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.


Environment Latin America

Epidemics in the Conquest of Latin America

Smallpox epidemic in the 16th century Florentine Codex.

By Viviana Espinosa Moreno, BA

The mass movement of people not only implies the mobilization of goods, culture, beliefs, and technology. Other agents can be relevant when we study the impact of such movements in host societies. Especially in exploring diseases and epidemics the agency of certain non-human elements like animals, plants, or microorganisms are pivotal to understand the history of some peoples and moreover to highlight the relationship between nature and society or diseases and society.

A demographic disaster

One of the historical events that elucidate this relationship is the conquest of America. It is recorded that more than half of the original indigenous population disappeared due to about 20 epidemics that were introduced within the 16th and 18th centuries. A more recent update estimated that an initial population of 54 million (similar to our 60.5 million) was reduced to 5.6 million, thus a 90% decline (Koch et al., 2018).

One of the theories that explain this demographic disaster is according to Crosby (1976) what he calls the “virgin soil epidemic” defining it as “those in which the populations at risk have had no previous contact with the diseases that strike them and are therefore immunologically almost defenseless.” In his point of view, this explains to some extent the success of the colonization project over the native populations.

However, we also must take into account other factors that created an ideal environment for diseases to spread, having a deadly effect on indigenous peoples. One example were the poor working conditions in the forced labor systems such as “Encomiendas and Mitas,” which deteriorated the physical health of indigenous peoples. These conditions increased the likelihood to die of any diseases. Accordingly, changes in the economic and social structures among the indigenous communities made them more vulnerable and defenceless to these factors.


Influenza was one of the first diseases that traveled with the Spanish in the era of Columbus. The Spanish veterinarian parasitologist and historian, Miguel Cordero del Campillo, showed in his work, “Crónica de Indias” that the first epidemic of European origin that reached America was the flu, which appeared to have had a zoonotic nature. The horses and pigs that Columbus embarked on the Canary Islands on his second trip to America fell ill from a respiratory illness identifiable with influenza, which also affected some crew members. This included Columbus himself, according to various chroniclers (Cordero del Campillo, 2001). There is evidence that the disease appeared the day after the disembarkation and subsequently spread on the island of what is today the Dominican Republic. There, it affected the Taíno community with particular intensity. Fray Bartolomé de las Casas, recounts how “people began to fall ill […] with terrible fever.” Another chronicler, Fernández de Oviedo, reports that: “more than two parts or half of the Spaniards died, and of the Indians themselves so many died that they could not be counted” (De Las Casas, 1877)


Another epidemic that contributed to the demographic catastrophe of Pre-Hispanic America was smallpox, the most contagious and deadly of the epidemics in America. In Puerto Rico, the first case of smallpox was documented in 1518, apparently first transmitted by an African slave, who came from one of the slave ships that arrived on the island. In Mexico, according to the chronicles, smallpox was also introduced in 1520 by a black slave, Francisco Eguía, who arrived with an expedition led by Spanish conquistador Pánfilo Narváez (147?–1528). (McCaa 1994). The disease first spread through Veracruz, then later extended to Tlaxcala, until reaching Tenochtitlan in the same year. In Tenochtitlan, one of the most densely populated cities of its time, smallpox spread with such force and speed that it contributed to the fall of the city.

A large part of Mexico’s indigenous population disappeared in the 16th century. Today’s specialists agree that the mortality of the smallpox epidemics of 1520, 1545, and 1576 could have been close to 80%. To give some numbers on the magnitude of the tragedy, McNeill, in his book “Plagues and People” (1977), calculates that in Mexico, of the 25 million people who may have existed shortly before the arrival of the Spanish, by the year 1620 only about 1.6 million remained. The smallpox disease even spread from Central America through Panama to the Andes and reached the Inca Empire before the arrival of another conquistador, Francisco Pizarro, in Peru in 1531 (García 2003). In consequence, these communities were much more vulnerable when the Spanish arrived.

Those are just some examples of the diseases that were present in America in colonial times. It would be possible to also name measles, typhus, and yellow fever, among others. As said above, these diseases were introduced by external agents to communities with a lack of immunity to such pathogens and in consequence were defenseless. The conquest of the continent and its peoples could be explained to some extent by the contribution of non-human agents as a silent army that besides the imposition of new socioeconomic order results in the breakdown of the indigenous structures and the fall of the main pre-Hispanic cities.


Cordero del Campillo, M. (2001). Crónicas de Indias. Junta de Castilla y León, Consejería de Educación y Cultura.

Crosby, A. W. (1976). Virgin soil epidemics as a factor in the aboriginal depopulation in America. The William and Mary Quarterly: A Magazine of Early American History, 289-299.

De Las Casas, B. (1877). Historia de las Indias (Vol. 1). Imprenta y litografia de I. Paz. García Cáceres, U. (2003). La implantación de la viruela en los Andes, la historia de un holocausto. Revista Peruana de Medicina Experimental y Salud Pública, 20(1), 41-50.

Koch, A., Brierley, C., Maslin, M. M., & Lewis, S. L. (2019). Earth system impacts of the European arrival and Great Dying in the Americas after 1492. Quaternary Science Reviews, 207, 13-36.

McCaa, R. (1995). Spanish and Nahuatl Views on smallpox and demographic catastrophe in Mexico. The Journal of interdisciplinary history, 25(3), 397-431. McNeill, W. H., & McNeill, W. (1998). Plagues and peoples. Anchor.