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Executive Summary

  • The evidence presented throughout this report allows us to state, without ambiguity, that the collapse of the Cuban health system is not due to inevitable fate, external factors, exceptional epidemiological contingencies, or adverse climatic events. On the contrary, it is the direct consequence of sustained national political decisions that have progressively dismantled the state’s essential capacities to protect the health and lives of its population.
  • The collapse of the healthcare system, structural food insecurity, environmental degradation, statistical opacity to hide the magnitude of the humanitarian catastrophe, and the prioritization of the economic interests of an elite over the basic human welfare of the population, constitute a scenario of avoidable, known, and persistent harm.
  • The evidence shows a systematic failure to fulfill this responsibility to protect the population. In the 21st century, the populist welfare state gave way to an extractive oligarchic state. Since then, the totalitarian and oligarchic Cuban state has not only been unable to guarantee the right to health, food, and a healthy environment, but has also ceased to be interested in fulfilling this principle. It has deliberately maintained a model that reproduces vulnerability: chronic disinvestment in public health, massive exportation of medical personnel, neglect of health and environmental infrastructure, and manipulation of epidemiological information to minimize the political cost of the disaster.
  • The current syndemic of arboviruses—that is, the simultaneous occurrence and intensification of several mosquito-borne diseases, such as dengue, Zika, and chikungunya, in a context of social and health deterioration—with its burden of preventable deaths, disabilities, and social suffering, is the most visible and striking expression of this failure.
  • The refusal to acknowledge the true magnitude of the crisis and to allow independent evaluation and cooperation mechanisms reinforces the political dimension of the damage. It has been acknowledged that at least 30% of the population (approximately 3 million Cubans out of 9.7 million) have fallen ill. This citizen audit has estimated, based on moderate calculations, the number of deaths based on these official figures, as well as on international parameters. The result of this calculation indicates that the number of deaths would reach at least 8,700. This shows that the state has lied again (as it did with the Covid-19 epidemic) by claiming that only 47 deaths had occurred by mid-December. The reality would be, at a minimum, 185 times greater.
  • The state’s responsibility to protect the population is not limited to preventing direct violence; it also includes the obligation not to subject the population to structural conditions that deliberately and progressively destroy life, health, and human dignity. Keeping millions of people in a state of malnutrition, health vulnerability, and exposure to epidemiological risks is a brutal form of structural violence exercised by those in power.