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HAVANA — The Cuban government announced Tuesday that it is re-imposing a hated travel permit requirement on many doctors, requiring them to get permission to leave the country in an attempt to counter a brain drain that it blames on the United States.

It is the first major retreat in Cuba’s policy of allowing unrestricted travel for its citizens, put in place in 2013 as President Raul Castro allowed new freedoms as part of a broad set of social and economic reforms.

The announcement set off waves of anger and worry among Cuban doctors and nurses, members of one of the country’s most respected and economically important professions. By midday, many Cuban doctors were trying to figure out whether quitting their jobs would free them of the travel limit.


“Instead of resolving the real problems of Cuban doctors, which is that salaries are low and we are working with limited resources, this measure shows that there’s no respect for the rights of citizens in Cuba,” said Dr. Eduardo Herrera, a surgeon at Calixto Garcia Hospital in Havana’s Vedado neighborhood.

The government announced on the front page of state media that health professionals in specialties that have been drained by large-scale emigration in recent years will now be required to get permission from Health Ministry officials in order to leave the country. The measure potentially affects one-tenth of the country’s work force, leaving very few families in Cuba untouched.


The Cuban government cites free, universal health care system as one of the crowning achievements of its socialist revolution. Medical missions abroad are one of the most important sources of foreign exchange for the Cuban government, which receives tens of thousands of dollars a year in cash or commodities for each doctor it sends overseas. Official statistics show that 500,000 of the country’s 5 million workers are health professionals.

The new policy was announced hours after a meeting Monday between U.S. and Cuban negotiators in Washington to address a crisis in Cuban migration, which has reached its highest levels in at least two decades this year. Cuba complained that the U.S. said it had no plans to change Cold War-era policies that give automatic legal residency to Cuban immigrants.

Like Herrera, many Cuban doctors cite low pay, poor working conditions and the possibility of well-compensated jobs in other countries as their primary reasons for emigrating. The Cuban government places the blame on the U.S. policy of granting automatic legal residency to Cuban immigrants, with special fast-track benefits for doctors who abandon government medical missions overseas.

The government has raised medical salaries in recent years, but few doctors earn more than $80 a month, a fraction of what they would earn in medicine in other countries, or even as drivers or waiters in Cuba’s booming tourist economy.

“The migration of Cuban health professionals is a concern for the country,” the government announcement read, blaming U.S. laws that aid Cuban medical emigration for having “the perverse objective of pushing Cuban health professionals to abandon their missions in other countries.”

Inside Cuba, many doctors and nurses complain that their profession has been devastated by waves of departures, with vital specialists now absent in many clinics and hospitals. The government announcement cited anaesthesiology, neurosurgery, obstetrics and gynecology and neonatal care as among the specialties worst hit by emigration of doctors.

“The reaction to this will be big,” one neurosurgery resident said Tuesday morning. “We doctors are pretty much fed up because they aren’t managing our situation well.”

He spoke on condition of anonymity for fear of repercussions from his supervisors.

Over the past two years, at least 100,000 Cubans have emigrated to the United States, the majority making a treacherous land journey from Ecuador through South and Central America and Mexico. The pace has quickened dramatically this year, with many Cubans fearing that the detente announced nearly a year ago between the United States and Cuba will mean the end to special migration privileges.

Left-leaning Latin American allies of Cuba began cracking down on Cuban migration last month. Nicaragua closed its border to Cuban migrants, leaving at least 3,000 trapped in emergency shelters in northern Costa Rica. And Ecuador last week imposed a visa requirement for Cuban travelers in an attempt to end its role as the starting point for most Cuban migration.

The Ecuadorean move set off two days of angry protests outside the country’s embassy in Havana, a highly unusual event in a country where the government unleashes swift crackdowns on unauthorized street demonstrations.