04 April 1997
The Washington Post

Cuba, Food, Medicine: America Should Not Be In The Business Of Inflicting Pain

Off hand, it is hard to think of any single foreign policy act by the United States that is meaner, more demeaning and altogether less defensible than the American embargo on medicine, medical supplies and food to Cuba. Added in 1964 to the broader anti-Castro embargo begun in 1960, the ban on foods and medicines is now a largely unnoted fixture of the hemispheric landscape.

Unnoted but not ineffective. The ban is in fact continually cutting deeper, making the United States a party -- to a degree that needs some sorting out -- to the infliction of pain and suffering on an unoffending civilian population. The toll is newly documented by a report a year in the making by nine experts organized by the American Association for World Health (1826 K St. NW, Washington 20006). Its honorary chairman is Jimmy Carter.

The end of Soviet subsidies and the passage of the Cuban Democracy Act of 1992 and the Helms-Burton Act of 1996, the report states, have done heavy damage that the island nation's world-hailed primary health care system has been able to limit only in part. Malnutrition, deterioration of water quality and sometimes fatal deficits in medicines, equipment and medical information are the results. It is detailed and dramatic stuff.

When the report came out last month, the Albright State Department was ready with a rejection of "any allegation that the United States government is responsible for the deplorable state of health care in Cuba." Of its $2 billion in foreign-exchange purchases, Cuba spent only $6 million on medicine, said the spokesman, observing that the embargo allows humanitarian shipments to Cuba and that "the United States" remains the largest donor. Fidel Castro chooses to spend not on his own people but on the "little toys" of his military and a nuclear power plant, he jeered.

Look closely here: The United States determinedly squeezes the medical sector and the whole Cuban economy, harasses the Cubans for trying to compensate and then blames Havana for failing to lighten the impact. The American government then boasts of opening the very humanitarian loophole it strives in practice to narrow. In fact, the fount of charity is not "the United States" but private donors who must conquer the obstacles their government has strewn in their path.

Note that at the United Nations the Clinton administration has just gotten Saddam Hussein to use the humanitarian loophole written into the sanctions constricting Iraq. It is a loophole substantially more generous and more accessible than the one affecting Cuba. Its use serves the people of Iraq and makes the other sanctions pressing on the Iraqi economy politically more sustainable. The same could be made true in Cuba.

From the feel of things, the group that has done this new study is sympathetic to the Castro government's campaign against the whole American embargo. The group's evident liberal leanings can be pounced upon by those who believe that against Castro anything goes.

My own view is that at this late date the general embargo has a modest but lingering utility as a card to play in a negotiated windup of the Communist regime. But the medical embargo is different. It mocks the notion that the purpose of medicine is to heal. It employs a technique of war against civilians. It separates Americans from the practice and belief of our closest friends. If it is an increment in the power equation, it is a dubious one, less the source of leverage than shame.

In the Cold War, we might have asserted a higher priority, the survival of our civilization. Does someone still need to be reminded that the Cold War is over? That Castro's days as a threat to our security and global poise are gone? No doubt he would try to profit if the medical embargo were lifted. But this is not going to be the measure by which he and his police state survive.

The question spins on as to whether engagement or isolation best erodes the mischief and the power of revolutionary regimes. We need not be the slaves of a foolish consistency. But if we have decided that engagement suits China and isolation suits Cuba, we are obliged to ask why.

One reason for the inconsistency arises from Cuba's visible presence in the neighborhood and from the seeming feasibility of engineering change in a small close-by place. A second reason is the startling readiness of the hard-line Miami Cubans to inflict pain upon their kin. Another is a historical rage at what some Americans perceive as Castro's insolence in maintaining his power over our teeth-gnashing. But none of these considerations can possibly rise to a level justifying the denial of American medicines to Cuban children.

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