They have also included the support and training of Cuban émigrés hostile to the Revolution, to facilitate invasions (such as the Bay of Pigs in April 1961) and terrorist bombings and attacks, as well as incursions into Cuban airspace to spray crops with noxious substances and to interfere with radar and telecommunication signals. All this is in addition to over 600 assassination attempts on Fidel Castro, Cuba’s President until 2008.  Declassified CIA papers released in the early years of the present century provide detailed accounts of the many plans made “to bring about the replacement of the Castro regime with one…. more acceptable to the US.”  (1)

The break-up of the USSR and the socialist countries of Eastern Europe in the late 1980s and early 1990s ended the economic co-operation between Cuba and these countries.  Since that time the scope and intensity of the measures taken by the US against Cuba has increased.  The Torricelli Act of 1992 forbade the trade of US products and services with the island by companies in third-party countries (hitherto permitted) or to Cuban companies or nationals living outside Cuba. The Helms-Burton Act of 1996 not only intensified the blockade, but also legalised the policy of direct US interference in Cuba’s internal affairs and sovereign rights. During the  same decade Cuba suffered a series of bomb attacks from US-paid mercenaries.  

In recent years, US legislation based on the Helms-Burton Act, but applied extra-territorially, has overridden national legislation existing in third-party countries, such as the refusal by hotels owned by US companies in Mexico and Norway, like the Hilton, to receive Cuban guests (2) or by banks, for example, HSBC, Barclays, Crédit Suisse and the Bank of Nova Scotia (not owned by US companies) to accept as customers Cuban organisations or nationals for fear of penalisation by the US (3).

Finally, in December 2003 President George Bush formed the Commission for Assistance to a Free Cuba in order to seek further ways of intensifying the blockade and to create a blue print of the economic system and society envisaged by Washington following the US government’s desired ‘regime change’ in Cuba. 

Its deliberations are found in two reports produced in 2004 and 2006.  In the Executive Summary at the start of the 2004 report, the Commission states openly that it is seeking “a more proactive, integrated and disciplined approach to undermine the survival strategies” of the Cuban state.  The 2006 report which bears the title ‘Report to the President’, goes a step further:  chapter 1 carries the title ‘Hastening the end of the Castro Dictatorship’ and indicates that “for reasons of national security and effective implementation, some recommendations are contained in a separate classified annex.”  One’s imagination need not be stretched when trying to guess the contents of this classified annex, given the long history of active US intervention (military, as well as through the use of economic pressure, the media and  intelligence to spread misinformation and promote unrest and insurgency) to destabilise and overthrow the governments of sovereign nations that do not meet with its approval, not only in Latin America and the Caribbean, but also in many other parts of the world.(4) 

Both reports contain the Commission’s observations on the main areas of the social infrastructure in Cuba;  they also include observations on the subjects of democratic rights, the rights of women and of Afro-Cubans, the rights of the labour force, the management of the economy and proposals for the future management of the Cuban economy, in conformity with the neo-liberal model the US has sought to impose in countries around the world, once regime change has taken place.

Quite apart from the arrogance of a world power that seeks to impose its own political and economic agenda on another sovereign state, the contents of the reports include a very large number of blatant misrepresentations and distortions of Cuba’s social and political institutions and the services they provide to the island’s population. In all cases these highly erroneous descriptions are used to justify the ‘remedial’ actions proposed by the reports to achieve regime change.

Some of the areas covered in the reports, namely democratic and human rights, the position of women and the rights of the labour force, are the subject of detailed articles already published in the Cuba Factfile (on the UK Cuba Solidarity Campaign website (5)).  This article will cover some of the main areas of the social infrastructure in Cuba mentioned in the 2006 report which are described as being so deficient that they have created “critical humanitarian and social needs” (page 3). The Commission attributes this state of affairs to negligence on the part of the Cuban state:   “the Castro regime is failing to address even the most basic humanitarian needs of the Cuban people” (page 3).

It will also cover the Commission’s observations in respect of the status of the black community on the island and Cuba’s relations with the international community.

Interestingly, no mention is made in the Commission’s report about the situation of gay rights in Cuba – a topic that often arises in discussion with groups opposed to the Revolution.  One can only presume that this is one area of Cuban society with which the Commission could find no fault.  (An article dealing with this subject can also be found in the Cuba FactFile.)

The aspects of the report dealt with in this article are the following:

2.  The Cuban Government’s Policy concerning the Welfare System

The Commission’s 2006 report alleges:

 “The Castro regime is failing to address even the most basic humanitarian needs of the Cuban people”   (page 3)

 “The regime ignores its obligations to its people and diverts its resources to maintain its grip on power…”   (page 12)

 “The Castro regime trumpets ‘the achievements of the Revolution’ in meeting the basic needs of the Cuban people.  In truth, the entire system has been constructed for the sustenance of the regime, not to serve the Cuban people or to allow for development…..”.   (page 13)

 “Today, Cubans live with the consequences of the regime’s deliberate decision to sustain itself at the expense of its people:  declining food stocks, increasing water shortages, crumbling medical infrastructure, the disappearance of basic medicines and devastated housing stock  (page 13)

“The Castro regime’s neglect of the needs of its people has been so severe for so long ,.......(page 32) “…the regime continues to manipulate health and other statistics….”  (page 13)

The facts

The Human Development Index, (published by the United Nations Development Program (UNDP) “provides a composite measure of three dimensions of human development:  living a long and healthy life (measured by life expectancy), being educated (measured by adult literacy and enrolment at primary, secondary and tertiary level) and having a decent standard of living (measured by purchasing power parity, PPP, income)” (6).  It “is constructed using data from international sources” (quote from introduction to HDI 2005 Fact Sheet on Cuba) (7).

In 2006 the HDI ranked Cuba 50th out of the 177 countries in the Index.  (In the same year the USA was ranked 8th and the UK 18th.)  Having achieved this ranking, Cuba is classified as enjoying “High Human Development” – the top out of the three categories into which all countries are placed. Only nine countries from Latin America and the Caribbean achieved this classification, Cuba – despite the US blockade of over 46 years - coming sixth out of these countries. (8)

Even more impressive is Cuba’s performance in The Human Poverty Index for developing countries (HPI-1), also produced by the United Nations (9).  In this report Cuba ranks 6th among the 102 developing countries for which the Index has been compiled – the higher the ranking the better the standard of living.
     
On the basis of findings by international bodies that use data from international (rather than Cuban) sources, there is no real evidence that the Cuban government neglects the needs of its population.


3.  The water supply in Cuba

The Commission alleges:

“Cuba today faces daunting water-supply… issues….”  (page 14.)
 
 “…only 62 percent of Cubans have reasonable access to disinfected water.”  (page 14)

“…..it is clear from independent sources…..polluted drinking water affect[s] a significant percentage of the Cuban population.” (page 13)

 “….increasing water shortages…”  (page 13)

The facts: 

In its 2007 report ‘The State of the World’s Children, UNICEF indicated that in 2004, 91% of the Cuban population had access to improved, i.e. unpolluted drinking water sources (10).  In the urban and rural areas of the island the figures were 95% and 78% respectively. (75% of the Cuban population live in urban areas.) The overall percentage was roughly the same as for Latin America and the Caribbean as a whole, although within the region there are marked differences:  Uruguay and Argentina have 100% and 96% access respectively, while Nicaragua and Haiti have 79% and 54%.  In 2006, the World Health Organisation and UNICEF Joint Monitoring Programme for Water Supply and Sanitation published a report which gave other details about the Cuban population’s access to improved drinking water.  It revealed that in 2004 (the most recent date for which figures were available) 82% of the urban population and 49% or the rural population had house connections (11). 

However it is still the case that over ½ million Cubans living in rural areas are not served by the water supply system and have to obtain water by other means, such as by cistern lorries, standpipes or wells.  A report produced by the UN Secretary General in 2006 (12) attributes the limitations to access to improved drinking water to the US blockade that impedes the island’s ability to purchase low-cost chemicals and equipment with which to treat water and waste water, thereby holding back further developments to the island’s water distribution infrastructure. The Secretary General calls for the blockade to be discontinued.

In spite of the difficulties caused by the US blockade, Cuba has been praised by UN agencies for its development of a public water supply.   In 2006 Dr Susan McDade, resident coordinator for the UN Development Assistance Framework, congratulated the island’s ability to secure access to drinking water for 95.6% of its population in the face of climate change which had caused severe droughts in the eastern part of the country (13).  On World Water Day on 23 March 2007 the UN Food & Agriculture Organisation representative, Francisco Aras, praised Cuba’s ability to deal with local water shortages ( see footnote 13). Even other US institutions do not agree with the Commission’s observations.  The Library of Congress’ profile on Cuba for 2006 praises Cuba’s record on water provision, describing it as “one of the highest figures in Latin America.” (14).  Over and above the difficulties presented by climate change, Cuba’s ability to supply drinking water to such a large percentage of her population is especially commendable when one bears in mind that since 1959 the island’s population has increased from just under 7 million to just over 11.3 million in 2007.  

Indeed it is in the context of Latin America and the Caribbean that Cuba’s achievements stand out.  In 2007 a report by the UN Environmental Programme described how “Almost 13.9% of the population of Latin America has no access even to a safe water supply” (15).  In the Caribbean as a whole the International Hydrological Programme, funded by UNESCO, reported in 2006 (16) that despite the existence of sufficient water resources, “the availability of safe water is becoming a major socio-economic issue” because of the deterioration of water quality due to waste and toxic substances.  The same report states that in Central America, despite abundant water resources, only 42% of the rural population and 87% of the urban population have access to drinking water.  Even then, the figures are skewed, as access to water and sanitation in Latin America and the Caribbean (except for Cuba) depend on the economic situation of the household.  In the Latin American region 80% of the wealthy minority have a drinking water connection at home whereas only 18% of lower-income households enjoy such a facility. 

Causes of death in developing countries are closely linked to water quality.  Two main causes of death in Latin America (and in the rest of the developing world) are diarrhoea and gastroenteritis, caused by contaminated drinking water (which is also directly linked to other common infectious diseases found in these countries, such as dysentery, and hepatitis) (17).  In Cuba, on the other hand, the main causes of death are those found in the industrial nations: cardiac disease, cancer and strokes. (18)

If the Commission’s strategy to improve Cuba’s water supply is to create a privatised system in accordance with the neo-liberal model imposed on other third-world countries (“the process of privatization” being a stated aim of the Commission, page 27), they are running against the wishes of the majority of people in the region.  In 2002 Danny Leipziger of the Finance, Private Sector and Infrastructure Group of the World Bank indicated (19) how 63% of Latin Americans oppose water privatisation.   Notwithstanding, the privatisation of natural resources, basic infrastructure and public services continues to be at the forefront of the US neo-liberal vision for the developing world, having been a measure imposed by the International Monetary Fund and the World Bank for nearly two decades despite its unpopularity and the hardships created by inflated charges beyond the means of large numbers of the populations in these countries.  On the  other hand, in debates in the international arena, it is Cuba that has highlighted the need to establish access to water as a right rather than as part of a commercial transaction– a point made by Dr McDade when she presented the Human Development Index Report to government representatives in 2006. (20)  It is for this reason that Cubans now pay just one peso a month for their water (the average salary being around 300 pesos), although hotels and tourist establishments pay considerably more.

 The Commission alleges:

“Water……... pipeline networks are in shambles.”  (page 14)
                           
The facts:   

In 1959, at the time of the Revolution, reservoirs in Cuba had a capacity for just 29 million m³ of water.  By the end of the 1980s the capacity had risen 300 times to 9,800 million m³ (21). Within Cuba, the Instituto de Recursos Hidráulicos (Hydraulic Resources Institute), created in 1962, has a network of 2328 water quality monitoring stations situated around the country serving 200 water supply systems. In 2006 the water supply network extended for 20,764km (an increase of 1,790 km since 2001), with 59 water treatment plants (56 in 2001) and 1,999 chlorination stations (1587 in 2001). (22)       

Indeed, since the 1990s, despite a severe economic recession and the tightening of the US blockade, the Cuban government has made the expansion and modernisation of the water supply - particularly in rural areas - a priority in its development projects. 


A report by the Red de Observaciones de la Calidad de las Aguas (Observation Network of Water Quality) produced in 2006 dealt with the causes of deterioration of water quality (23).  As a result the Cuban  government has been seeking to enter into partnerships with foreign companies to carry out work to provide a good quality water supply to all the population, the priority being given to upgrading existing pumping stations and to constructing a number of small hydro-electric power stations generating 1.6 – 4.0 Gwh/year. Between 2000 and 2007, 947 water supply projects were completed of which 63 were major projects to renovate water pipes and lay new ones in Santiago de Cuba and other cities, including Havana, particularly in some of the heavily-populated districts (such Old Havana, where for many years during the Special Period, people obtained drinking water from water lorries called pipas) (24).

In an article published in Energy Bulletin (25) Stephen Gibbs described how, in 2004, the Cuban government reacted to the most serious drought to afflict eastern Cuba in 40 years by building ten new water pumping stations and sinking 100 new wells.  In the longer term, there are three major projects currently being developed, (initiated before the Special Period of the 1990s, when they had to be postponed (26), but resumed in 2004) to channel water from the mountain ranges of the Escambray, the Nipe-Sagua-Baracoa and the Sierra Maestra to supply areas in the eastern part of the island affected by draught (27).  These projects involve the construction of dams, canals and 80 km of tunnels in mountain areas as well as laying hundreds of kilometres of pipes (see footnote 21).  Stephen Gibbs mentions how the pipes are being imported from Italy rather than from the US, on account of the blockade – thus incurring higher transport costs.

As mentioned above, the provision of improved water to rural and mountain communities has been a  priority of the Cuban government.  The Programa Rural Cubano, conceived in the early 1990s to provide drinking water and sanitation to rural communities, pinpointed the 258 communities in most need across ten provinces.  Between 1990 and 2001, 3,220 water pipelines were laid in rural areas, benefiting nearly two million people.  Between 1996 and 2001, another 426 pipelines were laid in mountain areas, benefiting 182,000 inhabitants (28).  Today almost all communities of 300 or more have a reliable water supply (29). Some of these projects receive support from UNICEF (30) and the Canadian International Development Agency.  Other examples of projects in rural areas to improve the provision of drinking water in the provinces of Guantánamo and Holguín (two out of a total of ten rural development projects in Cuba undertaken by the same organisation) are those being undertaken by the Basque development agency Euskadi-Cuba.       

In 2007, the Cuban Centre for Ozone Research (Centro de Investigaciones del Ozono de Cuba) developed a small domestic machine with which to treat drinking water using a carbon filter and
ozone for areas where water quality is not of the required standard, despite initial treatment. (31)

Therefore it cannot be said that the Cuban government is neglecting the needs of the population by allowing the water network to fall into disrepair when it is so obviously taking active steps to improve the quality of water provision.  Moreover, in the opinion of the writer of this article, it is disingenuous of the Commission to suggest US assistance to their proposed ‘Cuban Transition Government’ in order to “address the needs for potable water and sanitation in major urban and rural populations” including the provision of chlorine or other water-treatment materials, while impeding the present Cuban government in its very real efforts to ensure its population’s needs for treated water are being met.  Cuba certainly deserves the praise it receives for its achievements in water provision which are an indication of the very high priority given to public services and welfare by the government despite the stringent US blockade and the increasingly difficult climatic conditions.  


4.  Sanitation facilities in Cuba

The Commission alleges that:

“Cuba faces daunting….. sanitation issues, including inoperative sewage treatment  plants.”  (page 14)

“….only four percent of the sewage effluent has some degree of treatment.”   (page 14)
“…..sewer pipeline networks are in shambles.”   (page 14)
“…..the lack of sewer pipelines have caused a degradation of water quality.”  (page 14) 

The facts:

Again, reports produced by international agencies belie the Commission’s allegations that the island’s infrastructure for improved sanitation (32) and safe waste disposal has been neglected to the point of near collapse.

In 2006 the World Health Organisation and the UNICEF Joint Monitoring Programme for Water Supply & Sanitation – Improved Sanitation Estimate (33) reported that 99% of Cuba’s urban population and 95% of the island’s rural population had access to improved sanitation – the second highest in Latin America and the Caribbean after Uruguay (34). Cuba’s sewer network extends for 4,862 km, with 894 sewage treatment systems  - 2006 figures (having increased from 386 in 2001 (35).  In 2005, 40.8% of the population had access to a sewage system;  59.2% had septic tanks or latrines (36).

Figures for Latin America and the Caribbean show that the average access to improved sanitation facilities in 2004 was just 77% (37).  However, as in the case of water provision, the figures for the region include significant imbalances between the urban and rural areas (86% and 49%) as well as between different income and ethnic groups.  In Guatemala, Bolivia and Brazil in 2003, 50% of (wealthier) households headed by white men or women had access to a sewerage system while just 30% of (lower income households) had such access (38)

Wastewater:
The Commission alleges that:
“In the entire country, there are only five municipal wastewater plants”  (page 14)
“…insufficient levels of wastewater treatment….”   (Page 14)
“ Havana’s wastewater flow receives primary treatment only, and excess flow is discharged with minimal, if any treatment.”   (page 14)

The facts:

In Cuba there are eight wastewater treatment stations which treated 35.4% of waste water in 2006 (39), (down from 40% in 2002) and it is evident that there is a need for development in this area of the island’s infrastructure. It is for this reason that in recent years there has been a vigorous programme to upgrade and extend wastewater facilities. 

The infrastructure dealing with wastewater is managed by the National Water Resources Institute (Institute Nacional de Recursos Hidraúlicos) which sets norms and oversees the operations and developments in water supply and sanitation.  It also proposes water and sanitation policy to the Cuban National Assembly’s equivalent of the Cabinet (Consejo de Ministros).

The sanitation (and water) network is managed by different enterprises – both public and ‘joint ventures’, the latter being managed jointly by private companies and the Cuban Government.  All these enterprises are closely linked with the Institute and many of them work in groups.  One of these enterprises is Aguas de Barcelona, known in Cuba as Aguas de la Habana which has a 25-year contract to provide water and sanitation for eight of the fifteen municipalities in the city.  The infrastructure remains publicly owned and management responsibilities are shared by Cubans and Spaniards.  Aguas de la Habana is responsible for repairing water and sewage pipes, building new pipes, operating and maintaining water and sanitation systems, the drains and sewers (40).  There are many other ‘joint ventures’ of this kind in which the state shares the ownership of a project with a private overseas company.  One website alone (41) mentions about 60 water and sanitation projects with such countries as Japan, Germany, Italy and Spain, to repair sanitation systems, clean polluted waters and develop water and sanitation awareness and provision in schools and communities. Other kinds of sanitation development programmes are also in place, such as those to clean industrial waste from the Bay of Havana (42) and other bays and river outlets around the island. 
     
In this context, the situation in Cuba should again be compared with the rest of Latin America.  In her article on the treatment of wastewater in Latin America (43), Kelly A Reynolds indicates how just 10% of wastewater collected from drains is given some kind of treatment and only 5% of homes are connected to a
wastewater drainage system.  She continues to describe how only 5% of wastewater from all sources in third-world cities receives any kind of treatment

Cuba’s way of dealing with her need to improve sanitation facilities is in stark contrast to the neo-liberal model operating in other developing countries where the infrastructure is sold off and controlled by private companies.  The development of infrastructure in such scenarios has become a very costly affair, plunging the countries concerned even further into debt.  Kelly A Reynolds (44) quotes the estimate made by the World Bank in 1997 of approximately US$100 million for building a conventional plant for the secondary treatment of wastewater for one million inhabitants, not counting operating costs and maintenance.  She mentions how just 5% of wastewater treatment plants in Mexico were operating satisfactorily in 2002. 

Solid Waste Disposal:

The report alleges that:

“There are also alarming difficulties in the hygienic conditions of dumpsites…..”  (Page 14)
 “Trash pickup is intermittently undertaken which perpetuates the proliferation of mini-dumpsites in populated areas……”  (Page 14)

The facts:

A report produced in 2002 (45) describes the measures that have been put in place to improve waste collection services.  It mentions how each of the 14 provinces and 169 municipalities have set up a system of waste collection, transportation and disposal.  The report acknowledges openly that sanitation problems
persist and, among other measures to be taken in respect to rubbish collection, it identifies the need for further staff training and covered waste collection lorries.  A report produced the following year (46) also calls for more street cleaning and improved pay and conditions for workers within the sector. 

Thus, today in Cuba, 100% of the urban population (75% of the population of the island) receives solid waste collection services, carried out by the municipality or by private firms. (47)  By way of example, in
Havana, a city of 2.2 million inhabitants, in addition to street cleaners employed by the 15 municipalities, there is a fleet of lorries that collect municipal solid waste regularly from covered street containers. In Santiago, the second largest city in Cuba, there are over 100 street cleaners and dustmen working for the
Empresa Municipal de Servicios Comunales.  When the writer of this article was in Santa Clara in November 2007, there were street cleaners working daily in the city and rubbish was collected by lorries, also on a daily basis.  
 
Throughout Cuba there is a great deal of community action relating to solid waste disposal. CDR
groups (48) organise the collection of waste materials for recycling (again, witnessed by the writer) and groups of volunteers from the CDRs tidy up residential streets on a rotational basis.

What takes place in Cuba is in marked contrast to other cities in the developing world where between 50% and 80% of refuse is collected, the rest being dumped at random or burnt by the inhabitants themselves (49).  Both of the latter methods constitute a health hazard.  The first because of leachates from the open dumps that pollute the surface and ground water and the second on account of toxins generated which are released into the atmosphere through open incineration.  While Cuba is able to maintain a waste collection service throughout the island’s cities, in the other cities of Latin America it is the wealthy who benefit most from this service.  The roads where the shanty town and slum dwellers live (who form a large percentage of these cities’ populations) are usually steep, narrow and unpaved, which makes it extremely difficult for waste collection lorries to drive along them. 

Once collected, Cuba’s waste is disposed of in a variety of ways, which again compare favourably with other countries in Latin America and the Caribbean.  In a report produced in 2006 for USAID and the Comisión Centroamericana de Ambiente y Desarrollo (50) it was noted that 21.4% of Cuba’s solid waste is
disposed of in sanitary landfill (the average for Latin America being 22.6%), 57% is disposed of in landfill which receives some form of treatment to render it safe (Latin American average:  23.7%) and 20.5% is
sent to open rubbish tips (Latin American average: 45.33%)  The report indicates (on page 35) that the situation in Central America is worse:  70% of solid waste in the region is disposed of in open tips and the rest is disposed of randomly by the population.  The report emphasises that the municipalities should accept their responsibilities in organising the collection and disposal of solid waste.

In this context it should also be noted that in Cuba there are over 560 sanitary landfills where methane is siphoned off for recycling (rellenos sanitarios manuales) (51) and that there are three major recycling
plants in the west, centre and east of the island where 727.4 million tons (Mt) of rubbish is recycled a year (2006 figures) (52).

Although Cuba’s performance in solid waste disposal compares favourably with other developing countries, as in the case of liquid waste there are many areas which need development.  As well as the open rubbish tips, there is fly tipping (which also happens in the industrialised countries) and both have significant implications for public health (53).  It is for this reason that, contrary to the implications made by the Commission and despite the deep restraints caused by the blockade, the subject of solid waste disposal is taken very seriously by the Cuban government which has listed it as one of its top priorities for development projects undertaken(54).  It is therefore highly pro-active in the measures being taken to improve this aspect of the country’s infrastructure, some of the results of which can be witnessed today.

These measures are three fold.  First, there are numerous sanitation projects in conjunction with foreign companies, many of which involve solid waste disposal (See footnote no. 41 above).  One such project has been taking place in Cárdenas (55), a town of 90,000 inhabitants which has entered into a                                                                                                                                                                               joint venture with Madrid City Council and the Spanish aid agency, AECID.  The improvements will include the provision of 30,000 new waste containers, two dustcarts, a sanitary landfill and a waste treatment plant.  In October 2006, as part of a general project around the Bay of Havana, involving a number of countries and the UN Global Environment Facility, the Cuban government entered into a joint venture with Belgium (each country contributing about half each of the funding) to develop a system of rubbish collection which will enable the recycling and composting of solid waste in the municipalities of Old Havana and Regla (Havana). This is in addition to drainage and air monitoring projects (56).  There are numerous others.  Happily other countries show a more positive and constructive approach to assisting the Cuban government in its policy of ensuring safe and efficient waste disposal.

Secondly, in a country characterised by very high levels of public participation, the government is actively promoting campaigns to ensure public awareness in relation to the subject of safe, sustainable waste disposal.  In Ciego de Ávila there is an open training centre for the management of solid (and liquid) waste which offers study courses, workshops, seminars and which organises campaigns throughout the island, which are taken up by the municipalities and CDR groups, to promote public awareness on the importance of waste disposal (57). 

Thirdly, there are the measures being taken by the municipalities and at local level to ensure maximum efficiency in the disposal of waste.  Following a government report issued in 1997 (58) which identified a number of problems relating to the disposal of solid waste, steps have been taken in cities and towns around the country to improve this aspect of the infrastructure.  These have ranged from improved training for staff to updating legislation, improving rubbish collection services, promoting recycling and public hygiene awareness campaigns.

The 2002 report referred to above (see footnote 45) also calls for improved monitoring and waste treatment equipment and for the introduction of a process to integrate the disposal of industrial and dangerous waste – following treatment - with solid domestic waste. 

Although as yet only carried out in small quantities, the importance of recycling (including composting) is given much publicity in Cuba and is seen as an area on which to focus in future developments relating to the disposal of solid waste, it is given a prominent place in the numerous studies for future projects and reports which are undertaken on the subject. The island’s facilities and recycling rate have been praised by many individuals and agencies (59). Around the country there are centres, called casas de compra  for collecting raw materials found in solid waste which will be sold or recycled in other ways. In the province of Santiago there are 6 such centres (60).  (Interestingly, the Commission does not mention the development of recycling facilities as one of the ways in which it will assist its appointed ‘government’ with sanitation issues.) As has been mentioned above, one task carried out by CDRs is to collect material for recycling or to be made into compost (as in other developing countries, in Cuba over 50% of all solid waste is organic).  Emphasis is placed on small, locally-run projects.

One recycling project which has received considerable publicity has been an initiative – the Centro Procesador de Residuos Sólidos Urbanos de Guantánamo –  undertaken by a group of residents in the district of Sur-Isleta in the city of Guantánamo.  Through recycling rubbish, the group has converted a landfill site into gardens, organopónicos (communal allotments), a plant nursery with flowers, fruit trees and medicinal herbs. There are areas for breeding sheep, pigs and rabbits and organic waste is transformed into compost and humus for use both on the site and by farmers elsewhere.  160 cubic metres of rubbish is received daily at the site and recycled for use in the project.  This initiative has received a UN award as well as many national awards.  It has been duplicated in Havana and a similar project will be developed in Holguín (61).

Another initiative is taking place at the other end of the island, in Pinar del Río where in 2005 a local study was carried out (62) with a view to setting short, medium and long-term goals to improve the management of solid and liquid waste.  Emphasis was again placed on the need to find sustainable ways of managing waste by recycling and producing compost from organic waste.  More efficient ways of collecting waste were also examined with the longer-term goals of providing containers for different kinds of waste and improved waste collection by lorries.

The Commission alleges:

“….deficient handling and disposal of hazardous waste from hospitals.”   (Page 14)

The facts:

Since 1997 the management of dangerous waste has been the responsibility of CITMA, the Ministry of
Science, Technology and the Environment.  A speech by Dr Silvia Alvárez Rossell (63) in 2006 outlined the
existing regulations for the disposal of dangerous waste and pointed out that the measures taken for its
disposal are monitored, in addition to being subject to further study by working parties which have been
drawing up additional recommendations.  The regulations cover 1) the collection and re-use of oil waste, 2) the incineration of hospital waste, following appropriate collection and treatment and 3) the disposal of out-of-date medicines which have to be incinerated or disposed of in secure landfills.  At the time of the speech a working party was being formed dealing with the subject of disposal of batteries.  Although the disposal of
dangerous waste does appear to be uneven across the island, good practice is evident.  In relation to the
subject of hospital waste, Cuba (together with Costa Rica and India) was singled out for particular praise by the authors of an article dedicated to this subject (64) published in 2002 by the Asociación Alihuen, an Argentinean environmental organization.
 
The planning and development of the infrastructure for waste disposal is not so frequent in other countries of Latin America whose financial affairs are to a great extent dictated by the World Bank and the IMF that provide loans for proposed projects and which have to approve the items for which funds are borrowed.  As Martin Medina (Globalization, Development, and Municipal Solid Waste Management in Third World Cities, see footnote 49) points out, the equipment purchased, although suitable for the industrialized countries, is often unsuitable for conditions in the developing nations.  He cites the example of incinerators purchased by Mexico City for the general disposal of solid waste which were quite unsuitable, given that such a large proportion of the waste in that city is composed of humid, organic matter that does not sustain combustion.  When purchasing equipment, aid agencies are often restricted by their governments which oblige them to buy from domestic manufacturers.  This is the case of USAID which “must purchase from US companies 100 percent of the equipment used in development projects.” (Medina).

In the absence of a waste collection service provided by the local authority, in the case of all but the wealthiest areas of cities in the developing world, the main agents for waste collection and the sorting of waste are informal refuse collectors.  Martin Medina describes how informal refuse collector communities have developed around open dumps in these cities:  15,000 informal refuse collectors live and work in and around Mexico City’s municipal dumps which provide an income for women, children, the unemployed, the elderly and the disabled.  A similar situation exists in Santa Cruz, Bolivia, where informal refuse collectors Service about 37% of the population.  Globally, 2% of the population of the developing world survives by informally picking out rubbish from refuse dumps.  Such a sight is virtually absent in Cuba where women enjoy a high standard of education leading to secure employment, education is free for children, including at university level, the unemployed receive benefits while attending training courses to enhance their knowledge and skills and the disabled also receive benefits and assistance in finding employment (65).

Once again, the distortions contained within the Commission‘s report are patently clear.

5.  The system of healthcare in Cuba

The Commission alleges:
         “…a Cuban society fed up with broken promises and the failure of the regime to meet its basic needs.” 
       ( page 7)

“Today, Cubans live with the consequences of the regime’s deliberate decision to sustain itself at the   
       expense of its people:…. crumbling medical infrastructure….” (page 13)

“…Cuba’s increasingly fragile and depleted health-care system…..”  (page 33)


The facts
This is one of the most surprising aspects of the Commission’s report, given the plethora of reports, articles and accounts written by an array of international organizations and individuals from across the world which praise Cuba’s system of health care.

Indicators produced by different international agencies all coincide in showing that the Cuban population is one of the healthiest in the third world, on a par with that of many industrialised countries.  Three indicators of the general health of a country’s population used by international organisations such as the World Health Organisation and UNESCO are life expectancy, infant mortality rates and birth weight.

Life expectancy figures for 2007 published by the Pan American Health Organization (66) show Cuba as ranking well above the average for Latin America and the Caribbean and even above that of the United States:

Country/Region                 General                         Male            Female
Cuba                                     78.3 years        76.2             80.4 years       
Latin America & the       
Caribbean                            73.1 years        70.0 years        76.3 years       
Latin America                     73.5 years        70.4 years        76.7 years
Latin Caribbean                  72.0 years        69.5 years        74.6 years
Non-Latin Caribbean          71.8 years        69.2 years        74.5 years   

USA                                   78.2 years        75.6 years        80.8 years

The WHO’s figures for healthy life expectancy show a similar picture.  (In 2007, the 2002 figures given
below were the only ones available).   Here also we see Cuba as being nearly on a par with the world’s richest country (67):  
   
Country/Region                     General                            Males                              Females
Cuba                                68.5 years               67 years                70 years
USA                                  69 years               67 years                         71 years
“Region of the Americas”                                              63 years                           67 years

Perhaps it should be noted that, while Cuba’s life expectancy indicators have been steadily improving, those of the US have been deteriorating.  An article in the Sydney Morning Herald of 27 December 2006 points out that while in 1950 the US ranked near the top ten countries of the world for life expectancy, in 2006 the Human Development Report showed that the US had fallen to 30th place.  Some communities in the US fall well below the Cuban average (68):  black middle Americans have a life expectancy of 72.9 years, the southern low-income black population’s life expectancy is 71.1 years and that of the poor urban black population is 71 years.  Indigenous American men in several counties of South Dakota have an average life span of just 58 years.

With infant mortality rates, Cuba’s record is again far and away above the average for Latin America and the Caribbean and equal to that of the US.: 
   
Country/Region                         Infant mortality (under 1)                 Under 5 mortality rate
                    /1000 live births                                           /1000 live births
Latin America & Caribbean  (69)                       22.2 (2005)                           31 (2005)
Cuba    (2005)  (70)                      6                         7
US    (2005)  (see 70)                               6                            7

The indices provided by UNICEF (71) show that 100% of Cuban mothers receive ante-natal care and have a skilled attendant at delivery.  This is not the case for mothers in most countries in the region.  In the Americas, only Canada’s infant and under-5 mortality rates surpass those of Cuba at 5/1000 and 6/1000 respectively.

As Jo Ritzen, Vice President for Development of the World Bank remarked after visiting Cuba privately in 2005:  “Six for every 1000 in infant mortality – the same level as Spain – is just unbelievable.  You observe it and so you see that Cuba has done exceedingly well in the human development area.”  He added that developing countries could “learn a great deal by going to the island.”  (72)

The profile of Cuba given by the US Library of Congress in 2006 describes the island’s health system in terms that are diametrically opposed to those expressed by their compatriots on the Commission:  “…the
health of the Cuban population is more like that of a developed country than a developing one, with low infant mortality, low fertility, low rates of infectious disease, and high cancer and cardio-vascular disease rates.”  The document describes Cuba as having “a well-organized medical system.”

Other studies confirm the success of the Cuban health system:  in their article ‘Lessons from the margins of globalization:  appreciating the Cuban health paradox’ (73) the authors Spiegel and Yassi point out that, quite contrary to neglecting the population, the Cuban state is so pro-active in ensuring good health for its citizens that it provides lessons for other countries.  The active implementation of public policy affecting a wide variety of health determinants explains the Cuban paradox: a third-world country that achieves health indices comparable to those in developed countries, even during the period of extreme hardship in the 1990s.

Dr AJ Wills of the Department of Neurology at Queen’s Medical Centre, Nottingham, UK, would also
disagree with the Commission’s accusation of neglect by the Cuban government.  In his article Letter from Cuba (74) he points out how, unlike other countries in Latin America and the Caribbean, malaria has been eradicated from Cuba.  Moreover, after spending a week in the Department of Neurology in Santiago he describes how there was no waiting list for neurological outpatient appointments and how in-patient beds were easily accessible.  He adds “it is in the field of stroke medicine that Cuban achievements seem especially impressive” with their close integration of hospital and primary care, together with health campaigns warning of the dangers of hypertension which have reduced the incidence of strokes.  In a similar vein, another article published in the American Journal of Public Health in January 2006 (75) concludes that Cuba’s “levels of control of hypertension are the highest in the world” leading to a dramatic reduction in the number of deaths from cardiovascular disease.


 The Commission alleges:
“…it is clear from independent sources that …….untreated chronic diseases affect a significant percentage of the Cuban population.”   (2006 Report, page 13)

The facts:
Cuba has been praised for its management of infectious disease.  In their article ‘Infectious disease management:  lessons from Cuba’, (76) the authors, five doctors who have visited Cuba frequently over
many years describe the “resolutely preventative approach to health”, especially in the area of infectious
disease, with the lowest rates of HIV in Latin America and country-wide mosquito control to prevent the occurrence of Dengue.  Malaria has been eliminated in Cuba, while in Latin America there were 850,000
cases in 2003. Polio measles, mumps, rubella, diphtheria and tetanus have disappeared.  By 2005
UNICEF (77) declared Cuba to be free of iodine deficiency disorders, all salt for human consumption having been iodised since 2002.  The Pan American Health Organisation gave further statistics which reveal Cuba’s proactive approach to disease management (78):  Mortality rates for bronchial asthma declined from 5.2 per 100,000 in 1996 to 1.9 per 100,000 in 2000.  Food and waterborne diseases – common in third-world countries – declined rapidly in the 1990s:  in 1996 there were 716 outbreaks, in 2000 there were 306.  Testing is carried out for TB:  deaths from TB were under 1/100,000 of population in 2000, the cure rate is 92% and 99% of newborns receive a BCG vaccination.  (By contrast, in Latin America in 2002 there were 370,000 cases of TB.) (79)
The Commission  alleges:
“The regime has chosen its priority:  health spending on services and medicines for foreigners, rather than its own citizens.”  (2006 report, page 15)

“…the regime ….. restricts access to its medical facilities…..”   (Report page 13)


The facts: 
Cuba’s acclaimed health system provides universal access to services.  The island has developed its primary health care system which has at its heart neighbourhood-based family medicine.  Cuban GPs are responsible for approximately 800 patients (unlike the UK, where they care for over 1,800 patients, and the
US, where each Family Physician has approximately 3,200 patients (80).  They live in the communities they serve, providing primary care and preventative services and are responsible for screening, immunizations,
pre-natal care, monitoring chronic conditions and co-ordinating after-care when a patient leaves hospital.  

Every patient must be seen at least twice a year.  In addition to the work done by GPs, there are public health campaigns at neighbourhood level, programmes in alternative or traditional treatments as well as
vaccination programmes – children are routinely vaccinated against 13 diseases – and community services for the elderly. 

The more remote areas are not neglected.  The Pan American Health Authority praises the Turquino-Manatí plan set up in 1987 in order to ensure the provision of services and facilities, including health services, in the more remote parts of the country.  This includes 387 primary health teams, 1,137 health care facilities and 64 rural hospitals.  Programmes such as these are rarely found in the remote rural areas of other countries of Latin America and the Caribbean where access to medical facilities is often unreliable. (81).
        
 For specialist healthcare, every area has a polyclinic which provides basic emergency, specialist and rehabilitation services to patients.  Throughout the country there are 442 polyclinics.  In addition Cuba has 270 hospitals as well as the 64 rural hospitals.

A group of members of the American Public Health Association, who travelled freely around Cuba during a visit in 1995-6 (82) (the Special Period when Cuba was experiencing severe economic difficulties after the collapse of socialism in Eastern Europe and the intensification of the US blockade), had nothing but praise for the Cuban health system.  They were particularly impressed by the large numbers of doctors, nurses and allied professionals who ensured services reached the population in all parts of the country.  They noted that special health facilities were provided for the elderly by means of a comprehensive programme towards health promotion (including daily exercise) through grandparents’ circles.  Workers were also provided with healthcare services, with 4,722 workplaces offering such provision.

   In 2000 and 2001, delegations of 100 British doctors and medical staff, led by Dr Pietroni, visited Cuba (83).   Dr Pietroni  commented on his return in 2001:  "What we have found is that, although clearly Cuba is quite a poor country in terms of its GDP….. it is a very rich country in terms of its human resources  Many of the UK doctors have been amazed to find that family doctors in Cuba have a patient population of only 300 [the figure for 2001], whereas in the UK it's 1,800."

On 1 August 2006, BBC’s Newsnight carried a report about Cuba’s health service, as part of the “world's best public services series”, asking “what Britain and the rest of the world can learn from Cuba's medical system.”  During the four days they spent on the island, the Newsnight team set out to discover the reasons for the Cuban population’s “admirable health”, visiting GP’s surgeries, polyclinics, pensioners’ groups and interviewing patients.  Their conclusion:  “Within reason - and though hell will freeze over, while pigs cruise over Downing Street - he [Mr Blair] should go Cuban.” (84)  
       
The US Library of Congress Profile on Cuba contains no mention of restricted access to state facilities and benefits.  They write:  “Despite the almost subsistence-level wages of most Cubans, they are generally much better off than the citizens of many other developing countries because their meager salaries are supplemented with free education, subsidized medical care, housing and some subsidized food.” (page 10)  On the other hand, in the US itself, citizens who have no medical insurance (47 million in 2006, including about 9 million children, rising from 44.8 million in 2005) have restricted access to healthcare (85) and very limited access to preventative care.  20.2% of workers in the US are uninsured, unable to pay the price of an average family policy, which in 2004 was $9,068 a year. This situation led the National Academy of Science’s Institute of Medicine to recommend in January 2004 that policy makers should move towards universal healthcare.

Finally, even during the Special Period, in 2001, Cuba won extensive praise for its health service from James Wolfensohn, head of the World Bank.  At a press conference in Washington he said, "Cuba has done a great job on education and health and if you judge the country by education and health they've
done a terrific job…  So I have no hesitation in acknowledging that they've done a good job, and it does not embarrass me to do it. They should be congratulated for what they have done," (86)



6.  The effects of the US blockade on healthcare in Cuba
The Commission alleges:
“ Despite…..the ability to purchase medicines and medical devices from US companies and the rest of the international community for use in Cuban hospitals, the Cuban health-care system lacks basic supplies to treat the Cuban people on a daily basis.”  (page 15)


The facts:
The Commission mentions the US blockade, in force since 1961, just once in its report, on page 10. The stringent regulations administered by the Office of Foreign Asset Control in relation to permitted exports from the US to Cuba also receive scant attention (page 13, under the rubric of Recommendations)  Instead, the reader is led to believe that the Cuba has no problem in purchasing medical supplies from the US and that it is the Cuban state that is responsible for shortages which the Commission alleges are the result of revenue being siphoned off “to maintain its [the state’s] grip on power.”  This point is made nine times in the report: (pages 3 (twice), 6, 9, 12 (twice),13 (twice) and 20).

However, on page 12 of the report there appears a statement which reveals the true intentions of US economic policy towards Cuba:

“In order to undermine the regime’s succession strategy, it is critical that the U.S. Government
maintain economic pressure on the regime to limit its ability to sustain itself and repress the Cuban
people.  Moreover, as we rapidly approach the transitional moment, the more economic pressure
there is on the regime, the greater the likelihood there will be dramatic and successful change for
the Cuban people.”  [My italics]

It is indeed the blockade with its multitude of stringent and byzantine regulations relating to exports (and these include donations) that impedes the acquisition and use of essential medical products and equipment for Cubans who are in need of treatment.  A policy review published  on 15 May 2002 by the Cuba Working Group of the United States House of Representatives (87) criticized the “cumbersome US administrative procedures and restrictions” that “complicate and impede” the sale of medical products.  It called for decision making to be allowed by the companies themselves (rather than by the Office of Foreign Asset Control) and the repeal of the law which bans ships that visit Cuba from calling at an American port for 180 days. [See Cuba Factfile article on the Blockade on the UK Cuba Solidarity Campaign website]  The review also recommended “ending the [legal] requirement that donors and vendors of medical products monitor their use in Cuba…”  This refers to the legal stipulation that sellers of medical products must account for the destination of their exports and who they will benefit.

In his article “Health care in Cuba and the manipulation of humanitarian imperatives”, Dr Richard Garfield (88) describes how in July 2004 US firms were fined for the unauthorized export of medicines to Cuba.  The Chirron Corporation was penalized for shipping five vaccines, instead of the one originally
planned, to UNICEF in Cuba.  The company had notified the Office of Foreign Asset Control of their error, but “received the second highest penalty ever.”  In 2003 the OFAC had 21 staff dealing with Cuba and only four hunting the funds of Osama Bin Laden and Saddam Hussein.

The obstacles created by the blockade for US companies and their foreign subsidiaries wishing to export medical products to Cuba are outlined in more detail by Dr Anthony F Kirkpatrick from the College of Medicine at the University of South Florida. (89) :
-   Licences must be obtained on a contract-on-contract basis.  That is, a separate licence is required for each shipment of a product, which can take 3-12 months for approval.  Blanket licences for a product to cover an on-going export are not permitted.

-   Exporters are responsible for “on-site inspections” in Cuba to ensure medical supplies are not diverted from their intended use.  This entails considerable costs to the supplier who, if the requirement were carried out to its logical extreme, would be expected to inspect doctor’s surgeries, hospitals and clinics throughout Cuba, which would, in turn, result in an intrusion on Cuba’s sovereignty.  However some on-site inspections have been allowed.

-   The strict requirements for export licences means the exporter must satisfy the US government that products will not be used in human rights abuses, for military purposes, for the treatment of non-Cuban nationals or in the biotech industry.

-    The costs of shipment are increased because of US restrictions on air and sea traffic between the US and Cuba.

-    Technical and inadvertent violations of the blockade can incur fines of up to US$1 million for corporations and prison terms of up to 10 years for individuals. (90)

To offset the effects of the blockade, Cuba endeavours to purchase medical supplies produced by
non-US companies.  However as over 50% of the most important drugs used around the world are
manufactured by US companies or their subsidiaries, Cuba encounters real problems.  These problems are compounded when a non-US company manufactures a product containing 10% or more of a component produced in the US, as it is subject to the same blockade restrictions.  In other cases – particularly in developing countries - the potential loss of US aid to countries that export to Cuba serves as a strong disincentive to companies in these countries.

When US companies take over pharmaceutical companies and firms producing medical equipment previously belonging to non-US owners, exports to Cuba are discontinued.  When a UK company manufacturing diagnostic equipment which exported to Cuba was taken over by a US concern, International Murex Technologies, sales to Cuba stopped. (91)

For the Cubans, therefore, the blockade is a deterrent to arranging any long-term purchase from the US for fear that the medicines and equipment in question will be held up and/or not given an export licence. 
Finding alternative supplies in other parts of the world and arranging for shipment to the island is a costly procedure – using up extra financial resources that could otherwise be used to improve facilities for Cubans.  It is for this reason that Cuba has developed its own bio-technology industry in order to ensure a supply of medicines for its population.  This industry has been in the forefront of new research and treatments, such as those for Meningitis B, Hepatitis B and a cancer treatment based on a Theracim Hr3 formula.   However, clearly, it cannot supply all the equipment and medicines that are needed but unavailable.

Consequently Cuba continues to suffer severe shortages of medicines and medical supplies as a result of the US blockade.  On 8 November 2005, Resolution 60/12 was presented to the UN General Assembly calling for the US to end the economic, commercial and financial blockade against Cuba.  At the same time the Secretary General was asked to prepare a report on the implementation of the resolution. (92)  In order to do this he invited governments and UN agencies to provide him with information about the effects of the US blockade within Cuba.  In the report that was published (quote) “WHO, the Pan American Health Organization, the United Nations Population Fund, UNICEF and the United Nations Development Programme reiterated the impossibility for Cuba to purchase or receive donations for equipment, medicines, vaccines, antiretrovirals for the prevention and treatment of HIV/AIDS, last-generation antibiotics and laboratory materials produced by the United States or covered by United States patents. These prohibitions included products that were to be purchased through multilateral cooperation.  In many cases, licences were denied by United States Government institutions.”   Many specific examples are quoted in the report.  Below are a few of them:
-    The US company Baxter was prevented from providing continuous ambulatory peritoneal dialysis for 2032 patients living in remote areas of Cuba.
-    The American NGO Atlantic Philanthropic Service Co. was prevented from donating a molecular biology laboratory to Cuba’s Nephrology Institute, which meant that kidney transplant patients stood a lesser chance of survival.  In addition, spare parts for radiotherapy equipment were withheld from export.
-    Cuba has been unable to purchase equipment from Biorad for the molecular  epidemio-logical surveillance of the bacteria salmonelola, E. coli, shigella and Vibrio cholerae.
-    The US company Gilead refused to provide the antiretroviral drug Tenofovir for HIV/AIDS suffers because of the labyrinthine procedures involved in obtaining an export licence.
-    Firms supplying medicines and equipment for heart transplants for children also quoted the long and complex procedures for obtaining an export licence as reasons for refusing to export their products to Cuba.  The same applies to Pfizer who would not export the contraceptive Depoprovera to Cuba.  (In these cases Cuba was able to purchase the drugs elsewhere, but at higher prices and sea freight costs.)
-    UNICEF reported that the quality of medical provision, including urinary bags, for children with disabilities had been affected because of the blockade.
-    WHO/PAHO reported that products used to fight rodents, mosquitoes and other vectors had to be purchased in far-off markets, increasing costs by at least $318,000, as they were unobtainable from the USA.  This was also the case with the three vaccines that were not produced in Cuba.
-    These same organizations reported that patients requiring cardiovascular surgery were affected by the unavailability of equipment that might otherwise have been purchased from the US.
-    Other supplies denied to Cubans were Fisher incubators for new-born babies, UW Dupont Pharma organ preservation solution, Datex-Ohmeda hemodynamic monitors and Puritan Bennet lung ventilators.  Since Amersham Pharmacia Biotech – formerly a UK company – had been acquired by a United States firm, Cuba had no longer been able to purchase their kits or use the sequencing equipment that had already been acquired.

(Many more examples have been cited in the other reports produced yearly since 1992 to the present by the UN Secretary General under the title Necessity of ending the economic, commercial and financial embargo imposed by the United States of America against Cuba.)

It can be seen, therefore, that the Commission‘s claim that the US provides no impediment to the purchase by Cuba of medical equipment and medicines for its own population is patently inaccurate.  One can only admire – along with so many other people and organizations – the Cuban health services for achieving world-class results while having to care for the population in such adverse circumstances.




7.  Levels of nutrition of the Cuban population
The Commission’s report alleges:
“Chronic malnutrition…..  continue[s] to affect a significant percentage of the Cuban people.” (page 3)
“The policies of the Castro regime continue to….impoverish the Cuban people, and isolate Cuba from
economic advances enjoyed by the rest of the Western Hemisphere.”  (2006 report, page 12)

“..…the regime’s deliberate decision to sustain itself at the expense of its people:  declining food
             stocks…..”   (page 13)

 “…..it is clear from independent sources that chronic malnutrition….affect[s] a significant percentage
            of the Cuban population.”  (page 13)

“….the Cuban government has failed to meet the basic food needs of the Cuban people.”  (page 17)

The facts:
The importing of foodstuffs from the US to Cuba, which resumed in 2000, is one area of commercial activity where the blockade appears to have eased – despite a ruling passed in 2005 that all goods have to be paid for in cash before shipment.   This is a point made by the Commission’s report that quotes a figure of $1.2 billion’s worth of food imports (page 17) between 2001 and 2006.  Indeed from 2000 to 2006 agricultural imports to Cuba from the US were worth more than $2.3 billion.(93)

However, international indicators once again point to an incorrect assessment on the part of the Commission of the nutritional state of the island’s population.

One recognised social indicator of levels of health and nutrition is a child’s birth weight, which is directly affected by the mother’s diet and nutrition.  Despite the fact that there was a higher prevalence of low birth weight babies in Cuba (that is, weighing less than 2.5 kg – 5 lb 8 oz – at birth) during the Special Period of the 1990s when the country experienced food shortages, the figures for recent years have been better than those found in the US itself as well as in other countries of Latin America:

1998-2005:    
-  the percentage of infants with low birthweight in Cuba:  5%  (94) 
-  the percentage of infants with low birthweight in  US:     8%  (95)
-  the average percentage of infants with low birthweight in Latin America and the Caribbean:  9%  (96)
             

Similarly the trends in under-weight children below the age of 5 show Cuban children to be generally better nourished than their counterparts in Latin America and the Caribbean and close to the US:

2005:        
-  the average percentage of under-5s who were underweight in Latin America and the Caribbean:  7% (97)
-  the percentage of under-5s who were underweight in Cuba:    4% (98)
-  the percentage of under-5s who were underweight in the US:  2% (99)


Cuba’s policy in respect to feeding her population runs counter to the neo-liberal policies favoured by the US government, the World Bank and the International Monetary Fund in that all staple foodstuffs are
heavily subsidized.  Although, on account of the continuing blockade, rationing is still in force in order to ensure a basic level of food and calorie intake and nutrition at minimum cost, Cubans can also access food from legal private sources, for example from private farmers’ markets.  Recourse to the black market to supplement their rations is not as essential as the Commission claims.  Many workplaces and public places cultivate vegetables and fruit in ‘organopónicos’ (similar to communal organic allotments) to encourage more consumption of these foods as well as local self-sufficiency.  In addition, large organopónicos can be found in all cities and towns (there are 109 in Havana) where vegetables are grown for public consumption
all the year round.  The food is sold to the public at the place where it is grown.  These initiatives, which
were set up at the start of the Special Period to combat food shortages, have attracted attention from environmentalists and the media all over the world.

In addition, certain vulnerable groups receive additional food rations.  These include children up to the age of seven and pregnant women who receive one litre of milk a day and the elderly who receive additional food items.  Children are given a free lunch and snack at school and workers eat very cheaply at their workplaces.  Special foods are provided when necessary for the sick or for people who require a particular diet. (100)

For the more isolated mountain communities of the island, the Turquino-Manatí Plan, which was set up in 1987 to improve the quality of life and to ensure food security for the inhabitants (together with other types of services, such as health care and education), earned Cuba special praise in 2005 from the Mountain Partnership that described the island as “a pioneer in the protection of mountain environments and the improvement of mountain livelihoods.” (101)  (The Mountain Partnership’s comments are a far cry from the scenario described by the Commission (page 14) in which they predict a “massive influx” of “impoverished rural residents” into the cities “where there is the hope of increased income, relief supplies and Government services” when the US-approved ‘Cuban Transition Government’ takes power.  (One wonders what would have become of the special services developed by the previous socialist government.)
The allegations made in the report drawn up by George Bush’s Commission are again belied, this time by Cuba’s achievements in the area of nutrition.




8.  The status of Afro-Cubans
The Commission alleges:
“Afro-Cubans and mixed-ethnicity Cubans comprise 62 percent of the population and are increasingly aware of their gross under-representation in leadership positions.”       (page 8)
“They continue to be socially marginalized by the regime elite,…..”  (page 8)
“Afro-Cuban youths are a consistent target of police harassment, intimidation, arrest……..”       (page 8)
The facts
When asked by Ignacio Ramonet (102) whether he was satisfied with the situation of the black community within Cuba, Fidel Castro’s unequivocal answer was that he saw few grounds for satisfaction.  He then went on to outline the ways in which the government would be working in order to deal with the problem of marginalisation among Afro-Cubans.   His concern to eradicate social disadvantage in the black community is by no means new, however, and dates from the earliest times of the Revolution.
Prior to 1959, racial discrimination had been a fundamental characteristic of Cuban society.  For a brief period, during the Second War for Independence against Spanish colonial rule (1895-98), Afro-Cubans and mestizos were represented at all levels in the independence movement, in accordance with José Martí’s belief that all Cubans of all classes and ethnicities should be united.  However following US interventions from 1898 to 1902, at the onset of independence from Spain, and later from 1906 to1908, racist laws, mindsets and discriminatory practices, inherited from five centuries of slavery (slavery ended in Cuba as late as 1886) restricted participation by Afro-Cubans in public life.  The black community was marginalized. 
By the 1950s Afro-Cubans had a 30% illiteracy rate, suffered higher rates of unemployment and poorer housing conditions generally than other communities and had the lowest-paid jobs – a condition they shared with many black US citizens at the time.  The discrimination they encountered prevented access to good schools (103), professional occupations, clubs, restaurants, parks, beaches and cultural activities (the Cuban ballet was exclusively for white people).  The writer of this article learnt during a visit to Santa Clara in 2007 that, before the Revolution on Sunday evenings, when the townspeople gathered to dance to a band in the Parque Vidal – the main square – the area nearest to the bandstand was cordoned off, being reserved for whites. Afro-Cubans could enjoy the entertainment only from the other side of the barrier.   
The Revolution in 1959 signified a “fundamental watershed” (104) for Afro-Cubans.  From the outset the leadership challenged racism and discriminatory practices, which subsequently became illegal. (105)  The literacy campaigns, free education and healthcare, the redistribution of land, reduction in rents, new housing and recreational facilities all transformed the lives of Afro-Cubans.  In his book, Saney quotes a poem by the late Afro-Cuban poet, Nicolás Guillén:  ‘Tengo’  (‘I have’:  Translated by J.A. Sierra) that expresses the reactions of the black community in Cuba to their new status in society and to the opportunities open to them following the triumph of the Revolution:
 
When I see and touch myself,
I, Juan with Nothing only yesterday,
and Juan with Everything today,
and today with everything,
I turn my eyes and look,
I see and touch myself,
and ask myself, how this could have been.
I have, let’s see,
I have the pleasure of going about my country,
owner of all there is in it,
looking closely at what
I did not or could not have before.
I can say cane,
I can say mountain,
I can say city
say army,
now forever mine and yours, our,
and the vast splendour of
the sunbeam, star, flower
I have, let's see,
I have the pleasure of going,
me, a farmer, a worker, a simple man,
I have the pleasure of going (just an example)
to a bank and speak to the manager,
not in English,
not in "Sir," but in compañero as we say in Spanish.
I have, let's see,
that being Black
no one can stop me at the door of a dance hall or bar.
Or even on the rug of a hotel
scream at me that there are no rooms,
a small room and not a colossal one,
a tiny room where I can rest
I have, let's see,
that there are no rural police
to seize me and lock me in a precinct jail,
or tear me from my land and cast me
in the middle of the highway.
I have that having the land I have the sea,
no country clubs,
no high life, no tennis and no yachts,
but, from beach to beach and wave on wave,
gigantic blue open democratic:
in short, the sea.
I have, let's see,
that I have learned to read,
to count,
I have that I have learned to write,
and to think,
and to laugh.
I have… that now I have
a place to work
and earn
what I have to eat.
I have, let's see,
I have what I had to have.
(The Spanish version can be found on http://www.historyofcuba.com/history/havana/GuillenS.htm )
 
For the first time, black Cubans could join the professions, such as law, medicine and teaching and participate in public and political life, moving into positions of responsibility in politics and in social organisations, such as the trade unions.  For this reason, whenever the writer of this article has visited Cuba, some of the most enthusiastic supporters of the Revolution (but by no means the only ones) are the older black Cubans who remember the transformation it brought to their lives.  Certainly these people are far from feeling marginalised by their political leaders.  

However, as Saney points out (page 106 of his book), mindsets created over five centuries of slavery do not change in a few decades.  The initial belief of the leaders of the Revolution was that the introduction of a political system based on the values of equality and social justice ultimately would be sufficient to abolish the destructive stereotyping of Afro-Cubans.  By the 1980s, despite the great advances made, the poorer neighbourhoods still contained a predominantly black population and racist attitudes were still commonplace.  For that reason in 1986, at its Third Congress, the Communist Party decided to put in place a programme which had as its aim to bring more Afro-Cubans (as well as women and young people) into the decision-making bodies of the Party and of government.  Fidel Castro stated that the leadership should “duly reflect the ethnic composition of our people” and that the promotion of black Cubans “must not be left to chance….” adding “We need to straighten out what history has twisted.”  (Quoted by Saney pp 106-7) 

During that same period, legislation specifically prohibiting racial (and sexual) discrimination was introduced.  It should also be remembered that during the 1970s and 80s Cuba was engaged in conflict in Angola against the forces of apartheid.

At the present time there has been a significant improvement in the representation of Afro-Cubans in the Cuban leadership.  In 2003 there were six Afro-Cubans on the Politburo of the Communist Party, one quarter of the total.  There were a number of black provincial party leaders, notably in Havana and Santiago (quoted by Saney, p.107) and the presence of Afro-Cubans on the Council of State has also expanded as well as in provincial and municipal assemblies.  The TV news programme Mesa Redonda reported on 17 January 2003 that Afro-Cubans and mestizos (people of mixed race) represented 32.84% of deputies (MPs) voted into the National Assembly (the Cuban parliament).

Nevertheless, as Fidel Castro points out to Ignacio Ramonet (106) the situation of Afro-Cubans is still far from satisfactory.  It has commonly been accepted (Saney, Pedro Pérez Sarduy (107)) that the increased social divide that occurred during the Special Period of the 1990s, as the Cuban government introduced new measures to bring about economic recovery and to ensure the continued provision of services, also had the effect of holding back the advances made to combat racism in Cuban society.  Many black Cubans again found themselves at a greater economic disadvantage during the years of economic hardship. To a large degree this situation stemmed from the fact that the majority of those Cubans receiving remittances from abroad to alleviate the worst effects of the Special Period were white.  The Centre of Anthropological Research (Centro de Antropología) estimated that 30-40% of white Cubans, as opposed to 5-10% of black Cubans receive money from abroad.  Secondly, with the development of the tourist industry during the same period, the arrival of European firms to manage Cuban hotels brought to the island discriminatory attitudes relating to employment.  Afro-Cubans were confined mostly to menial jobs and constituted only about 5% of the workforce within tourism, while white Cubans were given managerial and front-line positions with access to much coveted dollar tips.  In some cases black Cubans were prevented from entering hotels (108).  Therefore, as Saney writes (109) “It should not be surprising that in the “race for dollars” those who are precluded from “legitimate” avenues choose “illegitimate” means by which to acquire foreign money.” 

Being denied the advantages enjoyed by the white population in the tourist industry, some Afro-Cubans sought to access dollars using illegal means.  This led to the revival in racist attitudes including the stereotype of black people as having a predilection for crime and prostitution.  In a more general sense, too, there was a resurgence of racism – which unfortunately persists to the present.  Lamentably, on her frequent visits to Cuba the author of this article has encountered overtly racist comments made informally by white Cubans about their black compatriots (which she has always challenged).

On the other hand, she could cite the numerous examples of instances where she has witnessed interaction between people of all ethnic groups, all of which have been in a spirit of friendship and solidarity:  within families, between neighbours and friends, among young people, pensioners’ groups, CDR groups, in cultural activities of all sorts, and not least in Santa Clara dancing in the Parque Vidal on a Sunday evening.

The leadership has not adopted a passive stance towards this revived racism.  Raúl Castro, at the time First Vice President of Cuba announced:   “…that if a person is denied entry to a hotel because he or she is black, then the establishment should be closed, thus applying our laws, even if the installation concerned is a joint venture [a hotel with joint ownership by a European company and the Cuban government, but which is run by the company]” (110)   And Raúl Castro meant what he said.  Saney mentions how previously a contract with the Spanish firm Guitart Hotels, SA had been voided when the management fired 800 workers, almost all of whom were black.  Following this, Guitart was sued successfully for discriminatory practices by the CTC (the equivalent of the Cuban Trades Union Congress).  He also quotes a complaint of discrimination against the management of the Parque Central Hotel which was resolved successfully.  The author mentions how “based on visits to various hotels, there has been a marked and substantial increase in the number of black Cubans ‘behind the desks.’” (111)

Fidel Castro also frequently expresses his condemnation of racism while acknowledging its continued existence in Cuba.  In 2003 he delivered his most detailed and heart-felt criticism at the Pedagogy Conference (112) and in his conversations with Ignacio Ramonet he declares his dissatisfaction with the unequal position of Afro-Cubans in society (113). 

With specific reference to the police, Fidel describes how he complained to the producer of a TV programme which was about police efficiency in tackling crime and which habitually showed black and mixed-race offenders.  He did so because he was concerned about the reinforcement of negative racial stereotypes (114) in addition to the fact that no publicity was ever given to white-collar crime.            

                                                                                                                           
As a result, new initiatives are being put in place to combat the scourge of inequality.  Priority is given to the importance of education to lift the marginalised communities out of poverty – poverty being seen as a main cause of criminal activity.  Vocational courses have been created which, if taken to a sufficiently high level, will allow access to university.  Professional training courses, such as those in teaching and social work, are given special attention in respect to their ethnic composition.  Education is also promoted during military service (usually 3 years):  recruits are exempt from one year’s service if they have their Bachillerato (secondary school certificate) and from a 2nd (the final) year if they attend an intensive course for university entrance.  In addition, a new commission has been created, named The Commission for the Centenary of the Founding of the Independent Party for People of Colour (Comisión por el Centenario de la fundación del Partido Independiente de Color), in order to explore more ways of eliminating racial discrimination (115).  Finally, the study of Cuba’s African cultural heritage is also being promoted to reinforce this component of Cuban identity.  When the writer of this article was in Santiago in 2002, a librarian at the public library informed her of a series of talks being given on the historical links between the black community of that city and the black community in Jamaica.

Thus, again the commission has been found wanting in its observations.  It is, of course, correct when it alleges that racism exists in Cuba (as it so evidently does in the US also).  However it omits to mention the historical rôle the US played in reinforcing racial stereotypes and racial discrimination in Cuba and the tremendous benefits brought by the Revolution to Afro-Cubans.  Neither does it refer to the consequences of the increased hardship caused by the intensification of the Blockade in the 1990s in respect to racist attitudes. Finally, it fails to mention the priority given by the Cuban political leadership to the abolition of racism and racial disadvantages in Cuban society, arguably an attitude not reflected by the leadership of the current US government towards racism and racial disadvantages within the US itself (116).  
 
9.  Cuba and the US’s humanitarian policies

The Commission alleges:

“…The Cuban government’s “cynical manipulation of United States’ humanitarian policies….” (page 6)
 ‘ …. The generosity Americans have always extended to Cubans….’    (page 5)

The facts:
As a number of commentators have pointed out, US policy towards Cuba has been anything but humanitarian. 

In the early 1990s, Cuba found herself on the verge of a severe economic depression as a result of her loss of trade with the USSR and the socialist states of Eastern Europe (which had accounted for 85% of her total trade).  As a result the island turned to US foreign subsidiaries from whom the island received $500-$600 million a year in imports, 90% of which were food and medicine.  In 1992 the US passed the Torricelli Act (Cuban Democracy Act) designed, in the words of Congressman Robert Torricelli, to “wreak havoc on the island” by preventing Cuba from buying goods from US subsidiaries in third countries and ships from docking in Cuban ports.  Cuba was plunged into an economic crisis that hit the population in every aspect of their lives: (117)  In addition to food shortages, the impact of drug shortages, and the inability to access spare parts and materials required to ensure clean water supplies and the functioning of medical equipment had serious consequences for the health of the Cuban population.  The incidence of TB increased, there was an increase in the number of low birth weight babies and a rise in mortality rates for the over 65s.  Food shortages gave rise to the worst epidemic of neurological disease in the 20th century:  over 50,000 people suffered from optic neuropathy, deafness, loss of sensation, spinal chord disorder and pain in the extremities. 

Five months prior to the passing of the Torricelli Act, the American Public Health Association had warned the US government that tightening the blockade would lead to an abrupt cessation of essential goods and result in widespread famine.(118)  These warnings were ignored, the political aims of the Act to encourage social unrest and regime change being the US government’s prime concern. 

In February 1995 in a letter to the US government, the Inter-American Commission on Human Rights of the Organisation of American States pointed out that the “virtually unattainable terms of trade in food and medicine with Cuba” contravened international law.  The Commission called on the US government to make changes.  None were forthcoming.

Anthony Kirkpatrick, in his article (see footnote 91) describes how in 1997 the American Association of World Health issued a 300-page report on the impact of the US blockade on health and nutrition in Cuba which concluded “the embargo is driving the [Cuban health] system towards crisis and causing significant
suffering and death.”  The State Department simply responded by attributing Cuba’s difficulties to that country’s government’s “adherence to a discredited communist model which required military spending as a priority over other priorities such as health care.”  It claimed falsely that Cuba dedicated a smaller percentage of its budget to health care than countries such as Jamaica, the Dominican Republic and Costa Rica.
 
The figures for healthcare expenditure for 1994-2004, given by UNICEF (119) are:

Cuba:             23% of GDP
Costa Rica        21% of GDP
Dominican Republic    10% of GDP
Jamaica          7% of GDP

On the other hand, twelve years later, in his article ‘Health care in Cuba and the manipulation of humanitarian imperatives’ (120), Richard Garfield describes how, at a seminar titled ‘Humanitarian Aid for a Cuba in Transition’, convened on 16 January 2004 by the University of Miami and the US Agency for International Development (USAID), US government representatives suggested the use of health and nutritional assistance as a means to effect regime change in Cuba! 
 
In fact it was as a result of prioritising health spending that the Cuban government managed to overcome the worst effects of US policy.  Furthermore, despite the relaxation of laws relating to food and medical exports in October 2000, as we have seen above, it still remains virtually impossible for Cuba to import medicines and medical equipment from the US on account of the excessive obstacles posed.  In 2006 94% of all trade with the US was for food and agricultural products.   
 
To compound Cuba’s problems in its limited trade with the US, in 2004 payment for goods was made as difficult as possible.  All goods now have to be paid in full before despatch through third-party banks, thus incurring additional banking fees.  Furthermore, as a result of US pressure on banks around the world (121), Cuba encounters increasing difficulties in processing foreign currency required to pay for its US imports.  Further difficulties relate to shipping as third-country ships must be used, incurring the Cuban government with additional expenses.

Richard Garfield quotes an ironical example of the US’s approach to humanitarian gestures. He writes:  “While fining pharmaceutical firms for exporting to Cuba, a US firm won OFAC approval to develop and distribute three experimental cancer drugs created in Havana.  The administration could lose votes if it denied treatments to sick children in the USA.  State Department spokesperson Darla Jordan said, ‘As a matter of policy the United States will continue to consider license requests where there is the potential to benefit public health.’ ” (122)  Why can the same humanitarian approach not be applied toward Cuban public health?

However, when referring to the “United States’ humanitarian policies” the Commission probably is not referring to acts of humanity performed by the US government, but by NGOs and individuals – the latter usually being Cubans living in the US – who wish to send supplies or remittances on their own behalf to organisations or individuals within Cuba.  It is apparently because of the humanitarian character of the US government that these organisations and individuals are permitted to visit the island or send aid.  However, since 2000 the US has drastically restricted even these small acts of humanitarian concern. 

A Consular Information Sheet published in January 2007 (123) sets out the regulations covering travel to Cuba which is limited to a very small number of categories of US citizens.  The following gives an example of the draconian laws in force.  People with relations in Cuba are allowed one visit of no more than fourteen days to visit immediate family in any one three-year period.  Visitors are only allowed to take $50 per day for living expenses and just $50 per trip for transport expenses.  Individuals who wish to send cash remittances to family members on the island are permitted to send $300 to one household in any three-month period, so long as members of the household do not include government officials or members of the Communist Party.

Humanitarian considerations do not extent to charitable organisations wishing to send aid to the island who encounter similar restrictions.  Suzanne Perry wrote in an article published in the Chronicle of Philanthropy in 2006 under the title “Charity’s Barrier Island -  U.S. restrictions hamper nonprofit: efforts in Cuba” :
“Virtually every nonprofit group that has ties to Cuba is feeling the pinch, finding it increasingly difficult to ship humanitarian aid, undertake environmental or preservation projects, cultivate ties with religious groups or meet with professional peers.” (124)
 
 10.  Cuba’s “international meddling”
The Commission alleges:
“‘The Cuban dictatorship….still seeks to frustrate democratic governance in the region and to actively undermine United States interests.”   (page 5 )
“the Cuban dictatorship today is a destabilizing force in the region…”  (page 7)
The facts:
The  Commission’s description of Cuba’s international ventures as ‘meddling’ appears ironic in view of the 9 direct and indirect US interventions in Latin America alone (125) and continued interventions – both direct and indirect – in all parts of the globe against regimes of which the US regime may disapprove.  This is in addition to its continuous involvement in activities to oppose and destroy the Cuban state since the earliest years of the Revolution, including the attempted Bay of Pigs invasion in 1961, abuses of diplomatic protocol to incite dissention and social unrest and the most recent incitement made by President Bush in November 2007 to the armed forces in Cuba to stage an uprising against the government, with promises of a reward in the ‘new order’ for anyone who takes part (126).
 
In contrast, Cuba’s military involvement has been limited.  The island’s principal foreign involvement (although there was some involvement also in the Congo and Algeria in the 1960s) was in Angola where, in 1976 Cuban forces assisted the armed forces of President Neto to repel a South African invasion in the south of the country.  Finally, in 1988 the Cuban, Angolan and Namibian forces turned back the final invasion made by the South African army at the Battle of Cuito Cuanavale, delivering a final blow to the system of apartheid in South Africa.  Thus it is Cuba that can be thanked for extending democratic government to the 11 million Africans, people of mixed race and of Indian descent in that country.  In the same context, recent revelations have indicated that during the period of the war in Angola, the US had established collaborative links with apartheid South Africa, supplying that country with weapons with which to attack newly-independent Angola (127).
Cuba’s role in the demise of apartheid in South Africa was clearly recognized by Nelson Mandela, now a close friend of Fidel Castro.  Saul Landau, who was at Mandela’s inauguration as President of his country wrote:  “I remember watching Nelson Mandela’s inauguration as South Africa’s first black president and him shaking the hands of heads of state until he came to Fidel. Mandela grabbed the Cuban President in a bear hug and whispered, audibly, "You made this possible." (128).
 
During the past two decades, Cuba’s ventures on the international scene, far from “seeking to frustrate democratic systems and to act as a destabilizing force” as alleged by the Commission, have been to improve the lives of people in need and are characterised by vital medical outreach in developing countries.  To extend assistance to peoples in need in a spirit of international solidarity is seen as an integral part of the core values underpinning Cuba’s socialist society.
Best known are Cuba’s medical brigades.  In 2006 there were 32,187 Cuban doctors working in 72 countries (129), mostly in Latin America, the Caribbean and Africa.  Populations of countries such as Equatorial Guinea, Mali, Haiti, Guatemala, Bolivia and Venezuela who live in shanty towns or in remote rural areas now receive medical services to which they had no access previously.  In each country, the thrust of Cuban assistance has been to bolster public health infrastructures, sometimes in hospitals, but mainly in primary care clinics and medical posts in areas where local governments have been unsuccessful in attracting doctors to the public sector.  In many of these countries, large numbers of medical practitioners emigrate in search of well-paid work abroad or choose to set up private consultancies only in the wealthier suburbs and districts of cities.
In countries, such as Honduras, Haiti, Guatemala, Mali, South Africa and the Gambia, there are whole regions where the Cubans have been the first bearers of local medical services to rural, indigenous and other marginalized communities.  They practise the Cuban philosophy of combining measures to ensure public health and disease prevention with clinical medicine.(130)  Guyana’s president, Bharrat Jaadeo, leader of Caricom (a Caribbean trade community) commented in reply to complaints by President Bush about Caricom’s association with Cuba: “If Cuba were to withdraw their doctors from Haiti, their health system would collapse.” (131)
 
As well as providing much-needed medical services, in 19 countries there are Cubans running training courses for midwives, paramedics, social workers and HIV-AIDS prevention and treatment projects.

Health professionals on the ground often lead local courses for other community-based health personnel and participate in more formal training for paramedical and allied health professionals. Most recently, Cuban biomedical engineers and technical support have been increasingly in demand, repairing nearly 55,000 pieces of medical equipment since 1999. (See footnote 130).

On other levels, Cuban medical scientists and advisors have participated in the design of public health departments and systems, in epidemiological research and in campaigns tackling specific health problems (malaria in several African countries, dengue in El Salvador and Honduras, cholera in South Africa, etc.).  They have also worked with health ministries to devise more reliable statistical record-keeping and information systems in many countries, especially in those with the weakest infrastructures.

Under these agreements, the host country provides the Cuban workers with their air fare, accommodation and food, domestic transportation, a place of work, and a monthly stipend (usually US$150-$200), while the Cuban health ministry pays them their regular salaries and other logistical support.  In the case of wealthier countries, such as South Africa, the host government pays an additional salary, part of which is kept by the professionals and part of which is paid to the Cuban health ministry. (See footnote 130)

Recently, Cuba has taken a more pro-active role in initiating trilateral collaboration, in which a third country or agency donates resources for health programs developed between Cuba and another nation.  This was the case of the 2001-2002 vaccination drive in Haiti, when Cuban epidemiologists and family doctors teamed up with Haitian health authorities to immunize 800,000 children against five childhood diseases.  Funds from the French government and 2 million doses of vaccines from the Japanese government completed the triangle.  The German government contributed to Cuban projects with Niger and Honduras; and the WHO has supported Cuban collaboration in the Gambia and elsewhere. According to the Cuban government, 95 non-governmental organizations worldwide contributed to Cuban health projects between 1999 and 2004. (see footnote 129)

‘Operación Milagro’ (Operation Miracle) is a medical project jointly funded by Cuba and Venezuela operating in 28 countries to offer eye surgery free of charge to poor, remote and marginalised communities.  The operations are carried out both in Cuba and in ophthalmologic centres set up in the countries themselves.  Some 700,000 patients from these countries were treated in the three years between 2004 and 2007.  Six hundred Cuban health professionals are involved and the aim is to treat 6 million people over a 10-year period and to extend the programme to Africa and Asia.

Another group of patients – this time from Belarus – have been treated in Cuba.  Since the Chernobyl disaster of 1986, Cuba has treated 17,000 children free of charge, all of whom have been victims of the explosion.

Disaster relief has been a further aspect of Cuba’s overseas involvement.  The Henry Reeve medical brigade (132) was formed in August 2005 when 1,500 Cuban doctors volunteered to assist the population of New Orleans following the devastation caused by Hurricane Katrina.  Initially, this offer of aid was ignored by the US government while the world observed the plight of the New Orleans poor in their struggle to survive the floods and subsequent destitution. State Department spokesman Sean McCormack, while reading out the names of the long list of countries that had offered help, pointedly omitted mentioning Cuba.  Then, at a media briefing in the first week of September, McCormack said that the Cuban medical brigade was probably not needed in New Orleans and the surrounding areas (133).  However the brigade was welcomed with open arms in Guatemala later in the year where 700 members worked with the population which had virtually been abandoned following the extensive flooding and mudslides that struck the country.

Then in October 2005, six days after receiving news of the earthquake that affected 3,000 sq.km of Pakistan, Cuba sent 2,465 health workers, of whom 1,439 were doctors, and set up 32 field hospitals, some in the most remote mountain areas.  In total, about 1.7 million patients were treated during the seven months the team remained in the country (they were the last international team to leave).  All treatment in field  hospitals as well as in refugee camps was given free of charge.  President Musharraf of Pakistan was  unequivocal in his comments about the Cuban medical brigade:  “I have no words to express my gratitude.” (134).  Previously there had been no diplomatic contact between the two countries.

Similarly a 135-strong Cuban medical team was sent to Indonesia following the earthquake in May 2006 where they set up two fully-equipped field hospitals and treated about 90,000 patients in the first two months. 

Not only does Cuba send medical brigades abroad, it also provides medical training in the form of medical schools established by Cubans in 9 developing countries.  The first such medical school was set up in the Yemen in 1976 and today there are schools in Ethiopia, Equatorial Guinea, the Gambia, Ghana, Guinea Bissau, Guyana, Haiti and Uganda.

Within Cuba, the Latin American School of Medicine (ELAM) was established in 1999 to provide free scholarships to students from developing countries – mainly in Latin America and Africa.  These students, which include young people from poor communities in the United States, would have no possibility of  studying if it were not for the opportunity offered by Cuba.  In 2007, 2,100 foreign medical students from about 25 countries graduated from the School.  These included eight students from the US, all from ethnic minority backgrounds. (According to the Association of American Medical Colleges, just 6% of practising doctors in the US are from ethnic minority backgrounds.(135)  Graduates from the School of Medicine are not required to repay their studies, but give an undertaking that they will work in deprived communities.(136)

It is not just in health care that Cuba offers practical help to communities across the world.  The literacy programme devised in Cuba, Yo, sí puedo (‘Yes, I can’), has benefited over 2 million people in 16 countries in Latin America, the Caribbean, Africa, Asia and Oceania.  As a result it won the 2006 UNESCO-50 literacy award.  In addition to Spanish, versions of the programme include Portuguese, Creole, Quechua, Aymará and English (for its use in New Zealand).  Using modern technology, such as television and video, the programme facilitates learning with minimal resources, essential in societies where funds are very limited (137).

In a world where 850 million people (20% of the adult population) are illiterate, according to UNESCO, Yo, sí puedo has become so popular and there have been so many requests for this programme that a post has been created at the Instituto Pedagógico Latinamericano y Caribeño of Professor of Literacy and Education for Young People and Adults (Cátedra de Alfabetización y Educación para Jóvenes y Adultos) (138).
 
 The Commission alleges:
 “The Castro’s regime’s international meddling is done at the expense of the needs of the Cuban people.” (pages 2 and 6)

The facts:

In the context of this allegation one has to mention the alternative trade agreements that Cuba has entered into with other countries which stand in direct opposition to those implemented by the US, such as CAFTA (Central America Free Trade Agreement) in 1994, NAFTA (North American Free Trade Agreement between Mexico. Canada and the US), also in 1994, and the failed FTAA (Free Trade Area of the Americas).

Many criticisms have been levelled against CAFTA, NAFTA  and similar agreements led by the US which disregard the rights to good working conditions, trade union membership and welfare of workers in participating developing countries. The consequences of such agreements, which include the privatization of state-owned services (incurring high charges for basic services), large numbers of workers receiving minimal wages for long hours of work in very sub-standard conditions and tariff agreements that allow preferential conditions for the wealthy multi-nationals and US farmers (who, on account of receiving government subsidies undercut farmers in developing countries) have not endeared these treaties to any in the develop-ing world except the small number of wealthy people who have benefited from them.  As Kari Lydersen described in an article published during the highly charged debate taking place in Costa Rica in 2007 before the population voted whether or not to join CAFTA, the wealth generated by such agreements is not enjoyed by the bulk of the population:  “Increased investment has been in textile, electronic and other manufacturing – industries that are known for sweatshop conditions and for quickly pulling up stakes when cheaper labor becomes available elsewhere on the globe.”  The article points out that despite the Agreement, one million textile factory jobs had shifted from the Americas to Asia during the previous decade. (139)

The vision of the ALBA trade agreement (the Spanish acronym for the Bolivarian Alternative for the People of our Americas) set up by Cuba and Venezuela in 2004, but now with 26 participating countries shows a radically different approach to trade agreements.  As Carlos Lage, the Cuban Vice-President, expressed at the 5th ALBA Summit held in April 2007:  “To think about humans and not in [terms of] markets means subordinating the economy to politics and not subordinating politics to business, banks and transnationals.”  (140)  In other words, ALBA is a treaty based on a vision of social welfare for all, mutual economic aid and development and cultural projects.  These are expressed in its 12 Guiding Principles (141).

Today there are four full members of ALBA – Bolivia, Cuba, Nicaragua and Venezuela.  In addition there are 22 agreement partner countries (142):  Argentina, Antigua and Barbuda, Bahamas, Belize, Dominica, the Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Haiti, Jamaica, Mexico, Panama, Paraguay, Peru, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Surinam and Uruguay.   ALBA is quickly replacing CAFTA as developing countries become aware of the advantages of a non-competitive agreement in which the populations of all participants benefit.

It is apparent, therefore, that there exists an increasing trend in Latin America and the Caribbean away from globalization and neo-liberal economic policies and trade agreements imposed by the US.  The impoverished communities of the sub-continent are becoming aware of an alternative form of development – that of co-operation, the pooling of talents and resources with the benefits being shared among the population as a whole.  From the point of view of the US this could well be seen as a destabilising trend and a way to “actively undermine US interests” (quote from the report).  Certainly Cuba is a major player in this process away from serving the interests of the most powerful nation on earth.  The blatant hostility towards the island’s foreign policy expressed by the commission is certainly comprehensible!

CONCLUSION

The report produced by the Commission for Assistance to a Free Cuba is a dishonest document.

There are few people – not least the Cubans themselves and their political leaders – who would deny that, despite the high position the country occupies in international rankings, particularly in the context of the developing world, it cannot rest on its laurels.  Undoubtedly there are many aspects of people’s lives and of the country’s economy and infrastructure that need further development.

However, it should always be remembered that whatever Cuba has achieved, particularly since the 1990s, it has been with one hand tied behind its back.  Difficult circumstances have been greatly exacerbated, as has so often been pointed out in this article, by the blockade and particularly by its intensification, which has caused shortages, deficiencies and not least, the expenditure of funds Cuba could ill afford.  The Helms-Burton Act, which makes interference with Cuba’s sovereignty a stated policy, has occasioned additional expenditure for the defence of the country and for the purchase and transportation of necessary imports – money that otherwise could have been spent on the well-being of the population and on improving the country’s infrastructure.

Furthermore, the Commission has been disingenuous in its allegations of a cynical disregard on the part of the Cuban government and political leadership towards the hardships experienced by the population and towards the deficiencies encountered in the functioning of public services and the economy.  Indeed, what appears to the writer of this article to be more the case is the awareness and concern on the part of policymakers that problems need to be dealt with and new measures introduced.  These have included projects undertaken in ‘joint ventures’ with foreign companies, restructuring the economy to allow private enterprise (both in agriculture and in urban areas) as well as the development of initiatives, such as tourism, the biotechnology industry and the ALBA trade agreement to overcome the grave problems posed by the blockade.

If Cuba is successfully on the road to overcoming the near devastation of the early 1990s, while still maintaining intact its free social provision, other populations of the developing world continue to suffer poverty with little prospect of any real improvement to their lives, despite the absence of a blockade.  In clear contrast to those populations, Cuba has been “identified as one of the few countries in which less than 10 percent of its population is subject to “human poverty” (United Nations Development Programme 1996 – a year when Cuba was still experiencing extreme economic difficulties) (143).  On the other hand, in 2002 Latin America Weekly reported that more than 40-60% of Latin America’s population lives in poverty. (144)   It should also be mentioned that Cuba is the one country mentioned in the Living Planet Report, produced in 2006 by the World Wildlife Fund, which has managed to achieve High Human Development (based on the criteria of the HDI Index) while maintaining the necessary levels of sustainability (145).

The reason for Cuba’s success has been encapsulated by Fidel Castro:  “ If Cuba has successfully carried out education, health care, culture, science, sports and other programs, which nobody in the world would question, despite four decades of economic blockade . . . it has been thanks to its privileged position as a non-member of the International Monetary Fund.”  (Fidel Castro, April 12, 2.000, addressing the Group of 77 at the South Summit Conference (146).

Yet it is the stated policy of the Commission to privatise Cuba’s infrastructure and industries “as part of a transition to an open, market-based economy” (page 27), which will enable the island to establish member-ship of the IMF – a recipe that has led to increased inequality, poverty, injustice, economic dependence, debt and instability in so many other developing countries of the world!

In 2001 Latin America Weekly reported that in Brazil, Colombia, Guatemala, Honduras and Nicaragua the top 20% “earn over 60 percent of national income, while the poorest 20 percent earn less than 3 percent.” (147)  On a global level, the distinction is even more marked:  in 2003 (UNDP, 2003) the wealthiest 1% of the world’s population had an income equivalent to the total income of the poorest 57% (3.2 billion people).  One is moved to ask why the Commission’s stated concern about government negligence and indifference in the context of Cuba is expressed so forcefully even when there is abundant evidence of real poverty, injustice and negligence in countless other countries.  Perhaps some of their concern could be directed towards those populations in those countries (and in their own) which are not as fortunate as the Cuban population.

Cuba, on the other hand, has not forgotten its obligations towards these people.  It considers its initiatives and collaboration in development programmes in order to offer hope and a better life to millions a duty arising from an ideology of equity and social justice from which the global powers can only stand to lose.  It may well be for this reason that so little is reported by the news media about Cuba’s role internationally.  No doubt it is also the reason for the ‘regime change’ so passionately desired by the US and for which it and its supporters go to such great lengths to misinform the public in countries throughout the world.
 
NOTES:

(1)  Statement from the  declassified ‘Program of Covert Action against the Castro Regime’ dated 16.03.1960, quoted in Psywar on Cuba  by Jon Elliston (publ. Ocean Press).  The book publishes copies of declassified documents which reveal actions intended to undermine and discredit the Cuban government in the early 1960s, such as supporting Cuban émigré terrorist attacks on the island,  setting up a US-controlled radio station, propaganda blitzes aimed at the foreign press (the Manchester Guardian and the Observer are mentioned) so that it adopts a more pro-US stance, fabricating documents as ‘proof’ of Cuba’s ‘international meddling’ and organising “subtle sabotage”  to weaken the economy, (such as wasting electricity and damaging sugar stalks in the harvest). Other declassified documents reveal plans to undermine and/or kill Fidel Castro.   In 1975, the Senate Select Committee to Study Government Operations reported finding “concrete evidence of at least 8 plots involving the CIA to assassinate Fidel Castro from 1960-65.”  One such plot involved commissioning 2 mafia figures on the Attorney General’s 10 most-wanted fugitives list  (http://nation.ittefaq.com/artman/publish/article_37147/shtml).  In 2001 declassified CIA documents dated March 1967 about Operation Northwoods revealed the military’s plans to carry out terrorist attacks within the US so as to blame them on the Cuban government and provide “Justification for US Military Intervention in Cuba” (http://www.ratical.org/ratville/CAH/Northwoods.html). Other documents mention the CIA’s knowledge of a ship carrying germs to Cuba from Florida in 1980, organised by the émigré terrorist group Omega-7: (http://www.cooperativeresearch.org/timeline.jsp?timeline=cuba).  Papers released in May 2005 identify Luis Posada Carriles as one of the “engineer[s]” of the October 1976 bombing of Cubana flight 455 from Barbados to Cuba, killing all 73 people on board. The US, who had discovered the plans to bomb the airliner in September, did not alert the Cuban authorities and Posada, convicted of an attempted assassination of Fidel Castro in Panama in 2000 and who also has boasted responsibility for bomb attacks in Havana in 1997, is living freely in the US.

(2)  http://www.guardian.co.uk/cuba/story/0,,2005898,00.html

(3)  http://www.reuters.com/article/businessNews/idUSN1829040120070719?sp=true

(4)  By way of example, see the SOA Watch website:  http://www.soaw.org/type.php?type=8   The SOA Watch website describes “The School of the Americas (SOA), in 2001 renamed the “Western Hemisphere Institute for Security Cooperation,” … a combat training school for Latin American soldiers, located at Fort Benning, Georgia.    Over its 59 years, the SOA has trained over 60,000 Latin American soldiers in counterinsurgency techniques, sniper training, commando and psychological warfare, military intelligence and interrogation tactics. These graduates have consistently used their skills to wage a war against their own people. Among those targeted by SOA graduates are educators, union organizers, religious workers, student leaders, and others who work for the rights of the poor. Hundreds of thousands of Latin Americans have been tortured, raped, assassinated, “disappeared,” massacred, and forced into refugee by those trained at the School...”

(5)  www.cuba-solidarity.org/

(6)  The HDI is published annually.   Introduction to 2006 HDI Report, Country Fact Sheet on Cuba.
       http://akgul.bilkent.edu.tr/hdr/hdr2006/statistics/countries/country_fact_sheets/cty_fs_CUB.html  

(7)  http://hdr.undp.org/statistics/data/country_fact_sheets/cty_fs_CUB.html   The quote is from the introduction to the HDI 2005 Fact Sheet on Cuba.

(8)   http://hdr.undp.org/hdr2006/pdfs/report/HDR_2006_Tables.pdf  The other categories are Medium Human Development (64th  to 146th) and Low Human Development (147th to 177th)

(9)   which “measures severe deprivation in health by the proportion of people who are not expected to survive age 40. Education is measured by the adult illiteracy rate.  And a decent standard of living is measured by the unweighted average of people without access to an improved water source and the proportion of children under age 5 who are underweight for their age.”  -  Introduction to 2006 report http://akgul.bilkent.edu.tr/hdr/hdr2006/statistics/indicators/17.html 

(10)    http://www.unicef.org/sowc07/docs/sowc07.pdf   page 111
 
 (11)  http://www.wssinfo.org/pdf/country/CUB_wat.pdf

(12) ‘Necessity of ending the economic commercial and financial embargo imposed by the United States of America against Cuba
 
 (13)  http://www.cubaminrex.cu/english/Look_Cuba/Society/2007/FAO.htm

(14)  http://memory.loc.gov/frd/cs/profiles/Cuba.pdf   page 11

(15)  http://www.unep.org/Documents.Multilingual/Default.asp?DocumentID=504&ArticleID=5558&l=en

(16) http://typo38.unesco.org/en/worldwide/ihp-lac.html

(17) http://www.agualatinoamerica.com/docs/PDF/DeLaLaveSepOct02.pdf:  
See Tratamiento de aguas residuales
en  Latinoamérica  -  Kelly A Reynolds, publ. In Agua Latinoamérica Sept/Oct. 2002

(18)  http://www.ucmh.sld.cu/rhab/vol5_num2/rhcm08206.htm
Instituto Superior de Ciencias Médicas de La Habana: Principales causas de mortalidad general en Cuba.  Año 2004

(19)  ‘Towards Socially Responsible Infrastructure Privatization’,  presented in September 2002 at the Americas’ Conference on Corporate and Social Responsibility held in Miami

(20)  See footnote (12) above  

(21)   See the article Para que tengamos agua published in Granma Internacional, 6 April, 2008, pages 8-9.

(22)   http://www.one.cu/aec2006/anuariopdf2006/capitulo1/I.28.pdf  (Oficina Nacional de Estadísticas)

(23)   http://www.hidro.cu/calidad.htm  Instituto Nacional de Recursos Hidráulicos:  Gestión integrada del agua

http://www.tierramerica.net/2003/0302/noticias4.shtml
CUBA: Más agua potable en La Habana por inversion extranjera por Patricia Grogg

(25)  Stephen Gibbs: ‘Drought brings Cuba to its knees’ publ. 30/07/2004 by Independent, found on Energy Bulletin website.   http://www.energybulletin.net/1340.html

(26)  On account of the severe economic crisis faced by Cuba after the fall of socialism in the USSR and Eastern Europe and the  intensification of the US blockade during the same period

(27)  These 3 schemes are the ‘Trasvase Centro-Oeste’ from the south of Sancti Spiritus through Ciego de Ávila to south of Camagüey;  the ‘Trasvase Este-Oeste’, supplying water to the provinces of Holguín, Las Tunas, the north-east of Camagüey and the north and centre of the Cauto Valley and the ‘Norte-Sur’, which connects two sets of rivers to increase the water supply in the province of Guantánamo.

(28)  http://www.cubasolar.cu/biblioteca/energia/Energia30/HTML/articulo05.htm

(29) 
http://revistas.mes.edu.cu:9900/EDUNIV/03-Revistas-Cientificas/Ingenieria-Hidraulica-y-Ambiental/2002/2/45002207.pdf       

(30) http://www.acdi-cida.gc.ca/CIDAWEB/acdicida.nsf/En/NIC-223122217-NDJ  Canadian International Development Agency -  Canadian Cooperation Program in Cuba
See also
http://www.euskadicuba.org/images/Proyectos%20de%20cooperaci%F3n%20en%20ejecuci%F3n.doc
PROYECTOS de COOPERACION

(31)  http://www.agualatinoamerica.com/docs/PDF/0701Velizetal.pdf  Evaluación de Equipo Ozonizador Doméstico para Tratamiento de Agua

(32) meaning connection to a public sewer, septic tank or a latrine

(33) http://www.childinfo.org/areas/sanitation/pdfs/2006/cuba_san06.pdf
See also UNICEF’s 2007 report ‘The State of the World’s Children:
http://www.unicef.org/sowc07/docs/sowc07.pdf p.113
and http://www.unicef.org/infobycountry/cuba_statistics.html

(34)  http://www.wssinfo.org/en/338_san_latino.html   WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation  (see the section Sanitation Data)

(35)  http://www.one.cu/aec2006/anuariopdf2006/capitulo1/I28.pdf  Oficina Nacional de Estadísticas

(36)  http://www.one.cu/aec2006/anuariopdf2006/capitulo1/I.25.pdf

(37)  http://www.unicef.org/sowc07/docs/sowc07.pdf  UNICEF 2007 report:  State of the World’s Children  Page 113, Table 3.

(38)   http://lnweb18.worldbank.org/LAC/LAC.nsf/ECADocByUnid/4112F1114F594B4B85256DB3005DB262?Opendocument
World Bank report 2003:  Inequality in Latin America and the Caribbean:  Breaking with History?
(39)   http://www.one.cu/aec2006/anuario/pdf2006/capitulo1/I.28.pdf
(40)  See footnote (21) above – article by Patricia Grogg

(41)  Accessible Information on Development Activities: http://aida.developmentgateway.org

(42)  UN Development Programme :  Apoyo al Programa de Saneamiento del Ecosistema:  Bahia de la Habana 

(43)  http://www.agualatinoamerica.com/docs/PDF/DeLaLaveSepOct02.pdf   Tratamiento de Aguas Residuales en Latinamérica

(44)  See Kelly A Reynolds, footnote (17)

(45)  Informe Analítico de Cuba/Evaluación regional de los servicios de manejo de residuos sólidos municipales

(46)  ‘El análisis sectorial de residuos sólidos de Cuba, seis años más tarde’  (a follow up to a report written in 1997.
 
 
(47)  http://www.one.cu/aec2006/anuariopdf2006/capitulo1/I.49.pdf   Oficina Nacional de Estadísticas de Cuba                                                                                                

(48)  Every neighbourhood in the country has a neighbourhood group – a CDR (Committee for the Defence of the Revolution), which,  in addition to organising civil defence, carries out a number of different social and educational activities as well as various forms  of voluntary work, such as the collection of recyclable waste.  Participation in these groups  which will encompass between 60-100 households, is entirely voluntary.

(49)  Globalization, Development and Municipal Solid Waste Management in Third World Cities by Martin Medina

(50)  http://www.ccad.ws/documentos/talleres/2006

(51)  http://www.sidsnet.org/docshare/other/20031105162032_Analysis_of_sectoral_solid_waste.ppt    ‘ Evolución del Análisis
Sectorial de Residuos Sólidos de Cuba seis años más tarde’  2003

(52)   http://www.one.cu/aec2006/anuariopdf2006/capitulo1/I.49.pdf   Oficina Nacional de Estadísticas de Cuba

(53)   Kelly A Reynolds notes that in the US there are 33,000 sites of abandoned toxic waste of which about 42% produce leachates that affect the underground water table.  This is despite tight controls and regulations relating to the quality of water in the aquifers.  See  Aguas Residuales y Riesgos de la Contaminación del Agua Potable, published in Agua Latinoamérica Vol. 5  No. 4 (about 2006  http://www.agualatinoamerica.com/column.cfm?T=T&ID=5822            
 
(54)  http://www.canurb.com/media/Presentations/BS_605/RBetancourt100205.pdf  CDM Investment Opportunities in Cuba, p.7

(55)  http://www.sodepaz.org/cooperacion/PAISES/cuba/cardenas.htm  Recogida de residuos sólidos en la ciudad de Cárdenas

(56)  UN Development Programme:  Apoyo al Programa de Saneamiento del Ecosistema Bahía de la Habana

(57)  Asociación Cubana de Ingeniería Sanitaria y Ambiental :  http:www.inhem.sld.cu/Acis/docs/informe_trabajo2005-2006.pdf 

(58)  Reference  to the 1997 report is made in a follow-up report produced in 2003: ‘El análisis sectorial de residuos sólidos de Cuba,  seis años más tarde’  which describes the measures that have been taken to improve the disposal of solid waste.  (Law 81 on the Environment of 1997 confers upon the Cuban state the duty of ensuring safe waste disposal via the Ministry of Economics and Planning and the Ministry of Public Health)

(59) One example is a study carried out by 2 Swiss researchers, Claudia R. Bindera, and Hans-Joachim Mosler: Waste-resource flows  of short-lived goods in households of Santiago de Cuba  on the website for ScienceDirect -

(60)  http:www.monografias.com/trabajos46/residuos-solidos/residuos-solidos2.shtml

(61) http://www.juventudrebelde.cu/cuba/2007-07-08/proyecto-medioambiental-guantanamero-resulta-premiado/                     

(62)  Agenda ambiental de la ciudad de Pinar del Río, una herramienta de gestión urbana:    http://www.ciget.pinar.cu/No.2005-4/agenda.htm   

(63)   http://www.medioambiente.cu/revistama/9_06.asp   Manejo de desechos peligrosos en cuba. Situación actual y perspectivas

(64) http://www.alihuen.org.ar/coalicion-ciudadana-anti-incineracion/manejo-de-los-residuos-hospital-2.html   Manejo de los  residuos hospitalarios by Hollie Shaner and Glenn McRae of CGH Environmental Strategies, Inc. Vermont, USA.                       

(65 )http://www.disabilityworld.org/April-May2000/IntntalNews/Cuba.htm

(66)  Pan American  Health Organization:  Health Situation in the Americas:  Basic Indicators 2007 
 http://www.paho.org/English/DD/AIS/BI_2007_ENG.pdf
 
(67)   http://www.who.int/whosis/whostat2007.pdf pages 23 (Cuba), 31  (US & the Americas)

(68)   News-Medical Net, 13 September 2006:   http://www.news-medical.net/?id=20107   

(69)  Pan American  Health Organization:  Health Situation in the Americas:  Basic Indicators 2007 
http://www.paho.org/English/DD/AIS/BI_2007_ENG.pdf

(70)   http://www.unicef.org/sowc07/docs/sowc07.pdf  (page 102)  The year after this statistic was published, Cuba recorded a drop in infant mortality to 5.3 per 1000 life births.

(71)   http://www.unicef.org/sowc07/docs/sowc07.pdf  (page 105)  However the infant mortality rates for some ethnic minority groups, such as those for African-Americans (at 9.3%) are considerably higher.

(72)   http://www.wicuba.org/world_bank.htm

(73)   Publ. in the Journal of Public Health Policy, 2004, this article gives a very detailed account of Cuba’s health policy.  It can be found at:   http://findarticles.com/p/articles/mi_qa4020/is_200401/ai_n9387386/pg_1

(74)  ‘Letter from Cuba’ publ. in  J. Neurol. Neurosurg. Psychiatry, 2003:74:286  -  http://jnnp.bmj.com/cgi/reprint/74/3/288.pdf    

(75) ‘Cardiovascular Disease and Associated Risk Factors in Cuba: Prospects for Prevention and Control’  by Richard S. Cooper, MD, Pedro Orduñez, MD, Marcos D. Iraola Ferrer, MD, Jose Luis Bernal Munoz, DDs and Alfredo Espinosa-Brito, MD, PhD, Vol. 96, No.1

(76)  By Drs. MacDonald, Holperin, Chaple, Scott and Kirk, published in July/August 2006 in the Canadian Journal of Infectious Diseases and Medical Microbiology.

(77)  http://www.unicef.org/infobycountry/cuba_statistics.html

(78)  Pan American Health Organisation report 2005:  Health Situation Analysis and Trends Summary:     
http://www.paho.org/English/DD/AIS/cp_192.htm  (the most recent figures given are from 2000)

(79)   BBC Mundo:   http://news.bbc.co.uk/hi/spanish/specials/2006/salud/newsid_5219000/5219870.stm

(80)   http://www.rxpgnews.com/medicalnews/healthcare/usa/article_5018.shtml

(81)  See the article by Andrés Martínez Fernández ‘Comunicaciones para salud en países en desarrollo ¿lujo o necesidad?’ on
https://upcommons.upc.edu/revistes/bitstream/2099/1452/1/01_Comunicaciones.pdf
See also the report ‘Equity and Reform in the Health Sector of Latin American and the Caribbean from 1995-2005’ commissioned by the International Society for Equity in Health – Chapter of the Americas, published April 2006.  The report states that one of the main problems in health sector reform in Latin America is the lack of incentives to attract skilled professionals to stay and work in poor and rural communities.  They prefer to work instead with the wealthier communities    in the urban areas – as was the case in Cuba before the 1959 revolution.  The Pan American Health Organisation has reported that over one quarter of the population of Latin America has no regular access to basic healthcare and that just over one half has regular medical insurance. 
(Quoted in BBC Mundo :
http://news.bbc.co.uk/hi/spanish/specials/2006/salud/newsid_5219000/5219870.stm.)
 
(82)   http://www.cubasolidarity.net/waitzkin.html

(83)  http://news.bbc.co.uk/1/hi/world/americas/1535358.stm

(84)   http://news.bbc.co.uk/1/hi/programmes/newsnight/5232628.stm

(85)   Report by ‘Results’:  http://www.results.org/website/article.asp?id=839

(86)   Reported in The Scotsman, 2 May 2001:
http://www.globalexchange.org/countries/americas/cuba/1293.html

(87) ‘A Review of US Policy toward Cuba’.  The Cuba Working Group is a 46-member group, evenly divided between Republicans  and Democrats.

(88)  Published in The Lancet Vol. 364, 18 December 2004. 

(89)  ‘The US attack on Cuba’s Health’ published in the journal of the Canadian Medical Association on 1 August 1997)
http://www.cmaj.ca/cgi/reprint/157/3/281.pdf

(90)  The US government has set up a hotline in Miami to encourage the public to report suspected illegal shipments of medications to Cuba

(91)  Quoted by Dr. Anthony Kirkpatrick in his article ‘Role of the USA in shortage of food and medicine in Cuba’ published in The  
Lancet 30 November 1996:  http://www.cubasolidarity.net/Kirkpatrick-lancet.pdf
 
(92)  http://64.233.183.104/search?q=cache:uqzahP6LCkIJ:www.cubavsbloqueo.cu/portals/1/Informe%2520Bloqueo%2520Ingl.
Doc+US+blockade+paho+cuba+medical+products+2006&hl=en&ct=clnk&cd=15&gl=uk  

(93)  http://cuba.blogspot.com/2007/05/cuba-set-to-negotiate-us-agricultural.html
Cuba set to negotiate US agricultural imports 5/27/2007

(94) http://www.unicef.org./infobycountry/cuba_statistics.html

(95) http://www.unicef.org/infobycountry/usa_statistics.html    Child Health USA 2004 points out that In 1984 the general percentage of infants with low birth weight in the US had been 6.4%.  The figures during the first years of this decade are the highest for the past 3 decades.  In addition, figures published in the report Child Health USA 2005 produced  by the US Dept. of Health & Human Services, Health Resources & Services Administration, Material & Child Health Bureau indicate that in 2004 the percentage of infants with low birth weight born to African Americans was 13.7. In 2003 andf 2002 the figures were 13.6 and 13.4 respectively.   
(http://www.mchb.hrsa.gov/chusa_06/healthstat/infants/0302lbw.htm)

(96) http://www.unicef.org/sowc07/docs/sowc07_fastfacts_tacro.pdf

(97)  CEPAL:  Annual Statistics for Latin America and the Caribbean, 2006.

(98)  CEPAL:  Annual Statistics for Latin America and the Caribbean, 2006:   
http://www.eclac.org/publicaciones/xml/4/28074/LCG2332B_1.pdf   See also  (50) above.

(99)  See UNICEF statistics mentioned in (51)

(100)  See the report ‘Cuba Sustainable Agriculture Study Tour, May 21-30 2003’  sponsored by Washington State University &
The Center for Sustaining Agriculture and Natural Resources:  http://csanr.wsu.edu/Cuba/CubaTripReport2003-09-09.pdf           

(101)  http://www.mountainpartnership.org/newsletter10.html  :  “Within the context of the Turquino-Manati Plan, an on-going TCP  project is putting local governing bodies in place to improve the quality of life and food security of mountain communities.  The project is doing this by strengthening the coordination and communication between multiple service providers, and  between communities and extension service providers.  It is also building the capacities of local experts as trainers in thesocial and learning aspects of extension, field test advanced bio-technology and organic technologies and involving communities in the design and management of mountain demonstration farms (or Fincas demostrativas’).  A revised multi-sector mountain extension policy “Sistema de Extensión Agropecuario y Forestal” has been drafted and an implementation plan Developed.” – Information about Cuba from the Mountain Partnership website.
(102)  Ignacio Ramonet ‘Cien horas con Fidel’, page 261 published 2006 by the Oficina de Publicaciones del Consejo de Estado 
(103)  In ‘Cien horas con Fidel’, Fidel Castro describes how the prestigious Jesuit schools that he attended in Santiago (el colegio de Dolores) and Havana (el colegio de Belén) did not admit black and mestizo pupils                                                                            
(104) Quote from Isaac Saney ‘Cuba – A Revolution in Motion’ Ch. 3. p.100
(105) Article 42 of the Constitution states that “discrimination because of race, colour, sex or national origin is forbidden and is punished by law;   Article 295 of the Cuban criminal code establishes fines and sanctions of between 6 months and 2 years for discrimination and incitement of hatred on the basis of gender, race or national origin (both quoted from Saney Ch. 3)
(106) Cien Horas con Fidel pages 261-2
(107) http://www.afrocubaweb.com/pedroperezsarduy/psseminar.htm  Race & Identity in Cuba 2003 – Pedro Pérez Sarduy     
(108)  See http://cubainfo.fiu.edu/Documents/DelaFuente.doc  the article Racism, Culture, and Mobilization by Alejandro de la        Fuente of the University of Pittsburgh which gives a comprehensive summary of the problem of racism in Cuba.
Also
http://www.trinitydc.edu/academics/depts/Interdisc/International/caribbean%20briefings/RecreatingRacism.pdf  in which   Alejandro de la Fuente gives a detailed account of the growth of racism during the Special Period.                                                               

(109) Op cit page 110.
(110)  Quoted by Raisa Pages in her article ‘On Gender and Racial Equality’ printed in Granma International on 18 March 2000
(111)  Saney pages 111-2
(112)  Saney, page 113-4
(113)  Cien Horas con Fidel  pages 261-5
(114)  Cien Horas con Fidel, page 263  Quote:  “¿Para qué sirve eso?  Para asociar el delito que irrita más a la población a un grupo étnico determinado.”
(115) The Chair of the Commission, Fernando Martínez Heredia stated in his inaugural speech on 27 December 2007: “It is this 
Commission’s responsibility to … broaden a part of national conscience and raise awareness about the wicked and tenacious   
cultural burden of racism in Cuba. Thus it must foster understanding of the national culture’s plurality and turn that complex wealth into a force majeure regarding our way of life and the project we stand for.” (“Le toca a esta Comisión … darle de ancho  a una parte de la conciencia nacional y ayudar a comprender mejor el avieso y tenaz lastre cultural que significa el racismo en nuestro país. Debe auspiciar así la comprensión del carácter plural de la cultura nacional, y la conversión de esa riqueza compleja en una fuerza mayor en la base de la manera de vivir y del proyecto que defendemos.”)

(116)  The US Census News site released on 29 August 2006 showed Afro-Americans as having the highest rates among people  living below the poverty level within the US: 24.9% - the rates for white Americans being 8.3%.   7.2 million (19.6%) of Afro-Americans had no health insurance (the national average being 15.9%).
http://www.census.gov/PressRelease/www/releases/archives/income_wealth/007419.html     The 2000 census showed further
disadvantages suffered by the Afro-American community:  just 4.8% of Afro-Americans were graduates or possessed a professional qualification compared with 9.8% of the white population.  A Batchelor’s degree was held  by just 9.5% of Afro-Americans as opposed to 16.6% of their white counterparts.   7.9% of Afro-Americans had studied to a lower level than 9th grade compared with 5.9 white America.
 
(117)  See  “Health and Human Rights in Cuba” by Pol de Vos, Mariano Bonet and Patrick Van der Struyft, published in The      Lancet, 2004  and “US Attack on Cuba’s Health” by Anthony F Kirkpatrick, published in 1997 by the Canadian Medical        Association Journal.

(118)   http://members.allstream.net/~dchris/CubaFAQ137.html

(119)  ‘The State of the World’s Children’:   http://www.unicef.org/sowc07/docs/sowc07.pdf        

(120)   Richard Garfield, DrPH, Publ. in the Lancet, Vol. 364, Issue 9438, dated 11 September 2004

(121)   See Reuters article ‘International banks shun Cuba under US scrutiny’ published on 19 July 2007: http://www.reuters.com/article/businessNews/idUSN1829040120070719?sp=true

(122)  Richard Garfiield’s quoted source:  ‘Elias P. Cancer drug deal with Cuba OK’d’  Los Angeles Daily News, 17 July 2004:
http://www.dailynews.com/Stories/0,1413,200~20950~22785

(123)  http://travel.state.gov/travel/cis_pa_tw/cis/cis_1097.html  The document emphasises that tourist travel to the island is prohibited and that “this restriction includes tourist travel to Cuba from or through a third country such as Mexico or Canada.  U.S. law enforcement authorities have increased enforcement of these regulations at U.S. airports and pre- clearance facilities in third countries.  Travelers who fail to comply with Department of Treasury regulations will face civil  penalties and criminal prosecution upon return to the United States.”   This document contains descriptions of Cuba with which the writer of this article – who has made 7 trips to the island as an independent traveler - does not concur.

(124)  From the issue dated May 18, 2006 :   http://www.philanthropy.com/free/articles/v18/i15/15000701.htm   The article gives examples of the severe curtailments in the activities of charitable organizations.  Here are two examples:  1. “It's Just the Kids, in Washington, was notified by the Treasury Department in early April that its license to build playgrounds in Cuba had been amended: It is now permitted to bring only three volunteers per playground site instead of 25 and must complete its projects within four days, instead of two weeks. What's more, the group's license would expire that month, instead of in April 2007.”   2.  “Operation USA, in Los Angeles, has been shipping medical supplies to Cuba for 10 years. But when the Treasury Department renewed its license in January, it added a new restriction: The charity could no longer send teams of doctors to Cuba to train their Cuban counterparts.”

(125)   For further information about US invasions and interventions in Argentina, Brazil, Chile, Cuba, Dominican Republic, Grenada, Guatemala, Haiti and Nicaragua in the 20th century, see the article on the Global Policy Forum Website ‘US Interventions   Abroad – By Regions’ :  http://globalpolicy.org/empire/history/regindex.htm

(126)  Neither should one forget US involvement in Cuba’s political affairs from 1898 onwards.  In Cien Horas con Fidel (p.374)             Fidel Castro describes how in 1898, the peace negotiations relating to Cuba’s independence and sovereignty which took place in             Paris following the war against Spain were conducted by Spain and the US, Cuba being excluded from the proceedintgs!  This event was followed by continued US involvement in which agreements, such as the Platt Amendment of 1901 which gave the US the right to intervene in Cuban affairs.  The occupation by the US of an area of Guantánamo against the wishes of the Cuban government is another indication of the lack of respect the US has relating to issues of sovereignty.                                                                       

(127)  These revelations are mentioned in the book Conflicting Missions: Havana, Washington, and Africa, 1959-1976 (The University of North Carolina Press). By Piero Geijeses, a former CIA station chief who uses material released by the National Security Archive, Washington, in 2002

(128)  http://members.allstream.net/~dchris/CubaFAQ131.html  Saul Landau is Director of Digital Media and International Outreach for the College of Letters, Arts and Social Sciences at the California State Polytechnic University Pomona                                                                     
(129)  Quoted by Dr Juan Carlos Dupuy Nuñez, head of Cuba’s emergency medical team, in an interview given to the magazine published by the UK Cuba Solidarity Campaign, CubaSí, Summer 2007, pages 22-23                                                                                                                                                   
(130)  http://www.saludthefilm.net/ns/cuba-and-global-health.html  This website, configured by MEDICC in 2007, gives a comprehensive account of Cuba’s health missions and assistance given to training and educating medical personnel from other third-world countries
(131)  Quoted in Summer 2007 edition of CubaSí, page 7
(132) named in honour of a New York citizen who fought to free Cuba from colonial rule in the 19th century                           
(133)  See http://www.hinduonnet.com/fline/fl2220/stories/20051007004301800.htm   Frontline, Volume 22 - Issue 20, Sep. 24 - Oct. 07, 2005
(134)  See the documentary On the slopes of the Himalayas’ dir. Roberto Chile, Cuba 2006
(135)  http://www.guardian.co.uk/cuba/story/0,,2134579,00.html
(136)  http://www.yesmagazine.org/article.asp?ID=1733  full details    Yes! Magazine, summer 2007 edition on medical brigades,       ELAM and US medical students in Cuba
(137)  http://www.larepublica.com.uy/cultura/250554-leer-y-escribir-yo-si-puedo   countries & statistical info. Article from      Uruguayan magazine La República:  Friday, 23 March, 2007  - No.2498
(138)  http://www.lpp-uerj.net/olped/documentos/2369.pdf  new post & prize
(139)   http://upsidedownworld.org/main/content/view/912/54/ publ. 27 Sept. 2007
(140)   A report on the summit is found on www.vensolidarity.org/Issue%20Overview/alba.php
(141)  The Guiding Principles (quoted on the site mentioned above include: a) Trade and investment should not be ends in        themselves, but instruments to achieve just and sustainable development.  b)  Special and differential treatment, that takes into      account the level of development of the diverse countries and the dimension of their economies.  c)  Economic complementarity and co-operation between the participating countries and not competition between countries and products.  d)  Co-operation and solidarity shown in special plans for the least developed countries in the region.  e)  Action to sponsor sustainable development through norms that protect the environment.  f)  Measures relating to intellectual property, while protecting the heritage of Latin America and Caribbean countries from the domination of transnational corporations.
(142)  The details of membership of ALBA are as follows
Full members:  Bolivia, Cuba, Nicaragua, Venezuela.

TeleSur TV channel:   Argentina Uruguay (in addition to the full members) Petrocarib (40% discount off international oil prices. Payment is made by countries exchanging services and products, eg sugar, rice, soybeans, for oil):   Antigua and Barbuda, Bahamas, Belize, Dominica, Dominican Republic, Grenada, Guyana, Haiti, Jamaica, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines,l Surinam (+ full members)                                                                                       Health Projects:   Argentina, Ecuador, El Salvador, Guatemala, Haiti, Mexico, Panama, Paraguay, Peru, Uruguay +Cuba and Venezuela
Cultural Agreements:   Antigua and Barbuda, Dominica, Ecuador, St. Vincent and the Grenadines + full members.

(143)  (United Nations Development Programme 1997) http://www.hartford-hwp.com/archives/40/067.html  quoted in Latin American Poverty; Cuba Blockade  28 June 1997

(144)  ‘For millions another lost half-decade’  Latin America Weekly, 12 November 2002

(145)  Sustainable development is a commitment to “improving the quality of human life while living within the carrying capacity of supporting ecosystems” (IUCN et al., 1991).

(146)  Quoted by Jerry M. Spiegel & Annalee Yassi in their article ‘Lessons from the margins of globalization…’  (see footnote 72)

(147)  ‘Climbing the Human Development Ladder’, Latin America Weekly, 17 July 2001