Cuban Healthcare Tested by Epidemic and Sanctions

Cuban Healthcare Tested By Epidemic and Sanctions

Since October, Cerro Children Hospital has been overrun with patients sick with chikungunya and dengue.

“Our entire neighborhood has it," says Nayarit Fraga, the mother of a one-year-old girl being treated at the hospital for the virus. “She’s doing better now but she was in intensive care with fluid in her lungs and abdomen.”

Cuba’s Ministry of Public Health has declared an epidemic. It estimates that a third of the population has contracted one of the mosquito-borne illnesses, which began sweeping across the island in July.

Most cases are chikungunya, which causes fever, headaches, eye pain, weakness, and most notably, joint pain. Arthritis-like symptoms can endure for months.

Cuba is no stranger to mosquito-borne viruses. Cuban epidemiologist Carlos Juan Finlay discovered in the 1880s that the Aedes Aegypti mosquito transmitted yellow fever. The same breed today also carries dengue, chikungunya and zika.

Cuba’s public healthcare is designed to stop epidemics in their tracks. But the island now faces its worst mosquito-borne disease outbreak in decades as ramped up U.S. sanctions have pushed the health system from preventative care to crisis management.

A proven system, undermined by scarcity

Through the 2010s, health personnel went door-to-door in every neighborhood, fumigating and eliminating stagnant water. The Ministry of Public Health would ramp up those efforts in response to rises in cases.

Dr. Samira Addrey, who is from the United States but studied medicine in Cuba at the Latin American School of Medicine (ELAM) between 2012 and 2020, took part in nationwide canvassing to address increased cases of Zika and dengue. (Watch an interview with Dr. Addrey about her experience studying in Cuba).

“I had never seen this level of intentional organizing and political will for managing outbreaks until I went to Cuba,” says Dr. Addrey. “This is a well-designed system that comprehensively addresses viruses…and it works.”

But much has changed since Dr. Addrey finished her studies. Authorities point to broken medical equipment and a lack of personnel as factors that are hindering fumigation efforts and door-to-door canvassing. Garbage collection, which removes breeding grounds for mosquitoes, has become infrequent. The country's severe economic crisis has left a once robust healthcare system struggling for medications, basic supplies and staff.

“Cuba does not lack knowledge or will to treat the virus,” says Dr. Addrey. “It lacks resources. And the reason is U.S. sanctions.”

Helping mosquitoes, not people

U.S. sanctions have been in place for more than six decades, but in 2019 the first Trump administration began implementing a barrage of targeted “maximum pressure” measures that have further ravaged the island’s economy and healthcare resources.

During a recent visit to Cuba, Alena Douhan, the UN special rapporteur on the impact of unilateral coercive measures, said U.S. sanctions have caused “widespread inaccessibility” to medicines, equipment and raw materials.

Economists say U.S. sanctions cost the island billions of dollars a year and scare foreign companies away from selling Cuba fuel, medicine, spare parts and machinery.

The economic crisis has fueled the country’s largest ever emigration wave, with more than a million people leaving over the past five years, including thousands of health professionals.

The situation has been particularly dire since 2021, when Trump put Cuba back on the U.S. government’s “State Sponsors of Terrorism” list during the final days of his first term, further cutting the island off from international trade, banking and investment.

The Ministry of Public Health used to supply almost all the country’s medicines, producing most of them domestically. Now, pharmacies and hospitals lack more than two-thirds of the medicines their patients need.

Over the past decade, Cuba’s first-world level health outcomes have plummeted, with infant mortality rates more than doubling from 2016 to 2025.

“We don’t need to have U.S. ships blocking our harbors,” Dr. Mitchell Valdes-Sosa, director of Cuba’s Center for Neuroscience, told us in the documentary we produced for Al Jazeera, Health Under Sanction. “By scaring off providers and by choking us through the banks, that’s enough to produce the results of a blockade.”

The epidemic in numbers

In the early months of the outbreak, the Ministry of Public Health released relatively little information and did not report any deaths, a delay that prompted criticism from some Cubans, particularly on social media.

Amid rising cases and increased public concern, health authorities began issuing daily updates on television from November 19 and started regularly reporting fatalities at the beginning of this month. Cuba has so far reported 47 deaths from chikungunya and dengue, most of them children.

For the week of Dec. 8-14, the Ministry of Health confirmed more than 21,000 cases of “unspecific febrile syndrome,” the diagnosis authorities are assigning to patients with symptoms that could be related to one of the viruses. Authorities suspect the real number is higher, since many people stay home, choosing not to seek medical care when they are ill.

The large majority of virus cases are suspected to have been chikungunya, but diagnoses are based on symptoms rather than testing, since there are not enough PCR tests.

"Unexpected," was how Cuban virologist Osvaldo Castro characterized the epidemic, attributing it to the population’s lack of immunity (this is Cuba’s first chikungunya epidemic). He also said that, compared to dengue, chikungunya is more symptomatic than other mosquito-borne diseases, with nine out of ten patients showing symptoms. Most people who get dengue, for example, don’t become symptomatic.

Chikungunya has become more common worldwide over the last decade, especially in Latin America. While the disease has a low fatality rate, severe complications can occur. The World Health Organization (WHO) notes many countries face challenges in identifying outbreaks proactively. According to the Pan American Health Organization (PAHO), the majority of the countries in the hemisphere have reported chikungunya cases this year, but only Brazil, Bolivia and Cuba have reported deaths.

Fighting an epidemic as resources dwindle

Scientists on the island are testing several Cuban-developed medications for their effectiveness in treating dengue and chikungunya. Cuba has one of the most advanced biotech industries in the Global South and was the only Latin American country to develop its own vaccines against Covid, despite U.S. sanctions hindering development and production.

Some targeted fumigation in areas where the outbreak is more severe has been taking place since November, but Cuba has been unable to revive systematic fumigation because there's not enough fuel.

"They used to fumigate more often, but the country is facing a fuel crisis," said one Havana resident.

Cuba's fuel scarcities could get worse. Donald Trump on Tuesday announced "a total and complete blockade of all sanctioned oil tankers going into, and out of, Venezuela." Cuba relies on Venezuela for some 30,000 barrels of oil per day.

Authorities expect virus cases to decrease this month as temperatures drop. Weekly cases have decreased by more than half since mid-November.

The Ministry of Health is instructing people with symptoms to seek medical help. Until recently, Cubans would visit their family doctor or a specialist for the slightest ache or pain. But amid U.S. sanctions that have created medicine shortages and spurred an exodus of health workers, many people who are sick now opt to stay at home.

“Cuban doctors are doing everything they can,” says Dr. Addrey. “Their struggle is not against the virus alone, but against a [U.S.] policy designed to make crisis permanent.”