor in Mexico to $4,000 from Italy per doctor after salaries are paid.
Bismarck Valerino, a Cuban doctor in Venezuela, says he was paid about $250 monthly after arriving in Venezuela in 2008, more than the $25 a month he made back on the island. Cuba imposed draconian rules, he said, barring doctors from leaving their quarters after 6 p.m. Supervisors even had to approve romantic relationships.
“There was always somebody watching,” said Valerino, who fled the program in 2011 and now lives in New York. “It was miserable.”
Cuba’s government, which has denied the forced labor claims, didn’t respond to requests for comment.
At a summit of Caribbean leaders in February, Rubio told reporters that the U.S. would provide alternatives to Cuban doctors. The U.S. Navy has sent a hospital ship, the USNS Comfort, through the region for short-term care, surgeries and training. But local officials say those limited programs can’t easily replace the Cuban medical workers.
Some of these countries have routed doctors’ pay through third-country recruitment firms and rebutted assertions of forced labor by documenting that the Cubans keep their own passports and bank accounts. Antigua and Barbuda recruited more than 120 nurses from Ghana in case it might “have to get rid of all of the Cuban nurses and doctors suddenly,” Prime Minister Gaston Browne said in January.
When the U.S. pressured St. Vincent and the Grenadines to cut loose its Cuban doctors last year, Prime Minister Ralph Gonsalves responded: “I will prefer to lose my visa than to have 60 poor and working people die.”
Write to Vera Bergengruen at vera.bergengruen@wsj.com and Ryan Dubé at ryan.dube@wsj.com
