Fidel Castro – revolutionary, internationalist and human rights defender

The People’s Health Movement pays tribute to Fidel Castro, a historic figure who has been the primary architect of a social project that has proven that the right to health can be largely achieved even in a resource-poor country, and that it is largely dependent on political will.
We have not conquered all justice, but we have to save the justice conquered - Fidel

“History Will Absolve Me”: Fidel’s revolutionary program (1953)

 Since the early 1950s Fidel played a central role in the revolutionary movement that overthrew the dictatorial regime of Fulgencio Batista. The attack on the Moncada Barracks in Santiago de Cuba on the 26th July 1953, was the start of the revolution. Fidel was arrested and put in jail. In prison, Castro wrote his most famous tract ‘History will absolve me’. This was his self-defense at the trial, where he developed the essential tasks of his revolution to come:

“The problem of the land, the problem of industrialization, the problem of housing, the problem of unemployment, the problem of education and the problem of the people's health: these are the six problems we would take immediate steps to solve, along with restoration of civil liberties and political democracy. (…) The problems of the Republic can be solved only if we dedicate ourselves to fight for it with the same energy, honesty and patriotism our liberators had when they founded it.”

The defense included his revolutionary program: “After settling the one hundred thousand small farmers as owners on the land which they previously rented, a revolutionary government would immediately proceed to settle the land problem. (…) It would distribute the remaining land among peasant families (…), and would promote agricultural cooperatives. (…) It would provide resources, equipment, protection and useful guidance. A revolutionary government would also solve the housing problem by cutting all rents in half, by providing tax exemptions on homes inhabited by the owners, by tripling taxes on rented homes. On the other hand, today possibilities of taking electricity to the most isolated areas on the island are greater than ever.

With these projects and reforms, the problem of unemployment would automatically disappear and the task of improving public health and fighting against disease would become much less difficult. (…) Finally, a revolutionary government would undertake the integral reform of the educational system, bringing it into line with the projects just mentioned with the idea of educating those generations which will have the privilege of living in a happier land. (…) An educated country will always be strong and free.”

The flourishing revolution: the right to independence and development (1959-1989)

Under the leadership of Fidel Castro the rebels were able to unite the population on an anti-imperialist and democratic program. After the victory of January 1st 1959, the program Fidel had elaborated in 1953 was put in practice.

Basic industrial sectors were nationalized, as were foreign trade and the financial sector, which were almost completely in the hands of foreigners, mainly from the USA. At the same time, a far-reaching land reform program was implemented. With the help of the Soviet Union, Cuba was able to ensure economic growth and development. Economic growth allowed social development, electricity and safe drinking water were made available for almost everyone, even in the most remote places of the country. Inhumane working conditions in the countryside, drastically improved and wherever possible production was industrialized.

The Cuban people acquired a house of their own, an assured income, better nutrition, better education, and other improvements of their living conditions, all of which are essential for health. The dramatic improvement of the health care services was only a secondary factor.
Through a massive literacy campaign, illiteracy was almost eradicated in an amazingly short period of time. Consequently, the formal educational system, including the primary and secondary schools as well as the universities, was expanded spectacularly. An extensive program for adult education encouraged everyone to achieve at least the level of secondary education. Also arts, science and sports were promoted.

Since the early 1960s women have the right to 12 weeks of pregnancy leave, with full pay. In 1974, this right was extended to 18 weeks. Since 1991, women can extend this leave up to six months after delivery, while retaining 60% of their salary.
The setup and expansion of many people’s organizations (neighborhood committees, women’s organizations, labor unions, youth organizations and the like) contributed significantly to the country’s revolutionary transformation. Neighborhood committees, for example, played an important role in health care delivery.

With or without the Soviet Union, ‘la lucha continúa’

The collapse of the Soviet Union in 1989 changed the international situation, with severe consequences for Cuba. Foreign trade reduced by almost 80% within a few years, and the Gross National Product dropped 34%. On top of this economic disaster, the United States tightened its 30-year economic blockade trying to strangle Cuba completely. Other countries were pressured to join this aggression. Nevertheless, Cuba’s response was stubbornly different from the structural adjustment programs that IMF and World Bank imposed on so many developing countries in the 1980s (and also on Greece in the ongoing European crisis).

In 1994 the most difficult years were over. Fidel: “Even if we have many difficult years ahead of us, we can say that the most difficult phase of this special period is already behind us. Through this experience our country can state in all modesty but with appropriate pride that not a single citizen was abandoned and that our country has a healthy and united people, which has confidence and faith in what it can achieve in the future”.

Internationalism: Fidel and Cuba’s support to the African liberation struggle

When Nelson Mandela was freed from prison and became the first president of post-apartheid South Africa, one of his first trips was to Havana. Visiting Havana in July 1991, Mandela referred to Fidel Castro as “a source of inspiration to all freedom-loving people”. Mandela responded to the US criticism about his loyalty to Fidel: “We are now being advised about Cuba by people who have supported the apartheid regime these last 40 years. No honorable man or woman could ever accept advice from people who never cared for us at the most difficult times.”

This statement of solidarity was no surprise. The involvement of Cuba in Africa started with its support of Algeria’s liberation struggle against France, then continued in the now Democratic Republic of Congo (DRC). After also having been heavily involved in Africa’s liberation struggle against Portugal, the Cuban internationalists were pivotal in the struggle against South Africa’s apartheid state. Twice – in 1976 and again in 1988 – the Cubans defeated a US-supported proxy force of the South African apartheid army. From his prison in Robben Island Mandela wrote: “It was the first time that a country had come from another continent not to take something away, but to help Africans to achieve their freedom.” In 1998, Fidel Castro told the South African parliament that by the end of the cold war at least 381.432 Cuban soldiers and officers had been on duty fighting hand-in-hand with African soldiers and officers for national independence or against foreign aggression. Not for nothing Mandela said in Havana: ‘The Cuban people have a special place in the hearts of the peoples of Africa.”

Fidel: “When many were investing in and trading with racist and fascist South Africa, tens of thousands of voluntary soldiers from Cuba fought against the racist and fascist soldiers. Cuba does not have a single investment in any of the countries where our internationalists fulfilled their duty; it does not have one dollar of capital invested, and does not own a single square meter of land”.

These wars ended, but Cuba continues its involvement in Africa mainly in the health and educational sectors, including the training of Africans in Cuban universities. During the Ebola outbreak in West Africa, even Cuba’s US critics had to acknowledge the massive Cuban contribution to alleviating the crisis. The work of Fidel’s Cuba to make health care truly accessible includes medical education that has provided doctors for poor communities world-wide. The ELAM is a School of Medicine which is totally free for students who come from 84 countries (Africa, Latin America, Asia and also USA) and who are committed to working in communities facing multiple disadvantage. ELAM graduates general practitioners with community health skills who return to their countries of origin to work with people. By 2016 ELAM had produced around 25,000 physicians, and another medical school in Venezuela has been inspired by the Cuban ELAM.

Another, almost unknown part of Cuban history, is Fidel’s decision to send an ambassador to Vietnam during the Vietnamese revolution. In the spring of 1969 Cuba opened an embassy in the liberated zones in the Vietnamese jungle, in solidarity with the ongoing liberation struggle. Also here Cuban solidarity was actively present. “The opening of this embassy in the jungle is an act of brotherhood of two peoples united for the eternity (…). This embassy is part of the struggle.” 

Rational organization of society and Cuban democracy

Fidel Castro: “If ants are capable of rational organization, and bees are capable of rational organization, why not human beings, the most extraordinary of nature's creations, the only being provided with true intelligence? Can a society with hundreds of thousands of unemployed people be considered rational? There are billions of unemployed in the world. Capitalism has been unable to create a rational society. It creates a society full of contradictions and absurdities, full of paradoxes. It has created a society which depletes everything, natural resources but especially human resources, a society that alienates everything. What we have obtained in education, health, and many other fields shows what a society that tries to organize itself in a rational way can do. But without this rationality, without this rational organization, no country in the world could have resisted what our country is resisting. Our country has never been subjected to those so-called economic shock policies that wipe out hospitals, schools, social security and vital resources for low income people. We have resisted and not a single one of those measures was ever used, and those that we did implement to confront this terribly difficult situation were discussed with all of the people, not just in our National Assembly. When we adopted measures to confront the difficult situation of the special period all were discussed, first of all, at the grass-roots level, with workers, farmers, students and other mass organizations, at hundreds of thousands of assemblies and later at the National Assembly. Then, after they had been studied by the National Assembly, they were sent back to the grass-roots level for further discussion before their final adoption by the Assembly.” 

Victory in the Sierra Maestra did not convert everyone to the rational view of social organisation and over the succeeding years there were dissenters, many of whom went into exile in the US. The risks to the Cuban revolution posed by such dissidents were greatly magnified by the hostility of successive US governments and their enthusiasm to use Cuban dissidents to destroy the revolution. Questions on whether Fidel and his comrades found the right balance in managing dissent – including victimization of homosexuals, for which Castro later apologized - underlines the challenges to be addressed in creating a more rational, more egalitarian society; challenges which must be faced wherever la lucha continúa.

Fidel and the right to health

The organization of an integrated health system is upheld as a central state responsibility. Until today Cuban health care continues to be free and of good quality. Health care costs are covered through the revenues from the state economy and taxes. Cuban health policy clearly demonstrates the importance for population health of deliberate social action with a very explicit focus not only on medical care but on the determinants of health: education, nutrition, housing, employment and social cohesion. Rather than seeing medical and non-medical determinants as competitive, Cuba has chosen, despite very limited resources, to go for both. Important is that primary care physician (and nurse) teams have responsibility for the health of geographically defined populations, not merely for those patients who come in the door. The health care system becomes a key part of the process, the mechanisms of social intervention, through which those non-medical determinants are addressed. Every Cuban has the right to health care according to his needs. User fees or ‘co-payments’ are completely unthinkable, because they would immediately cause inequality in access to health care. Consequently, health care remains exclusively in the hands of Cuba’s public sector.

Already in 1962 56 Cuban doctors went to Algeria to work in this newly independent country for fourteen months. Since then, co-operation with other countries of the South has only increased. There were, and still are, tens of thousands of doctors, specialists, professors, nurses and technicians active in dozens of countries of the third world, especially in Africa and Latin America. Besides the many young GPs from all over Cuba, specialists, professors, and researchers with years of experience in neurology, surgery, gynecology, epidemiology and pediatrics participate in this program. In many African countries they help local medical faculties or even assist them to get started. Like anything, Cuban health care can be improved, but as Fidel himself has expressed, “We have not conquered all justice, but we have to save the justice conquered.”