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(NEW YORK) — For more than 60 years, hundreds of thousands of Cuban health care workers have been deployed across the globe.

Under the government’s medical missions program, doctors, nurses, technicians and other staff are sent to countries around the world to provide care to underserved communities, in many cases for a fee.

The Cuban government has said the missions, or “medical brigades,” have entered countries at war, hit by natural disasters and ravaged by outbreaks of disease, saving thousands of lives.

Critics, including the Trump administration, have held a different view, claiming that the health professionals are coerced into volunteering, partly as a way to bring in much-needed currency, and that their movements are restricted. The U.S. State Department has referred to the missions as “forced labor” and has pressured countries to stop accepting Cuban medical workers.

“The Trump administration, Biden administration and U.N. have all understood that these medical mission programs are a forced labor scheme that exploit Cuban workers,” White House principal deputy press secretary Anna Kelly said in a statement to ABC News. “These labor export programs abuse the participants, enrich the corrupt Cuban regime and deprive everyday Cubans of essential medical care that they desperately need in their homeland.

Kelly noted President Donald Trump believes “Cuba is a disaster that’s in its last moments of life, and these programs are one of many ways that they repress their own people.”

Cuba’s Ministry of Foreign Affairs did not return multiple requests for comment from ABC News.

A White House official told ABC News there is vast opposition to the Cuban medical missions program across political parties, in both chambers of Congress and from international organizations.

The humans rights organization Prisoners Defenders said in 2020 that it submitted a report to the United Nations and the International Criminal Court claiming it has evidence of “a pattern of slavery” on the medical missions.

Countries including the Bahamas, Guatemala, Guyana, Honduras, St. Vincent and the Grenadines and Paraguay have begun phasing out the missions, reviewing medical cooperation agreements or canceling contracts with the Cuban government.

Some international relations experts told ABC News that there is some truth to the allegations that Cuban medical workers are often closely monitored by Cuba’s government, but that the medics are also providing care to communities that would otherwise not receive it.

History of the program

After the Cuban Revolution began in 1959, many doctors left Cuba for the U.S. Newly installed leader Fidel Castro saw an opportunity to set up programs to train doctors not just for Cuba but to be sent overseas as a type of medical diplomacy, according to John Kirk, a professor emeritus of Latin American Studies at Dalhousie University In Halifax, Nova Scotia, who has written several books on Cuba.

The first medical mission was a small team of doctors sent to Chile, which experienced the strongest earthquake ever recorded in 1960. The first medical brigade was sent to Algeria in May 1963. In the 1970s, medical missions expanded greatly to Latin America and Africa.

Some countries, like Gambia or Haiti — which are poorer — pay Cuba nothing for medical care, according to Kirk. However, richer countries such as Qatar pay the Cuban government a monthly fee, about 25% of which is given to the Cuban medical workers themselves, he noted. Qatar pays Cuba about $9,000 to $10,000 a month for these services, Kirk said.

Cuba’s Ministry of Foreign Affairs did not immediately reply to ABC News’ request for comment on how much countries pay Cuba for the service of medical workers.

Between 1960 and 2023, 600,000 doctors, nurses and technicians participated in this program in 165 different countries, according to the Cuban government.

As of 2024, Cuba had 54 brigades with more than 22,600 medical workers, according to Granma, the official newspaper of Cuba’s communist party.

Philip Brenner, a professor emeritus in the School of International Service at American University, with expertise in U.S.-Cuba relations, said one example of Cuba’s program was Operación Milagro in Venezuela, launched in 2004, to provide ophthalmology services.

“More than 1 million people regained eyesight, and it wasn’t a major operation,” Brenner told ABC News. “These were like cataracts that people had, but they had no access to medical care until the Cuban doctors came in. They served an enormous number of people around the world.”

Criticism of the program

The U.S. government has long been critical of the Cuban medical missions program, claiming health care professionals are forced into it and sending workers overseas deprives Cubans of the medical care they need at home.

In August, the State Department revoked visas and imposed visa restrictions on several Brazilian government officials, former Pan American Health Organization officials and their family members due to “complicity” with the Cuba’s “labor export scheme.”

“These officials were responsible for or involved in abetting the Cuban regime’s coercive labor export scheme, which exploits Cuban medical workers through forced labor,” Secretary of State Marco Rubio said in a statement.

Brazil’s government did not respond to the allegations but Brazilian President Luiz Inácio Lula da Silva revoked the visa of a U.S diplomat who sought to visit former President Jair Bolsonaro. Lula said the measure was reciprocal for the U.S. revoking visas in August, according to the Associated Press.

The Cuban government did not reply to ABC News’ requests for comment on these claims.

Kirk, the Dalhousie professor emeritus, said of the 270 Cuban medical professionals that he interviewed, most said they volunteered and were not forced to partake in these missions, but he acknowledged it doesn’t mean they weren’t forced.

Sebastián Arcos, interim director of the Cuban Research Institute at Florida International University, said no one is physically forced to participate in these missions, but the conditions in Cuba push many to work in the program to try and earn some money to support their families.

“The other [thing] is, once you participate, once you volunteer for one of these missions, you earn credits with the Cuban regime,” he told ABC News. “Any kind of acknowledgement or respect that you can get from the Cuban government will help your career.”

Arcos said he is familiar with the experiences of those on missions because his wife’s sister, Karem Montiel, was part of a Cuban medical brigade in Eritrea, Africa.

Montiel told ABC News she used to teach embryology at the University of Medical Sciences in Havana and was selected to join a medical brigade in 2010 to teach at Eritrea’s Orotta School of Medicine.

She said she had a good relationship with her students, but criticized the Cuban government’s involvment in the program .

“That is nothing else but slavery, 21st century slavery,” she said. “I was the one doing the work but [the Cuban government is] the one who gets the money. … They own all the Cuban doctors. They make the money, they get paid for those doctors being there, working, and they pay the doctors the bare minimum.”

Montiel said that working as a doctor in Cuba, she was paid the equivalent of $23 per month. She said she was paid more to go on a medical mission but the salary is deposited in a bank account in Cuba, which doctors cannot access until they return to the country.

According to Montiel, the chief of the medical brigade holds on to everybody’s passports. She added that the chief of her mission also accompanied all staff to any immigration appointments they had.

According to Montiel, there are two reasons doctors go on the medical missions: either to get more money and buy things they are unable to buy in Cuba — like computers or TVs — or to attempt to escape Cuba.

Montiel did the latter and left her medical mission early, defecting to the U.S. in December 2010.

“Nobody goes [on medical missions] for the humanitarian reasons to help out the people in need, or the poor people who do not have access to health care,” she said.

She now works as a nurse practitioner in Miami, and her husband and two children have since joined her.

Arcos is also skeptical that the Cuban government is performing the medical missions for purely humanitarian purposes.

“The Cuban government is not really trying to help other people who are less fortunate,” he said. “This is a business for them. They are making money. They are gathering intelligence. They are influencing other governments, and all of this is done on the backs of hardworking people.”

Why is the US ramping up pressure?

For the last several months, the Trump administration has been increasing pressure on governments that receive Cuban medical personnel.

The federal government warned that it could impose sanctions against governments that accept the health workers. The administration said that the program is “exploitative,” with workers forcibly separated from their families, subjected to surveillance, given little pay and under threat if they don’t return to Cuba.

Several countries have recently pulled out of agreements and some that haven’t said the U.S. is pushing them to do so.

During the Second World Congress on Racial and Ethnic Health Disparities in January, Prime Minister Philip Pierre of Saint Lucia said he’s faced pressure from the U.S. government over not having the Caribbean island’s medical students be trained in Cuba.

“We also have Cubans who come over to work. So, the American government has said we can’t even train them in Cuba. So, I have a major issue on my hand,” Pierre said, according to local reports.

In a statement on Facebook last month, the U.S. Embassy to Barbados, the Eastern Caribbean and the inter-governmental Organisation of Eastern Caribbean States denied speaking with Saint Lucia’s government about international education.

“The United States continues to call for an end to exploitation and forced labor in the illegitimate Cuban regime’s overseas medical missions program,” the embassy wrote.

Kirk and Brenner say the U.S. has signaled in the past that it is looking for a regime change in Cuba and placing a stranglehold on the economy may help achieve that objective.

Both said they believe that stranglehold can be maintained through the energy blockade, which has been in place since January, and by cutting a major source of income for Cuba: the medical missions program.

“Because Cuba does earn hard currency from some of the doctors being sent abroad, one of the ways in which the United States has tried to strangle the Cuban economy is by getting countries to end their medical programs with Cuba,” Brenner said. “Even though those medical programs have benefited the people in those countries, the goal has been very narrow: one of trying to hurt Cuba. And it’s been very effective; it’s one of the ways in which Cuba has lost hard currency.”

What will happen to counties that pull out?

For countries that pulled out of Cuba’s program, the experts said they expect to see worsening health conditions.

“We’d have to expect to see more chronic disease and more people dying from disease that otherwise they wouldn’t die from because of the lack of help from Cuba,” Brenner, from American University’s School of International Service, said.

He added that it doesn’t seem like the U.S. has the means to replace the hole that may be left behind by Cuba, especially with the dismantling of the U.S. Agency for International Development (USAID).

“The United States had previously provided some assistance to these countries through USAID but, under [the Department of Government Efficiency], USAID was essentially destroyed, and the medical programs that the United States had haven’t been resumed,” Brenner said.

Not all counties are pulling out of agreements, however. Mexican President Claudia Sheinbaum said on Wednesday that she will keep an agreement with Cuba’s government and continue to have Cuban doctors working in Mexico.

Kirk noted that Mexico currently has about 3,000 Cuban medics in the county. He added that if Mexico does pull out of its agreement with Cuba, it will be “a major blow, symbolically, politically and financially.”

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(WASHINGTON) — A U.S. official tells ABC News that the U.S. Coast Guard is “in active pursuit of a sanctioned dark fleet vessel that is part of Venezuela’s illegal sanctions evasion.”

“It is flying a false flag and under a judicial seizure order,” the official added.  

The action comes after the U.S. Coast Guard seized an oil tanker off the coast of Venezuela on Saturday, just ten days after the seizure of a sanctioned oil tanker.

Unlike that first vessel seized, the tanker seized Saturday is not on any sanctions list maintained by the U.S., EU, U.K. or U.N., according to Kpler, a data firm that tracks transportation and logistics networks.

Homeland Security Secretary Kristi Noem confirmed Saturday’s operation in a post on social media, saying that the Coast Guard “apprehended” the tanker with support from the Department of Defense in a pre-dawn action. She said the tanker had last made port in Venezuela.

“The United States will continue to pursue the illicit movement of sanctioned oil that is used to fund narco terrorism in the region,” Noem said in the post. “We will find you, and we will stop you.”

Last week, President Trump threatened to impose what he called “a total and complete blockade of all sanctioned oil tankers” traveling to and from Venezuela – a move that could devastate the Venezuelan economy, since oil exports are the lifeblood of President Nicholas Maduro’s regime.

In response to Trump’s announcement, Maduro said Venezuela would continue to trade oil and that Trump’s “intention” is regime change.

“This will just not happen, never, never, never – Venezuela will never be a colony of anything or anyone, never,” Maduro said.

The U.S. has amassed the largest military presence in the Caribbean in decades, including the world’s largest aircraft carrier.

The Pentagon also has so far struck 28 alleged drug boats in the Caribbean and Eastern Pacific, killing at least 100 people, without providing any public evidence that the boats were carrying illegal drugs or identifying those killed.

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(NEW YORK) — New work requirements for the Supplemental Nutrition Assistance Program (SNAP) are set to go into effect on Feb. 1 and it could mean that millions of Americans lose their benefits.

Nearly 42 million Americans, including low-income families and vulnerable households, rely on the federal program to help pay for groceries or other household essentials.

However, under President Donald Trump’s megabill that was signed into law in July, work requirements were amended for most people to receive benefits for longer than three months over three years.

Under the megabill, the upper age limit for those who need to meet work requirements was raised from age 54 through age 64 for the first time for able-bodied adults without dependents.

Additionally, exemptions were changed for parents or other family members with responsibility for a dependent under 18 years old to under 14 years old.

“Millions of people will unnecessarily be kicked off the rolls,” Joel Berg, CEO of the nonprofit Hunger Free America, told ABC News. “They will lose the food they need, and sometimes family members need. … More Americans will go hungry. Soup kitchens and food pantries and the food banks that supply them will not have the resources to meet this need.”

According to August 2025 estimates from the Congressional Budget Office, about 1.1 million people will lose SNAP benefits between 2025 and 2034, including 800,000 able-bodied adults through age 64 who don’t live with dependents and 300,000 parents or caregivers up to age 64 with children aged 14 and older.

An additional 1 million people who are able‑bodied adults ages 18 to 54 — or 18 to 49 starting in 2031 — who do not live with dependents but would have received a waiver from work requirements could also lose benefits.

Exemptions were also removed for homeless individuals, veterans and young adults who were in foster care when they turned age 18 under the megabill.

Berg said it could be very difficult for these populations to not only get jobs but provide the documentation to prove to the government they are meeting work requirements.

“It will be extraordinarily difficult for them, and they are among the most vulnerable Americans already,” he said. “Some of the most vulnerable populations — homeless people, veterans and young people who just left foster care — are going to lose their food, lose their groceries and there is no plan in place to fix that.”

CBO estimates that while there will be reductions in SNAP participation among these groups, it will be partially offset by the increases in participation among American Indians, who received exemptions under the megabill.

Supporters of the work requirements have said they are necessary to combat waste, fraud and abuse. SNAP benefits are administered under the Food and Nutrition Service (FNS) by the Department of Agriculture.

Agriculture Secretary Brooke Rollins said in an interview on Fox Business on Friday that SNAP benefits are meant to be used temporarily and not long-term.

“The American dream is not being on [a] food stamp program,” Rollins said. “The American dream is not being on all these programs. That should be a hand up, not a handout. … As of yesterday, we have moved 1.75 million people off of SNAP. … A stronger economy, higher wages, I mean this is what we’re fighting for every day, not bigger programs, smaller programs. People to have real jobs, real health care, a real opportunity for their children and their grandchildren.”

FNS didn’t immediately respond to ABC News’ request for further comment.

Data from the 2023 American Community Survey shows the majority of American families receiving SNAP benefits had at least one family member working in the past 12 months.

However, work requirements can reduce program participation. A 2021 report from the National Bureau of Economic Research found SNAP work requirements could lead to up to 53% of eligible adults exiting the program within 18 months.

“These work requirements aren’t really about promoting work. They’re about dehumanizing people and attacking the ‘other’,” Berg said. “Most SNAP recipients are pro-work, and most SNAP recipients are already working, or children or people with disability or older Americans. So all this is sort of a diversionary debate.”

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