| Commission for Assistance to a Free Cuba -Report Home Page Released by the Bureau of Western Hemisphere Affairs May 6, 2004 Chapter 2: Meeting Basic Human Needs in the Areas of Health, Education, Housing, and Human Services I. EXECUTIVE SUMMARY
A. Overview
Cuba’s transition from the Castro regime to a democratic society with a free economy will be a challenging process. Meeting the basic human needs of the Cuban population involves the removal of the manifestations of Castro’s communism; the introduction of the values and practices of democracy and free enterprise; and the building of institutions and services that will improve the health, nutrition, education, housing, and social services available to the Cuban people.
The fundamental goal of any assistance to a free Cuba must be to empower the Cuban people to enable them to create an authentic democracy and free market economy. Empowering the Cuban people will mean improving their economic and social well-being, ensuring that adequate health and social services are provided, reconstructing a democratic civic culture through education and institution-building, dealing with the human cost of the totalitarian police state, and supporting the Cuban people as they cope with these issues and work to transform themselves.
Improving their condition will require dramatic reforms to ensure that democratic values and a civic culture return, that important democratic institutions — including private and faith-based organizations — are able to flourish, and that helping agents such as schools, clinics, and community centers respond to real needs and are accountable to the citizenry.
Some of the effort to meet basic human needs will involve immediate, short-term assistance to ensure that critical health, nutrition, and social services are addressed; that schools are kept open and provided with needed instructional materials; that housing emergencies are attended to; that comprehensive needs assessments and data collection are begun; and that food aid is distributed as needed.
Over the medium- and long-term, a variety of programs and services are identified that U.S. public and private sources can provide to the Cuban people, as a new Cuban government initiates the process of fundamental reform, establishing a rule of law, safeguarding human rights, and creating a new climate of opportunity. It is expected that such assistance will be available not only from U.S. Government agencies and contractors, but also from other international donors, international organizations and institutions, philanthropic foundations, non-profit expert organizations, and businesses interested in investing in Cuba’s future. Cuban-American and other U.S. citizens and organizations would be involved in these efforts.
Both short- and long-term issues will involve the work of many players and will need to be coordinated. The Cuban people are educated and, despite the repression of the Castro regime, have shown themselves to be remarkably resilient, savvy, and entrepreneurial. They will need the resources (including short- and long-term loans), technical assistance, and general support to enable them to improve health standards, manage the change to a market economy, and maintain and improve their infrastructure and services.
B. Seven Foundations for Action in Cuba’s Transformation
There are seven overarching principles that are so fundamental to a successful transition that they cut across all other actions and issues. They are:
1. All that is done must have the goal of empowering the Cuban people. Cuba must be free and sovereign, and the pride its people have in their culture, history and hopes for the future must be affirmed. Assistance proposed herein is illustrative. It will be up to the Cuban people through an open, democratic process to decide what assistance Cuba may seek from international sources.
2. The international community, especially organizations in the Western Hemisphere, can play a leading role in assisting the transition process. The U.S. Government can work through the Organization of American States and regional agencies, and with the United Nations and its agencies, and other organizations and individual countries.
3. Churches and other religious bodies have an important role in building a free Cuba.
4. The Cuban diaspora will want to take a role in helping the homeland. It might be useful to establish an umbrella organization to help coordinate diaspora assistance, such as a “Foundation for Assistance to a Free Cuba.”
5. U.S. and other assistance to Cuba should be coordinated to ensure it is managed effectively and provides help where it is needed most. The U.S. Government might consider creating a planning and coordination team before Castro’s regime falls, and, as appropriate, involve public and private sector donors including foundations, non-profit organizations, and corporations.
6. The United States and others should be prepared to help Cuba depoliticize its institutions and promote justice and reconciliation. The U.S. Government can assist Cuban efforts to eliminate profoundly politicized Castro-era textbooks, other instructional materials and media resources, as well as support the Free Libraries of Cuba network to enhance the physical presence of diverse materials and circulation of free ideas. Cubans may want to establish a justice and reconciliation process to address Castro’s crimes, identify regime victims, and assist the social healing process; they may request outside help.
7. The United States and the international community should enable the Cuban people to develop a democratic and civic culture, a free economy, and the values and habits essential to both. The U.S. Government could create the “Cuba Civil Society Education Project” to help provide the resources, training, and materials for education in democracy, civic values, and entrepreneurship at all levels. Radio and Television Martí can continue to provide transition information, support and information to civil society, and training opportunities for free Cuba’s journalists.
II. INTRODUCTION1
The Cuban people will soon undergo a change from the personal rule of Fidel Castro and his communist regime, which have run Cuba since 1959. What follows in this chapter is a survey of areas in which the U.S. Government and private organizations could offer assistance to a free Cuba in the areas of health, education, housing, nutrition, and human services. This document proposes a wide range of possible actions, which a Cuban transition government might request or which the U.S. Government might propose, and a Cuban transition government may accept. They are not intended to be prescriptive; the fundamental goal of any assistance to a free Cuba must be to empower the people to enable them to create an authentic democracy and free market economy. ____________________ Empowering the Cuban people will mean improving their economic and social well-being, ensuring that adequate health and social services are provided, reconstructing a democratic civic culture through education and institution-building, dealing with the human cost of the totalitarian police state, and supporting the Cuban people as they cope with these issues and work to transform their country. According to a report issued by the Cuba Transition Project (CTP) in June 2003, “living conditions have deteriorated as evinced by an acute housing shortage estimated at 1.66 million dwellings. At least 13 percent of the population is clinically undernourished as the state food rationing system now provides for only a week to ten days of basic alimentary needs [per month]. Unemployment has reached 12 percent, based on official data, and as many as 30 percent of workers are displaced or underemployed” while “university enrollment has fallen 46 percent as would-be college students opt for more lucrative jobs in the tourism industry.”2
Further, a paper by Jerry Haar published by CTP in October 2003 indicated that, “while working conditions and labor rights in the Americas offer a mixed picture, in no country in the hemisphere are they worse than in Cuba.”3 ____________________ Some of the effort to meet basic human needs will involve immediate, short-term assistance to ensure that critical health, nutrition, and social services issues are addressed; that schools are kept open and provided with depoliticized texts, other instructional materials; that any housing emergencies are attended to; and that comprehensive needs assessments and data collection are begun. Short-term assistance should be planned in advance and be available as appropriate while a new Cuban government forms itself and sets its plans and priorities for the important work ahead.
Different components of the Inter-American system, such as the Organization of American States, the Inter-American Development Bank, the Inter-American Institute for Cooperation on Agriculture, the Pan American Health Organization, and the Pan American Development Foundation could coordinate the delivery of assistance offered by other nations of the hemisphere using the same mechanisms and procedures available to all member states. In addition, private organizations (e.g., foundations, expert associations, and faith-based organizations) and businesses could supply much needed assistance, experience, and knowledge. It will be important to coordinate these elements to determine which actions to take and to implement them as quickly and smoothly as possible.
A rapid assessment of immediate needs should focus on the critical initial six months. Longer-term assistance will be necessary for an undetermined period of time as the new Cuban government initiates the process of reforming what exists, establishing a rule of law, safeguarding human rights, renovating and reconstructing infrastructure and services, building new institutions, and creating a new climate of opportunity.
Both short- and long-term issues will involve the work of many players and will need to be coordinated. The Cuban people are educated and, despite the Castro regime, have shown themselves to be remarkably resilient, savvy, and entrepreneurial. They will need resources (including short- and long-term loans), technical assistance, and general support to enable them to improve health standards, manage the change to a market economy, and maintain and improve their infrastructure and services.
A. Foundations for Action in Relation to Cuba’s Transition
A well-educated and healthy population, a safe environment, and adequate human services are critical to the success of most, if not all, of the recommendations in the other sections of this report. At the same time, meeting human needs in the special Cuban context depends upon a transition process that ideally embraces several fundamental principles.
1. Assistance to a Cuban Transition Must Be a Multilateral Effort
Many different international organizations and donors are interested in Cuba and will want, and need, to be involved in the transition. It will be important to:
Religious organizations can play an indispensable role in the transition to a free Cuba. This is not simply because religion and religious institutions have been suppressed under the communists or because external religious bodies have roots in Cuba and seek to help. Rather, the special importance of religious institutions in the transition is due to the fact that they are one of the few intact nongovernmental organizations on the island that have the trust of the people and the means to organize through an existing social network of communications and distribution channels at all levels of society.
In the words of Teo A. Babun, Jr., executive director of the aid association Evangelical Christian Humanitarian Outreach (ECHO)-Cuba: “Faith-based nongovernmental organizations currently conduct neighborhood humanitarian services, providing transportation, obtaining medical supplies, and providing meals. Church-affiliated social services are permitted to receive educational, financial, and material support from sister organizations in the United States [and elsewhere]. In return, the Cuban government demands that church-affiliated NGOs on the island serve people without regard to their religious beliefs.”4
____________________ Religious charities have established a climate of popular trust, a reputation for service to all as opposed to the narrow sectarianism of the past, and effective grassroots networks. Given the manifest difficulties, some of these organizations are truly remarkable:
Despite a recent relative decline in numbers, Catholics are still by far the largest group of Christians in Cuba and the Church today is probably far stronger and more authentically Cuban than in the past. There are rapidly growing evangelical and mainline Protestant Christian communities, and a small but active Jewish community. They are centered in the cities of Havana and Santiago de Cuba, and supported by B’nai B’rith and various U.S. congregations. In addition, there are a significant numbers of followers of Afro-Caribbean religions such as Santeria. Religion in Cuba appears to have been strengthened, not weakened, by the people’s ordeal under Castro.
Reasonably accurate data as of 2000 for the number and distribution of religious Cubans are as follows5: ____________________
3. Strengthening Social Service Delivery Capability of Independent Churches and Synagogues in Cuba Organized assistance bodies such as Cáritas de Cuba, ECHO-Cuba, B’nai B’rith, and the relief organizations of the major Protestant churches with Cuban connections (Baptist, Methodist, Episcopal, Lutheran, Pentecostal, Presbyterian) should be included in any planning for short-term and medium- to long-term transition assistance. i. Use the networks of churches within Cuba and invite sister organizations outside Cuba to assist them. a. Religion and short-term assistance The churches can play a role in the initial planning and coordination of donor services for short-term humanitarian assistance. Ideally, they would have a “seat at the table” in whatever intergovernmental and interorganizational committees are constituted to oversee provision of immediate transition assistance. Cuban church leaders, as well as members of sister faith communities outside Cuba, can play an important role in the diplomatic and organizational work accompanying the political transformation. Within most communities, churches and faith-based organizations are a major part of the support system. The Cuban people during a transition likely will want to maintain and strengthen those systems. Faith-based organizations can provide emotional support, a sense of trust, and continuity. They can also be used to educate and to communicate information to individuals and communities on the subject areas covered in this chapter. b. Religion and medium- and long-term assistance Religious organizations and leadership, from the local community up to the national and international levels, can also play significant roles in medium- and long-term reconstruction work in Cuba. Religious congregations, charities, orders, and other bodies will be needed to help provide social services, education, community organization, health care, and to address infrastructure issues such as housing and communications. Houses of worship can play a major role in helping Cuban society make independent ethical and moral judgments, and in providing the values needed to function in a free society. ii. Differentiate the leadership of the Cuban Council of Churches, a Castro-infiltrated body, from the sincere grassroots churches that have been forced to join it. In 1941, the Cuban Protestant Christian churches formed an ecumenical council to work together on joint initiatives, such as providing aid to the poor and supporting the interfaith seminary at Matanzas. The Council remained independent until it was taken over by the Castro regime in the early 1960s and used as a means to control the Protestant churches then operating on the island. Since then, it is fully identified with the regime and is controlled by Castro supporters, including Christian Marxists and liberationists, several head of the Council are or were members of Castro's rubber-stamp communist national assembly. The Council is now the only legal religious body other than the Roman Catholic Archdiocese of Cuba. At the same time, it should be noted that most of the grassroots clergy and laity of the denominations that belong to the Cuban Council of Churches (CCC)6 are sincere Christians who have been caught in an impossible situation. (No member church has been able to leave the CCC since several Baptist groups did so in the early 1960s.) Like the Roman Catholics and others who have had to deal with the regime, the overwhelming majority of these mainline and evangelical Christians are not sympathizers with Castro and the communists, and therefore should not be denied assistance or a role in Cuban religious affairs due to “guilt by association.” ____________________ The U.S. government should not deal directly with the CCC during the transition, but should work with the individual member churches and other religious groups that have a stake in Cuba. It is important not to appear to take sides in internal Cuban religious affairs or endorse one faith group or set of groups over another. It should be U.S. policy to support the involvement of all genuinely non-political religious groups in both the transition and the development of a free Cuba, regardless of their beliefs or forced associations with the former regime.
4. The Cuban diaspora will want to take a role in helping the homeland Well over 1,500,000 Cubans have left the island for opportunities and freedom elsewhere since the communist revolution of 1958.7 This exceeds ten percent of Cuba’s current population of slightly over 11 million. Today, over 1.2 million persons of Cuban ancestry live in the United States alone, over 813,000 of whom are estimated to be Cuban-born.8 Many other Cubans and persons of Cuban ancestry live in Spain, Mexico, the Dominican Republic, Puerto Rico, and other countries. ____________________ 8U.S. Bureau of the Census, "2000 Census and Current Population Survey Tables," Census Factfinder, February 2004, http://www.factfinder.census.gov/. i. Urge the Creation of a “Foundation for Assistance to a Free Cuba” to help diaspora Cubans channel assistance and coordinate relief operations One important way diaspora Cubans might contribute to a Cuban transition is to set up a foundation through which assistance to Cuba can be channeled. Such a foundation could coordinate donations and other assistance, and would be a more efficient and powerful voice in the transition process than a variety of uncoordinated individual activities. 5. U.S. and other assistance to Cuba should be coordinated to ensure it is managed effectively and provides help where it is needed most A defined core team of key U.S. Government agencies, NGOs, international organizations, and vendor representatives should be identified, which can work with Cuban transition authorities to facilitate assistance, manage priorities, and help prevent inefficient or poorly unorganized situations. This assistance should be delivered under the umbrella of the inter-American system to provide other hemispheric nations a framework within which they can make their own contributions. i. Create and put in place a short-term assistance planning and coordination team before a transition begins A team of U.S. Government agencies, in contact with international organizations, private sector organizations (secular relief and assistance organizations, corporations), and religious bodies, should be formed to organize and coordinate the initial phase of transition assistance. This should be done, if possible, prior to any actual change of regime and be ready to move quickly into operational mode. It is vital that relief efforts be coordinated and managed in conjunction with emergent Cuban authorities and those engaged in diplomatic and security measures. Without coordination across all sectors, short-term assistance activities could degenerate into a situation dangerous for assistance workers, unreliable for transshipment of supplies, and overwhelming for the Cuban people and authorities. ii. Create medium- and long-term coordination groups for public and private sector donors that can continue to work with a new Cuban government The cooperation and coordination established during the initial short-term assistance phase should be continued into the subsequent phases of the transition, when planning and cooperation on projects will still be desirable. Donors, vendors, charities and agencies should be encouraged to work with the new Cuban government and non-governmental organizations in Cuba to select priority projects, develop action plans, and carry out joint endeavors. There will be a tremendous amount of work to do. Without continuing coordination there could be problems involving movement of persons, shipments, communications and payment, as well as unnecessary duplication and overlap. Helping ensure the safety and security of key infrastructure, including public buildings, transportation, and communications networks will also be important. iii. The special case of drug use prevention and control Castro’s Cuba is a proven trafficking point for drugs and has its own drug problems. Drug use and addiction are public health concerns, best dealt with by public health approaches — prevention, early intervention, and treatment — provided the procedures are based on solid findings of scientific research. Outreach, identification, referral, and treatment programs will need to be developed in sufficient number and type until they are available and accessible in every part of Cuba. Once Cuba has established the conditions that will allow it to rejoin the inter-American system, particularly the OAS, standards and commitments set by the Inter-American Drug Abuse Commission in the Anti-Drug Strategy of the Americas and the Multilateral Evaluation Mechanism will facilitate meeting the objectives outlined. Resources devoted to education about drug abuse prevention and stopping drug problems could be balanced with near equal emphasis on public health, public safety, and market disruption. Cuban and international resources could be devoted to prevention efforts and to instituting adequate interdiction and control efforts. 6. As Cuba seeks to depoliticize its institutions and promote justice and reconciliation, the United States and others should stand ready to assist. The Cuban transition is likely to resemble other post-communist transitions in that there will be a need to help Cuban society begin the long process of recovering from the effects of ideology, terror, corruption, and warped institutional and social attitudes and habits. 7. The Cuban people should be enabled to develop a democratic civic culture, a free economy, and the values and habits essential to both. Cuban society under Castro operates on the principle of “resolver,” or getting by via deals and other informal arrangements to resolve issues. This principle works in the peculiar climate of a communist regime with a pervasive bureaucracy, insufficient and corruptly distributed resources, and a thriving black market. It is not a good foundation for building a free society with an objective rule of law, honest institutions, and formal market institutions. Even though many Cubans understand the concepts of freedom and seek self-reliance, experience with other post-communist transitions indicates that it will take a concerted effort to change old habits and develop a genuine culture of democratic free enterprise. III. IMMEDIATE ACTIONS A. The Current Situation in Cuba Prior to Transition A thorough, accurate, and comprehensive assessment of Cuba’s humanitarian needs must await the end of the Castro dictatorship. The Castro government rigidly controls calculation of mortality and morbidity rates, estimates of household income, food availability, nutrition, and other key indicators of humanitarian needs, in order to score political points and win debates in international fora. These data are fundamentally unreliable. 1. The Health Care System Partial reporting from independent sources inside and outside Cuba indicates the health sector is near collapse and the nutritional needs of the Cuban people are increasingly unmet. This is the result of a long process of decline that began to accelerate fifteen years ago. The demise of the Soviet Union in the late 1980s led to the sudden withdrawal of billions of dollars in annual Soviet subsidies to Cuba. By 1989, Cuba’s entire economy was in crisis. Cuban GDP fell by some 40 percent between 1989 and 1993. The emergence of an epidemic of optic neuropathy in 1991 (a disease caused by nutrient deficiency) characterized that decline. By 1992, the Cuban curative health system was in shambles due to serious shortages of equipment, medicine, and supplies. The health sector, more than any other, depends on hard currency imports. In 1989, Cuba imported an estimated $227 million in health-related goods. Part of this value was in-kind or the result of bartering arrangements provided by the former Soviet Union. These non-monetary arrangements disappeared after 1989 with the loss of socialist trade relations. By 1993, Cuba’s health-related hard currency imports amounted to only an estimated $67 million. Access to basic medicines declined precipitously from 1989 to 1993 and supplies became irregular, depending on unstable access to foreign exchange, rapidly changing sources of purchase, and changing patterns of donation. The Cuban ration system substituted herbal medicines. Cuban hospitals increasingly turned to acupuncture as a substitute for anesthesia. Cuban GDP grew by only 10 percent from 1993 to 1996, and sporadically thereafter, accompanied by a serious decline in the purchasing power of the Cuban peso that gutted salaries and health ministry budgets. The process of stagnation and deterioration continues to the present. Today, the Cuban government still prohibits physicians from engaging in private practice, and pays them only about US$20-$30 per month, far less than a what a maid or bellboy earns from tips in a Cuban government-run tourist hotel. As a result, many Cuban doctors and nurses have given up their professions to work in tourism or the informal economy. 2. Nutrition and Sanitation The failure of the Castro regime’s Marxist economic policies together with external factors such as the declining price of sugar have made it impossible for the Cuban government to maintain an effective food-rationing system, either through food imports or through domestic production. During the first thirty years after the Cuban revolution, the Cuban government imported about half of all protein and calories intended for human consumption. After the withdrawal of Soviet subsidies, importation of foodstuffs declined by about 50 percent from 1989 to 1993, and per capita protein and calorie availability from all sources declined by 25 percent and 18 percent from 1989 to 1992, respectively. Currently, only about 1200 calories per person per day are available from low-cost rationed distribution. Cuban government statistics show that the burden of calorie, protein and micronutrient deficits falls predominantly on adult men, whose caloric intake fell from 3100 in 1989 to 1863 in 1994. However, infants, children, pregnant women, and the elderly also suffer acute deprivation. The proportion of newborns weighing less than 2500 grams rose 23 percent, from 7.3 percent of all births in 1989 to 9.0 percent in 1993. Guaranteed daily milk rations reached only children up to the age of 7 after 1992. Anemia affected about half of all children and adolescents and half of pregnant women aged 15 to 45 during the 1990s. Cuban government data on pregnant women show that, from 1988 to 1993, the percentage of women with inadequate weight at pregnancy rose 18 percent, from 7.9 percent to 9.3 percent. Women with weight gains of less than 8 kilogram during pregnancy rose from 5.3 percent to 5.8 percent. Cuba’s economic decline in the 1990s also resulted in a reduction of the materials needed to ensure clean water. From 1990 to 1994, Cuban government statistics show the proportion of the population with domestic water connections declined from 83 percent to 81 percent in urban areas and from 30 percent to 24 percent in rural areas. During the same period, the portion of the population without access to potable water increased from 10 percent to 12 percent. The country’s ability to produce or import chlorine declined, reducing the population covered by chlorinated water systems from 98 percent in 1988 to 26 percent in 1994. In 1994, only 13 percent of the country’s 161 municipal water systems were chlorinated. Mortality from diarrheal diseases rose from 2.7 per 100,000 in 1989 to 6.8 per 100,000 in 1993. Poor nutrition and deteriorating housing and sanitary conditions were associated with a rising incidence of tuberculosis, from 5.5 per 100,000 in 1990 to 15.3 per 100,000 in 1994. Medication shortages were associated with a 48 percent increase in tuberculosis deaths from 1992 to 1993. From 1989 to 1993, these conditions were also associated with a 67 percent increase in deaths due to infections and parasitic diseases and a 77 percent increase in deaths due to influenza and pneumonia. 3. Education The Cuban school and higher education curricula are completely politicized. Mathematics, for example is taught by solving problems related to such things as how many guns are needed to defeat counterrevolutionaries. Professionals such as lawyers are trained to function as servants of the regime rather than as ethically independent practitioners. Educators as well as students are required to be state informants. Individuals are not allowed to finish school or enter postsecondary training or education programs unless they are deemed politically acceptable, have demonstrated loyalty to the Castro regime, and have actively participated in required organizations and labor activities. The state of the educational physical plant is deteriorating due to the collapsing economy, the age of the facilities, and the poor management of available resources. Many facilities dating from before 1958 are in poor shape, especially those in rural areas, particularly in the east of the island. Formerly private and church schools seized by the regime have deteriorated out of neglect. School and university textbooks and library materials are written and produced by the regime, and the content is suspect in all but the most advanced technical and scientific fields. Access to imported materials is severely restricted, and many books and journals are outdated by the time anyone is allowed to use them. The educational system has also suffered the loss of hundreds of qualified teachers because of poor pay (the equivalent of less than $10 a month). Many teachers have left the system to work in tourism. Elementary and early childhood education has been especially hard hit due to both teacher attrition and the relatively low priority placed on these areas by the state. The staffing situation is now such that the regime has instituted programs of training “courageous ones,” secondary teachers who will teach every subject except English and physical education, and crash courses to train secondary students to teach in primary schools. School completion is also affected by economic problems. Students increasingly see the earning potential of the black market and even menial jobs in the dollar-based tourist industry as incentives to drop out of school. Only about five percent of Cuban school graduates now go on to higher education. Vocational education and training suffers from lack of resources, modern programs, incentives to stay in school, and the traditional low prestige of studying occupational subjects as opposed to academic subjects. According to information provided by the U.S. Agency for International Development (USAID), total foreign aid from official sources to all sectors of the Cuban government in 2003 was estimated at $106.6 million. This includes $33.6 million in multilateral aid through the United Nations, $6.37 million from the European Union, $5.8 million from the OPEC fund, and the remaining amount (in millions of dollars) from bilateral donors including Spain (Central Government and Basque Regional Government), Japan, Canada, China, France, Kuwait, Sweden, Germany, Norway, Switzerland, and Brazil. In addition, Venezuela provides Cuba up to 82,000 barrels of petroleum per day under concessionary financing. In July 2003, Fidel Castro announced Cuba would no longer accept “scraps of aid” from the European Union (EU). The following month, Cuban authorities informed the EU delegation in Havana of its plan to cancel 22 cooperative projects managed by the EU and other European countries. This came after the EU censured the sentencing of 75 Cuban dissidents to an average of 28 years in prison after mock trials, and the execution of three Afro-Cubans who hijacked a ferry in an attempt to flee the island.
5. Traditional Coping Mechanisms of the Cuban People Cubans have long used five coping mechanisms to survive:
Officially reported ration levels are likely not distributed evenly among all classes of the population given the tendency of Marxist societies to distribute food and medicine based on bureaucratic rank — the more important you are to the survival of the state apparatus the higher your ration. Thus, it is likely that the official food distribution system is no longer a main source of food for the Cuban poor who increasingly survive through the informal sector, or that there is widespread acute malnutrition, or both. A well designed humanitarian aid program should be targeted on this distressed population of urban poor for whom these coping mechanisms are not available, who are suffering disproportionate deprivation from the economic collapse, and whose precarious livelihoods may be endangered by disruptions during the transition.
6. The Link Between Coping Mechanisms and Relief Operations
At the heart of all humanitarian relief strategies lie two priorities: saving lives and reducing human suffering. While relief commodities can supplement a humanitarian relief effort, it is the immediate rehabilitation programs that yield the greatest and most productive results in making people self-sufficient.
The two essential missions — saving lives and reducing suffering —need to form the basis of the work done by and through UN agencies, the Red Cross, non-governmental organizations, and donor aid agencies such as USAID. An implied part of these two imperatives is the notion that humanitarian assistance should stabilize people’s condition, at a minimum, so their situation does not worsen through unintended consequences or inadvertently flawed programming. The more chaotic conditions become, the more likely it will be that the rule of unintended consequences will apply and that humanitarian relief programming will get drawn into the chaos or even exacerbate it if not properly designed.
B. Developing a Transition Assistance Plan9
How the transition in Cuba proceeds will profoundly affect the nature of the humanitarian response. Humanitarian relief managers, as a professional principle, plan for the worst and hope for the best. ____________________ 1. Humanitarian Aid Objectives
The adoption of the following objectives depends on the political situation, the nature and assistance requests of the transition government, and the diplomatic objectives of donor governments.
RECOMMENDATIONS:
1. Conduct a Needs Assessment at the Outset of Transition
We will not know for certain what the needs are in Cuba until a humanitarian assessment can be done by an objective outside agency, given that reports from the current Cuban government are politicized. If requested, this assessment can be done by the United States Government through the Office of Foreign Disaster Assistance (OFDA) within USAID using a standard format widely accepted among humanitarian agencies. UN agencies or the Red Cross movement could also do such an assessment.
RECOMMENDATION:
D. Challenges in Providing Humanitarian Aid
The challenges to the proper design and successful implementation of the program will be substantial. Some of the issues are predictable.
1. International humanitarian agencies have developed a set of standards for working in complex emergencies called the “Code of Conduct,” which has sought to correct problems uncovered in previous relief efforts.
It is essential that all aid groups be familiar with the “Code of Conduct” and the established international standards that have been developed for working in complex emergencies. One way to facilitate this process could be through the establishment of a “Foundation for Assistance to a Free Cuba,” referred to earlier in this Chapter.
2. The old order will not relinquish power willingly and will try to subvert or corrupt the transition process to enrich itself and maintain its influence.
In other post-communist countries, the party cadres have used their inside understanding of bureaucratic offices, their old boy network of connections within the party, their superior education, and any money they had amassed under the old regime to put themselves in a commanding position to disrupt the transition or for personal gain. They will likely see the resources represented in the aid effort as a source of wealth from which they may further enrich themselves.
Following the collapse of other communist regimes, members of internal security apparatus privatized themselves and formed organized criminal syndicates to feed off legitimate new businesses and the humanitarian aid agencies. They did this through protection rackets, threats of violence against aid agencies, raking off rent and equipment, and other schemes. It is possible that a similar phenomenon could appear in Cuba, as the old order seeks to protect its privileges, unless an organized effort is made to protect the aid agencies doing the humanitarian response.
3. A very large number of aid agencies will likely want to participate in the humanitarian aid response in Cuba because of its visibility within the United States and the public demand for action.
These efforts must be coordinated. Directing and managing the response of humanitarian agencies to the Cuban transition will not be easy: reducing overlapping aid agencies’ sectoral and geographic jurisdiction, managing the inevitable competition for aid resources and media coverage, and coordinating programmatic conflict among agencies will be a major undertaking. A large number of diverse, eager assistance donors is yet another reason to establish a coordinating committee.
4. The participation of people at the neighborhood level in making decisions about the aid effort in their communities is desirable and will provide a critical opportunity to build civil society, help develop local institutions, and nurture the democratic values needed to build self-government.
Because Cuba has not functioned under a stable democratic system within the living memory of most people in the country, we cannot expect democratic values and decision-making processes to be readily understood. The transformation of values will be rocky but important to encourage.
E. Implementing Short-Term Assistance
The architecture of the international humanitarian response system that has developed in the post-cold war period to respond to emergencies similar to the one expected in Cuba is highly diffuse, decentralized, extraordinarily complex, and full of internal tension.
1. Key Non-governmental Organizations
The architecture of the system includes NGOs, which are the front line distributors of aid and managers of local aid programs. While there are perhaps 400 NGOs registered with USAID, only 150 of them are members of the NGO trade association called InterAction, and of these, only 40 to 50 do humanitarian relief programming (the rest are focused entirely on long-term development). Of these 40 to 50 NGOs, only 20 to 25 run large enough programs, possess the technical proficiency and resources, and have sufficient staff to have a serious impact in Cuba.
The qualified NGOs have developed, through past experience as well as their own internal strategic planning, certain sectoral expertise in areas such as public health, medicine, agriculture, and food aid. Many of these 20 to 25 NGOs have been informally meeting within the InterAction umbrella for the past three years to coordinate their ongoing work in Cuba. Those NGOs with a presence in Cuba now have a comparative advantage over those who enter the country for the first time during a democratic transition. They know the local elite, for better or worse, the operation of the local markets, agricultural conditions, medical facilities, and have a staff of some kind in place. Groups that are not established parts of the humanitarian assistance architecture may want to consider coming together to create an umbrella foundation that could work with other donors and to funnel assistance.
One major benefit of NGOs, beyond their experience in emergency response and technical field expertise, is their grassroots network within American society that can mobilize public support among their contributors for an aid effort in an emergency. NGOs have been increasing their presence on the ground in Cuba gradually, as the economic deterioration has grown more severe. Because they are constrained by the Cuban government from developing indigenous, grassroots organizational structures, NGOs do not have the same ground presence they might have in other countries.
2. International Organizations
Four UN agencies have the operational and legal mandates under the UN Charter to do humanitarian relief work: the World Food Program (providing food aid and food for work projects), UNICEF (addressing the long-term needs of developing countries), the UN High Commissioner for Refugees (providing international protection for refugees), and the UN Development Program (providing long-term development). One UN secretariat level agency, the Office of the Coordinator of Humanitarian Assistance (OCHA), has the mandate to coordinate the emergency response for UN agencies and NGOs. The new High Commissioner for Human Rights has been given the mandate to monitor and protect against human rights abuses.
3. Key U.S. Federal Agencies F. Food Aid for Cuba in the Short Term
There are a number of different food security scenarios that could confront a transition government in Cuba. For instance, the domestic Cuban food supply, transportation, infrastructure, and the storage base could be disrupted by turmoil that could follow a vacuum of authority. The U.S. Government and private organizations have determined that there may very well exist a severe case of malnutrition and lack of available supply and money to feed the Cuban people, or sectors of the Cuban people, to avoid massive sickness and disease.
RECOMMENDATIONS:
We have learned enough from other humanitarian emergencies to begin planning for a transition in Cuba.
RECOMMENDATIONS:
A. Health
The Cuban health system of socialized medicine was designed for the population to receive free preventive, curative, and rehabilitation care, including primary care, routine medical attention, dentistry, and hospital care requiring advanced medical technology. Cuba’s state-operated medical system started to decline when Soviet subsidies ended in 1989. Cuba is now faced with shortages of equipment, medical supplies and medication. Although the problem is not as severe as in other Caribbean nations, Cuba has an unquantified HIV/AIDS problem, fueled by the regime’s tacit acceptance of prostitution.
The physical, mental, and emotional health of the Cuban people is directly linked to their level of empowerment. Healthy individuals are better able to make informed decisions about their own well-being and that of their community. This ability to be involved in the decision-making process leads, in and of itself, to a sense of empowerment.
The Cuban people will likely expect a new government to place an emphasis on public health. With the proper equipment and supplies, Cuban physicians and other health care professionals will be able to practice medicine to an even higher standard. This will lead to a healthier population that will want to be involved in all areas affecting their lives.
1. Public Health Infrastructure: Ensuring Adequate Systems and Resources
It will be important, if asked by the transition government, to provide adequate epidemiological data and other health unit assistance. Cuban health care units integrate the monitoring, epidemiological surveys, and evaluation of the health care system. Such units also conduct rapid assessments and epidemiological investigations. Good epidemiological data will be necessary to determine where needs exist for short-term interventions and long-term plans in the health sector. UN agencies, along with the World Health Organization/ PAHO, already have a presence in Cuba. Several NGOs in New York and Florida may also be able to provide technical assistance to Cuba.
RECOMMENDATIONS:
i. Acute Care
Cuba has by all accounts enough hospitals and hospital beds; however, the physical structure of these buildings is often in disrepair and unsafe. There is some question as to whether Cuba, in fact, has a surplus of secondary and tertiary health care facilities. Cuba also produces a surplus of medical professionals. There is no private health care, either in terms of insurance or providers. Sanitation is a concern in health care facilities and hospitals. Medical and surgical supplies, furniture, equipment, and medications (inpatient and outpatient prescribed and over-the-counter) are in short supply.
RECOMMENDATIONS:
Family doctors in Cuba, who number some 28,500, provide the vast majority of primary care coverage. There is a surplus of physicians, to the point that the Castro regime exports doctors as part of subsidized programs in the developing world. Cuba’s primary care and preventive medicine systems are faced with shortages of medicines and supplies even though Cuba has an established pharmaceutical industry. Primary care is also hampered by a poor transportation infrastructure, especially outside major urban centers. There are several avenues for assistance to Cuban health authorities in improving primary care services.
RECOMMENDATIONS:
Older people present a potentially vulnerable population in Cuba. Fourteen percent of Cuba’s population is 60 and over. According to a just released joint MERCK/PAHO report, in the next 20 years Cuba will have more people over 60 than under 15. By 2025, over ten percent will be over 80.
RECOMMENDATIONS:
Cuba currently reports a low prevalence of HIV infection but is at high risk for a rapid spread of the epidemic. Men who have sex with other men represent 85 percent of infected men. They and people practicing commercial sex are the most vulnerable groups for HIV infection. There has now been an increase in the transmission of HIV in the heterosexual population. It is estimated for every case diagnosed there is one case that is not diagnosed. Although the rates are low, it is important that during the transition the prevention message and treatment continue.
i. Changing the Sanitarium Policy
From the onset of the HIV/AIDS pandemic until 1993, the Castro regime forcibly isolated HIV/AIDS patients in state sanitariums. Since 1993, the regime has not required that HIV positive people live in sanitariums indefinitely. Newly diagnosed patients are required to spend eight weeks in a sanitarium completing courses on how to live with the virus, how to avoid transmitting it to others, the importance of follow-up treatment, and how to handle discrimination. Forty-eight percent of HIV positive Cubans live in these sanitariums. Many of these patients are rejected by their families and are the target of widespread discrimination, and thus choose to remain in the facilities.
ii. International Collaboration
It will be important to coordinate with the Global Fund for AIDS, TB, and Malaria (GFATM), which has given funding to Cuba for the prevention of HIV and treatment and care of people living with HIV.
iii. Combating Prostitution and Irresponsible Sexual Activity
Prostitution and child prostitution and exploitation are already a significant problem in Cuba due to increased tourism. Youth often become sexually active due to the absence of support systems and increased unemployment that may occur with changes in established systems. During the transition, the message of prevention can disseminated through many means, including schools, churches, printed material, television and radio, and peer education. Along with the prevention message, child prostitutes may need additional intervention with psychological issues. The GFATM has also given funding to Cuba for this prevention activity. Several Caribbean countries have very good programs and could share their experiences.
iv. Workplace HIV/AIDS Prevention
Although the reported incidence of HIV/AIDS in Cuba is relatively low, the growing rate of infection in the heterosexual population and the lack of awareness by many people who carry the virus create conditions in which the disease could rapidly spread. Any spread of HIV/AIDS could have a devastating impact in the workplace and the economy by causing declines in output and productivity; losses of income and available labor; and higher health and labor costs related to sick leave, absenteeism, medical insurance, replacement and training, death-related costs, and shortage of skilled labor. The stigma attached to HIV/AIDS can also be particularly onerous in the workplace, making those who carry the virus subject to severe employment discrimination. On the prevention side, the potential impact of HIV/AIDS in the workplace makes it a powerful forum for raising awareness and attacking the spread of the disease.
RECOMMENDATIONS:
According to estimates, the Castro regime holds more than 100,000 prisoners, or 900 inmates for every 100,000 people, in some 200 labor camps and prisons. At least 300 members of the total prison population are documented political detainees. It is possible that the total number of prisoners detained on various questionable charges is actually higher. The high number of prisoners, one of the world’s highest rates of incarceration, is reflective of both the communist dictatorship’s control practices and the high real crime rate that is the result of the post-Soviet economic decline and the regime-induced breakdown of family structures. By all accounts, prison and camp conditions are extremely poor and inmates are frequently denied proper medical care, external contact, and other services.
RECOMMENDATIONS:
Cuba shares common health problems with the U.S. and other regional partners. Similar interests exist across a broad spectrum of priority health concerns, including HIV/AIDS, dengue, and other infectious diseases; cardiovascular disease; hypertension; diabetes; nutritional disorders; cancer; and chronic pulmonary diseases, including asthma. RECOMMENDATIONS:
During the transition, the mental and emotional health of the Cuban people will be subjected to increased stress. Significant events and changes, whether positive or negative, can disrupt daily lives. Emotional stress is most often seen fairly early. It is important that healthcare professionals — including physicians, mental healthcare workers, and other counselors such as qualified clergy — be prepared to deal with this possibility.
i. Community-based Intervention
Initially, the community and community leaders, faith-based organizations, schools, and other civic institutions might benefit from some basic training in community-based interventions to restore a sense of wellness and hope to the general public. Humanitarian organizations and organizations that are trained in these situations can provide crisis intervention as needed.
ii. Mental Health Education
Similarly, mental health professionals may benefit from continuing medical education in the use of the new medications for various psychiatric diagnoses. This can be accomplished through exchange programs with partner countries.
iii. Evaluation of Patients in Mental Institutions
Evaluation of patients in Cuban mental institutions could be done fairly quickly. There are suggestions that the regime has used psychiatric and mental health facilities as instruments of repression and intimidation. The incarcerated population may also need a rapid mental health assessment since many may be political prisoners.
iv. Evaluation of the Elderly
Older people are often overlooked in times of emergency. The feelings of loss, trauma, confusion, and fear familiar to all people in emergencies can be more damaging for older people. They may need special support to recover emotionally and find new roles. Elderly people’s chronic health, mobility, and mental-health problems are not a priority for aid agencies in most emergencies.
Relief efforts could include sensitizing and training community mental health professionals to the special needs of older Cubans who may have an especially difficult time dealing with changes and losses. Older Cubans could be provided with crisis intervention, counseling, and information. Outreach efforts to older Cubans could be made, as they may not reach out for services. These efforts could involve organizations such as the American Red Cross, HelpAge International, and Little Havana Activities & Nutrition Center of Dade County, Inc.
RECOMMENDATIONS:
Cuba is a proven trafficking point for drugs and possesses its own drug problems. With the possible stresses on individuals during the transition there may be an increase in drug use, including alcohol. There are several U.S. and international sources of assistance that could help address these challenges. A great deal of data and written material in many languages can be translated into Spanish. For example, existing health professions training in Spanish developed by SAMHSA could be provided in the early stages of transition, on issues such as screening mechanisms within primary care settings for identifying addictive disorders, co-occurring mental health problems, and traumatic stress. Moreover, in Puerto Rico, the Addiction Technology Transfer Center is an immediate resource that can be tapped as a vehicle to establish host country links and to coordinate addiction training and treatment programs with other NGOs and international relief agencies. There may need to be Cuba-specific research and data on drug use and effective treatment methods. Drug use and addiction are public health problems, which are best dealt with by public health approaches — prevention, early intervention, and treatment.
RECOMMENDATIONS:
1. Overview
The current state of the Cuban education system may be summarized by a statement from Cuban scholar Graciella Cruz-Taura in a report to the University of Miami’s Cuban Transition Project:
Most assessments of the state of Cuban education continue to conclude that Cuba is an indebted, poor country with a highly educated population that is particularly well trained in the exact and military sciences. One decade after the collapse of the Soviet world, the Cuban educational system is besieged by diminishing resources, ideological ambiguity, and labor demands unable to accommodate the scientifically trained graduates the Revolution had showcased as one of its major accomplishments and as the cornerstone of its legitimacy. It was a system designed to service Marxist-Leninist ideology and the one-party state. If Cuba is going to make a peaceful transition into an age of globalization and post-communism, this philosophy of education must be reversed to one that will legitimately and effectively service the individual.10 ____________________ Implementing the change proposed by Cruz-Taura and other experts likely will require actions focused on renewing a participatory civic culture that supports free enterprise, the rule of law, and personal accountability; promotes alternative solutions to problems, including those solutions provided by public, private, and faith-based entities; encourages high standards for students and educators; and introduces new governance models that encourage parental and community involvement and devolve significant responsibilities to local and institutional leadership. The aims of education and training at all levels could be to reinforce democracy and produce the knowledge and skills needed to allow Cubans to be successful in the global economy.
This section is divided into three parts: recommendations that apply to the whole Cuban education system; recommendations specific to particular levels and types of education; and recommendations for the related areas of cultural preservation and exchange.
2. Assistance for System-wide Reform of Cuban Education
i. Reintroducing Democratic Values Through Education
A Cuban transitional government, together with assisting governments, international organizations, and private donors, may want to complete a comprehensive review and needs assessment regarding system reform, priorities for action, and available resources. We have identified certain issues as basic to long-term reform and critical at all levels of the education system.
a. Civil Rights and Equal Access to Educational Opportunity
A democratic Cuba likely will operate a free public education system that is open to all parents who choose to enroll their children in it, and will permit and recognize private and church-related schools and allow parents the option of using them. Access to postsecondary education, both vocational and academic, likely will be encouraged for all qualified graduates of secondary schools, and the higher education system should be open to public, private, and church-related institutions. Assistance to parents and adults in financing education likely will be made available as resources permit and should be available to all who qualify for it. Cuba has a sad history of separating disabled citizens and denying them access to mainstream opportunities, as well as socioeconomic, racial-ethnic, and political discrimination. The new system likely will cease discriminatory practices that exist and avoid introducing new ones such as discrimination for reasons of political revenge or elitism. The United States could offer several forms of assistance, if asked, to help the transition government establish such a system.
RECOMMENDATIONS:
A priority of the new Cuban education system may well be building a culture of shared democratic ideals and citizenship skills. This likely will require the removal and replacement of biased, ideological, and outdated instructional materials; the retraining of educators; a comprehensive civic education program involving schools, communities, churches, and the media; and curricula designed to address specific post-communist transition issues such as respect for law and trusting others, responsibility and accountability, participatory democracy, and entrepreneurship.
Once initial replacement of heavily politicized materials is complete, a transition government may want to introduce curriculum content in civic and democracy education and in character education programs that inculcate values at all levels by working with public education authorities and appropriate civil society groups, including those providing or sponsoring private education. Training and retraining educators likely will be an essential component, as will be the introduction of material on the new Cuban legal and political systems. Models for this civic curriculum could involve resources such as the Department of Education’s Civitas Latin America program. In order to minimize resistance to the change, efforts should be made to identify educational texts and materials from other Spanish-speaking countries that could be used by Cuba.
Cubans at all education levels can benefit from education in the principles and values of free enterprise economics and the appropriate knowledge and skills for employment and advancement. This probably requires the modification of the curriculum at all levels, retraining of educators, and encouraging the nascent business community to engage in economics and business education in partnership with public and private educational providers.
Cubans will want to feel that the new system works for them, and they likely would benefit from informal advice, counseling, and networking in addition to more formal services. A useful part of the overall civic and economic education process can be to establish mentoring networks, via churches, business and professional associations, fraternal associations, and clubs to enable Cubans to build the contacts and obtain the advice that will be important as they navigate the new civil society, consider career options, seek to start businesses, or look for jobs or specific assistance. Organizations outside Cuba that have island connections, such as church groups, Freemasons, Rotary and other business clubs, and other private groups can be beneficial as mentoring partners to Cuban citizens of all ages, professions, and circumstances.
RECOMMENDATIONS:
Cuba has always had a national education system overseen by an education ministry. The new Cuban government will determine what kind of governance structure is best for Cuba’s future. Regardless, the extreme centralized control, security institutions, and opposition to private education that characterized the Castro regime will no doubt be modified or eliminated. Suggestions for how the U.S. Government could assist a transition change a free Cuban educational governance organization include the following.
a. Encourage Educational Diversity
Modern systems of education are increasingly diverse. Strong public education sectors are supplemented by private sectors that supply both general and specialized services to populations that choose them. Alternative approaches to education, such as distance learning, are becoming increasingly common and important as tools for both traditional and nontraditional providers. And the national system will be more responsive to Cubans and cost-effective if a mechanism is provided that permits public input as well as a measure of self-governance. The post-transition Cuban education system will be stronger and better able to serve all of the needs of the Cuban people and economy if it recognizes and encourages educational diversity.
RECOMMENDATIONS:
As with other aspects of a transition, Cuba’s education system can benefit from the establishment of a modern information system. This step will be important in order to be able to make and implement good policy decisions and monitor progress over time. A transition government likely will want to ensure that data collection is regular and that all institutions, public and private, are held accountable for performance. This effort could make use of the Summit of the Americas Regional Indicators project and enlist the help of other countries. The National Center for Education Statistics can contribute expertise.
c. Parent, Employer, and Community Involvement
No matter how a free Cuba decides to organize the governance of education, it will be useful to be able to provide ways for the government and the schools to receive assistance from interested donors and to help build democracy through organic connections to the communities in which schools are located and which they serve.
RECOMMENDATIONS:
To promote national dialogue on school reform, the United States could assist a transition government in establishing a National Commission on Progress through Education, in association with Cuba’s existing network of libraries. Each library could be designated as the organizing entity for a local “Progress through Education” dialogue. Community members in attendance could voice concerns and share ideas directly with officials from the new Ministry of Education. The dialogue could focus on particular themes, such as curriculum and teacher education. In addition to serving as a community needs assessment, such a process could help to establish ownership and empowerment in education reform and send the message that the government is dedicated to creating a system of education that is responsive to the needs of the people.
RECOMMENDATION:
Working with a new Cuban Ministry of Education, community education boards could encourage local community participation in local school affairs by establishing an outreach program focused on community ownership and investment in schools. Building from the success of similar initiatives in the region, officials from the Inter-American system and the United States could work with the Cuban Ministry of Education, the Independent Libraries network, and other national stakeholders to establish local school community education boards. The specific functions of these boards would evolve as necessary, yet the two primary goals might be to (1) encourage support and accountability for education in the community by promoting the importance of quality education to a private sector, NGOs, and private agencies, and by demonstrating ways in which these entities can become involved in local schools; and (2) formally represent the needs of the community (teachers, students, and administrators alike) to the national government, and the private and non-profit sectors on an on-going basis.
RECOMMENDATION:
After a transition, a free Cuba will develop a new generation of educational and civic leaders even as it reorients current students, educators, and community leaders. These twin needs provide an opportunity to develop a cadre of potential leaders, experts, and researchers, who can assume positions of influence in academic, government, and nongovernmental sectors.
RECOMMENDATION:
A free Cuba will likely seek to create an education system that is modern, flexible, and open. There are mechanisms for maintaining high standards that may have particular relevance for the transition process in Cuba and for the specific needs of the Cuban education system as it reforms itself.
a. Curricular Standards and Assessments
A new Cuba’s educational leaders will likely revise the school curriculum to rid it of communist ideology and to update those portions that could not keep pace with international intellectual developments while the Castro regime controlled what people learned and how. Vocational and higher education institutions may also need to revise their curricula as appropriate. If requested, U.S. educators could assist in the creation of a system of standards, curricula, and assessments in core academic content areas and elective areas in the Cuban school curriculum.
1. Duration of Schooling
Cuba is a country that has operated a school cycle consisting of 9 years of compulsory education. Incentives to drop out and seek employment in the black market or tourism sectors, and perceived disincentives to finish school (through the 12th year) and seek postsecondary education, have produced a significant population of undereducated persons.
2. Academic Standards for All Students
A system of standards and assessment may be needed to ensure that all Cuban children (including those with disabilities) have access to a quality education and that their performance is assessed on their achievement of set standards. Individual student achievement data could inform education policy decision regarding curriculum, academic focus, and professional development.
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