COVID-19 Diplomacy Geopolitics Health Humanitarianism International Health Latin America Medicine United States

Internationalizing Cuban Medical Internationalism

A doctor’s surgery in Jaimanitas, Cuba. Source: Soydcuba, CC BY-SA 3.0, Wikimedia Commons

By Nicolas Friden, BA

As many different countries choose many different approaches in order to fight the virus, it still remains a huge task, even for the majority of countries in the developed world. As countries with a functioning health care system like France or even Germany struggle to contain the outbreak of the virus.

If the Covid-19 epidemic has shown one thing, it might well be that despite our belief we cannot control any and every disease. While somehow most Western countries might come through this pandemic relatively unharmed, it has still shown us that we have a lot to learn about our approach to a functioning medical system.

One country that frequently eclipses the rest of the World when it comes to medical expertise and a functioning heath care system is Cuba. While many are aware that Cuban doctors are sent to a lot of different countries, especially poorer ones, the proportions of this aid and cooperation system are less known.

However, if this system of health cooperation is functioning so well, why don’t any of the major countries in the World aspire to imitate some of its aspects in order to improve their own health diplomacy? Is the capitalist world too stubborn to adopt good ideas from other systems?

While Cuba is a relatively poor country compared to most of the Western World, this has never been an excuse for not providing medical aid and medical assistance to those most in need in any part of the World. For example, as Hurricane George devastated Haiti in 1998, Cuba immediately sent a force of 200 medical staff to help the local population. But the Cuban model doesn’t stop at immediate medical relief. This is actually only the beginning. After the initial damage is more or less under control, Cuban doctors and medical staff usually stay there and begin to train and treat the patients in the devastated country so as to provide development assistance to the local health authorities. This includes the process of transmitting knowledge to the local population by either training staff on the ground, or, more importantly even, by providing local students with the chance to acquire a medical degree in Cuba. This allows fully trained medical personnel to come back and be able to help the local population where it is most needed.[1]

This feat is even more impressive if you consider that every single step of the way is free of charge. This is seen by some as a true act of solidarity to the ones that are most in need. This is particularly astonishing as Cuba didn’t have a lot of support and of trading partners after the Soviet Union collapsed. In the early 1990s, male body weight in Cuba fell by 20-25 pound on average and public transportation was cut by 80%. Still, even in these difficult times for the country, its foreign policy regarding health remained the same, and Cuba continued assisting others where and when they needed it. [2]

So why is it that Western countries are neither discussing nor adopting the Cuban model to some extent?

The two parts of this question might well be closely linked to each other, as the West and in particular the United States have always had a hard time accepting Cuba’s existence in the first place. Since Cuba has a socialist government, it was always viewed as a possible threat in Washington, which imposed a trade embargo on the country, already in 1958. Writing this in 2021, when the Soviet Union is long gone, and an East West divide is not so visible anymore, it is astonishing that this embargo remains in place.

This might be one reason why Western media and policy-makers remain reluctant to fully acknowledge the real role Cuba plays when it comes to global medical relief. This whole situation really is an indictment on most powerful Western governments, as they remain unable to even acknowledge that their way of thinking might not be the best or even the only way.

As the Covid-19 pandemic rages on stronger than ever (especially in the United States, the one country that will not in any case acknowledge Cuba’s know-how or accept its existence), the Cuban situation compared to the rest of the World remains under control for the moment and Cuba is only waiting for the opportunity to help its neighbours[3].

It remains difficult to see a change of course for the United States, when it comes to its relationship with Cuba and its reluctance to accept any kind of help or advice coming from this country, but maybe if the rest of the World starts implementing some Cuban medical policies, the US eventually could follow the same path.

[1] John M. Kirk, “Cuban Medical Internationalism and Its Role in Cuban Foreign Policy,” Diplomacy & Statecraft 20, no. 2 (August 5, 2009): 275–90.

[2] Ibid.


Diplomacy Geopolitics Medicine Security State Surveillance

Podcast: The Practice of Quarantine in History

A 1883 cartoon depicting members of the New York Board of Health trying to contain immigrants suffering from Cholera. © Corbis Images

By Anna Dyshlevaya BA, Viviana Espinosa BA & Ksenia Shibaeva BA

The podcast discusses the emergence of quarantine as a historical practice.

Asia Diplomacy Geopolitics

What impacts do epidemics have on geopolitical and diplomatic issues? The example of the Manchurian Plague

Gravediggers during the Manchurian Plague (papers of Dr. Richard Pearson Strong, on repository at Harvard University’s Francis A. Countway Library of Medicine)

By Cedric Carlier, BA


During these unsafe Covid times, we hear about different countries that use the emergency situation to their own good. During the past few months, we have noticed for instance that China, among others, has taken advantage of the pandemic to further extend its territory in the South China Sea. Although it is not clear if there is a direct link between the pandemic and their increasing aggression, others like the US Department of State argue that China is using the weakness of other countries due to the pandemic situation to expand its power in the South China Sea. In this blog post, I will explain how epidemics have an impact on the strategic advantages between states and have an impact on diplomacy, focusing mainly on China’s experience facing foreign threats during the Manchurian plague in the early 20th century and comparing it with the current situation.

The Great Manchurian Plague and the interests of the great powers

As Summers (2012) explains in The Great Manchurian Plague of 1910-1911: The Geopolitics of an Epidemic Disease, the plague occurred between 1910 and 1911 and caused the death of about 60 000 people, mostly in Manchuria (northeast China), even though other cases were also reported in other regions, such as Beijing and Tianjin. The Manchurian plague is a story of railroads, foreign markets and geopolitics on a huge scale. At a time of great international issues and even warfare, a deadly infectious disease appeared, killing and devastating on its way.

It is important to remark that several Great Powers were interested in the Manchurian region at the time. Not only Russia and Japan, but also France, Germany, Great Britain and the US had ambitions in Manchuria. China, which was extremely weak at the time, tried to use its political and diplomatic means to win over the Great Powers to its own advantage. Furthermore, alliances between the various nations were quite considerable: on the one hand, Russia was assisted by France and Germany and on the other hand, Japan and Great Britain cooperated. As for the United States, they decided to stay neutral, as they lacked alliances with European countries.

As the plague was spreading southward along the railway routes of Manchuria, both the Russian and Japanese foreign governments located in Harbin and in Dairen respectively started realizing the benefits and dangers the disease could bring. Despite the weakness of its government, however, China initially managed to resist these attacks on its sovereignty, but that did not last very long.

Russia tried to take advantage of the situation by bringing in more troops with the alleged aim to enforce quarantines and to control travel and population movements. Nonetheless, Russia’s influence in Manchuria was constantly becoming weaker, especially after its defeat in the Russo-Japanese war and the loss of dynamics during its Far East strategy. Furthermore, by the end of the plague, Russia’s main surrogate in Manchuria had great financial issues and his power was very limited in the region. Russia, nonetheless, still tried to take advantage of the Manchurian plague to regain control and keep its power in the region. However, the presence of other major economic and military powers, especially Japan, prevented Russia from expanding its power, which explains how its influence in Manchuria came to an end.

Japan’s interests in Manchuria and Korea were clear from the time of the Meiji Restoration, i.e., the political revolution of 1868. Furthermore, the Sino-Japanese war in 1895 and Russo-Japanese war in 1905 permitted Japan to exert great power in both Korea and later in Manchuria. During the Manchurian pandemic, Japan, which was already present in the southern part of Manchuria, saw an opportunity to consolidate its well-established position in the region by extending its influence in the field of public health, quarantines and other forms of population control. In January 1911, at the peak of the epidemic and before the International Plague Conference, the Japanese started bringing more troops to Manchuria and accommodating them in barracks along the South Manchuria Railway, claiming that the purpose of these constructions was to quarantine sick low-class passengers. In addition, Japan kept extending its influence northward towards Mukden, partly through the relocation of Viscount Oshima from Dairen to Mukden. It then claimed that he headed the Japanese Sanitation Commission, which was responsible for anti-plague work there and thus needed to be transferred.

International plague conference in Mukden

The international plague conference in Mukden played a crucial role in the geopolitical and diplomatic issues of Manchuria. The international conference meant that China was admitting that it needed assistance in managing the growing pandemic, even though it would only accept international help on its terms. The conclusions of the conference were that China had to improve its public health organization, its medical education system, and its hospital and quarantine provisions. In the aftermath of the conference, however, both China and Japan attempted to take advantage of these dynamics to increase their influence in Manchuria by developing new initiatives.

After the conference, Japan used its agent of colonialism, i.e., the South Manchuria Railway Company, to further extend its influence in the region, by for example founding a new medical school in Mukden, which was controlled and staffed by Kyoto Imperial University. It also founded in China the North Manchurian Plague Prevention Service, which represented the first stage toward a national public health system. It was, however, very Westernized, as it had a senior staff of ethnic Chinese who had studied Western medicine. Furthermore, the junior staff physicians were often graduates of Western medical schools in China. The organization later became the National Quarantine Service, which was, however, ended due to Japanese aggression in 1937.


In summary, major economic and military powers such as Japan and Russia took advantage of China’s vulnerability to the plague in Manchuria to try to expand their territory and thereby refine their diplomatic and geopolitical strategies. Russia, however, was less successful in this respect, and so it is mainly Japan that achieved its expansion in the region. Thus, whereas about 100 years ago China was the victim invaded by various Great Powers such as Russia and Japan, it is now being criticized for “exploiting the distraction or vulnerability of other states to expand its unlawful claims in the South China Sea” (US Department of State) during the current pandemic. Based on the events of the Manchurian plague and the current situation in the South China Sea, we can easily conclude that it is not at all uncommon for Great Powers to take advantage of pandemic situations in a geopolitical and diplomatic way and that the power positions can change very quickly throughout history.

Historical information on the plague in this text taken from William C. Summers (2012): The Great Manchurian Plague of 1910-1911: The Geopolitics of an Epidemic Disease. New Haven: Yale University Press

Welle (, Deutsche. “Is China Taking Advantage of COVID-19 to Pursue South China Sea Ambitions? | DW | 26.05.2020.” DW.COM. Accessed January 23, 2021.