Cuba’s extraordinary global medical record shames the US blockade

From Ebola to earthquakes, Havana’s doctors have saved millions. Obama must lift this embargo

• 
• • Seumas Milne
  • The Guardian, Wednesday 3 December 2014 20.07 GMT

Illustration: Eva Bee

Four months into the internationally declared Ebola emergency that has devastated west Africa, Cuba leads the world in direct medical support to fight the epidemic. The US and Britain have sent thousands of troops and, along with other countries, promised aid – most of which has yet to materialise. But, as the World Health Organisation has insisted, what’s most urgently needed are health workers. The Caribbean island, with a population of just 11m and official per capita income of $6,000 (£3,824), answered that call before it was made. It was first on the Ebola frontline and has sent the largest contingent of doctors and nurses – 256 are already in the field, with another 200 volunteers on their way.

While western media interest has faded with the receding threat of global infection, hundreds of British health service workers have volunteered to join them. The first 30 arrived in Sierra Leone last week, while troops have been building clinics. But the Cuban doctors have been on the ground in force since October and are there for the long haul.

The need could not be greater. More than 6,000 people have already died. So shaming has the Cuban operation been that British and US politicians have felt obliged to offer congratulations. John Kerry described the contribution of the state the US has been trying to overthrow for half a century “impressive”. The first Cuban doctor to contract Ebola has been treated by British medics, and US officials promised they would “collaborate” with Cuba to fight Ebola.

But it’s not the first time that Cuba has provided the lion’s share of medical relief following a humanitarian disaster. Four years ago, after the devastating earthquake in impoverished Haiti, Cuba sent the largest medical contingent and cared for 40% of the victims. In the aftermath of the Kashmir earthquake of 2005, Cuba sent 2,400 medical workers to Pakistan and treated more than 70% of those affected; they also left behind 32 field hospitals and donated a thousand medical scholarships.

That tradition of emergency relief goes back to the first years of the Cuban revolution. But it is only one part of an extraordinary and mushrooming global medical internationalism. There are now 50,000 Cuban doctors and nurses working in 60 developing countries. As Canadian professor John Kirk puts it: “Cuban medical internationalism has saved millions of lives.” But this unparalleled solidarity has barely registered in the western media.

Cuban doctors have carried out 3m free eye operations in 33 countries, mostly in Latin America and the Caribbean, and largely funded by revolutionary Venezuela. That’s how Mario Teran, the Bolivian sergeant who killed Che Guevara on CIA orders in 1967, had his sight restored 40 years later by Cuban doctors in an operation paid for by Venezuela in the radical Bolivia of Evo Morales. While emergency support has often been funded by Cuba itself, the country’s global medical services are usually paid for by recipient governments and have now become by far Cuba’s largest export, linking revolutionary ideals with economic development. That has depended in turn on the central role of public health and education in Cuba, as Havana has built a low-cost biotech industry along with medical infrastructure and literacy programmes in the developing countries it serves – rather than sucking out doctors and nurses on the western model.

Internationalism was built into Cuba’s DNA. As Guevara’s daughter, Aleida, herself a doctor who served in Africa, says: “We are Afro-Latin Americans and we’ll take our solidarity to the children of that continent.” But what began as an attempt to spread the Cuban revolution in the 60s and became the decisive military intervention in support of Angola against apartheid in the 80s, has now morphed into the world’s most ambitious medical solidarity project.

Its success has depended on the progressive tide that has swept Latin America over the past decade, inspired by socialist Cuba’s example during the years of rightwing military dictatorships. Leftwing and centre-left governments continue to be elected and re-elected across the region, allowing Cuba to reinvent itself as a beacon of international humanitarianism.

But the island is still suffocated by the US trade embargo that has kept it in an economic and political vice for more than half a century. If Barack Obama wants to do something worthwhile in his final years as president he could use Cuba’s role in the Ebola crisis as an opening to start to lift that blockade and wind down the US destabilisation war.

There are certainly straws in the wind. In what looked like an outriding operation for the administration, the New York Times published six editorials over five weeks in October and November praising Cuba’s global medical record, demanding an end to the embargo, attacking US efforts to induce Cuban doctors to defect, and calling for a negotiated exchange of prisoners.

The paper’s campaign ran as the UN general assembly voted for the 23rd time, by 188 votes to 2 (US and Israel), to demand the lifting of the US blockade, originally imposed in retaliation for the nationalisation of American businesses and now justified on human rights grounds – by a state allied to some of the most repressive regimes in the world.

The embargo can only be scrapped by congress, still stymied by the heirs of the corrupt US-backed dictatorship which Fidel Castro and Guevara overthrew. But the US president has executive scope to loosen it substantially and restore diplomatic ties. He could start by releasing the remaining three “Miami Five” Cuban intelligence agents jailed 13 years ago for spying on anti-Cuba activist groups linked to terrorism.

The obvious moment for Obama to call time on the 50-year US campaign against Cuban independence would be at next April’s Summit of the Americas – which Latin American governments had threatened to boycott unless Cuba was invited. The greatest contribution those genuinely concerned about democratic freedoms in Cuba can make is to get the US off the country’s back.

If the blockade really were to be dismantled, it would not only be a vindication of Cuba’s remarkable record of social justice at home and solidarity abroad, backed by the growing confidence of an independent Latin America. It would also be a boon for millions around the world who would benefit from a Cuba unshackled – and a demonstration of what can be achieved when people are put before corporate profit.

Ebola and failing markets tell us that we need to work together

Governments must heed the warnings of our brightest minds and reshape our societies to help those most in need

• 
• • Will Hutton
  • The Observer, Sunday 19 October 2014

Janet Yellen, the chair of the US Federal Reserve, who said last week that inequality is un-American. Photograph: Cliff Owen/AP

Last week, the world’s stock and bond markets swung wildly. They worried about the threat of world deflation, falling oil prices and further systemic weaknesses in the financial system. But perhaps they were most concerned about whether spooked governments had the will to do anything, even if those governments could agree on what that should be. If they can’t manage a co-ordinated response to Ebola or one against the cruelties of Isis, then it is hardly likely they are going to find common ground in managing the fissures in the world economy.

It is not as though there is not the beginning of a policy and intellectual consensus about what is wrong. Inequality is increasingly understood to be poisoning everything; governments cannot continue with business as usual policies; interdependencies have to be recognised and acted on. The problem is doing any of it.

Thus only last week, Janet Yellen, chair of the US Federal Reserve, joined one of her predecessors, Alan Greenspan, and the governor of the Bank of England, Mark Carney, in arguing that the growth of inequality was not only wrong morally but having increasingly baleful economic consequences. Then there were the strictures of the managing director of the IMF, Christine Lagarde.

Inequality, they all say, fosters fear, creates too much demand for credit to compensate for squeezed living standards, drives asset price bubbles, catalyses financial instability, weakens banks and, by displacing too much risk on to those who cannot bear it, undermines the legitimacy of capitalism. You have to blink with incredulity – and then blink again at markets falling because they want to see purposeful government action.

But governments everywhere seem paralysed, relying on central bankers’ promises not to raise interest rates to keep everyone calm and buy time for a few more months. No electoral majority can be mustered for even common sense, centrist radicalism that might address inequality or put economies stricken by the legacy of too much private debt and low demand back on their feet. They are stymied by their terror of going beyond the comfort zone of business as usual, as if the world had not changed after the financial crisis. It demands thinking – and doing – the hitherto unthinkable. Austerity remains the conventional wisdom.

In any case, rightwing populists challenge any such imaginative action as wrong. It’s not the aftermath of the financial crisis that’s the problem for them. It is foreigners, immigrants and the EU. We don’t need to look out for others, act purposefully to reshape our economies to lower inequality or accept interdependencies, declaim the world’s Nigel Farages. We are going to look out for number one, lock out foreigners and the rest of the world will meekly accept our assertion of self-interest.

This incubus goes far beyond economics. Thus the Ebola crisis has been gathering force for over a year. But it has taken the prospect of 10,000 new cases a week by December in Liberia, Sierra Leone and Guinea for it to become a global threat. It’s taken this to shock world governments into a response that even now is grudging and inadequate. To stem the epidemic, burials have to be safe and more than 70% of new sufferers immediately isolated, but for that there has to be a vast expansion of the health infrastructure, along with thousands of doctors and nurses.

West Africa has neither, nor is any crash mobilisation yet in prospect. Governments have been more preoccupied with stopping cases arriving in Europe, Japan and the US than getting involved in the messy and expensive business of tackling Africa’s health inequalities, the root of the epidemic. Only in the past week has there been some movement, with Britain committing £125m to Sierra Leone and others beginning to make common cause. But only $100,000 of the $1bn UN fund has been subscribed. The reality of interdependence, even before a global epidemic, is hard to accept.

If this is hard, it is much harder to accept the interdependency of global finance and beyond that the interdependencies of whole societies such as our own. Nobody is dying a horrible death. But it is very striking how difficult it is to convince the financial, political and intellectual elite that what happened in 2008/9 changed everything. For a generation, western societies in general, and Britain in particular, relied on the massive growth of private credit to mask the dysfunctionality of their capitalism. There was too little attention paid to ensuring the mass of people had economic opportunity in businesses that invested, innovated and grew. The assumption became rooted that the state was the problem and that business and markets would provide, which they could as long as private debt levels doubled every 20 years.

What is so chilling about George Osborne’s approach to running the economy is that he really believes he can go back to those times. So do Republicans in the US and so in her way does Angela Merkel. As Martin Wolf, chief economics commentator of the FT, writes in his magisterial account of today’s global economy, The Shifts and the Shocks, the elites have not been disabused of the notion that global finance can continue as before. The vast overhang of private debt is depressive, he argues. Governments must spend and borrow more for perhaps another decade. Central banks must continue with extraordinary monetary policies. Banks and banking need wholesale reform. Deflation, not inflation, is the threat.

Wolf applauds the world’s governments for acting so positively for 18 months after the crisis – and lambasts them for thinking all was well too soon and cutting spending when the co-dependency of state and market and need for extraordinary measures have never been more apparent. The result is self-defeating secular stagnation threatening to topple into worse – in essence, this is what spooked the markets last week.

Finance needs further reshaping; we need purposeful action to lower inequality, which will involve raising taxes on the wealthy, while governments have to borrow and spend, with infrastructure spending being an easy win. Parallel policies are needed abroad.

Europe or foreigners are not the cause of our ills. Ukip and the Tory right will make things worse, not better. Just as the best in the world can see what needs to happen in West Africa, so the best are dissociating themselves from the prescriptions of the right. Nigel Farage and the British right have to be understood for what they are: the political equivalent of Ebola – a virus that threatens our economic and social health.