An elderly woman living in the Habana Centro neighbourhood of the Cuban capital has had a bad fall. Her neighbours on the quiet residential street think she may have broken her hip, and they climb up and down the narrow stairs to her apartment to see what she needs.
As the neighbours wait on the pavement for the woman's family to arrive, a grim debate about what to do next takes place. One person suggests taking her to the nearest hospital, but they are immediately shouted down.
“What are they going to do for her there? There is nothing,” one woman says, throwing up her hands. “It’s so unclean in those places, she’ll catch a disease and die.”
With chronic shortages, Cuba’s medical system is on the brink. Now, a US fuel embargo, which went into effect earlier this year, has led to rolling blackouts across the island.
“This is the latest in a long series of problems,” Dr Steven Ullman, professor and director of the Centre for Health Management and Policy and the Miami Herbert Business School, University of Miami, told The National. Since the collapse of the Soviet Union, a close ally of Cuba, “there's always been an issue in terms of shortages going on”.
Several Cubans described hospitals with no supplies, staffed by overworked and underpaid medical professionals who despair over the little treatment they can provide. One Cuban told The National that surgeons were having to operate on patients by the light of their phones in some places, though this claim could not be verified.
Following the capture of Venezuela's leader Nicolas Maduro in January, the US initiated an oil embargo on Cuba, threatening tariffs on any countries providing fuel to the island in an effort to pressure the government in Havana to “make a deal”.
Great on paper
Dr Ullman said that Cuba's healthcare system model is excellent – on paper, at least.
“It uses a tiered approach,” he explained. “You have a physician and a nurse who are responsible for a certain small geographic area, and they know that area, they serve that area – they understand population health, they can focus on prevention – so in concept, it is a very nicely structured system.”
He added that Cuba's physicians are very well trained, and that despite the restrictions created by US sanctions since the 1960s, the country developed a successful biopharmaceutical industry.
“Cuba has essentially had to develop a lot of their own resources,” Dr Ullman said. “During the Covid crisis, they developed their own medications to deal with that, and they've basically had to be sort of self-supporting in many aspects.”
In addition, Cuba has also emphasised the use of “green medicine” – using alternative methods, including herbal remedies, for prevention and to provide care. But long-standing economic restrictions, corruption and now the fuel embargo have pushed the island to the breaking point.
Street medicine
Raul, a resident of San Antonio de los Banos who asked to go only by his first name, is a diabetic. He says that without support from family abroad and local charitable organisations, he would be dead.
“It’s thanks to people who are bringing in medicine from abroad that we’re surviving … if you just depend on the hospitals, you’ll die,” he told The National.
He added that his mother had been taken to hospital several times, but due to a lack of supplies, the family were forced to search for medicine “on the streets”.
Havana resident Fernando's wife is also a diabetic, as well as hypertensive, and he says they are also forced to scour the city for the medicines she needs. He highlighted that doctors are chronically underpaid, so even though medicine is expensive, people still find ways to thank them.
In addition to the lack of supplies, The National was told that many doctors, nurses and other medical professionals, including professors of medicine, are leaving the country for better opportunities.
“We give gifts to doctors here, not because of corruption, but to thank them for their work, because they are not paid well and they still work,” he says.
According to the UN, essential medicines in Cuba are available at only about 30 per cent of normal levels. A Havana resident told The National that shelves in regular pharmacies are empty, and the prices there are very high. “Unless you know someone abroad who is willing to bring in medicine, most people have limited options,” the person said.
Amid a dearth of supplies, Cubans pool resources that come in from outside the country. When someone in the community goes abroad or receives a shipment from family, they donate medicines and medical supplies to a sort of communal pharmacy so their neighbours can have access.
“According to our statistics, 70 per cent of people in Cuba won't get the medicines that they require, and this is according to different sources, and while the supply side might be there, there are always challenges,” Francisco Escobar, chief executive of Asymmetrica Investments, which has a start-up that brings humanitarian aid to people in Cuba, told The National.
The blame game
Where the blame lies for the current situation depends on who you ask.
“It’s due to the blockade that we’re in the situation that we’re in,” says Raul, referring to the US embargo on the island that has existed since the 1960s.
Fernando also avoided blaming Cuba's government for his troubles. “We're under pressure because of [US President Donald] Trump,” he says. “He thinks he's king of the world – but Cuba is not his.”
Other Cubans The National spoke to agreed – things are worse now due to US pressure. But the US says Cuba's government is responsible for the current situation.
“The Communist Cuban regime continues to pose a deep, multifaceted threat to US national security and our hemisphere’s stability,” said Secretary of State Marco Rubio in announcing a new round of sanctions last week.
“These designations reflect President Trump's unwavering vision for a free Cuba – one where the regime's illicit financial networks, repressive apparatuses, and entrenched Castro-era power structures are dismantled, and where the Cuban people, not their oppressors, inherit the nation's future.”
Washington says the Cuban healthcare system has been used to prop up the government through the massive revenue it takes in from its overseas doctors and health tourism programmes.
Cuba has long offered first-rate health tourism, a major source of foreign currency for the government. So-called tourist hospitals provide foreigners and government officials with low-cost, high-quality care. Critics have said this has led to a two-tier healthcare system that has left regular Cubans out in the cold.
Amid intensifying US sanctions, this industry has suffered, but Havana appears to be working towards jump-starting it. During a high-level meeting held in early June, attended by The National, Cuban government officials pitched the possibility of direct foreign investment in a variety of different tourism projects on the island.
Speaking to a group of foreign businessmen, Cuban officials highlighted the possibility of the construction of healthcare sites aimed at international tourists, including in desirable locations such as Isla de Juventud.
Following the meetings, in mid-June, Cuba announced sweeping economic reforms that observers described as the most significant since the Communist revolution.
Still, it remains to be seen whether these developments towards economic openness are enough to satiate the US. Mr Trump has indicated that the pressure will continue until the country makes a deal with Washington – something that would probably include regime change.
Dr Ullman prescribed caution when looking to the future of Cuba's healthcare system.
“It's a bit of a rollercoaster ride,” he said. “Cuba has things to provide in terms of some of the quality of what they do ... there's opportunities for fertilisation.”
Salim A Essaid contributed to this report
