II 

117TH CONGRESS 

1ST SESSION S. 2138 

To respond to international trafficking of Cuban medical professionals by 

the Government of Cuba, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 17, 2021 

Mr. MENENDEZ (for himself and Mr. RUBIO) introduced the following bill; 

which was read twice and referred to the Committee on the Judiciary 

A BILL 

To respond to international trafficking of Cuban medical 

professionals by the Government of Cuba, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Combating Trafficking of Cuban Doctors Act of 2021’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

Sec. 3. Sense of Congress. 

Sec. 4. Annual report and determination on international trafficking of Cuban 

medical personnel. 


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Sec. 5. Reestablishing the Cuban Medical Professionals Parole program. 

Sec. 6. Role of the Pan American Health Organization. 

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) In 2019, the Government of Cuba main4 tained an estimated 34,000 to 50,000 medical per5 sonnel in more than 60 countries under conditions 

6 that represent forced labor, according to the Depart7 ment of State. 

8 (2) Since the outbreak of the COVID–19 pan9 demic in early 2020, the Government of Cuba has 

10 deployed approximately 1,500 medical personnel to 

11 at least 20 countries. 

12 (3) The Department of State’s 2020 Traf13 ficking in Persons report ranked Cuba in Tier 3 and 

14 included evidence regarding Cuba’s foreign medical 

15 missions and the Government of Cuba’s long16 standing failure to criminalize most forms of forced 

17 labor, specifically noting allegations that Cuban au18 thorities coerced participants to remain in foreign 

19 medical missions by— 

20 (A) ‘‘withholding their passports and med21 ical credentials’’; 

22 (B) ‘‘using ‘minders’ to conduct surveil23 lance of participants outside of work’’; 

24 (C) ‘‘restricting their movement’’; 


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1 (D) ‘‘retaliat[ing] against their family 

2 members in Cuba if participants leave the pro3 gram’’; or 

4 (E) ‘‘impos[ing] criminal penalties, exile, 

5 and family separation if participants do not re6 turn to Cuba as directed by government super7 visors’’. 

8 (4) On July 26, 2019, the United States im9 posed visa restrictions under section 212(a)(3)(C) of 

10 the Immigration and Nationality Act (8 U.S.C. 

11 1182(a)(3)(C)) against certain Cuban officials and 

12 other individuals responsible for the coercive labor 

13 practices of Cuba’s overseas medical missions. 

14 (5) The United Nations Special Rapporteur on 

15 contemporary forms of slavery and the United Na16 tions Special Rapporteur on trafficking in persons, 

17 especially women and children, in their letter to the 

18 Government of Cuba on November 6, 2019— 

19 (A) noted reports of coercive labor prac20 tices through the Government of Cuba’s foreign 

21 medical missions; 

22 (B) highlighted reports by Cuban medical 

23 professionals that they received regular threats 

24 from Cuban officials while working overseas, in25 cluding sexual harassment of women; and 


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1 (C) expressed concern that the practices 

2 referred to in subparagraphs (A) and (B) con3 stitute slavery and trafficking in persons. 

4 (6) In July 2013, the Cuban Ministry of Health 

5 signed an agreement with the Brazilian Ministry of 

6 Health to formalize an arrangement for Cuban doc7 tors to provide medical services in Brazil that— 

8 (A) required the administration of former 

9 Brazilian President Dilma Rousseff to transmit 

10 a monthly payment through the Pan American 

11 Health Organization (referred to in this section 

12 as ‘‘PAHO’’) to the Cuban Ministry of Health 

13 for the medical services provided by each Cuban 

14 doctor serving in Brazil; and 

15 (B) prevented participating Cuban doctors 

16 from seeking employment in Brazil outside of 

17 the formal structure of the agreement. 

18 (7) In implementing the agreement described in 

19 paragraph (6), the Cuban Ministry of Health acted 

20 through the for-profit Cuban Medical Services Trad21 ing Corporation (referred to in this section as 

22 ‘‘CMS’’)— 

23 (A) to pay each Cuban doctor approxi24 mately 5 to 25 percent of the monthly payment 

25 received from PAHO; 


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1 (B) to retain approximately 70 to 90 per2 cent of the monthly payment for each doctor re3 ceived from PAHO; and 

4 (C) to permit PAHO to retain approxi5 mately 5 percent of such monthly payments. 

6 (8) Between 2013 and 2019, according to the 

7 digital platform Diario de Cuba, the Government of 

8 Cuba— 

9 (A) garnished the salaries of more than 

10 20,000 Cuban medical professionals who served 

11 in Brazil under the Mais Me ́dicos program; 

12 (B) frequently confiscated their passports; 

13 and 

14 (C) prohibited family members from ac15 companying them. 

16 (9) Cuban doctors were the only medical profes17 sionals participating in the Mais Me ́dicos program to 

18 have their salaries directly garnished by their gov19 ernment, while doctors of other nationalities serving 

20 in Brazil received the full amount of the payments 

21 made for their medical services under the program. 

22 (10) The Government of Cuba stated that 

23 Cuban doctors unwilling to return to the country 

24 after their participation in foreign medical missions 


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1 would not be permitted to return to their homeland 

2 for 8 years. 

3 (11) In February 2019, Brazil’s Ministry of 

4 Health announced reforms to the Mais Me ́dicos pro5 gram that— 

6 (A) terminated the arrangement with the 

7 Government of Cuba and PAHO; and 

8 (B) allowed Cuban medical personnel to re9 main in Brazil and be paid directly by the Bra10 zilian Ministry of Health. 

11 (12) The Government of Cuba’s response to the 

12 reforms referred to in paragraph (11) was to order 

13 the Cuban medical personnel to return to Cuba, 

14 rather than allowing them to be fully and directly 

15 compensated. Most Cuban medical personnel re16 turned to Cuba, as ordered, although approximately 

17 2,000 Cuban medical personnel remain in Brazil. 

18 (13) The Government of Cuba realized profits 

19 in excess of $6,300,000,000 during 2018 from ex20 porting the services of Cuban professionals, of which 

21 foreign medical missions represent the majority of 

22 the services and income. 

23 (14) Countries in which similar abuses to those 

24 suffered by Cuban medical professionals in Brazil 


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1 have been reported to have occurred include Angola, 

2 Guatemala, Mexico, Qatar, and Venezuela. 

3 (15) In Venezuela, a group of Cuban doctors 

4 reported in 2019 that they had been directed, and 

5 often coerced, to use their medical services to influ6 ence votes in favor of the Maduro regime, includ7 ing— 

8 (A) by denying medical treatment to oppo9 sition supporters; and 

10 (B) by giving precise voting instructions to 

11 elderly patients. 

12 (16) The term ‘‘severe forms of trafficking in 

13 persons’’ is defined under section 103(11)(B) of the 

14 Trafficking Victims Protection Act of 2000 (22 

15 U.S.C. 7102(11)(B)) as ‘‘the recruitment, harboring, 

16 transportation, provision, or obtaining of a person 

17 for labor or services, through the use of force, fraud, 

18 or coercion for the purpose of subjection to involun19 tary servitude, peonage, debt bondage, or slavery’’. 

20 SEC. 3. SENSE OF CONGRESS. 

21 It is the sense of Congress that— 

22 (1) the Government of Cuba subjects Cuban 

23 doctors and other medical professionals to state24 sponsored human trafficking; 


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1 (2) the Government of Cuba should fully com2 pensate Cuban medical professionals who have par3 ticipated in, or who are currently participating in 

4 foreign medical mission programs in other countries, 

5 including Brazil’s Mais Me ́dicos program, for the 

6 full amount of wages paid to the Government of 

7 Cuba; 

8 (3) the Government of Cuba should immediately 

9 and transparently respond to requests for informa10 tion from the United Nations Special Rapporteur on 

11 contemporary forms of slavery and the United Na12 tions Special Rapporteur on trafficking in persons, 

13 especially women and children; and 

14 (4) foreign governments and international orga15 nizations that enter into agreements with the Gov16 ernment of Cuba or the for-profit Cuban Medical 

17 Services Trading Corporation or other companies af18 filiated with the Government of Cuba to procure the 

19 services of Cuban medical professionals directly as20 sume legal risks related to their participation in 

21 forced labor arrangements and human trafficking. 


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1 SEC. 4. ANNUAL REPORT AND DETERMINATION ON INTER2 NATIONAL TRAFFICKING OF CUBAN MEDICAL 

3 PERSONNEL. 

4 (a) ANNUAL REPORT.—Not later than 180 days after 

5 the date of the enactment of this Act and annually there6 after until the date specified in subsection (c), the Sec7 retary of State shall submit a report to the Committee 

8 on Foreign Relations of the Senate and the Committee 

9 on Foreign Affairs of the House of Representatives that— 

10 (1) identifies the countries that are hosting 

11 Cuban medical personnel who are participating in 

12 foreign medical missions for the Government of 

13 Cuba; 

14 (2) to the extent feasible, includes an estimate 

15 of— 

16 (A) the number of Cuban medical per17 sonnel in each country; and 

18 (B) the value of the financial arrangement 

19 between the Government of Cuba and the host 

20 country government; 

21 (3) describes the conditions in each country 

22 under which Cuban medical personnel live and work; 

23 and 

24 (4) describes the role of any international orga25 nization in each country hosting Cuban medical per26 sonnel. 


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1 (b) DETERMINATION ON HUMAN TRAFFICKING.—In 

2 each report submitted pursuant to subsection (a), the Sec3 retary of State shall determine whether— 

4 (1) the Cuban medical personnel in each coun5 try identified in the report are subjected to condi6 tions that qualify as severe forms of trafficking in 

7 persons (as defined in section 103(11) of the Traf8 ficking Victims Protection Act of 2000 (22 U.S.C. 

9 7102(11))); and 

10 (2) Cuba’s foreign medical missions program 

11 constitutes proof of failure to make significant ef12 forts to bring the Government of Cuba into compli13 ance with the minimum standards for the elimi14 nation of trafficking in persons (as determined 

15 under section 108 of the Trafficking Victims Protec16 tion Act of 2000 (22 U.S.C. 7106)). 

17 (c) SUNSET.—The Secretary of State is not required 

18 to submit the report otherwise required under subsection 

19 (a) after the date on which the Secretary submits a second 

20 consecutive annual report under such subsection that in21 cludes a determination under subsection (b) that Cuban 

22 medical personnel are no longer subjected to trafficking 

23 in persons. 


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1 SEC. 5. REESTABLISHING THE CUBAN MEDICAL PROFES2 SIONAL PAROLE PROGRAM. 

3 (a) IN GENERAL.—The Secretary of Homeland Secu4 rity, in coordination with the Secretary of State, shall rein5 state the Cuban Medical Professional Parole program to 

6 authorize the admission into the United States of Cuban 

7 medical personnel conscripted to study or work in a third 

8 country under the direction of the Government of Cuba. 

9 (b) AUTHORITY.—The Director of U.S. Citizenship 

10 and Immigration Services may exercise the discretionary 

11 parole authority under section 212(d)(5)(A) of the Immi12 gration and Nationality Act (8 U.S.C. 1182(d)(5)(A)) and 

13 subsections (c) and (d) of section 212.5 of title 8, Code 

14 of Federal Regulations, to permit eligible Cuban nationals 

15 to come to the United States, including for urgent human16 itarian reasons or significant public benefit. 

17 (c) ELIGIBILITY CRITERIA.— 

18 (1) IN GENERAL.—A Cuban medical profes19 sional is eligible for consideration of parole under 

20 the Cuban Medical Professional Program if he or 

21 she— 

22 (A) is a Cuban national, citizen, or person 

23 habitually residing in Cuba; 

24 (B) is a medical professional who, at the 

25 time he or she seeks such parole, is conscripted 


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1 by the Government of Cuba to study or work in 

2 a third country; and 

3 (C) is not inadmissible under section 

4 212(a) of the Immigration and Nationality Act 

5 (8 U.S.C. 1182(a)). 

6 (2) ADMISSION OF FAMILY MEMBERS.— 

7 (A) IN GENERAL.—The spouse and unmar8 ried children accompanying the primary appli9 cant in the third country referred to in para10 graph (1)(B) shall be eligible for parole under 

11 the Cuban Medical Professional Program in 

12 conjunction with an application from an indi13 vidual described in paragraph (1). 

14 (B) APPLICATIONS.—A Cuban medical 

15 professional granted discretionary parole under 

16 section 212(d)(5)(A) of the Immigration and 

17 Nationality Act (8 U.S.C. 1182(d)(5)(A)) pur18 suant to this section may submit an application 

19 to U.S. Citizenship and Immigration Services 

20 seeking admission to the United States of his or 

21 her spouse and unmarried children. 


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1 SEC. 6. ROLE OF THE PAN AMERICAN HEALTH ORGANIZA2 TION. 

3 (a) FINDINGS.—Congress finds that the Pan Amer4 ican Health Organization (referred to in this section as 

5 ‘‘PAHO’’)— 

6 (1) has contributed to the health and well-being 

7 of the people in the Western Hemisphere for longer 

8 than a century, with the United States serving as a 

9 member state since 1925; 

10 (2) engages in technical cooperation with its 

11 member countries— 

12 (A) to fight communicable and noncommu13 nicable diseases and their causes; 

14 (B) to strengthen health systems; and 

15 (C) to respond to emergencies and disas16 ters; 

17 (3) as of May 21, 2021, had assisted dozens of 

18 countries in the Americas with their response to the 

19 COVID–19 pandemic, including— 

20 (A) supporting the delivery of 12,800,000 

21 vaccines to countries in the Americas through 

22 the COVID–19 Vaccines Global Access 

23 (COVAX) facility; 

24 (B) providing more than 26,000,000 

25 COVID–19 tests in countries and territories 

26 throughout the Americas; and 


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1 (C) 162 shipments of more than 

2 50,000,000 articles of personal protective equip3 ment to countries and territories throughout 

4 the Americas; 

5 (4) has privately commissioned a third-party re6 view of its role in the Mais Me ́dicos program; and 

7 (5) adopted governance reforms to increase the 

8 oversight of projects funded by voluntary contribu9 tions that present a high level of institutional risk 

10 for PAHO during the 72nd Session of the Regional 

11 Committee of the World Health Organization for the 

12 Americas, which convened on September 28th and 

13 29th, 2020. 

14 (b) SENSE OF CONGRESS.—It is the sense of Con15 gress that— 

16 (1) PAHO is the preeminent multilateral orga17 nization dedicated to public health issues in the 

18 Americas; 

19 (2) PAHO— 

20 (A) has played a vital role in strengthening 

21 health systems in Latin America to address the 

22 COVID–19 pandemic; and 

23 (B) continues to provide essential health 

24 assistance to meet the needs of Venezuelans af25 fected by the ongoing humanitarian crisis in 


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1 their country and displaced individuals in other 

2 countries in the region; 

3 (3) the United States should continue to sup4 port PAHO, including through payment of assessed 

5 contributions (in full and on time) and voluntary 

6 contributions, to ensure PAHO’s continued oper7 ations; 

8 (4) according to the Department of State, the 

9 Brazilian Court of Accounts, and PAHO’s official 

10 independent external auditor, the Tribunal de 

11 Cuentas de Espan ̃a, PAHO’s role in the Mais 

12 Me ́dicos program, as described in section 2, raises 

13 serious questions; and 

14 (5) PAHO should provide greater transparency 

15 about its role in the Mais Me ́dicos program and 

16 strengthen its internal oversight and risk manage17 ment to require that its external auditor reports be 

18 distributed to PAHO board members and discussed 

19 at PAHO board meetings. 

20 (c) REPORT.—Not later than 90 days after the date 

21 of the enactment of this Act, the Secretary of State and 

22 the Secretary of Health and Human Services shall jointly 

23 submit a report to the Committee on Foreign Relations 

24 of the Senate and the Committee on Foreign Affairs of 

25 the House of Representatives that includes— 


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1 (1) a review of and findings on PAHO’s role in 

2 the Mais Me ́dicos program between 2013 and 2019; 

3 (2) a summary of corrective actions to be taken 

4 by PAHO; and 

5 (3) recommendations for further corrective ac6 tions, as necessary. 

7 (d) ACCOUNTABILITY MEASURES.—The Secretary of 

8 State and the Secretary of Health and Human Services 

9 shall jointly— 

10 (1) take all necessary steps to ensure that 

11 PAHO undertakes governance reforms that 

12 strengthen internal oversight and risk management 

13 for all future programs; and 

14 (2) not later than 30 days after the receipt of 

15 the results of the independent, third-party review of 

16 PAHO’s role in the Mais Me ́dicos program, provide 

17 a briefing to the Committee on Foreign Relations of 

18 the Senate and the Committee on Foreign Affairs of 

19 the House of Representatives that includes a de20 tailed summary of such results and the progress 

21 made in PAHO’s efforts to strengthen internal over22 sight and risk management. 

Æ 


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