Pedro Valdés was born in the small village of San Juan y Martínez, in one of Cuba’s poorest provinces, four hours from Havana. The 68-year-old farmer was in the capital city only once: as a child to greet the guerrilla fighters following the 1959 revolution.
Valdés said he loved everything that followed: literacy programmes and free education; agrarian reform; social support for the elderly and disabled; and access to healthcare. He vowed never to leave Cuba.
But when he contracted COVID-19 recently and was unable to leave his home, his sons – who live abroad after leaving the country in 2006 and wanted to find medication and food for their father – turned not to the government but to social media, for assistance from local community organisations.
As the pandemic, US sanctions, and deteriorating support from Venezuela have worsened living conditions for Valdés and many other Cubans, these grassroots groups are stepping in to fill the gaps left by scant international aid and insufficient government support.
The public health system – which had long exported doctors to developing countries – is in danger of collapse, healthcare workers warn, and shortages of food and other basic supplies have increased, especially since the start of the year.
Valdés blames the situation on the US economic embargo, which was further strengthened by the Trump administration just days before the November 2020 US presidential election, and which effectively banned remittances to Cuba via official mechanisms. Cash remittances represent approximately a quarter of Cuba’s GDP, and those wired through official channels are distributed to Cubans in a devalued currency.
“It is impossible for anything here to move forward with these measures,” he told The New Humanitarian.
Cuban migration to the United States has increased this year, with arrivals of Cubans seeking asylum at the US-Mexican border up about 25 percent since January, according to US government data. US border officials noted 1,900 arrivals at the southern border in January and 4,500 in August.
“As long as there are food and medicine shortages, decreased abilities of families abroad to send remittances – all these factors play into ongoing migration from Cuba,” said Jessica Bolter, a policy analyst at the Migration Policy Institute.
Originally devised in response to acute inequalities that existed prior to the revolution, Cuba’s social justice plan – universal and free education, healthcare, social security, guaranteed employment and basic nutrition – now appears to many to have run its course.
Major blows have been dealt to Cuba by the collapse of the former Soviet Union in the early 1990s and the loss of its $4.3 billion a year in subsidies, which prompted the start of the “special period”; the economic crisis in Venezuela, its regional ally and energy supplier; and the reimposition of US sanctions, which initially cut revenues from the tourism business. These were piled on top of mismanagement of resources, as the army has taken control of much of the economy, leaving many citizens vulnerable and in a state of neglect.
Since 2007, the government has considered food a “national security” issue because of its importance for the stability of the country. But following the country’s worst drought in over a century from 2014 to 2017, as well as flooding from hurricanes and coastal sea level rise, it has imposed additional measures to ensure domestic food security.
These measures included decisions in 2020 to reduce dependency on imports, which have been estimated to make up anywhere from 30 percent to 70 percent of food supplies, with the exact number an ongoing issue of debate. Cuban food production – often involving “prehistoric conditions” – has remained low, and hard currency shortages have prompted the most severe food shortages since the 1990s.
Since May, the health system has been plunging into near-collapse, faced with a surge in COVID-19 infections, after the virus had been kept under control for the first year. Medicines became dangerously sparse and reports of people dying flooded social media.
By August, Cuba had registered one of the highest COVID-19 infection rates per capita globally. The Caribbean nation did not join the COVAX vaccine procurement programme and has been developing its own jabs, which it recently submitted to the World Health Organization for approval. A vaccine roll-out aims to have “full” immunisation by 31 December, President Miguel Díaz-Canel Bermúdez told the UN General Assembly last week.
Glenda López Herrera, a doctor at the Hospital Ernesto Guevara in Las Tunas, in eastern Cuba, told The New Humanitarian that medical supplies, including COVID-19 tests, have been in short supply in recent weeks. “I am certain that confirmed coronavirus cases are even more than the official figures,” she said, speaking by phone. “The same is true for deaths. I don't think authorities are trying to hide the truth, but there are not enough tests to get a sense of the real numbers of symptomatic patients, not to mention asymptomatics.”
It was not surprising when Cubans took to the streets on 11 July in some of the largest recent demonstrations to protest government mismanagement of the economy and the health system, with many demanding greater access to vaccines and medicine.
“The humanitarian situation is very dire,” said Mariakarla Nodarse Venancio, the assistant director for Cuba at WOLA, a research and advocacy organisation focused on Latin America. Her view is one shared by many people and NGOs in the country. “There is a real emergency.”
After cracking down on protesters and putting hundreds behind bars in July, the government scrapped import duties on medicines, foods, and other essentials. But due to limited flights to Cuba, direct deliveries of medicines, food, and hard currency – particularly through critical informal remittances – have practically vanished.
In response, citizen groups have sprung up, inspired by the success of a campaign organised after a powerful tornado ripped through Havana in 2019. The grassroots initiatives have gained ground through social media, collecting donations from private citizens for other Cubans.
A Twitter campaign using the hashtag #SOSMatanzas, aimed at raising awareness of the health crisis in the province east of Havana, was launched in early July. The drive, supported by international influencers, evolved into #SOSCuba, which itself mutated into a political movement to hold Cuban authorities directly responsible for the situation in the country.
For Willy Pedroso, a professor at the University of Havana, such initiatives are based on an important component of Cuban idiosyncrasy: solidarity. “These exchange networks are not new, but in a context of high penetration of information and communications technology, they are more visible, and their articulations are perfected.” But as many groups are spontaneous and short-lived, they are also difficult to quantify, he added.
An informal database assembled by a Cuban journalist, Rafael Escalona, lists more than 40 grassroots aid initiatives, launched in response to the health crisis and promoted mainly through social media. One such citizen-led group was created in June by Thais Lisset Hernández, a young executive at a private advertising firm, and Frank Yunior De Chávez, an equally young professor, who served as collection points in the capital for donations to Matanzas. They said they were surprised when – just a day after announcing the initiative – they had already received over 20,000 Cuban pesos ($833), two packs of medicines, and more than 100 masks left at their front door.
The group posts needs on Twitter, and donors in Cuba and abroad send money to purchase food and medicines; others who have unneeded supplies send them to Hernández to redistribute. Recently, operations have expanded into the provinces of Ciego de Ávila, Cienfuegos, and Pinar del Río.
“Through my social media channels, I search for people's needs, mostly food and medicines,” Hernández explained. “Some people already know I am collecting donations and write to me directly asking for different products.”
“Funny story: People in the queues and food market staff already know who we are and what we are doing and they let us buy first,” she said. “At my house, we classify donations, make smaller parcels, rent a car, and drive to volunteers in Pinar del Río with the donations, who take care of distribution there.”
Some countries and international organisations have increased aid, especially since July.
“The emergency is very real, and the international community and the United States need to find a way to constructively support the Cuban people,” Nodarse Venancio of WOLA said.
A day before the protests, Foreign Minister Bruno Rodríguez said on Twitter that medical supplies had been donated by “organisations and Cubans living abroad from 20 countries”.
After the July protests, Vietnam, Mexico, Russia, and Nicaragua sent shipments of food. China also sent supplies, including personal protective equipment and antigen tests.
Cuba’s mission to the UN in Geneva did not respond to requests to comment on the aid efforts from humanitarian groups and organisations to the country.
Rising anger at empty shelves and growing needs
The EU recognised the humanitarian and political grievances of Cubans following the protests, and Italy donated funds to the World Food Programme (WFP) to supplement diets at hospitals in Havana and Matanzas, at the epicentre of the pandemic. Canada and UNICEF supported COVID-19 response through donations in August of the drug dexamethasone, used to treat the virus.
Some aid has been ongoing. The Pan American Health Organization (PAHO) has coordinated donations of medical equipment and PPE since last year and partnered with the EU to help strengthen COVID-19 response capacities at the health ministry. PAHO did not respond to requests for comment about any expansion of assistance.
When asked about its humanitarian response to Cuba following the protests, the UN’s emergency aid coordination body, OCHA, wrote via email that: “The United Nations System in Cuba has a COVID Socio-Economic response plan to address the challenges that the pandemic has laid bare. The response plan includes the participation of all agencies in the country.” The UN office said seven agencies involved have received $17.1 million to date.
Elena Gentili, country director at Oxfam, told The New Humanitarian that the situation in Cuba was “a complex humanitarian situation involving different populations, with greater effects on groups most exposed to vulnerabilities and pre-existing inequalities.”
Oxfam is in the process of withdrawing from Cuba as part of a wider cost-cutting plan and Gentili said it was working with civic societies, local governments, academics, and community leaders to coordinate response and “promote spaces for constructive dialogue”. Its transition plan, Gentili said, also included capacity building on climate change adaptation, disaster risk reduction, and women’s leadership.
After the protests, the Catholic aid organisation Caritas, one of the few independent organisations with a wide reach within the country, distributed PPE, COVID-19 tests, medicines, and ventilators.
Reliance on initiatives
Despite an uptick in some international aid after the July protests, citizen aid initiatives have now spread to all 15 provinces.
Informal groups trading medicines on social networks have proliferated, with the government turning a blind eye. On one such group, La Farmacia, nearly 157,000 subscribers on Telegram can describe the medicines they need and barter other items for them. Renato Rodríguez Suárez, the administrator of the platform, explained: “The rules of the group are clear: Buy or sell is not allowed. Members exchange or donate the medicines they have.”
Other groups openly sell medicines, where high prices for high-demand drugs are made very clear.
In Santa Clara, when Paula Bello tested negative after she developed COVID-19-like symptoms, she was unable to access any treatment. Via WhatsApp, she consulted a cousin who is a doctor, who recommended that she take Azithromycin if her symptoms worsened.
“I had chest tightness, coughing, trouble breathing, and feared I had something in my lungs,” Bello explained. She got an X-ray, showing that she had had pneumonia and still suffered from bronchitis. “Almost a month after the symptoms started, I have not managed to recover, nor have I been able to get the antiviral drugs indicated in the protocol.”
Bello was able to get spare tablets of Azithromycin from friends and acquaintances – this was a huge relief as online black-market platforms were charging 6,000 pesos ($250) for six pills. But it was impossible for her to find any of the other treatments she needed – at any price – including vitamins. "The hospitals were [too] collapsed to provide me with treatment,” she said. “There were not enough tests to confirm the virus, and the pharmacies were also out of medicines.”
Although shortages of medicines have been an ongoing problem, the government only began talking about chronic scarcities of specific treatments – such as for hypertension and contraceptives – in 2017 due to a hard currency squeeze, which limited imports of needed inputs. By April 2020, state-run firm BioCubaFarma admitted that around a fourth of its medications were unavailable.
Authorities have lashed out against the illicit sale of medicines, blaming merchants for the shortages, just as they accused doctors of mistreating patients when public discontent over the state’s management of the pandemic grew. Health professionals responded with a rare criticism of the government.
The government has pressured organisers of the informal groups that trade medicines on social networks to issue statements saying that their actions are humanitarian and non-political.
“The government would prefer to control all relief efforts, but they don’t have the capacity to,” Nodarse Venancio of WOLA said. Community-driven groups are responding as best they can but are mostly located in Havana and nearby provinces, she added.
“The only way the emergency can be tackled is by accepting external aid,” she said. WOLA, she added, was hopeful that US President Joe Biden’s administration would decouple its policy towards Cuba from politics in order to respond to the humanitarian situation.
“There is a lot of polarisation of voices in the Cuban-American community, and it has a big weight on what the administration may or may not decide.” She said her organisation encouraged the United States to lift caps on remittances, remove obstacles to humanitarian aid, and reinstate staff at the embassy in Havana, particularly consular employees who would facilitate visits of relatives bringing needed goods into the country.
In the meantime, groups like the one run by Hernández are kept busy. “We have talked to Cubans abroad who want us to take over imported donations, but nothing has been decided yet,” Hernández said. “We don't know if we are ready to manage larger donations coming from abroad, and the flights are still restricted. We will continue carrying out this task as long as there are people in Cuba who want to donate the little they have and others who need it.”
Yery M. García reported from Madrid. Paula Dupraz-Dobias provided additional reporting from Geneva. Edited by Josephine Schmidt.