HAVANA, 3Nov. 30th (nytimes) As a member of Cuba’s international medical mission, Dr. Ramona Matos Rodríguez received $400 a month while posted in Brazil, a small fortune in her home country.
It was not long before she figured out that physicians from other countries also working in Brazil’s “More Doctors” program were taking home 20 times as much. Even the Pan American Health Organization, an international agency affiliated with the United Nations that brokered the arrangement, received a percentage for the doctors’ work.
“We realized that they fooled us Cuban doctors,” said Dr. Matos, 56, who now lives in Miami. “They tricked us.”
PAHO, a division of the World Health Organization, made about $75 million off the work of up to 10,000 Cuban doctors who earned substandard wages in Brazil, according to the allegations in a lawsuit filed on Friday in the United States District Court in Miami.
Dr. Matos and three other doctors who defected from Cuba’s contentious medical diplomacy program in Brazil accuse PAHO in the lawsuit of aiding in human trafficking.
The suit is the first against an international agency over compensation from Cuba’s medical mission. Cuba sends tens of thousands of doctors to countries around the world in what it bills as humanitarian missions. Its economically struggling government is paid for the services, sharing only a small fraction with the doctors who perform the work.
Brazil is the only country in which a United Nations-affiliated agency plays a key role in Cuba’s mission.
Although novel, the suit faces an uphill battle: International organizations like the World Health Organization have broad immunity from civil actions. Attempts to hold the United Nations liable for bringing cholera to Haiti, which killed thousands of people, have been rebuffed by courts in the United States.
The Cuban doctors are not allowed to hold onto their passports, go out for a night on the town or live with their children, the doctors have said. A state security agent keeps a close eye on their activities.
More than half of their small salaries are held for them in a bank in Cuba, and is forfeited if the doctors defect.
At least 7,000 of them did so under a Bush administration program that gave the Cuban doctors working abroad residency in the United States.
President Obama ended the residency program in one of his last acts as president. With that escape valve cut off, hundreds of Cuban medical professionals have begun to sue in Brazilian courts.
After Brazil’s president-elect, Jair Bolsonaro, criticized the program as modern-day slavery, the Cuban government last week began to repatriate hundreds of its doctors. Cuba has defended the program, noting that the doctors’ education was free, and they are paid more than they would get if they stayed home.
In a statement, a spokesman for PAHO, Luís Felipe Sardenberg, said the agency’s role did not involve “contractual arrangements with individual physicians.” He said the doctors had benefited by “improving their skills by participating in specialization courses and learning, research and extension activities.”
Sam Dubbin, a Miami lawyer representing the doctors, argued that PAHO had acted too far outside its mission in administering the medical program. Immunity for organizations like the World Bank or the International Monetary Fund applies only for work done within the scope of an international agency’s mission, he said.
Last month, the United States Supreme Court heard arguments in a case against another international agency over the immunity issue. That case stems from fishermen in India who sought damages from the International Finance Corporation, which financed a dam that did not comply with local laws.
Brian Concannon, a human rights lawyer at the Institute for Justice & Democracy in Haiti, said similar arguments failed when his organization sought restitution for cholera victims in Haiti.
“My guess is that the court is not even going to listen to that,” he said.
James F. Haggerty, who is handling another case against the United Nations over the cholera outbreak, said the lawsuits will eventually lead to reforms.
“The immunity of the U.N. and its agencies leads to all sorts of negligent or even criminal behavior since, without the fear of liability, shortcuts are taken, mistakes made, and the innocent suffer,” he said. “Bit by bit, piece by piece, lawsuits attacking U.N. immunity will eventually lead to reform — putting an end to the kind of damage that results from reckless acts driven by a belief that there will never be consequences.”