Medicine Shortages and Public Health Decline Outside Havana

For decades, Cuba’s healthcare system has been held up as evidence that universal care can survive under scarcity. That image fractures quickly once you leave Havana. In provincial cities, small towns, and rural areas, medicine shortages and infrastructural collapse have turned routine care into daily improvisation, and increasingly, a matter of chance.

Shortages are not abstract. They are visible, physical, and unevenly distributed. While Havana remains the system’s international showcase, hospitals in central and eastern provinces operate in what many clinicians describe as free fall. Clean linens are missing. Disinfectants are rationed or absent. Transport for patients, and at times even for the deceased, simply does not exist. Amid prolonged blackouts and food shortages, healthcare has become one of the clearest fault lines between the centre and the periphery.

According to Dr Marlon Carbonell Gonzalez, an intensive care and emergency medicine specialist formerly working in Havana, clinical practice has been reshaped by scarcity itself. In high-acuity settings, medicine no longer follows evidence-based protocols but what he describes as a ‘triage of scarcity.’ Decisions are guided not by need, but by what happens to be available. What kills patients now is often not disease, but absence: no oxygen, no antibiotics, no reagents when they are needed. The same shortages, alongside food scarcity and blackouts, fuelled protests in 41 cities in July 2021.

Today, 18–20 hour power cuts cripple hospitals, surgery is frozen, and nearly 95,000 people, including 10,000 children, wait indefinitely. Around 30% will never reach the operating table. Cuba’s population is ageing fast. Nearly 2.4 million people, 21.6% of the population, are over 60, yet chronic illness unfolds in a system no longer built for continuity. With private pharmacies and clinics illegal, families are forced into informal markets. On the black market, a blister pack of pills costs between $3 and $4, roughly a quarter of the average monthly Cuban salary at the unofficial exchange rate. For many older people, survival depends less on diagnosis than on whether relatives abroad can send money.

Doctors see the fallout daily. Patients arrive after taking uncertified or expired medications, suffering toxic reactions. Others die waiting for transfers that never come because ambulances lack fuel or are broken down. Dr Gonzalez describes ‘universal healthcare’ as functionally hollow: free in theory, inaccessible in practice. The system no longer protects the most vulnerable, it filters them.

The deterioration is measurable. A joint study by Dr Gonzalez and Dr Rosali Santiago Roibal, a paediatric intensive care specialist formerly working in Matanzas, documents a 27% increase in maternal mortality. The causes are starkly material: shortages of prenatal vitamins, diagnostic tools, and basic hygiene supplies. At the same time, diseases previously considered eradicated are re-emerging, signalling deep public health regression. This is occurring even as the state continues to deploy medical missions abroad as a political instrument, while provincial hospitals at home increasingly resemble medical deserts.

Resource collapse is often framed externally, but both physicians emphasize that responsibility lies first and foremost with the Cuban state itself. The shortage is not inevitable. In 2024, the state failed to secure $300 million for essential medical imports while continuing to fund political projects. Years of corruption and mismanagement have hollowed out healthcare long before external barriers come into play. Restrictions on scientific collaboration, including exclusion from 21 U.S. biomedical databases, aggravate the crisis, but they do not explain it. Paradoxically, Cuban-developed products could generate an estimated $1.4 million in income if collaboration were allowed, funds that could support domestic care if reinvested locally.

Inside hospitals, the ethical burden has become unbearable. Doctors earn roughly $20–$25 a month while being asked to manage impossible responsibility. Between 2021 to 2022, over 30,000 healthcare professionals, including 12,000 doctors fled Cuba. Dr Gonzalez, now part of the Cuban medical community in exile in the United States after a dangerous journey through Central America, stresses that departure was not an escape from responsibility. It was a refusal to remain silent within a system that stripped patients and professionals alike of dignity. From abroad, physicians continue to advocate for structural change and a healthcare system no longer governed by repression.

Cuba’s healthcare crisis is no longer symbolic. It is clinical, geographic, and deeply personal. It unfolds in darkened wards during 20-hour blackouts, in families trading savings for pills, and in provincial towns where access to care has become a question not of ideology, but of survival.

Further information and opportunities to engage with organisations working in this area are listed below:
https://www.firsthandaid.org/
https://cubavive.org.uk/
https://www.give2cuba.com

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