It’s worth noting that, like most countries in the world, the Cuban economy underwent a severe COVID-related contraction; gross domestic product (GDP) per capita growth was -10.7 percent in 2020, one of the worst in the region (Table 3). However, unlike most other countries in the region and around the world, Cuba did not subsequently experience a sizable post-COVID rebound during the years that immediately followed. Average annual GDP per capita growth from 2020 to 2024 was just 0.4 percent, as compared with the regional average of 3.2 percent. During this period, the quality of health care and access to health care services in Cuba sharply deteriorated amid widespread shortages of medicines and medical supplies and amid the departure of many health professionals.

In spring 2024, CEPR staff visited health care facilities in Cuba and observed firsthand some of the mounting challenges that the health care sector was experiencing. There were shortages of basic, critical medical supplies, such as syringes, inhalers, and even saline solution. At a cardiological center for children, we observed a toddler who needed to undergo a surgical operation that would have been avoidable had the center had access to catheters. We met a young doctor who lamented being the only graduate from his class that was still practicing medicine in Cuba, and he attributed this to the shrinking wages for doctors. At the National Oncological Institute we learned that medical staff were having great difficulty obtaining basic laboratory chemicals and were unable to access spare parts for radiotherapy equipment; as a result, they were unable to treat many cancer patients in a timely manner. The institute once had a total of 60 medical physicists (who were specialized in cancer treatment) and now had only 16. They previously had 16 anaesthesiologists and now had only five.

Since then, reports indicate that the situation in the Cuban health care sector has grown far worse. Due to a continuous increase in fuel shortages and electricity blackouts around Cuba, many hospitals have been unable to provide critical services, and all but vital surgeries have been put on hold. Ambulances are often unavailable for urgent care due to a lack of sufficient fuel. Medical providers in pediatric clinics have reported having to take small children off of ventilators during power shortages and manually pump air into their lungs in order to try to keep them alive.27 

The direct and indirect impact of the tightening of US sanctions on Cuba that began in 2017 very likely played a substantial role in the extremely large jump in Cuba’s infant mortality rate.

Sanctions and Infant Mortality: What Recent Studies Tells Us

Over the past decade, Cuba has been subjected to a dramatic increase in the scope and intensity of sanctions imposed by the United States. The resulting negative effects on the Cuban economy, which we will look at in greater detail in the next section, would be expected to lead to increased mortality. There is also considerable empirical and statistical evidence that economic sanctions of the type imposed and intensified in Cuba over the past decade can cause substantial increases in deaths in target countries. 

Most recently, an August 2025 study for The Lancet Global Health by economists Francisco Rodríguez, Silvio Rendón, and Mark Weisbrot estimated that broad, unilateral sanctions — mostly imposed by the United States — increased deaths in sanctioned countries by approximately 564,000 annually, based on a panel regression including 152 countries.28 This is comparable to worldwide annual deaths from armed conflict.29 

This study incorporated a number of statistical methods to demonstrate the causal relationship between the sanctions imposed and the increased death rates that resulted.30

The Lancet Global Health study found that children under five years old accounted for 51 percent of the deaths caused by these sanctions. Infant mortality is generally about three-quarters of under-five mortality. So these numbers indicate a profound disproportionality in the impact of sanctions on infants as compared with other age groups; infants are only about 1.6 percent of the world population.31 

This would indicate that a rise in infant mortality of the size that has taken place over the past decade in Cuba — or even greater — might be expected under the conditions that Cuba experienced during that period. There is other compelling statistical evidence that would also strongly indicate the sanctions that Cuba has been subjected to would cause a substantial increase in infant mortality. Some of this can be found in another study based on panel regressions and published by the Bank for International Settlements (BIS). It involves 180 countries and examines the relationship between recessions and mortality in emerging market and developing economies (EMDEs).32

These results are directly relevant to the relationship between sanctions and mortality. That is partly because economic slowdowns, recessions, depressions, and even hyperinflation — which is generally economically devastating — are among the most important types of economic damage from sanctions that increase death rates. In one of the most well-documented experiences of sanctions, Venezuela lost 74 percent of its GDP from 2012 to 2020,33 more than three times the contraction of the US economy during the Great Depression. Most of this was due to economic sanctions. The first year of the Trump administration’s sanctions on Venezuela (2017–18) saw an increase of 40,000 deaths,34 with many more in the years that followed.

Cutting a country off from most international financial markets, including normal levels of borrowing, would be expected to cause recessions. Fiscal and debt crises, balance of payments crises, and the loss of essential imports that are needed for production as well as for the maintenance of critical infrastructure often follow the loss of financial access. Direct restrictions on imports play a similar role in damaging the economy; in Cuba’s case this has been seen most acutely following the near-total blockade of oil imposed by the Trump administration over the past few months. Restrictions on exports and remittances can also contribute to recessions and balance of payment crises. 

These ways in which sanctions cause, and worsen, recessions and crises mean that they will also spur higher levels of mortality through this economic impact. The statistical relationship between recessions and mortality therefore provides important statistical evidence for the impact of sanctions on mortality. 

Economists at the BIS found that “child mortality rises in a highly significant way in recessions in EMDEs, by about 6 deaths per 1000 births.”35 The authors of the BIS paper define a recession for a country as a year in which the economy has negative growth. 

Again, these numbers are for mortality of children under five years old. As mentioned above, about three-quarters of this mortality in the world is infant mortality, so this study implies that a recession would increase mortality by 4.5 deaths per 1,000 births. This is most of the increase that the data show for Cuba (from 4.0 to 9.9 or 5.9 deaths per 1,000 births) (see Table 2).

Of course there is considerable lethal impact of sanctions in Cuba that is not brought about through the impact of recessions: the lack of access to medicines and medical supplies; the breakdown of care that depends on electricity or fuel for transport; water, hygiene, and sanitation failures; and the loss of repair capacity or spare parts. Mosquito control, prenatal outreach, vaccination campaigns, and many other public health measures can be seriously weakened from the direct impact of sanctions, with or without a recession.36

It is worth noting the causal relationship between the sanctions inflicted on Cuba and the increase in infant mortality is pretty clear from observable, physical, medical, and other evidence — much of which is described below. Statistical studies, including the panel regressions cited here, provide further quantitative, empirical, and replicable evidence of the magnitude of deaths and harm caused by this economic violence, which has been accelerating in Cuba over the past decade.

The Economic and Social Impact of Recent US Cuba Policy

The United States has maintained an extensive economic embargo against Cuba since the early 1960s.37 While the effects of this embargo were widely felt on the island, for decades they were largely offset by preferential trade access, credit on favorable terms, and subsidies from the Soviet Union.38 The shock caused by the termination of Soviet economic support to Cuba in the early 1990s led to a deep and prolonged economic downturn.

In the years that followed, the US sanctions regime against Cuba intensified and was more difficult to remove through the passage of two key pieces of legislation. The 1992 Cuban Democracy Act (or Torricelli Act) blocked US aid to any country giving “assistance” to the government of Cuba, barred foreign subsidiaries of US firms from transacting with Cuba, and prohibited any ship that made a stop in Cuba from docking in the US for 180 days thereafter.39 The 1996 LIBERTAD (or Helms-Burton) Act codified the ongoing US embargo, which had mostly been imposed via executive action, into US law and, through Title III of the Act, included extraterritorial effects by creating potential liability for both US and foreign companies engaged in business with Cuban entities. In response to strong opposition from other countries, especially in Europe, President Bill Clinton and every subsequent US president blocked the application of Title III until, in 2019, President Donald Trump changed course and allowed it to be enforced.40 

The sanctions regime began to be eased in the 2000s, a change that accelerated with the Obama administration’s policy of progressive normalization of relations with Cuba, announced in December 2014. Over the following months, the US reestablished diplomatic relations; removed Cuba from the State Sponsors of Terrorism list; softened travel and remittances restrictions; and loosened restrictions on exports, imports, and financial transactions. For example, foreign-made exports to Cuba from third-party countries were subject to US export controls if more than 10 percent of their content by value is of US origin (the de minimis rule).41 President Barack Obama raised this threshold to 25 percent. However, in part due to the Helms-Burton Act, the decades-old US embargo largely remained in place.

Trump 1.0: An Unprecedented Expansion of US Sanctions

After taking office in 2017, President Trump began to reverse key aspects of Obama’s normalization policy and progressively added new restrictive measures, leading to the most severe sanctions regime that Cuba had yet faced. First, a 2017 presidential memorandum created what came to be called the Cuba Restricted List, which identified Cuban entities for which all “direct or indirect” financial transactions were banned.42 It would be repeatedly expanded in the years that followed, with many of the sanctioned entities linked to Cuba’s vital tourism sector, including most major hotels.43 In 2019, the de minimis threshold was reduced back to 10 percent, significantly limiting Cuba’s access to many imported goods. Travel was further restricted with the end of an Office of Foreign Assets Control general license for “people-to-people” educational trips in 2019 — resulting in an abrupt decline in US tourism to the island and the end of all cruise-line travel there — and the suspension of charter flights from the US in 2020.44 Various restrictions on remittances culminated in Western Union, the only US entity authorized to manage private remittance flows, being forced to close its Cuban operations in 2020.45 

Potentially the two most damaging sanction measures were the lifting of the suspension of the Helms-Burton Act’s Title III in May 2019 and the redesignation of Cuba as a State Sponsor of Terrorism (SSOT) in 2021, just before President Trump left office. 

Title III entitles US citizens and entities (including citizens who were Cuban at the time of the nationalization) to sue third-party individuals and companies that have “trafficked” in property that was nationalized after the revolution. While there have been relatively few cases filed since 2019 — although there are two cases currently before the Supreme Court46 — Title III increases the risks of investing and trading with Cuban firms and reportedly has had a major chilling effect by deterring potential investment and business partnerships from all over the world.47 

The re-inclusion of Cuba on the SSOT list in early 2021 caused wide-ranging disruption as risk-averse firms closed their Cuba operations.48 Many international financial institutions, which were already reluctant to engage with Cuba due to recent multibillion dollar fines against banks that violated sanctions, stopped processing transactions with Cuban entities and individuals.49 According to the Cuban government, between August 2021 and February 2022, “a total of 100 foreign banks were identified as being involved in 261 actions” that included “closing accounts and established banking contracts, returning transactions, refusing to create accounts,” and “canceling passwords for the exchange of financial information” through SWIFT.50 Even companies that conduct transactions permitted under US law, such as those engaged in exporting food to Cuba, can expect increased scrutiny from the US Securities and Exchange Commission because of the designation. Many businesses prefer avoiding the likely red tape they would encounter if they continued working with Cuban entities, even if doing so were entirely legal under US law.51 

Cuba’s SSOT designation has also had a major impact on travel to Cuba. With the designation in place, foreign nationals from the 42 countries that qualify for visa-free travel to the US — through the US Electronic System for Travel Authorization (ESTA) — are required to apply for US visas if they travel to Cuba. This requirement deters tourism and business trips from ESTA-qualifying countries, including most European countries, the UK, Japan, Australia, Chile, New Zealand, Taiwan, South Korea, and Qatar, among others. This measure, along with increased restrictions on US travel to Cuba, severely hampered Cuba’s ability to recover from the COVID-19 shock that had decimated tourist arrival numbers and caused a proportional fall in tourist revenue, one of the primary sources of foreign income for the country.52

Health services exports via international medical “missions” have been another key target of US sanctions in recent years. Key Trump administration allies, President Jair Bolsonaro’s Brazil and President Nayib Bukele’s El Salvador, ended their countries’ medical cooperation programs with Cuba in late 2018 and in April 2019, respectively.53 From July 2019, the US began to impose visa restrictions on foreign officials involved in the programs.54 The US Department of State issued a statement in September 2019 calling on all countries to stop using Cuba’s medical missions.55 Subsequently, the governments of Ecuador and Bolivia also ended their missions.56 As the pandemic got underway, Senators Marco Rubio and Bob Menendez called on the Department of State to issue instructions to embassies encouraging governments to withdraw from these programs.57 US Secretary of State Mike Pompeo also pressured the Pan American Health Organization to investigate what he characterized as Cuba’s “slave trade in doctors.”58 

The targeting of these medical missions by the US government causes harm not just to Cuba. The missions are directed at economically deprived and marginalized sectors of the populations of mostly poorer countries and the fees are based on solidaristic pricing, with some countries receiving the aid as donations.59 The missions’ work in West Africa during the Ebola crisis was particularly highly praised, including by the then-head of the World Health Organization (WHO) and by senior figures in the Obama administration.60 This mutually beneficial trade has been an important contribution to Cuba’s foreign currency revenues, and the attacks on the programs by the first Trump administration can be seen in the data, with medical services exports falling from $6.4 billion in 201861 to just under $4 billion in 2020.62  

Income from tourism fell from $3.3 billion in 2017 to $2.6 billion in 2019,63 and it then fell drastically during the pandemic to just over $400 million in 2021, but by 2024 it had only recovered to $1.3 billion — just 40 percent of its 2017 level.64 

In Chart 1, we can see how, between 2018 and 2024, the number of foreign visitors to Cuba has fallen dramatically both in absolute terms and relative to neighboring countries whose economies are also heavily reliant on income from tourism. From receiving 4.6 million international tourists in 2017 and 4.7 million in 2018, Cuba’s tourist arrivals fell sharply during the pandemic and had only partially recovered by 2024, with 2.2 million tourists arriving that year.65

Remittances, which are one of the main financing channels for the private sector,66 were restricted through caps, restrictions on recipients, and the addition of the main Cuban remittance processing firm to the State Department’s Cuba Restricted List in June 2020.67 The latter addition had the effect of forcing Western Union to exit the Cuban market, greatly complicating the sending of remittances to the island, causing a diversion toward informal and more costly channels.68 Transaction costs from other remittance agencies in Miami reportedly reached as high as 40 percent after the closure of Western Union (which had charged fees of about 11 percent).69 Remittances peaked at just over $4 billion in 2018; they then fell to $2.8 billion in 2020 and to just $1.8 billion in 2022.70 The remittances partially recovered — likely attributable to actions taken by the Biden administration — to $2.3 billion by 2024.71 

A rough indicator of the economic decline since 2018 can be seen in import levels, changes in which can suggest changes in levels of domestic demand and, by implication, purchasing power. Imports of goods fell72 substantially from $11.5 billion in 2018 to $8.1 billion in 2024, a fall of almost 30 percent or 19 percent in per capita terms.73 There is a lack of detailed balance of payments data that could show the drivers of these changes with more confidence,74 but it is plausible that the hardening of US sanctions were a major factor as they reduced Cuba’s access to foreign currency,75 curtailed its access to credit, and raised the cost of imports. An econometric study of the period 1994–2020 found that the tightening of US sanctions against Cuba were associated with a statistically significant reduction in GDP and household consumption.76

The fall in Cuban imports is also likely understated in the official data. First, note that this is a nominal indicator; if adjusted for price inflation, the decline would be more dramatic. For example, if we deflate Cuba’s food imports by a price index, then food imports, which increased in nominal terms by 19 percent over the period 2018–2024, actually fell in real terms by 6 percent.77 Second, many of the sanctions raised the cost of international transactions. For example, the de minimis change has, in many cases, forced importers to source alternative, more expensive goods as the previously purchased imports contained more than 10 percent US-made components. Therefore, the volume of imports — data for which the Cuba National Statistics Office does not publish — could have fallen more sharply still. 

The rise in out-migration from Cuba beginning in 2021 (Table 4) is likely another result of the sharp decline in living standards. According to Cuba’s statistics agency, the population fell by 13 percent,78 from 11.2 million in 2020 to 9.8 million in 2024,79 and this was led largely by a massive rise in net migration — which had ranged from 15,000 to 25,000 per year between 2015 and 2019, rising to hundreds of thousands annually from 2021.80 As a point of comparison, every year since 2021 has surpassed the previous peak in 1980, when (on net) 142,000 Cubans left during the Mariel Boatlift.81

Effects on Cuba’s Health Care Sector

Cuba’s health care sector has been particularly hard hit by the “maximum pressure” coercive economic measures imposed by US administrations since 2017. We previously noted the sharp degradation of health care services in the years that have followed. As we have seen, the expansion and tightening of US sanctions have played a substantial role in this deterioration of health conditions and services. In addition, during CEPR’s fact-finding trip to Cuba in March 2024, we learned more about how these sanctions have directly hampered the provision of health care by blocking, or greatly limiting, the procurement of essential medicines, inputs, supplies, and equipment. 

For instance, not long before our 2024 visit to Cuba, the state enterprise MEDICuba — which imports and exports medicines and medical supplies for the state health care system — was forced to shut down a production line of vaccines for six months after a US company suspended the shipment of critical inputs. Similarly, Cuba has struggled to import many basic medical supplies, with formerly reliable suppliers suddenly halting shipments. The health care providers that we interviewed told us that in many cases this appeared to be the result of the Trump administration’s 2019 decision to lower the de minimis threshold from 25 percent to 10 percent, thereby prohibiting the export to Cuba of any goods containing more than 10 percent US-origin content. Given that the vast majority of medication, medical equipment, and many medical supplies contain more than 10 percent US-origin content (including US-patented technology or components), MEDICuba has had to seek medical goods from distant locations, often at higher-than-market rates and in many cases has been unable to find alternatives with less than 10 percent US-origin components.

Staff at Cuba’s primary pharmaceutical manufacturer and research facility — BioCubaFarma — recounted how the German company Sartorius — one of the world’s leading suppliers of lab equipment — abruptly stopped supplying the facility with filtration bags and other indispensable products once the 10 percent de minimis rule came into effect. They have struggled to find reliable alternative suppliers ever since. 

The staff of various medical institutions also described the extreme difficulty that they’d had in obtaining credit lines to purchase essential medical goods following the Trump administration’s decision to put Cuba on the SSOT list — a designation that, as we have explained above, has led to many international financial institutions refusing to engage with Cuban entities. Staff at Cuba’s primary cardiological center for children recounted how, following the SSOT designation, it became extremely challenging to obtain financing for the purchase of supplies and medication. In another instance, medical practitioners recounted how there was suddenly a lack of HPV vaccines due to a foreign credit line having been suspended. Given how cash-strapped Cuba has become in recent years — in large part as a result of sanctions designed to reduce the country’s access to foreign exchange — the financial embargo resulting from the SSOT designation has greatly constrained medical providers’ ability to effectively meet the needs of their patients. 

Trump 2.0: A Further Hardening of Sanctions and a Fuel Blockade

The second Trump administration has taken additional measures designed to further debilitate the Cuban economy with the goal of achieving regime change. On his first day in office, President Trump reversed two of President Joe Biden’s actions, one of which had begun the process for removing Cuba from the SSOT list and the other of which had eliminated the Cuba Restricted List. On January 29, 2025, Secretary of State Rubio withdrew Biden’s waiver of Title III of the Helms-Burton Act.82 On February 6, 2025, the administration reactivated the Cuba Restricted List.83 The list was also expanded with the inclusion of the main firm for processing remittances, which forced the exit of Western Union from Cuba and greatly complicated remittances to the island.84 Then, in June 2025, the administration tightened restrictions on transactions with Cuban entities and on US travel to Cuba.85 These measures further limited Cuba’s access to international financial markets and further dampened the flow of US visitors — and US dollars — to the island.

In addition, Secretary of State Rubio and other State Department officials have doubled down on their efforts to terminate Cuban medical missions abroad through sanctions or threats of sanctions on officials in host countries and other forms of pressure directed at host country governments. A senior Caribbean official told POLITICO that the State Department’s campaign has generated “a lot of fear” in the region86 and that US pressure — which has included the cancellation of US visas of foreign officials87 — has “never been this open.” As a result of this pressure campaign, Jamaica, Honduras, Guatemala, and Guyana have terminated decades-old Cuban medical missions, leading to the departure of well over 1,000 Cuban medical professionals who had been providing primary care services to primarily low-income communities in those countries.88 After the US military intervention in Venezuela, the new Venezuelan government also began to send back Cuban doctors, after pressure from the US.89

But by far the most devastating President Trump policy has been the US de facto blockade on all Cuban imports of fuel, which has effectively been in place since the beginning of 2026. First, following the US military intervention in Caracas, Venezuela, on January 3, the US administration blocked oil shipments from Venezuela, which had been Cuba’s primary fuel supplier for most of the past three decades.90 Then President Trump signed an executive order declaring a “national emergency,” identifying Cuba as an “unusual and extraordinary threat” to the national security of the United States and providing for economic retaliation — in the form of high tariffs — against countries supplying the island with oil, particularly Mexico, which reportedly overtook Venezuela as Cuba’s largest supplier of oil in 2025.91 Although the US Supreme Court barred the administration from imposing tariffs through national emergency declarations in February, the Trump administration has prevented oil shipments — except for one tanker from Russia at the end of March92 — from reaching the island, as the New York Times and other outlets have reported.93 

These new President Trump measures, and particularly the current oil blockade, have had a dramatic effect on the economy and on basic services on the island. Given that the majority of Cuba’s electricity generation is reliant on foreign oil products, the country has been wracked by increasingly frequent and prolonged power outages.94 On March 16, the entire island experienced an electrical blackout.95 Fuel shortages have led to rationing that has paralyzed much public transportation and caused long lines at gas stations.96

The health care sector has been particularly affected, with hospitals only performing emergency surgeries.97 Five million Cubans — about half of the population — have chronic conditions and could have their medications or treatments affected, with oncology, cardiovascular care, and kidney disease already facing a heavy impact from the shortages of fuel.98 NBC reported in March that 300 ambulances were sitting idle due to lack of fuel or spare parts for maintenance, leaving only 25 electric ambulances available for the entire country.99 In February, one general practioner quoted in the British Medical Journal said: 

The healthcare system is in total collapse. Working conditions are dreadful: healthcare staff are not provided with food, and sometimes not even drinking water; the bed linen is dirty; there are no fans in hot weather. In addition, there are no gloves, protective equipment, or face masks for staff. There is a shortage of doctors, nurses, and health technicians, as well as half of the basic medicines and essential medical supplies. There are power outages and no way to communicate by mobile phone or landline. It feels like a country at war.100

According to recent news reports, power outages are greatly limiting the use of X-ray machines, ultrasounds, CT scans, and other diagnostic imaging tools.101 Many medicines, vaccines, and medical supplies such as blood require refrigeration or freezing; in March, the WHO’s Director-General highlighted the emergence of problems in the cold chain for vaccines caused by the fuel blockade.102 While hospitals have backup generators, which are usually diesel-run, there are delays of a few minutes before these kick in after power cuts, complicating vital life-support machines — for example, in neonatal units, nurses have to rush to manually pump ventilators for premature babies.103 In late February, a young pregnant woman being treated for anemia in a maternal health clinic told the AP, “there’s been a drastic change since January. . . . There’s no bread, no milk for nutrition. . . , no medicines.”104

At the same time, reports suggest that the general health of the Cuban population has declined as a result of malnutrition and the sharp deterioration of sanitary conditions. These conditions stem in part from the lack of sufficient power to pump water into buildings and the accumulation of waste in public spaces, due to a shortage of fuel with which to operate sanitation vehicles.105 Shortages of electricity affect food storage, increasing spoilage and the risk of foodborne illness. This latter risk is also raised by the lack of cooking fuels; as an alternative, Cubans are reportedly using wood and other more polluting fuels106 — even burning trash107 — which worsens air quality and can provoke respiratory illness, particularly for vulnerable populations such as infants.108 

Cuba is experiencing an unprecedented nationwide surge in mosquito-borne illnesses, such as chikungunya, Dengue fever, and oropouche.109 One-third of the population is estimated to have experienced infection from an arbovirus such as these.110 The severity of these outbreaks is likely a product of the sanctions. Shortages of fuel and insecticide have prevented the massive fumigation campaigns previously used to keep the mosquito populations carrying these diseases in check.111 A typical response to disruption in the water supply is to store water in containers, which are ideal breeding spots for disease-carrying mosquitos.112 

Given the increasingly dire state of Cuba’s health care system and the decline in the state of health of the general population, it is highly likely that Cuba’s infant mortality rate has increased significantly since 2025 when it had reached 9.9 per 1,000 live births.113 Other key health indicators, like life expectancy and maternal mortality, are highly likely to have also deteriorated since the beginning of the year. 

A recent New York Times report on the effects of the US fuel blockade on Cuba’s energy sector noted that, in Cuba’s leading maternity hospital,

Doctors, nurses, cleaners and mothers all struggle to get to the hospital because of the lack of fuel. This translates into dirtier delivery rooms, fewer health workers to deliver babies and mothers arriving after labor is dangerously far along.

“We are receiving much more severe cases,” [obstetrician-gynecologist] Dr. Delgado Peruyera said, noting that three newborns died in February, the most she could ever recall in one month.114

Conclusion

In early 2019, New York Times columnist Nicholas Kristof wrote that “an American infant is, by official statistics, almost 50 percent more likely to die than a Cuban infant.”115 He noted that “Cuba achieves excellent health outcomes even though the American trade and financial embargo badly damages the economy and restricts access to medical equipment.” Today, Kristof’s observations are no longer valid. Last year, Cuba’s IMR was 83 percent higher than the US’s, and reports suggest that it has risen to even higher levels over the last few months. The Cuban health care system has been deeply affected by dire shortages of supplies, medicine, personnel, and — as of the last few months — fuel and electricity. 

As the evidence in this paper indicates, the primary cause of the unprecedented rise in Cuba’s IMR, and the crisis in its once robust health care system, is almost certainly the hardening of US sanctions that began in 2017 and increased steadily in the years thereafter, with only a minor easing during the Biden administration. These measures, which have been imposed on top of the long-standing US trade and financial embargo, include the ever-expanding Cuba restricted entities list, the tightening of the de minimis threshold for imports to Cuba, the re-inclusion of Cuba on the SSOT list, the application of Title III of the Helms-Burton Act, and sanctions targeting Cuba’s medical missions, among other measures. 

Together, these “maximum pressure” policies have vastly restricted Cuba’s access to foreign exchange and to essential imports and have contributed to a severe decline in Cubans’ standard of living and in the quality of basic services — especially health care. In these conditions, studies show that infant mortality — and mortality generally — can be expected to rise. For hundreds of thousands of Cubans, the only viable option has been to migrate to the US and other countries, in what has been the biggest wave of out-migration in Cuba’s contemporary history. Others, including at least 1,800 children under the age of one, have died.

The current US fuel blockade, which has prevented nearly all fuel shipments from reaching Cuba, has made an already dire situation much worse. More infants — more vulnerable people — can be expected to die as a result. 

Two US legislators who recently visited Cuba noted, “this is cruel collective punishment — effectively an economic bombing of the infrastructure of the country — that has produced permanent damage. . . . We do not believe that the majority of Americans would want this kind of cruelty and inhumanity to continue in our name.”116

Legislators in both the US House and Senate have introduced legislation that would mandate the end of US participation in the current blockade on the grounds that it is illegal and unconstitutional under US law.117 This is because it involves the US military in hostilities without congressional authorization. 

In international law, the US naval blockade of Cuba, which has been enacted through both threats exerted on third party states and corporations, and the physical interception of oil tankers en route to Cuba,118 is clearly an unlawful use of force, as stipulated in Article 2(4) of the United Nations Charter.119 It also violates the Charter of the Organization of the American States’s prohibition of coercive measures of an economic or political character (Article 20).120

Naval blockades are also typified in United Nations General Assembly Resolution 3314 as acts of aggression (Article 3).121 The resolution defines aggression as “the use of armed force by a State against the sovereignty, territorial integrity, and political independence of another State” (Article 1). As a result of this use of armed force, the United States is now engaged in an armed conflict,122 as defined under Common Article 2 of the Geneva Conventions. The Fourth Geneva Convention strictly prohibits the collective punishment of civilians in any armed conflict. This can be prosecuted as a war crime.

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World Health Organization (WHO). n.d.-a. “Domestic General Government Health Expenditure (GGHE-D).” Global Health Expenditure Database. Accessed April 10, 2026. https://apps.who.int/nha/database/ViewData/Indicators/en

———. n.d.-b. “Infant Mortality Rate (Between Birth and 11 Months per 1000 Live Births).” Indicator Metadata Registry, Global Health Observatory. Accessed April 10, 2026. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/1

Wulfhorst, Ellen. 2019. “U.S. Says Cuban Medical Missions Are Trafficking Doctors.” Reuters, September 27. https://www.reuters.com/article/world/us-says-cuban-medical-missions-are-trafficking-doctors-idUSKBN1WC00W/

Wyss, Jim. 2025. “Western Union Halts Money Transfers to Cuba Citing New Sanctions.” Bloomberg, February 10. https://www.bloomberg.com/news/articles/2025-02-10/western-union-halts-money-transfers-to-cuba-citing-new-sanctions

Footnotes

  1. It is “strongly related to those structural factors like economic development, general living conditions, social well being, and the quality of the environment, that affect the health of entire populations” (Reidpath and Allotey; 2003). The World Health Organization also notes that infant mortality rates “reflect the social, economic and environmental conditions in which children (and others in society) live” (WHO; n.d.-b).
  2. Cubadebate (2026); ONEI (2025c, 2025d).
  3. World Bank (n.d.-b).
  4. Rodríguez, Rendón, and Weisbrot (2025).
  5. There are about 132 million births per year, which is 1.6 percent of the 8.1 billion world population in 2024. UN DESA (2024, 2025).
  6. Doerr and Hofmann (2022).
  7. It was rescinded by President Joe Biden on January 14, 2025 and reinstituted by President Trump on January 20, 2025.
  8. The Trump administration reinstored the State Sponsor of Terrorism designation without providing credible evidence that Cuba supports terrorism and despite a prior formal US Department of State review that concluded that there was no basis for maintaining the designation.
  9. This was reversed by President Biden on January 14, 2025 but re-instituted by President Trump on January 20, 2025.
  10. President Biden ordered the renewal of the waiver on January 14, 2025; the Trump administration reversed Biden’s order on January 29, 2025
  11. Following the forced exit of Western Union in 2020, there are reports of transaction fees rising from 11 percent to as much as 40 percent. See Delgado (2024).
  12. Nicas and Triebert (2026).
  13. UN Tourism (n.d.).
  14. ONEI (2022; 2025i).
  15. ONEI (2019; 2023b).
  16. UNCTAD (n.d.).
  17. Excluding donated goods and goods acquired in ports by means of transport. ONEI (2025g).
  18. ONEI (2025b).
  19. Augustin and Nicas (2026); Trotta (2026).
  20. Solis, Murray, and Sesin (2026).
  21. Associated Press (2026a).
  22. L. Taylor (2025).
  23. It is “strongly related to those structural factors like economic development, general living conditions, social well being, and the quality of the environment, that affect the health of entire populations” (Reidpath and Allotey; 2003). The World Health Organization also notes that infant mortality rates “reflect the social, economic and environmental conditions in which children (and others in society) live.” (WHO; n.d.-b).
  24. World Bank (n.d.-e).
  25. IBGE (n.d.).
  26. DEIS (2026); DANE (2026); INEGI (2024); STATIN (n.d.).
  27. Trotta (2026).
  28. Rodríguez, Rendón, and Weisbrot (2025).
  29. Weisbrot (2025).
  30. These methods included entropy balancing, Granger causality, event-study, and instrumental variables.
  31. There are about 132 million births per year, which is 1.6 percent of the 8.1 billion world population in 2024. UN DESA (2024, 2025).
  32. Doerr and Hofmann (2022).
  33. IMF (2026).
  34. Weisbrot and Sachs (2019).
  35. Doerr and Hofmann (2022).
  36. See below for more detail and see also Escobedo et al. (2026).
  37. The goals and mechanisms of this emerging policy were laid out in a 1960 memorandum by the then Deputy Assistant Secretary for Inter-American Affairs:  The only foreseeable means of alienating internal support is through disenchantment and disaffection based on economic dissatisfaction and hardship. . . . it follows that every possible means should be undertaken promptly to weaken the economic life of Cuba. If such a policy is adopted, it should be the result of a positive decision which would call forth a line of action which, while as adroit and inconspicuous as possible, makes the greatest inroads in denying money and supplies to Cuba, to decrease monetary and real wages, to bring about hunger, desperation and overthrow of government. (US Department of State, Office of the Historian [n.d.].)
  38. Hernández-Catá (2001).
  39. Cuban Democracy Act of 1992 (1992).
  40. Rotstein (2019).
  41. Government of Canada, Trade Commissioner Service (2024).
  42. The White House (2025b).
  43. The list also includes ANTEX, which manages professional services including health-care exports in some countries; GAESA conglomerate, whose subsidiaries comprise a significant share of the Cuban economy; and FINCIMEX and (since 2025) Orbit S.A., which both process remittances. US Department of State (2025a).
  44. This restriction was removed by Biden in 2022 and has not yet been reimposed by President Trump. Shepardson (2022).
  45. Reuters (2020). Biden reduced restrictions on remittances in 2022, allowing Western Union to return in 2023 in cooperation with the Cuban firm Orbit, which processed the transactions. When Trump returned to office in 2025, Orbit was added to the reinstated Cuba Restricted List that also banned other financial services companies involved in processing remittances. This compelled Western Union to again close its Cuban operations. I. Taylor (2025).
  46. The two cases are Havana Docks Corp v. Royal Caribbean Cruises, Ltd. and Exxon Mobil v. Corporación CIMEX. The former is notable as Christopher Landau, current Deputy Secretary of State, was counsel for Havana Docks Corporation prior to his nomination. The Trump administration has filed briefings to the Supreme Court in support of Havana Docks. CEPR (2026).
  47. See Domínguez López, Cornelio Hitchman, and Barrera Rodríguez (2025).
  48. The redesignation was issued in large part on the grounds that Cuba had hosted members of the Colombian National Liberation Army (ELN) to conduct peace talks with the Colombian government and because “citing peace negotiation protocols, Cuba . . . refused Colombia’s requests to extradite ten ELN leaders living in Havana.” Norway — which was a co-guarantor of the peace process — also opposed their extradition. Pompeo (2021); Acosta (2019).
  49. BNP Paribas, for example, was fined $9 billion in 2014. Gordon (2024).
  50. MINREX (2022). The Society for Worldwide Interbank Financial Telecommunication (SWIFT) is the main international payments network.
  51. Rodríguez Rodríguez (2025).
  52. Gordon (2024).
  53. O’Boyle (2018); Diario Las Américas (2019).
  54. Ortagus (2019).
  55. Wulfhorst (2019).
  56. Marsh and Zodzi (2020). The Bolivian mission was reinstated after the restoration of democracy in 2020.
  57. Menendez and Rubio (2020).
  58. Pompeo (2020).
  59. Baggott and Lambie (2019), Escobedo et al. (2021), Marsh and Zodzi (2020).
  60. Baggott and Lambie (2019), Beldarraín Chaple and Mercer (2017).
  61. ONEI (2019).
  62. ONEI (2023b). There is a series break after 2022 (when these exports were $4.9 billion), with the “Servicios de salud humana y servicios de atención social” category appearing to be merged into “Servicios personales, culturales y recreativos,” of which medical services appears to be the main contribution. This was $5.4 billion in 2024, the last year for which there is data. The recovery can be attributed to the restoration of the programs in Bolivia and Brazil. ONEI (2023b, 2025h).
  63. ONEI (2022).
  64. ONEI (2025i).
  65. UN Tourism (n.d.).
  66. ECLAC (2023, 2).
  67. ECLAC (2023).
  68. Delgado (2024).
  69. Delgado (2024, 204).
  70. UNCTAD (n.d.).
  71. Ibid.
  72. Excluding donated goods and goods acquired in ports by means of transport.
  73. ONEI (2025f). There was also a significant goods import compression of about US$4.4 billion or 30 percent from 2013 to 2016. This is likely explained by the sharp fall in the price of oil over these years — and, from 2015, the decline in Venezuela’s economy, which reduced exports to Cuba; the value of Cuba’s oil imports fell by US$4.5 billion over the period. See Hernández-Catá (2019).
  74. The latest statistical yearbook only has partial current account data until 2020, in which year a deficit emerged. It does not have capital account or reserves data. ONEI (2025a).
  75. Exports fell by 32 percent over 2018–2024, with goods exports (which accounted for just 16 percent of total exports in 2024) falling somewhat faster (-38 percent) than services exports (-31 percent). ONEI (2020a, 2020b, 2025f, 2025h).
  76. Vidal (2025).
  77. Deflated by authors using the FAO’s Food Price Index, which is a measure of the change in international prices of a basket of food commodities. FAO (2026). Food imports data from ONEI (2023a; 2025g).
  78. A research note by Albizu-Campos (2025) argues that the official data understates out-migration — the author’s adjustments indicate that the population actually fell by 24 percent. While some of the adjustments suggested are reasonable, others — such as treating CBP encounters as individual migrants — seem to introduce a source of overestimation.
  79. ONEI (2025b).
  80. ONEI (2025e).
  81. Ibid.
  82. Rubio (2025b).
  83. US Department of State (2025b); Li et al. (2025).
  84. There are reports that Cuban-Americans who want to send money are having to rely on more costly and risky routes to send money, including cash carried by mules, cryptocurrency transactions, and transfers sent via third countries. CiberCuba Editorial Team (2026); Wyss (2025).
  85. The White House (2025a, 2025b).
  86. Toosi and Bazail-Eimil (2026).
  87. Rubio (2025a).
  88. Associated Press (2026b); González (2026); Reuters (2026); Wilkinson (2026).
  89. Reuters (2025).
  90. Webber (2026). There is disagreement in the reporting with Reuters noting figures that show Venezuela continued to be Cuba’s main supplier over the first 10 months of 2025. Parraga and Sherwood (2025).
  91. The White House (2026).
  92. This shipment is insufficient to meet Cuba’s oil needs, being equivalent to just 7–10 days of demand. The White House spokesperson said that they would treat future shipments on a case-by-case basis, and it is notable that Mexico, despite the stated desire of its president, has not restarted shipments. Levine et al. (2026).
  93. Marimow (2025); Nicas and Triebert (2026).
  94. United Nations (2026)
  95. Durán and Coto (2026).
  96. Associated Press (2026a).
  97. OnCuba Staff (2026).
  98. Rodríguez and Durán (2026).
  99. Solis, Murray, and Sesin (2026).
  100. Taylor (2026).
  101. Rodríguez and Durán (2026); Taylor (2026).
  102. Ghebreyesus (2026).
  103. Trotta (2026).
  104. Rodríguez and Durán (2026).
  105. Eighty-four percent of water pumping is dependent on electricity, and 10 percent of the population rely on (gasoline-/diesel-dependent) tanker trucks for potable water. United Nations (2026).
  106. BBC (2026).
  107. Blanco (2026).
  108. Edelson (2009).
  109. L. Taylor (2025).
  110. Escobedo et al. (2026).
  111. Colomé (2025).
  112. See Novaes and de Sousa (2022).
  113. Preliminary figure. Cubadebate (2026).
  114. Augustin and Nicas (2026).
  115. Kristof (2019).
  116. Jayapal and Jackson (2026).
  117. Weisbrot (2025).
  118. Nicas and Triebert (2026).
  119. United Nations (1945).
  120. See Articles 19 and 20 of OAS (1993).
  121. United Nations General Assembly (1974).
  122. ICRC (1949).