Italy's poorest region is defying American diplomatic pressure to end a controversial medical staffing arrangement with Cuba's socialist government — a standoff that's forced a conservative governor to choose between ideology and keeping hospital emergency rooms open.
More than 200 Cuban doctors now staff remote hospitals across Calabria, the impoverished southern region at the tip of Italy's boot. The arrangement began in January 2023 after a shortage of homegrown healthcare workers forced some hospital departments to close entirely. "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.
Diplomatic Friction
The program triggered a February visit from U.S. charge d'affaires to Cuba Mike Hammer, who flew to Calabria alongside the U.S. consul-general in Naples. Talks with Governor Roberto Occhiuto were cordial, but Hammer made clear that alternative sources of international staff would be highly appreciated. "I had some pressures also during the Biden administration. But pressure grew under Trump," Occhiuto 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 U.S. has long criticized Cuba's medical missions as a moneymaker for the socialist government that the Trump administration has isolated, sanctioned and wants to see changed. Facing U.S. pressure, some Caribbean and Central American countries have canceled Cuban missions. Jamaica ended its 50-year medical cooperation agreement with Cuba in March, affecting nearly 300 healthcare workers. Honduras expelled more than 150. But Occhiuto — a high-ranking member of a political party strongly rooted in anti-Communist sentiment — has refused. Even if Cuba's socialism doesn't fit with his political views, he says the region depends on them.
The Financial Reality
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. "Cuban medical brigades are a key source of hard cash for the failing regime," the State Department told the AP in an emailed response to questions. The Calabria deal attempts to sidestep these concerns by paying Cuban doctors directly rather than paying the Cuban government agency that runs medical missions. Calabria makes deposits in their Italian bank accounts.
Yet Cuban doctors told the AP they still send as much as half their salaries to the Cuban government. Emergency medicine specialist Zoila Yakelin Arevalo Cruz, 38, who left her young son in Cuba in mid-2023, 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 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."
Healthcare Crisis
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. The emergency room where Arevalo Cruz works 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," Arevalo Cruz 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."
Occhiuto told the AP he would like to triple the Cuban medical staff to about 1,000 but has refrained to avoid running afoul of Washington. 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. Officials in Cuba have said it has 22,000 medical personnel deployed to 55 countries in what they called a "mission of solidarity." Mexico's President Claudia Sheinbaum in March defended the program and said it provides vital care to underserviced people.
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."
Why This Matters:
Calabria's dependence on Cuban medical staff exposes the consequences of decades of fiscal mismanagement, corruption, and failed governance. A region that spent 17 years under special administration for budget deficits can't attract its own doctors — forcing a conservative governor to partner with a socialist regime he opposes ideologically. The arrangement raises questions about sovereignty and the true cost of government healthcare systems that can't compete for talent. While U.S. officials rightly highlight concerns about Cuba profiting from its doctors' labor, the immediate alternative is closed emergency rooms. The State Department's pressure campaign has succeeded in Jamaica and Honduras, but Italy's situation reveals the limits of diplomatic leverage when domestic policy failures create dependency on authoritarian regimes. Occhiuto's willingness to accept direct payment arrangements and independent applications from Cuban doctors suggests market-based solutions might eventually replace the controversial government-to-government pipeline.