More than 200 Cuban doctors are keeping hospital emergency rooms open across Calabria, Italy's poorest region, even as U.S. officials pressure local leaders to end the program. The medical professionals arrived in January 2023 to staff remote facilities that had been forced to close departments due to severe healthcare worker shortages.
"It was a disaster. I was keeping the emergency room open all by myself," said Francesco Moschella, chief physician of Polistena hospital, recalling the days before the Cubans arrived. Their presence triggered a February visit from U.S. charge d'affaires to Cuba Mike Hammer and the U.S. consul-general in Naples, who made clear that alternative sources of international staff would be "highly appreciated."
A Region Left Behind
Calabria ranks dead last among Italy's 20 regions in public healthcare access, according to the health ministry. Until April, the region had spent 17 years under special administration due to persistent budget deficits. Corruption scandals and Mafia infiltration affected health investments, while newly graduated doctors built careers in Italy's wealthier north instead.
The emergency room where Cuban specialist Zoila Yakelin Arevalo Cruz works in Polistena sees 30,000 patients annually. Six Cuban doctors make up half its staff. "In this hospital there were lines that lasted up to eight or 12 hours," Arevalo Cruz said. "Now, thanks to our work, in less than an hour a doctor visits you."
For a first-world country, the 38-year-old didn't expect such serious doctor shortages. She left her young son in Cuba in mid-2023 to take the position. During an AP visit last month, she conducted her work in now-fluent Italian, having picked up local dialect by chatting with grateful former patients.
Diplomatic Tensions Mount
Calabria's Gov. Roberto Occhiuto has refused to end the program despite escalating pressure. "I had some pressures also during the Biden administration," he said. "But pressure grew under Trump." 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 told the AP he'd like to triple the Cuban medical staff to about 1,000 but has refrained to avoid running afoul of Washington. The State Department didn't answer questions about the meeting.
U.S. Secretary of State Marco Rubio has accused the Cuban missions of being "a form of human trafficking," referencing Cuba's government keeping most of doctors' salaries and allegedly confiscating some passports. "Cuban medical brigades are a key source of hard cash for the failing regime," the State Department said in an emailed response, adding it was sharing information with partner nations on "the sobering realities of Cuban medical brigades to which they might otherwise be unaware."
Facing U.S. pressure, Jamaica ended its 50-year medical cooperation agreement with Cuba in March, affecting nearly 300 healthcare workers. Honduras expelled more than 150.
Workers Defend Their Mission
Calabria's deal pays Cuban doctors directly rather than paying the Cuban government agency that runs medical missions, making deposits in their Italian bank accounts. Cuban doctors told the AP they still send as much as half their salaries to the Cuban government.
"We are all aware of the economic situation Cuba is going through," Arevalo Cruz said. "It's a contribution that we make voluntarily because Cuba trained us, educated us and made us doctors." Cuban cardiologist Daisy Luperon Loforte added, "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."
Occhiuto confirmed that 63 Cuban doctors, some previously involved in Cuba's international medical mission, recently applied to work in Calabria's healthcare system independently. The Cuban government didn't comment on whether the doctors applied for positions outside the program.
Patients are largely unaware of the diplomatic tensions. "They're smart, they have empathy and they're also humble — something you don't often see with Italian doctors," said Maria Morano. "We are lucky they came, otherwise our hospital would have been closed."
Occhiuto is an unlikely booster of the Cuban program as a high-ranking member of a political party strongly rooted in anti-Communist sentiment. Calabria's deal to bring in Cuban doctors was praised in Granma, the newspaper of Cuba's Communist Party. "Can you imagine, I got my photo in Granma?" he said, smiling.
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. Officials in Cuba have said it has 22,000 medical personnel deployed to 55 countries in what they called a "mission of solidarity."
Why This Matters:
The standoff in Calabria reveals how decades of underinvestment in public healthcare infrastructure leaves vulnerable communities dependent on stopgap solutions, even when those solutions create diplomatic friction. When regional governments fail to attract domestic medical professionals through adequate compensation and working conditions, patients in rural and economically marginalized areas bear the cost through reduced access to care. The controversy also highlights tensions between geopolitical pressure campaigns and the immediate healthcare needs of underserved populations. While debates over labor practices and government revenue deserve scrutiny, Calabria's experience demonstrates that without structural investment in public health systems and workforce development, regions will continue seeking international staff to fill critical gaps — regardless of diplomatic consequences. The patients who've seen wait times drop from 12 hours to under one hour aren't concerned with Cold War-era ideological disputes; they're concerned with whether emergency rooms stay open.