“The embargo on Cuba is the most comprehensive set of US sanctions on any country, including the other countries designated by the US government to be state sponsors of terrorism”. [United States Government Accountability Office]
For nearly half a century, the USA has unilaterally imposed an economic, commercial, and financial embargo against Cuba. The severity and the scope of the sanctions have varied, depending on political developments in Cuba, the USA and the rest of the world.
The continuous imposition of the embargo has provoked frequent and intense debates in international forums. The UN General Assembly has repeatedly condemned the US embargo as contrary to the Charter of the United Nations and international law. On 29 October 2008 the UN General Assembly passed a resolution reiterating for the 17th time its call on the USA to end its embargo against Cuba. That resolution was adopted with 185 votes in favor, three against and two abstentions. The Inter-American Commission on Human Rights has also reiterated its position regarding “the impact of such sanctions on the human rights of the Cuban people and, therefore, insists that the embargo be lifted.”
The international community has denounced the US embargo because it violates international law, and on moral, political and economic grounds. Since Barack Obama took office as President of the USA in January 2009, there has been an intense debate and numerous calls at the national and international level for lifting the US embargo against Cuba. Unfortunately, within this debate there is hardly any mention of the negative impact of the embargo on the human rights of Cubans.
PROVISIONS AND SCOPE OF THE EMBARGO
The USA imposed the first economic sanctions against Cuba in 1960 by completely stopping sugar cane imports from Cuba. This was in response to Cuba’s nationalization of foreign property and businesses, the majority owned by US nationals. Since then, the US government has consolidated and extended the scope of the sanctions against Cuba. The original trade embargo has broadened into a more comprehensive set of economic, financial and commercial sanctions which rest principally on the following statutes and regulations:
- Trading With the Enemy Act of 1917, section 5(b);
- Foreign Assistance Act of 1961, section 620(a);
- Cuba Assets Control Regulations of 1963;
- Cuban Democracy Act of 1992, also known as the Torricelli Act;
- Cuban Liberty and Democratic Solidarity (Libertad) Act of 1996, (Helms-Burton Act);
- The Trade Sanctions Reform and Export Enhancement Act of 2000.
TRADING WITH THE ENEMY ACT OF 1917
The Trading with the Enemy Act (TWEA) gave the President of the USA the authority to impose economic sanctions against foreign nations by prohibiting, limiting or regulating trade and financial transactions with hostile countries in times of war. In 1933, the US Congress amended section 5(b) of the Act, granting the President authority to impose comprehensive embargoes against foreign countries during “the time of war or during any other period of national emergency declared by the President”. Based on the provision of “national emergency”, President Dwight D. Eisenhower suspended trade with Cuba, a few days after his administration broke diplomatic relations with the country on 3 January 1961.
The TWEA prohibits any type of trade or financial transaction, including those related to travel, transportation or business, in times of war or when a national emergency has been declared in relation to a specific country. In practice, these prohibitions impose a ban on among other things, travel to and from Cuba, commerce and remittances.
In 1977, Congress again amended the TWEA by limiting the President’s powers to impose sanctions the Act provides for during time of war only. However, Congress permitted the temporary continuation of presidential authority to maintain economic sanctions on countries as a result of a “national emergency” declared by the President before 1 July 1977. In addition, the President may “extend the exercise of such authorities for one-year periods upon a determination for each such extension that the exercise of such authorities with respect to such country for another year is in the national interest of the United States.”
Since 1978, all US presidents issued memorandums or presidential determinations extending under the TWEA, for one year at a time, the situation of “national emergency” with respect to Cuba on the grounds that it is “in the national interest of the United States”. In September 2008, President George W. Bush issued a determination “continuing for 1 year, until September 14, 2009, the exercise of those authorities with respect to Cuba as implemented by the Cuban Assets Control Regulations, 31 C.F.R. Part 515.”
Cuba is the only country that faces economic and trade sanctions from the USA under the provisions of the TWEA.
THE 1961 FOREIGN ASSISTANCE ACT, SECTION 620(A)
In 1961, the US Congress approved the Foreign Assistance Act, which forbids any assistance to all communist countries, including Cuba, and to any other country which gave assistance to Cuba. It also authorizes the US President to “establish and maintain a total embargo upon all trade between the United States and Cuba”.
On 3 February 1962, acting under the authority of the Foreign Assistance Act, President John F. Kennedy suspended all trade with Cuba. He imposed, by Presidential Proclamation 3447, an embargo on all trade with Cuba, prohibiting the “importation into the United States of all goods of Cuban origin and goods imported from or through Cuba” and “all exports from the United States to Cuba”. President Kennedy directed the Secretary of the Treasury to implement the prohibition of all imports from Cuba and the Secretary of Commerce to impose the embargo on all exports to Cuba. The proclamation does not contain time limits or conditions for the lifting of the embargo and is still in effect, although since then the embargo has been written into law and expanded by regulations and new legislation (see below).
THE 1963 CUBAN ASSETS CONTROLS REGULATIONS
In 1963, the US government issued the Cuban Assets Controls Regulations (CACR) under section 5(b) of the Trading With the Enemy Act of 1917. The stated goal of the sanctions is to “isolate the Cuban government economically and deprive it of U.S. dollars.” The sanctions froze all Cuban assets in the USA and mandated the US Treasury Department to regulate all commercial transactions with Cuba, including authorized travel to Cuba by US nationals. Although the regulations do not ban travel itself, freedom of movement between the USA and Cuba has been limited because all transactions related to travel to Cuba are restricted. These include, for example, food, hotel accommodation, transportation, items for personal use by travelers, and the sale of airplane tickets in the USA. The CACR has been modified over the last four decades; travel restrictions were eased under the presidency of Jimmy Carter and then tightened again under the presidency of George W. Bush.
Furthermore, the CACR prohibited the direct or indirect export of US products, services and technology to Cuba.
The Treasury’s Department Office of Foreign Assets Control still remains in charge of interpreting and implementing the provisions of the embargo through a set of regulations. The CACR also provides for criminal penalties for violation of the sanctions, ranging up to 10 years in prison, corporate fines of up to US$1 million and individual fines of up to US$250,000. Civil penalties of up to US$55,000 can also be imposed.
THE 1992 CUBAN DEMOCRACY ACT (TORRICELLI ACT)
In 1992, President George H. Bush signed the Cuban Democracy Act (the Torricelli Act) into law, forbidding subsidiaries of US companies from trading with Cuba, US nationals from travelling to Cuba and remittances being sent to the country. One of the stated goals of the Cuban Democracy Act (CDA) was to “seek a peaceful transition to democracy and a resumption of economic growth in Cuba through the careful application of sanctions directed at the Castro government and support for the Cuban people”.
The CDA seeks to “encourage the governments of other countries that conduct trade with Cuba to restrict their trade and credit relations.” It also tries to limit international cooperation towards Cuba by imposing “sanctions on any country that provides assistance to Cuba”, including ending US assistance for those countries and by disqualifying them from benefiting from any program of reduction or forgiveness of debt owed to the USA.
The CDA states that exports of medicines and medical supplies, equipment and instruments shall not be restricted. However, these products may be exported to Cuba, from the USA or US subsidiaries based in another country “only if the President determines that the United States Government is able to verify, by onsite inspections and other appropriate means, that the exported item is to be used for the purposes for which it was intended and only for the use and benefit of the Cuban people.” This requirement does not apply to donations of medicines for humanitarian purposes to NGOs in Cuba. However, by imposing on-site verification, the CDA makes the export of medicines and medical supplies to Cuba virtually impossible. According to the US Department of Commerce, “under the CDA, the on-site monitoring requirement applies to all sales, and also applies to all donations of medical equipment, instruments and supplies. Monitoring also applies to donations of medicines except to nongovernmental organizations for humanitarian purposes.” In addition, a special licence must be obtained from the US government prior to the export of any of these goods and “export license applications for most goods are subject to a policy of denial, although some specific goods are subject to case-by-case review”. The government of the USA was certainly not able to carry out the on-site inspections and therefore the burden fell on the exporters, making them subject to severe sanctions as included in the CACR if the procedures were not followed (see above).
The tightening of the embargo through the CDA provides for humanitarian assistance by allowing the donation from individuals or US NGOs of medicines to Cuban NGOs only for humanitarian purposes. However, the CDA places conditions that food, medicine and medical supplies for humanitarian purposes can only be made available to Cuba when the government of Cuba has changed through free and fair elections.
The CDA made it impossible for foreign subsidiaries of US companies to trade with Cuba. Other provisions of the CDA include a 180-day prohibition from loading or unloading in US territory of any vessel that had entered Cuba to trade goods or services. In an attempt to restrict the government of Cuba from gaining access to US currency, the CDA limited remittances to Cuba only to finance the travel of Cubans to the USA.
THE 1996 CUBAN LIBERTY AND DEMOCRATIC SOLIDARITY (LIBERTAD) ACT (HELMS-BURTON ACT)
In 1996, the US Congress approved new legislation aiming at strengthening the enforcement of the US embargo against Cuba. In March 1996, President Bill Clinton signed into law the Cuban Liberty and Democratic Solidarity (Libertad) Act, most commonly known as the Helms-Burton Act. This act further wrote into law the sanctions against Cuba. In particular, it sought to “strengthen international sanctions against the Castro government”, and to “plan for support of a transition government leading to a democratically elected government in Cuba.”
The Helms-Burton Act is divided into four titles. Title I: “Strengthening international sanctions against the Castro government” aims, among other things, at cutting Cuba’s economic assistance and trading relationships with third countries, and opposing Cuba’s membership in international financial institutions by instructing US executive directors in each institution to oppose the admission of Cuba as a member. In fact, Cuba is barred from membership of the International Monetary Fund, the International Bank for Reconstruction and Development, the International Development Association, the International Finance Corporation, the Multilateral Investment Guarantee Agency and the Inter-American Development Bank. Any loan or assistance provided by any of these institutions to the government of Cuba will result in the withholding of the same amount by the US Secretary of Treasury from payment to that institution. Title I also reaffirms the provisions of the CDA, in particular its extra-territorial aspects, including the imposition of penalties on foreign companies doing business in Cuba.
Title II of the Act: “Assistance to a free and independent Cuba” establishes the steps for the “termination of the US embargo against Cuba”. These include a presidential determination, in consultation with Congress, suspending certain provisions of law such as section 620(a) of the Foreign Assistance Act of 1961, the Cuban Democracy Act of 1992, and the regulations prohibiting transactions with Cuba. Other provisions of the law defining the US embargo can be suspended once a democratically elected government is in place in Cuba. Sections 205 and 206 of this title provide the requirements for determining a Cuban transition government and a democratic government. One of those requirements is the return to US nationals of property nationalized by the Cuban government after 1 January 1959.
This title also defines what US policy would be “towards a transition government and a democratically elected government”. Under the title’s provisions, the US government will provide its assistance – economic, food, medicine, medical supplies and equipment – to a transition government in Cuba and to the people ofCuba. It will also encourage other countries to do the same. Furthermore, Title II, section 202(iii) states: “only after a transition government in Cuba is in power, freedom of individuals to travel to visit their relatives without any restrictions shall be permitted”.
Title III of the Helms-Burton Act: “Protection of property rights of United States Nationals” provides for compensation and allows US nationals to sue foreign companies deemed to have gained from investments in property (the Act uses the term “traffic in property”) that belonged to US nationals prior to its nationalization by the Cuban government. This provision is allegedly aimed at preventing foreign investment in Cuba. The enforcement of Title III has been suspended since the Helms-Burton Act was approved by Congress. President Bill Clinton first suspended for six months the possibility of launching legal actions against foreign companies. Since then, US presidents, including Barack Obama, have issued a waiver postponing the enforcement of Title III for six months at a time.
Title IV: “Exclusion of certain aliens” provides for the exclusion or expulsion from the USA of those who “traffic in confiscated property”, including executives and employees – and their family members – from foreign companies that invest in Cuba in properties that belonged to US nationals before their nationalization by the Cuban government.
THE 2000 TRADE SANCTIONS REFORM AND EXPORT ENHANCEMENT ACT
In October 2000 the US Congress passed the Trade Sanctions Reform and Export Enhancement Act (TSRA), which started to relax the enforcement of the economic and trade embargo and allowed the sale of agricultural goods and medicine to Cuba for humanitarian reasons. Since 2002, the USA has been the major supplier of food and agricultural products to Cuba. From 2005, US regulations required these exports to be on a cash-in-advance basis with full payment before the products were shipped to Cuba, and the transactions had to be made through banks in a third country. In 2008, Cuba imported more than US$700 million worth of food and agricultural products from the USA. In March 2009, the US government eased these restrictions, allowing Cuba to continue buying food and agricultural products and pay after shipment.
Under the TSRA, exports of food and agricultural products to Cuba remain regulated by the Department of Commerce and require a licence for export or re-export. The export of medicines and medical supplies continues to be severely limited. Although the TSRA contemplates the export of medicine, this legislation does not supersede the Cuban Democracy Act of 1992 and therefore the necessity of a presidential certificate through onsite verification remains in force.
ECONOMIC AND SOCIAL RIGHTS
“The negative impact of the embargo is pervasive in the social, economic and environmental dimensions of human development in Cuba, severely affecting the most vulnerable socioeconomic groups of the Cuban population.”. [Office of the Resident Co-ordinator of the United Nations system for operational activities for development, July 2008]
International law, including human rights law, provides limits to the imposition of sanctions. There is growing recognition that in imposing sanctions, such as trade embargoes, states must take into account the effects that these sanctions may have on the enjoyment of economic, social and cultural rights in the country affected, must effectively monitor its consequences on the realization of these rights and take steps to address any adverse impact on the population of the affected state.
This recognition stems directly from the obligation of states under the UN Charter to promote human rights. It is also derived from Article 2 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), which requires states parties to “take steps, individually and through international assistance and co-operation, especially economic and technical, to the maximum of its available resources, with a view to achieving progressively the full realization of the rights recognized in the present Covenant…”
The USA signed, in October 1977, but has not yet ratified the ICESCR. As such, while not legally bound by its provisions, it is obliged to not defeat the purpose of the Covenant. According to article 18 of the 1969 Vienna Convention on the Law of Treaties, signed on 24 April 1970 by the USA, “a State is obliged to refrain from acts which would defeat the object and purpose of a treaty when: (a) it has signed the treaty or has exchanged instruments constituting the treaty subject to ratification, acceptance or approval, until it shall have made its intention clear not to become a party to the treaty.”
The Committee on Economic, Social and Cultural Rights has noted that the obligation of states to protect “at least the core content of the economic, social and cultural rights” of the affected people in the state targeted by sanctions derives from the Charter of the United Nations to promote respect for all human rights.
For the past 14 years, the UN Secretary-General has documented the negative impact of the US embargo on Cuba. In her last report to the Human Rights Council, the Personal Representative of the United Nations High Commissioner for Human Rights on the situation of human rights in Cuba described the effects of the embargo on the economic, social and cultural rights of the Cuban people as “disastrous”. “The adverse consequences of economic sanctions on the enjoyment of human rights”, a study prepared by Marc Bossuyt for the Sub-Commission on the Promotion and Protection of Human Rights, concluded that the US embargo violates human rights law in two distinct ways. Firstly, “the fact that the United States is the major regional economic power and the main source of new medicines and technologies means that Cuba is subject to deprivations that impinge on its citizens’ human rights.” Secondly, by passing legislation that “tries to force third-party countries into embargoing Cuba as well” – the 1992 Torricelli Act – the US government attempted to turn “a unilateral embargo into a multilateral embargo through coercive measures, the only effect of which will be to deepen further the suffering of the Cuban people and increase the violation of their human rights”.
The imposition of the embargo does not exempt the Cuban government from its obligations to respect, protect and fulfill human rights. While the embargo affects the capacity of the Cuban government to progressively work towards the realization of some economic, social and cultural rights, the government must provide the greatest protection of these rights, to the maximum of its available resources. In doing so, it must not discriminate and it must prioritize the most vulnerable groups in society.
According to the UN Development Program, Cuba has already achieved three out of eight Millennium Development Goals (universal primary education, promoting gender equality and empowering women, and reducing child mortality) and is on track to achieve the five other goals by 2015 or is very likely to do so. In spite of Cuba’s achievements, the US embargo has been a significant factor in hindering further progress on meeting the MDGs, particularly in further reducing infant and maternal mortality rates.
The US Government Accountability Office reported that in 2006, US medical and pharmaceutical exports to Cuba amounted to US$120,000 (0.04 % of total exports to Cuba). Exports of licensed humanitarian items, including donated medicine and medical products, amounted to US$6.9 million (1.98% of total exports to Cuba). After the passing of the 2000 Trade Sanctions Reform and Export Enhancement Act, which eased exports of agricultural products and medicine to Cuba, the total US exports to Cuba from 2001 to 2008 increased from US$7.2 million to US$711 million, according to the figures from the US Census Bureau. The Department of Commerce authorizes the use of License Exception Agricultural Commodities for exports of agricultural products to Cuba. The process for obtaining these licences has been speeded up and can be issued within 14 days. However, exports of medicine and medical devices to Cuba are not eligible for License Exception Agricultural Commodities and continue to be subject to the requirements provided for in the Cuban Democracy Act, the most constraining of all being the requirement of on-site verification.
Although the easing of exports of agricultural products has a positive impact in addressing food shortages and contributes towards the realization of the right to food for Cubans, the export of medicines and medical equipment continues to be severely limited and has a detrimental impact on the progressive realization of the right to the highest attainable standard of health.
The Department of Commerce, in its 2008 Report on Foreign Policy-Based Export Controls, clearly states the restrictions in exporting goods and medicines to Cuba:
“The Department generally denies license applications for exports or reexports to Cuba. However, the Department considers applications for the following on a case by-case basis:
– exports from foreign countries of non-strategic, foreign-made products containing 20 percent or less U.S.-origin parts, components, or materials, provided the exporter is not a U.S.-owned or controlled foreign firm in a third country;
The Department reviews applications for exports of donated and commercially supplied medicine or medical devices to Cuba on a case-by-case basis, pursuant to the provisions of Section 6004 of the Cuban Democracy Act of 1992.”
IMPACT ON THE RIGHT TO HEALTH
“The restrictions imposed by the embargo help to deprive Cuba of vital access to medicines, new scientific and medical technology, food, chemical water treatment and electricity.” [Personal Representative of the High Commissioner for Human Rights, 26 January 2007]
Article 12(1) of the ICESCR acknowledges that the right to health embraces a wide range of socio-economic factors that promote conditions in which people can lead a healthy life, and extends to the underlying determinants of health, such as food and nutrition, housing, access to safe drinking water and adequate sanitation, safe and healthy working conditions, and a healthy environment. Article 12.2 further declares that “the steps to be taken… shall include those necessary for… [among others] the creation of conditions which would assure to all medical service and medical attention in the event of sickness.” The right to health is not limited to the right to, but does include, health care. Article 25 of the UDHR recognizes the right of “everyone… to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services…”
The negative impact of the US embargo on the Cuban health care system and on the right to health of Cubans during the 1990s has been documented in a 1997 report by the American Association for World Health (AAWH). The 300-page document is still the most comprehensive study on the issue. Based on a fact-finding mission to Cuba, the AAWH identified that the embargo contributed particularly to malnutrition affecting especially women and children, poor water quality, lack of access to medicines and medical supplies, and limited the exchange of medical and scientific information due to travel restrictions and currency regulations. The AAWH found that “a humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventive health care to all of its citizens… Even so, the U.S. embargo of food and the de facto embargo on medical supplies has wreaked havoc with the island’s model primary health care system.”
During the first three decades of the embargo, the export of medicines was allowed for “humanitarian” reasons only. In 1992, with the passage of the CDA, the sales of medicines were exempt from the embargo. However, access to medicines became virtually impossible for Cuba. Every export of medicine required that “the President of the USA certify, through on-site inspections approved by the President, that all components of a shipment of medical products to Cuba were used for the purpose intended.” The tightening of the US embargo during the 1990s exacerbated the economic crisis in Cuba as the country had lost the economic support from the Soviet Union. This affected the capacity of the Cuban health system to deliver to the population the same standards of health care as before the economic crisis.
The Resident Coordinator for the Operational Activities for Development of the United Nations System reported in the UN Secretary-General’s 2008 report on the impact of the US embargo:
“Goods, services or technologies produced by the United States or covered by United States patents or containing any element produced or patented by the United States are not available to Cuba. This includes medicines, medical equipment and other products under the category of humanitarian assistance, even when such products are purchased through multilateral cooperation.”
The CDA contains provisions for its enforcement outside the USA, resulting in severe limitations to Cuba’s access to an international supply of medicines and medical equipment. Furthermore, the expansion of US pharmaceutical companies in the last three decades has limited the number of companies able to export their products to Cuba without facing penalties from the US government. The Helms-Burton Act penalizes non-US companies and nationals for trading with Cuba. Although commercial opportunities are available to Cuba throughout the rest of the Americas, Europe, Asia, and elsewhere, the Helms-Burton Act has an inhibiting effect on non-US medical companies, therefore limiting Cuba’s access to medicines, medical equipment and technologies. In the health care sector in particular, Cubans are denied the latest generation of equipment and medicine, available in some cases only from US companies or at prohibitively high prices through third countries. For instance, the World Health Organization reported “lack of diagnostic materials and equipment, replacement parts, surgical supplies and drugs hinders the operations of emergency services and care for patients in serious condition. The resources for treating patients who need this type of care, adults and children alike, are limited. In the case of patients with psychiatric disorders, state-of-the-art drugs are unavailable.”
The Committee on Economic, Social and Cultural Rights has recommended that economic sanctions should not restrict the supply of medicines and medical equipment to another state. General Comment No. 14 on the right to the highest attainable standards of health says that “[s]tates parties should refrain at all times from imposing embargoes or similar measures restricting the supply of another State with adequate medicines and medical equipment. Restrictions on such goods should never be used as an instrument of political and economic pressure.”
The provision of health care has also suffered from the limitations and restrictions imposed by the embargo on the procurement of basic and specialized medical equipment and chemical components needed for the production of generic medicines.
In July 2004, a US biotechnology firm based in California settled a civil penalty with the Office of Foreign Asset Control (OFAC) for a total of US$168,500. The firm had voluntarily disclosed to OFAC the shipment of three vaccines for infants and children between 1999 and 2002 from its factories in Germany and Italy while the company held a licence to export only one vaccine through UNICEF, the UN Children’s Fund.  According to Medical Education Cooperation with Cuba, a US-based NGO promoting medical exchanges with Cuba, the vaccines included those for polio, haemophilic influenza, flu, rabies and a vaccine for measles, mumps and rubella. 
In November 2005, the Bureau of Industry and Security, Department of Commerce imposed a civil penalty of US$ 37,500 on a company based in Massachusetts specialized in medical equipment for, among other things, “attempting to export and conspiring to export [in 2000] X ray film processors to Cuba via Canada without the required license and with knowledge that a violation would occur”.
UNICEF reported that Cuba was unable to import nutritional products destined for children and for consumption at schools, hospitals and day care centers. This had an adverse effect on the health and nutritional status of the population and is believed to be a contributing factor in the high prevalence of iron deficiency anemia which in 2007 affected 37.5 per cent of children under three years old. Children’s health was also put at risk by a decision from syringe suppliers to cancel an order for 3 million disposable syringes by UNICEF’s Global Alliance for Vaccines and Immunization when it became known that the units were destined for the implementation of the programme in Cuba.
The number of children suffering from heart conditions who are waiting for appropriate treatment at a paediatric hospital has increased after Cuba was unable to buy from the US based companies the necessary medical equipment for their treatment. The companies allegedly refused to negotiate with Cuba because of the restrictions set by the US embargo. The World Health Organization reported that “lack of access to products manufactured by United States companies such as St. Jude Medical, Boston Scientific and Amplatzer prevents the provision of proper care to seriously ill patients who need a pacemaker, St. Jude prosthetic valves or septal occluders, forcing their treatment with alternative, riskier surgical techniques”.
Scarcity of medication and equipment has also affected treatment for children being treated at the National Institute of Oncology and Radiology. According to UNICEF “it has been impossible to purchase a positron emission tomography/computerized tomography (PET/CT) scanner, a state-of-the-art piece of medical equipment needed for treatment that is made by only three manufacturers worldwide, all unauthorized to negotiate with Cuba.”
Programs to prevent and fight HIV/AIDS have also suffered from the embargo even when these are implemented by UN agencies. In 2006, the purchase of antiretroviral drugs by UNICEF in support of the Global Fund to Fight AIDS, Tuberculosis and Malaria was delayed, because major suppliers to UNICEF could not offer their products for the implementation of the Fund programmes in Cuba due to the US embargo. According to UN reports, transactions with more distant suppliers resulted in an increase in prices and delays in procurement of antiretrovirals.
In August 2007, media reports revealed that the US Treasury Department had refused to renew a licence to health organization Population Services International (PSI) to export condoms to Cuba for distribution to groups at high risk of contracting HIV infection.
Although Cuba produces its own antiretrovirals, there is a considerable delay between the marketing of a new antiretroviral and the production of the generic version. During this period, access to new drugs could be life-saving for many Cubans living with HIV/AIDS. However, Cuba cannot import the latest antiretrovirals from the USA or from other countries due to patent restrictions. The Joint United Nations Programme on HIV/AIDS reported in 2008 that “Abbott was prevented from selling two drugs for AIDS treatment — Ritonavir and Liponavir + Ritonavir — resulting in a sixfold increase in price to acquire them from another manufacturer. Similarly, Gilead replied that it could not supply the antiretroviral drug Tenofovir because to do so it would require an export licence from the United States.”
The UN Development Program (UNDP) reported delays in acquiring equipment to measure viral load and flow cytometers to determine CD4 cell count, due to difficulties imposed by the embargo in the purchasing process.
The increase in the costs for purchasing the necessary medicine or medical materials is hampering the implementation of UN development projects and programmes. The repercussions of these difficulties are ultimately felt by the intended beneficiaries of these programs, who face long delays before having access to adequate medicine or treatment.
The impact of economic sanctions on health and health services is not limited to difficulties in the supply of medicine. Health and health services depend on functioning water and sanitation infrastructure, on electricity and other functioning equipment such as X-ray facilities or refrigerators to store vaccines. The financial burden and commercial barriers have led to shortages or intermittent availability of drugs, medicines, equipment and spare parts. It has also hindered the renovation of hospitals, clinics and care centres for the elderly.
The US President has the authority to lift the embargo, with Congressional approval, only if certain conditions are met within Cuba, namely that a transitional government is in place and that a democratic process is established. However, the President can also send a clear message to Congress on the necessity of adopting a new approach towards Cuba in line with the foreign policy of his administration and in compliance with 17 successive resolutions from the UN General Assembly calling for the lifting of the embargo, and similar calls from the Inter-American Commission on Human Rights. The economic, trade and financial sanctions against Cuba, compounded by the lack of measures from the US government to monitor and alleviate the negative impact of the embargo on the Cuban population, are defeating the purpose of the provisions of the ICESCR, in particular with regards to advancing the rights of the Covenant through international co-operation. The US government is also acting contrary to the Charter of the United Nations by restricting the direct import of medicine and medical equipment and supplies, and by imposing those restrictions on companies operating in third countries.
No one familiar with US practices in the region or elsewhere can possibly believe that the goal of intensive US terror operations against Cuba and harsh economic warfare was intended to “bring democracy to the Cuban people.” That is just propaganda, unusually vulgar in this case.
The actual reasons for the terror and economic warfare were explained clearly at the very outset: the goal was to cause “rising discomfort among hungry Cubans” so that they would overthrow the regime (Kennedy); to “bring about hunger, desperation, and overthrow of the government” (Eisenhower’s State Department). The threat of Cuba, as Kennedy’s Latin American advisor Arthur Schlesinger advised the incoming president, is that successful independent development there might stimulate others who suffer from similar problems to follow the same course, so that the system of US domination might unravel. The liberal Democratic administrations were outraged over Cuba’s “successful defiance” of US policies going back to the Monroe Doctrine, which was intended to ensure obedience to the US will in the hemisphere.
For decades a large majority of Americans have wanted to establish normal relations with Cuba. In more recent years, substantial US business interests (agribusiness, energy, others) are in favor of that too. Of course, the US is entirely isolated in the world in maintaining the embargo; at the UN it can only garner support, reflexively, from Israel and a few Pacific dependencies. But the policy persists, causing bitter suffering among Cubans, impeding economic development, and undermining moves towards more internal democracy.
If the US is to maintain any shred of credibility on an international level, it must end the embargo on Cuba. Otherwise, all the talk about democracy and freedom is exactly that: just talk!
Thanks for reading,
- “CUBA: THE US EMBARGO AGAINST CUBA: ITS IMPACT ON ECONOMIC AND SOCIAL RIGHTS”, Amnesty International, September 2, 2009, Index# AMR 25/007/2009. This article is fully annotated: http://www.amnesty.org/en/library/info/AMR25/007/2009/en