Cuba’s Ebola Diplomacy

Even in this age of international coalitions, the one arrayed against the Ebola outbreak in West Africa is impressive.

In September, more than a hundred and thirty nations voted in favor of a United Nations Security Council resolution declaring the virus, which is rampant in Liberia, Guinea, and Sierra Leone, a threat to international security and creating the U.N. Mission for Ebola Emergency Response, or UNMEER, devoted to fighting the virus.

The mission was put under the control of Anthony Banbury, a veteran U.N. troubleshooter, who hoped to tackle the job without the red tape that often bogs down U.N. missions.

Within a week, Banbury had assembled a team of international experts, selected from thousands volunteers from the U.N.’s myriad agencies, and headed off to kick-start operations at his new field headquarters, in Accra, Ghana.

President Obama has also made Ebola a top priority, ordering sixty-five health professionals, supported by nearly four thousand U.S. troops, to Liberia to help oversee the construction of eighteen mobile health clinics there. The United Kingdom has undertaken a similar initiative, dispatching seven hundred and fifty troops and medical teams to Sierra Leone, a former British colony.

Other countries, including Japan and India, have made donations of money, equipment, and small teams of medical personnel. Last week, after coming under criticism for not doing more, China announced that it will send its own sizeable military contingent and medical corps to the region.

But, in a sense, all of these countries are following the lead of Cuba. On September 12th, President Raúl Castro’s health minister announced that Cuba would send nearly five hundred health-care professionals to West Africa. Since then, a hundred and sixty-five Cubans have arrived in Sierra Leone and a second group of eighty-three have arrived in Liberia and Guinea; two hundred more are expected.

No other country, to date, has contributed as many trained health-care professionals to the Ebola crisis as Cuba has. (The closest parallel to Cuba’s effort may be Doctors Without Borders, the French-based humanitarian organization, which currently has more than two hundred and fifty international medical staff in the region, as well as more than three thousand local workers.)

Cuba has long been known for its roving teams of medical doctors and nurses. Indeed, Cuba, an island nation of eleven million people, with eighty-three thousand trained doctors—one of the highest proportions of doctors in the world—has become something like the world’s first responder to international crises in recent years.

It dispatched hundreds of Cuban medical personnel to Pakistan after an earthquake in 2005 and to Haiti following the catastrophic 2010 earthquake there, as well as to other far-flung emergencies. At any given time, there are an estimated fifty thousand Cuban doctors working in slums and rural areas in as many as thirty other developing nations around the world; up to thirty thousand work in Venezuela, in a bilateral aid-for-oil arrangement that was initiated by the late President Hugo Chávez.

This is the result of a long-term strategy that the Cuban government has pursued since seizing power in 1959. The policy is both economic and political. Health-workers are an exportable resource that, with an investment in schools, a small country without many natural ones can produce on a large scale.

Castro’s medical internationalism has been a huge financial boon to the island, earning it an estimated eight billion dollars a year. But the focus on medical training has also contributed to the endurance of Cuba’s appeal in the developing world, nearly a quarter century after the collapse of Communism elsewhere.

Hundreds of thousands of students from Africa, Asia, Latin America—and some from the United States—have received subsidized medical educations at the Latin American School of Medicine, which has its main campus in western Havana. In 2013, an estimated nineteen thousand five hundred students from more than a hundred countries were said to be enrolled there.

Participation in Cuba’s international medical corps provides additional income for the island’s underpaid doctors and nurses; it is also a source of pride. In its appeal for Ebola duty, Cuba’s government was deluged with more than fifteen thousand volunteers. (In addition to deploying intensive-care doctors and nurses, the Cuban teams in West Africa include surgeons, anesthesiologists, epidemiologists, and pediatricians, in an attempt to provide a comprehensive range of health care.)

Cuba’s outsize gesture in West Africa has not gone unnoticed, and may pave the way for the start of some Ebola diplomacy between Havana and Washington. On October 19th, Secretary of State John Kerry named Cuba as a nation that had made an “impressive” effort in the anti-Ebola campaign.

Ten days later, following a Havana conference on Ebola that was attended by two American officials representing the C.D.C., in a highly unusual break with procedure between the two nations, which do not have normal diplomatic relations, Raúl Castro said, pointedly, “Cuba is willing to work side by side with all nations, including the U.S., in the fight against Ebola.”

Returning on Friday from her own fact-finding tour of the Ebola-struck countries, the U.N. Ambassador Samantha Power also pointedly praised the Cuban mission.

The Ebola diplomacy follows a friendly handshake that Raul Castro and President Obama exchanged at Nelson Mandela’s funeral in South Africa, last December, and has added to anticipation that the Obama Administration may seek to finally lift the remaining restrictions in the United States’ trade embargo against Cuba.

The embargo has been in place for forty-three years; removing it would pave the way for a full restoration of diplomatic relations. (Thanks to the Helms Burton Act, which Clinton signed into law, entirely lifting the embargo requires an act of Congress. But Obama can apparently scrap most of its provisions by executive order.) The Times editorial page has twice in the past month called for a lifting of the embargo, citing Cuba’s Ebola initiatives in its second piece.

On Tuesday, and not for the first time, the U.N. General Assembly voted overwhelmingly against the U.S. embargo against Cuba. This time, the vote count was a hundred and eighty-eight to two. Speaking at a conference called “Cuba in Transition” that was held at Columbia University in mid-October, Greg Craig, a Washington lawyer and former White House counsel, pointed out that the time for Obama to move on Cuba was coming up very soon, or not at all.

He said that the ideal time to do so would be after the U.S. midterm elections, thus minimizing any domestic political fallout, and before the Summit of the Americas, a meeting of the hemisphere’s leaders that is convened every three years, and which will be held in April, in Panama.

Both Obama and Raul Castro—who has been invited at the insistence of the other leaders, in an unprecedented vote at the last, summit in 2012, have already said that they will attend. If Obama and Raúl Castro do meet there, it will be the first time in more than half a century that an American leader and a Cuban leader have sat down at the same table across from each other. At Columbia, Craig said his advice to Obama was simple: “Just do it.”

By Jon Lee Anderson, The New Yorker

November 4, 2014

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