Combating Trafficking of Cuban Doctors Act of 2021
Bill: S.2138 | Sponsor: Sen. Menendez, Robert (D-NJ)
Policy area: International Affairs

Summary:
Combating Trafficking of Cuban Doctors Act of 2021
This bill requires the Department of State to reinstate the Cuban Medical Professional Parole program to authorize the admission into the United States of Cuban medical personnel conscripted to study or work in a third country under the direction of the Cuban government. The State Department must also submit an annual report and determination on the international trafficking of Cuban medical personnel, as well as report on and make recommendations related to the role of the Pan American Health Organization in this practice.

To respond to international trafficking of Cuban medical professionals 
           by the Government of Cuba, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Combating 
Trafficking of Cuban Doctors Act of 2021''.
    (b) Table of Contents.--The table of contents for 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.
Sec. 5. Reestablishing the Cuban Medical Professionals Parole program.
Sec. 6. Role of the Pan American Health Organization.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) In 2019, the Government of Cuba maintained an estimated 
        34,000 to 50,000 medical personnel in more than 60 countries 
        under conditions that represent forced labor, according to the 
        Department of State.
            (2) Since the outbreak of the COVID-19 pandemic in early 
        2020, the Government of Cuba has deployed approximately 1,500 
        medical personnel to at least 20 countries.
            (3) The Department of State's 2020 Trafficking in Persons 
        report ranked Cuba in Tier 3 and included evidence regarding 
        Cuba's foreign medical missions and the Government of Cuba's 
        longstanding failure to criminalize most forms of forced labor, 
        specifically noting allegations that Cuban authorities coerced 
        participants to remain in foreign medical missions by--
                    (A) ``withholding their passports and medical 
                credentials'';
                    (B) ``using `minders' to conduct surveillance of 
                participants outside of work'';
                    (C) ``restricting their movement'';
                    (D) ``retaliat[ing] against their family members in 
                Cuba if participants leave the program''; or
                    (E) ``impos[ing] criminal penalties, exile, and 
                family separation if participants do not return to Cuba 
                as directed by government supervisors''.
            (4) On July 26, 2019, the United States imposed visa 
        restrictions under section 212(a)(3)(C) of the Immigration and 
        Nationality Act (8 U.S.C. 1182(a)(3)(C)) against certain Cuban 
        officials and other individuals responsible for the coercive 
        labor practices of Cuba's overseas medical missions.
            (5) The United Nations Special Rapporteur on contemporary 
        forms of slavery and the United Nations Special Rapporteur on 
        trafficking in persons, especially women and children, in their 
        letter to the Government of Cuba on November 6, 2019--
                    (A) noted reports of coercive labor practices 
                through the Government of Cuba's foreign medical 
                missions;
                    (B) highlighted reports by Cuban medical 
                professionals that they received regular threats from 
                Cuban officials while working overseas, including 
                sexual harassment of women; and
                    (C) expressed concern that the practices referred 
                to in subparagraphs (A) and (B) constitute slavery and 
                trafficking in persons.
            (6) In July 2013, the Cuban Ministry of Health signed an 
        agreement with the Brazilian Ministry of Health to formalize an 
        arrangement for Cuban doctors to provide medical services in 
        Brazil that--
                    (A) required the administration of former Brazilian 
                President Dilma Rousseff to transmit a monthly payment 
                through the Pan American Health Organization (referred 
                to in this section as ``PAHO'') to the Cuban Ministry 
                of Health for the medical services provided by each 
                Cuban doctor serving in Brazil; and
                    (B) prevented participating Cuban doctors from 
                seeking employment in Brazil outside of the formal 
                structure of the agreement.
            (7) In implementing the agreement described in paragraph 
        (6), the Cuban Ministry of Health acted through the for-profit 
        Cuban Medical Services Trading Corporation (referred to in this 
        section as ``CMS'')--
                    (A) to pay each Cuban doctor approximately 5 to 25 
                percent of the monthly payment received from PAHO;
                    (B) to retain approximately 70 to 90 percent of the 
                monthly payment for each doctor received from PAHO; and
                    (C) to permit PAHO to retain approximately 5 
                percent of such monthly payments.
            (8) Between 2013 and 2019, according to the digital 
        platform Diario de Cuba, the Government of Cuba--
                    (A) garnished the salaries of more than 20,000 
                Cuban medical professionals who served in Brazil under 
                the Mais Medicos program;
                    (B) frequently confiscated their passports; and
                    (C) prohibited family members from accompanying 
                them.
            (9) Cuban doctors were the only medical professionals 
        participating in the Mais Medicos program to have their 
        salaries directly garnished by their government, while doctors 
        of other nationalities serving in Brazil received the full 
        amount of the payments made for their medical services under 
        the program.
            (10) The Government of Cuba stated that Cuban doctors 
        unwilling to return to the country after their participation in 
        foreign medical missions would not be permitted to return to 
        their homeland for 8 years.
            (11) In February 2019, Brazil's Ministry of Health 
        announced reforms to the Mais Medicos program that--
                    (A) terminated the arrangement with the Government 
                of Cuba and PAHO; and
                    (B) allowed Cuban medical personnel to remain in 
                Brazil and be paid directly by the Brazilian Ministry 
                of Health.
            (12) The Government of Cuba's response to the reforms 
        referred to in paragraph (11) was to order the Cuban medical 
        personnel to return to Cuba, rather than allowing them to be 
        fully and directly compensated. Most Cuban medical personnel 
        returned to Cuba, as ordered, although approximately 2,000 
        Cuban medical personnel remain in Brazil.
            (13) The Government of Cuba realized profits in excess of 
        $6,300,000,000 during 2018 from exporting the services of Cuban 
        professionals, of which foreign medical missions represent the 
        majority of the services and income.
            (14) Countries in which similar abuses to those suffered by 
        Cuban medical professionals in Brazil have been reported to 
        have occurred include Angola, Guatemala, Mexico, Qatar, and 
        Venezuela.
            (15) In Venezuela, a group of Cuban doctors reported in 
        2019 that they had been directed, and often coerced, to use 
        their medical services to influence votes in favor of the 
        Maduro regime, including--
                    (A) by denying medical treatment to opposition 
                supporters; and
                    (B) by giving precise voting instructions to 
                elderly patients.
            (16) The term ``severe forms of trafficking in persons'' is 
        defined under section 103(11)(B) of the Trafficking Victims 
        Protection Act of 2000 (22 U.S.C. 7102(11)(B)) as ``the 
        recruitment, harboring, transportation, provision, or obtaining 
        of a person for labor or services, through the use of force, 
        fraud, or coercion for the purpose of subjection to involuntary 
        servitude, peonage, debt bondage, or slavery''.

SEC. 3. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) the Government of Cuba subjects Cuban doctors and other 
        medical professionals to state-sponsored human trafficking;
            (2) the Government of Cuba should fully compensate Cuban 
        medical professionals who have participated in, or who are 
        currently participating in foreign medical mission programs in 
        other countries, including Brazil's Mais Medicos program, for 
        the full amount of wages paid to the Government of Cuba;
            (3) the Government of Cuba should immediately and 
        transparently respond to requests for information from the 
        United Nations Special Rapporteur on contemporary forms of 
        slavery and the United Nations Special Rapporteur on 
        trafficking in persons, especially women and children; and
            (4) foreign governments and international organizations 
        that enter into agreements with the Government of Cuba or the 
        for-profit Cuban Medical Services Trading Corporation or other 
        companies affiliated with the Government of Cuba to procure the 
        services of Cuban medical professionals directly assume legal 
        risks related to their participation in forced labor 
        arrangements and human trafficking.

SEC. 4. ANNUAL REPORT AND DETERMINATION ON INTERNATIONAL TRAFFICKING OF 
              CUBAN MEDICAL PERSONNEL.

    (a) Annual Report.--Not later than 180 days after the date of the 
enactment of this Act and annually thereafter until the date specified 
in subsection (c), the Secretary of State shall submit a report to the 
Committee on Foreign Relations of the Senate and the Committee on 
Foreign Affairs of the House of Representatives that--
            (1) identifies the countries that are hosting Cuban medical 
        personnel who are participating in foreign medical missions for 
        the Government of Cuba;
            (2) to the extent feasible, includes an estimate of--
                    (A) the number of Cuban medical personnel in each 
                country; and
                    (B) the value of the financial arrangement between 
                the Government of Cuba and the host country government;
            (3) describes the conditions in each country under which 
        Cuban medical personnel live and work; and
            (4) describes the role of any international organization in 
        each country hosting Cuban medical personnel.
    (b) Determination on Human Trafficking.--In each report submitted 
pursuant to subsection (a), the Secretary of State shall determine 
whether--
            (1) the Cuban medical personnel in each country identified 
        in the report are subjected to conditions that qualify as 
        severe forms of trafficking in persons (as defined in section 
        103(11) of the Trafficking Victims Protection Act of 2000 (22 
        U.S.C. 7102(11))); and
            (2) Cuba's foreign medical missions program constitutes 
        proof of failure to make significant efforts to bring the 
        Government of Cuba into compliance with the minimum standards 
        for the elimination of trafficking in persons (as determined 
        under section 108 of the Trafficking Victims Protection Act of 
        2000 (22 U.S.C. 7106)).
    (c) Sunset.--The Secretary of State is not required to submit the 
report otherwise required under subsection (a) after the date on which 
the Secretary submits a second consecutive annual report under such 
subsection that includes a determination under subsection (b) that 
Cuban medical personnel are no longer subjected to trafficking in 
persons.

SEC. 5. REESTABLISHING THE CUBAN MEDICAL PROFESSIONAL PAROLE PROGRAM.

    (a) In General.--The Secretary of Homeland Security, in 
coordination with the Secretary of State, shall reinstate the Cuban 
Medical Professional Parole program to authorize the admission into the 
United States of Cuban medical personnel conscripted to study or work 
in a third country under the direction of the Government of Cuba.
    (b) Authority.--The Director of U.S. Citizenship and Immigration 
Services may exercise the discretionary parole authority under section 
212(d)(5)(A) of the Immigration and Nationality Act (8 U.S.C. 
1182(d)(5)(A)) and subsections (c) and (d) of section 212.5 of title 8, 
Code of Federal Regulations, to permit eligible Cuban nationals to come 
to the United States, including for urgent humanitarian reasons or 
significant public benefit.
    (c) Eligibility Criteria.--
            (1) In general.--A Cuban medical professional is eligible 
        for consideration of parole under the Cuban Medical 
        Professional Program if he or she--
                    (A) is a Cuban national, citizen, or person 
                habitually residing in Cuba;
                    (B) is a medical professional who, at the time he 
                or she seeks such parole, is conscripted by the 
                Government of Cuba to study or work in a third country; 
                and
                    (C) is not inadmissible under section 212(a) of the 
                Immigration and Nationality Act (8 U.S.C. 1182(a)).
            (2) Admission of family members.--
                    (A) In general.--The spouse and unmarried children 
                accompanying the primary applicant in the third country 
                referred to in paragraph (1)(B) shall be eligible for 
                parole under the Cuban Medical Professional Program in 
                conjunction with an application from an individual 
                described in paragraph (1).
                    (B) Applications.--A Cuban medical professional 
                granted discretionary parole under section 212(d)(5)(A) 
                of the Immigration and Nationality Act (8 U.S.C. 
                1182(d)(5)(A)) pursuant to this section may submit an 
                application to U.S. Citizenship and Immigration 
                Services seeking admission to the United States of his 
                or her spouse and unmarried children.

SEC. 6. ROLE OF THE PAN AMERICAN HEALTH ORGANIZATION.

    (a) Findings.--Congress finds that the Pan American Health 
Organization (referred to in this section as ``PAHO'')--
            (1) has contributed to the health and well-being of the 
        people in the Western Hemisphere for longer than a century, 
        with the United States serving as a member state since 1925;
            (2) engages in technical cooperation with its member 
        countries--
                    (A) to fight communicable and noncommunicable 
                diseases and their causes;
                    (B) to strengthen health systems; and
                    (C) to respond to emergencies and disasters;
            (3) as of May 21, 2021, had assisted dozens of countries in 
        the Americas with their response to the COVID-19 pandemic, 
        including--
                    (A) supporting the delivery of 12,800,000 vaccines 
                to countries in the Americas through the COVID-19 
                Vaccines Global Access (COVAX) facility;
                    (B) providing more than 26,000,000 COVID-19 tests 
                in countries and territories throughout the Americas; 
                and
                    (C) 162 shipments of more than 50,000,000 articles 
                of personal protective equipment to countries and 
                territories throughout the Americas;
            (4) has privately commissioned a third-party review of its 
        role in the Mais Medicos program; and
            (5) adopted governance reforms to increase the oversight of 
        projects funded by voluntary contributions that present a high 
        level of institutional risk for PAHO during the 72nd Session of 
        the Regional Committee of the World Health Organization for the 
        Americas, which convened on September 28th and 29th, 2020.
    (b) Sense of Congress.--It is the sense of Congress that--
            (1) PAHO is the preeminent multilateral organization 
        dedicated to public health issues in the Americas;
            (2) PAHO--
                    (A) has played a vital role in strengthening health 
                systems in Latin America to address the COVID-19 
                pandemic; and
                    (B) continues to provide essential health 
                assistance to meet the needs of Venezuelans affected by 
                the ongoing humanitarian crisis in their country and 
                displaced individuals in other countries in the region;
            (3) the United States should continue to support PAHO, 
        including through payment of assessed contributions (in full 
        and on time) and voluntary contributions, to ensure PAHO's 
        continued operations;
            (4) according to the Department of State, the Brazilian 
        Court of Accounts, and PAHO's official independent external 
        auditor, the Tribunal de Cuentas de Espana, PAHO's role in the 
        Mais Medicos program, as described in section 2, raises serious 
        questions; and
            (5) PAHO should provide greater transparency about its role 
        in the Mais Medicos program and strengthen its internal 
        oversight and risk management to require that its external 
        auditor reports be distributed to PAHO board members and 
        discussed at PAHO board meetings.
    (c) Report.--Not later than 90 days after the date of the enactment 
of this Act, the Secretary of State and the Secretary of Health and 
Human Services shall jointly submit a report to the Committee on 
Foreign Relations of the Senate and the Committee on Foreign Affairs of 
the House of Representatives that includes--
            (1) a review of and findings on PAHO's role in the Mais 
        Medicos program between 2013 and 2019;
            (2) a summary of corrective actions to be taken by PAHO; 
        and
            (3) recommendations for further corrective actions, as 
        necessary.
    (d) Accountability Measures.--The Secretary of State and the 
Secretary of Health and Human Services shall jointly--
            (1) take all necessary steps to ensure that PAHO undertakes 
        governance reforms that strengthen internal oversight and risk 
        management for all future programs; and
            (2) not later than 30 days after the receipt of the results 
        of the independent, third-party review of PAHO's role in the 
        Mais Medicos program, provide a briefing to the Committee on 
        Foreign Relations of the Senate and the Committee on Foreign 
        Affairs of the House of Representatives that includes a 
        detailed summary of such results and the progress made in 
        PAHO's efforts to strengthen internal oversight and risk 
        management.
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