More than 200 Cuban doctors now staff remote hospitals across Calabria, Italy’s poorest region, even as the United States pushes to stamp out the long-running program. The arrangement has kept emergency rooms open in a place where a shortage of homegrown healthcare workers had already forced some hospital departments to close. That’s the real story here: not diplomatic theater, but a public health system held together by imported labor while power brokers argue over who gets to control it.
Who Keeps the Lights On
Francesco Moschella, the chief physician of Polistena hospital, put it bluntly: “It was a disaster. I was keeping the emergency room open all by myself,” he said, recalling the days before the Cubans arrived in January 2023. His words land harder than any official statement. They describe a system that had already failed the people it was supposed to serve, leaving one doctor to prop up an emergency room until outside workers arrived.
Zoila Yakelin Arevalo Cruz, an emergency medicine specialist, works in that same hospital. She left her young son in Cuba in mid-2023. The emergency room in Polistena town sees 30,000 patients annually, and six Cuban doctors make up half its staff. “For a first-world country, Europe, we had a completely different idea. We didn’t think that the shortage of doctors was so serious,” she said. “In this hospital there were lines that lasted up to eight or 12 hours. Now, thanks to our work, in less than an hour a doctor visits you.”
That’s the hierarchy in plain sight. Patients waited eight or 12 hours. Then they didn’t. The difference wasn’t a speech from a minister. It was labor.
Washington Wants a Different Arrangement
The U.S. has long criticized the Cuban program and called it a moneymaker for the socialist government that the Trump administration has isolated, sanctioned and wants to see changed. U.S. Secretary of State Marco Rubio has accused the Cuban missions of being a “form of human trafficking” — a reference to Cuba’s government keeping most of doctors’ salaries and allegedly confiscating some passports. The State Department told the AP in an emailed response that “Cuban medical brigades are a key source of hard cash for the failing regime,” and said it was sharing information with partner nations on “the sobering realities of Cuban medical brigades to which they might otherwise be unaware.”
The U.S. charge d’affaires to Cuba, Mike Hammer, flew to Calabria in February alongside the U.S. consul-general in Naples. Talks with Calabria’s Gov. Roberto Occhiuto were cordial, but Hammer made clear that alternative sources of international staff would be highly appreciated. Occhiuto said, “I had some pressures also during the Biden administration. But pressure grew under Trump.” He said he told Hammer his government is working on incentives to lure Calabrian doctors home. “But at the same time, I have also reiterated to the U.S. Ambassador Hammer that I needed to keep hospitals open and that I intend to keep the Cuban doctors who are currently in Italy in their posts,” Occhiuto said.
The State Department did not answer questions about the meeting. Occhiuto’s office provided the AP with a photo of him meeting Hammer. The photo says plenty on its own. So does the fact that Washington can pressure governments across the region while the hospitals still need the workers.
The Deal, the Deficit, the Damage
Calabria ranks last among Italy’s 20 regions in public healthcare access, according to the health ministry. Until April, Calabria had spent 17 years under special administration due to persistent budget deficits, which along with corruption scandals and Mafia infiltration affected health investments. Many newly graduated doctors built careers in the north instead. That’s the machinery underneath the crisis: budget failures, corruption scandals, Mafia infiltration, and a regional health system left to rot while people with power argue over the optics.
Cuba’s doctors have worked for decades in developing nations such as Gambia and Venezuela, skilled in providing care with scarce resources. During the COVID-19 pandemic, Cuba sent doctors to several areas of Italy. Calabria continued employing Cubans after the pandemic ended. Calabria’s deal to bring in Cuban doctors was praised in the newspaper of Cuba’s Communist Party. “Can you imagine, I got my photo in Granma?” Occhiuto said, smiling.
The Calabria deal pays Cuban doctors directly rather than paying the Cuban government agency that runs medical missions, and Calabria makes deposits in their Italian bank accounts. Cuban doctors told the AP they still send as much as half their salaries to the Cuban government. Arevalo Cruz said, “We are all aware of the economic situation Cuba is going through. It’s a contribution that we make voluntarily because Cuba trained us, educated us and made us doctors.” Cuban cardiologist Daisy Luperon Loforte said, “We do not consider ourselves modern-day slaves at all, as somebody called it. We love our country, we give an economic contribution and we are happy to do so.”
Those quotes matter because they show the contradiction without any editorial varnish. The doctors are doing the work. The governments are doing the bargaining.
Patients See the Work, Not the Diplomacy
Patients are largely unaware of the diplomatic tensions. Maria Morano said, “They’re smart, they have empathy and they’re also humble — something you don’t often see with Italian doctors. We are lucky they came, otherwise our hospital would have been closed.” That’s the bluntest verdict in the whole story. Not from a minister. Not from a diplomat. From someone who would have been left with a closed hospital.
The Calabria governor confirmed that 63 Cuban doctors, some of them previously involved in Cuba’s international medical mission, recently applied to work in its healthcare system independently. The Cuban government didn’t comment on whether the doctors applied for positions outside the program. Meanwhile, some Caribbean and Central American countries have canceled Cuban missions under U.S. pressure, while Jamaica ended its 50-year medical cooperation agreement with Cuba in March, affecting nearly 300 healthcare workers, and Honduras expelled more than 150. Mexico’s President Claudia Sheinbaum defended the program in March and said it provides vital care to underserviced people.
The pattern is hard to miss. States pressure. Hospitals strain. Workers move. Patients wait. Then, when the system starts to breathe again, the same authorities rush in to claim the terms of survival as their own.