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More than half of respondents (56.9%) said they make these payments “always or often,” with Havana leading the way (66.6%). By region, it is as follows: West (58.8%), East (55.8%) and Center (51.9%).

The most informal “priced” services are obtaining medicines, surgical procedures and diagnostic tests with medical equipment

The most informal “priced” services are obtaining medicines (57.6%), surgical procedures (27.9%) and diagnostic tests with medical equipment (10%). Even interventions such as cesarean sections, abortions or treatment of fibroids require the disbursement of sums between 25,000 and 45,000 CUP (65 to 117 dollars, depending on the black market exchange rate), without counting the inputs that must be purchased from outside the system.

The paradox is brutal. Cuba allocates just 2.1% of the state budget to health and social assistance, but maintains 24,000 doctors working in 56 countries, which in 2022 reported revenues of $4.882 billion, according to official data. Of these, between 75% and 90% of the salaries paid by the recipient governments remain in the coffers of the Cuban State.

Meanwhile, national pharmacies have a shortage of more than 50% of the basic list of medicines, and hospitals show signs of abandonment, with collapsed ceilings, rodents, closed rooms and poor hygiene, documented in multiple independent reports.

The report intersperses the figures with shattering testimonies: an anesthesiologist who operates with stored supplies “for my own family,” a neonatal nurse who admits delaying care to patients without “recommendations,” or a patient who had to give two pigs to the doctors for a hernia operation. Others, like Alexis Dominguez, are waiting for urgent surgery while paying up to $150 just to be put on a list.

The situation of women is even more outrageous. The chapter dedicated to gynecology and obstetrics documents payments for cesarean sections, abortions, regulation of periods and even a minimum medical protocol during delivery. A young woman, for example, paid 10,000 pesos to have her cesarean section performed because her baby was in danger, after 36 hours of labor. “Paying gives you the ability to be demand,” she says bluntly.

The research highlights that the most alarming thing is not the existence of corruption, but its normalization. Almost 83% of respondents believe that corruption in health is “widespread” or “very widespread,” and more than 52% say they have stopped seeking medical care due to illegal payments.

The report qualifies this phenomenon as a form of institutionalized violence, which is exercised not only by action but also by omission

The report qualifies this phenomenon as a form of institutionalized violence, which is exercised not only by action (improper charges, mistreatment and negligence) but also by omission (inefficiency, endless waiting and lack of resources). “What used to be a right is today a privilege,” she summarizes crudely.

The authorities, for their part, have chosen to minimize the problem. Miguel Díaz-Canel acknowledged in April 2025 that there are “negative trends” such as the illegal sale of services, but he limited himself to calling for them to be addressed “forcefully.” In the absence of a structural strategy, the government only punishes isolated cases, without admitting that corruption is the direct result of low wages, lack of resources and chronically low investment by the state.

The study concludes that the Cuban SNS is not being privatized in the classical sense, but in practice. Health no longer depends on the state, but on the patient’s pocket or contacts. And what is more worrisome, even newly graduated doctors are deserting, invalidating their degrees rather than practicing in these conditions. Between 2021 and 2023, more than 63,800 health professionals left the system.

“Your health service is free… but it costs money.” The poster at the entrance of some hospitals might seem like a cruel joke. But in Cuba, where pain and disease have become a product of the black market, that irony is already an undeniable truth.

Translated by Regina Anavy

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Authorities mention compliance with Law 150 Natural Resources and Environment and the standards on air and waste emissions. They also highlight achievements such as sleeve filters that reduced dust emissions to 1.4 mg/m³ monitoring systems and restoration projects with the reforestation of the Cuban pine and international partnerships.

But independent media testimonies and Facebook posts contradict this narrative. Testimonies abound with images of black dust on skin and clothes, and reports of cases of respiratory disorders, mainly in infants. All this describes an alarming reality despite the alleged environmental measures.

“It’s like we’re breathing poison”

Journalist Mario J. Pentón collected heartbreaking statements: “Every day we have to endure a substance that falls from the sky. You clean and then everything’s dirty again. What comes out of your throat is black. It’s like breathing poison. These people are slowly killing us,” wrote a resident of that area, in the province of Holguín. “Today Moa’s Facebook page was lit up, with many people complaining about the same thing. There is despair, frustration and a growing rage,” he added.

The ministry highlights the existence of four environmental monitoring stations in residential areas and epidemiological surveillance protocols. According to Joel Queipo Ruíz, first secretary of the Communist Party in Holguín, there has been no identifiable increase in medical care for respiratory or allergic conditions in recent weeks. But citizens claim the opposite: children suffering from chronic cough and persistent dust on their skin and clothes. The official explanation does not match the daily reality in Moa.

Allegations of a “slow death” in Moa are not new

Allegations of a “slow death” in Moa are not new. Independent studies recall years of exposure to toxic gases, lower life expectancy compared with other Holguín municipalities, and a high prevalence of respiratory and dermatological diseases. In addition, recent flood waters from the Cabaña river aggravated exposure to pollutants in neighborhoods such as Ecrin, Cabaña and La Veguita, where neighbors suffer from both the climate crisis and industrial pollution.

The response of the Ministry of Energy and Mines is simplistic and reactive. An isolated incident does not explain a chronic crisis. They talk about technology and monitoring without showing tangible results. There are no real comparisons of pollutant levels before and after, nor public health data to support their position.

Viral photos, citizen voices and local health reports reinforce the perception of being in the forefront of an announced ecocide. The government boasts about laws and open dialogue. However, the authorities’ indolence in the face of decades of environmental deterioration, the lack of verifiable data and the urgency of the testimonies reveal the absence of real commitment.

Translated by Regina Anavy

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COLLABORATE WITH OUR WORK: The 14ymedio team is committed to practicing serious journalism that reflects Cuba’s reality in all its depth. Thank you for joining us on this long journey. We invite you to continue supporting us by becoming a member of 14ymedio now. Together we can continue transforming journalism in Cuba.

Despite institutional pressure, García enjoyed broad public support from the start. “They gave him a very long sentence, when in Santa Clara, as elsewhere, not even a shop window was broken and nothing happened at all,” his brother-in-law Jonatan López wrote on the social network X after hearing the sentence.

In May 2022, authorities announced that García would be transferred to an open regimen camp in El Yabú, a change that never materialized. Shortly thereafter, while going with his father Nedel García Pacheco to the prison of Guamajal to collect some belongings, both were intercepted on their way home. State Security agents transferred them to the 5th Santa Clara Unit for a “conversation,” and the minimum severity measure was revoked.

Throughout his sentence, García was steadfast in his convictions. In an interview with Cubanet, he said: “How am I going to regret the proudest act of my life, of all Cubans? It was the happiest day in history, the day when the people rose up against the oppressor.”

Now 27, Andy has returned home. One of his first gestures upon leaving was to visit the tomb of his paternal grandmother, who died during his imprisonment. He has also been able to rejoin his maternal grandparents, whose health has deteriorated in recent years.

“Andy is free, he owes nothing to the regime, and he’s going to take his time to be with the family,” said his mother. The family does not rule out continuing pressure from State Security, which in these cases usually tries to prevent former political prisoners and their relatives from talking to the independent press.

Translated by Regina Anavy

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COLLABORATE WITH OUR WORK: The 14ymedio team is committed to practicing serious journalism that reflects Cuba’s reality in all its depth. Thank you for joining us on this long journey. We invite you to continue supporting us by becoming a member of 14ymedio now. Together we can continue transforming journalism in Cuba.

“This is a story of today, and a movie that contains a call to action. People come out of the cinema feeling that they can do something,” said Luengo

Although the song has already become a mass phenomenon, winning two Latin Grammy Awards – as song of the year and best urban song – both the Spanish artist and the Cuban singer agreed that it is now the turn of the documentary, which arrives in the US after its premiere in Europe.

“What we hope will happen is that thousands of people will send messages to Cuba saying ’You are bright, brave people. We’re with you’ (…), and that they identify with the pain of the people they see in the documentary,” said Romero.

“If previously the largest group that came out on the streets were Cubans, what we want to achieve is that this coming July 11 the groups that come out are not only Cubans but also citizens of every country demanding freedom for the people,” he added.

And although both argue that the musical theme “was historic” and managed to open the eyes of the world and demonstrate the strength of the Cuban people, they admit that there is still a long way to go.

“We are talking about a defenseless people, a people who have been oppressed for 56 years. Without water, without electricity, without food, it is very difficult to face a machine like the dictatorship that has all the weapons,” said the Cuban artist.

Among them are different forms of repression that the artists themselves personally suffered. It was the case of Romero, who left Cuba several years ago, and Maykel Osorbo, another of the interpreters of Patria y Vida, who was sentenced in 2022 to nine years in prison for “disobedience, resistance and contempt.”

“We are always asked at the end of the film if Maykel is still in prison,” recalled Luengo.

The documentary itself is banned in Cuba, which the Spanish artist interprets as a win: “That means we have done our job well”

The documentary itself is banned in Cuba, which the Spanish artist interprets as a win: “That means we have done our job well.”

In contrast, with the premiere in Miami they want the thousands of Cubans living in this city to go to the theaters “to feel it and mourn,” and take other people with them to show them what is happening in Cuba.

“It is a common malaise, not only of the young people, not only of the people who have left, but also of the people who are still there, practically unable to sleep [because of the power outages],” summed up Romero, before issuing a final warning to the Cuban government.

“Now the dictatorship has nothing to hold on to. Every time there are stricter laws, they inflict more and more fear, and that only makes you understand one thing: they are very afraid of the Cuban people because they know what they are capable of doing,” he said.

Translated by Regina Anavy

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COLLABORATE WITH OUR WORK: The 14ymedio team is committed to practicing serious journalism that reflects Cuba’s reality in all its depth. Thank you for joining us on this long journey. We invite you to continue supporting us by becoming a member of 14ymedio now. Together we can continue transforming journalism in Cuba.

The collapse of Cuban coffee is a palpable reality. Consumers notice it in the disappearance of the product in the bodegas, in the increase of the price of the bean on the informal market and even in the quality of what they manage to buy. According to the National Bureau of Statistics and Information, production in the sector has fallen by 51% over the last five years.

“From Miami comes La Llave and Bustelo coffee, which they like very much because they have the traditional Cuban roast, and when people drink it they remember what the coffee here used to be like,” says the seller. “But also in recent years, other cheaper brands come in, and although they are of lower quality, for any Cuban they are glorious compared to the bodega coffee”.

El Morro, El Dorado, La Carreta and Cubanazo are some of the names that have also slipped from Florida into Cuban coffee shops. In the large community of Cuban exiles, the products from shops and supermarkets fill the niches that the deep economic crisis has opened up for them in Cuba. From school uniforms for all levels of education to generators for the blackouts: goods designed and intended for the consumer within Cuba have grown in recent years.

“My cousin who lives in Hialeah says that she only buys those packages of coffee to send here because they aren’t what she likes to drink every day,” the cafeteria employee admits.” But here they do very well because people don’t have the rationed coffee, which hasn’t appeared in Matanzas since February.” Mixed or low quality, the imported coffee always exceeds by far the bitter and often unnamed coffee that is distributed through the ration book.

“Before I bought the coffee that they sold in the bodega, mixed it with peas and added a little of the good coffee,” explains Rafael, but even that possibility is a thing of the past because now the rationed coffee “neither arrives nor serves. The few peas I can buy are for eating,” he adds, in allusion to the grain that for decades served both the state and consumers to stretch the monthly coffee ration.

With a pension of 2,500 pesos per month, Rafael would need almost half his retirement – about 1,200 – to purchase a 284-gram package of La Llave. Paying this amount would be a mistake, so he carries in his head a mental map of where he can still drink coffee in a cafe that has prices of 10, 20 or even 40 pesos a cup.

“If I don’t have a sip in the morning, I get a headache, but if I drink it in a state cafeteria I’ll probably end up with a belly ache”

“I have had coffee in the kiosks at bus terminals, and it was like being struck by lightning,” he explains. “If I don’t have a sip in the morning, I get a headache, but if I drink it in a state cafeteria I’ll probably end up with a belly ache,” he says, summing up his dilemma. The state premises that still distribute the popular drink have been reduced, and the volume of his laundry has also been limited. “If you get to the water truck ten minutes after they start dispensing it, it’s already gone,” Rafael complains.

There is, however, the option of going to a better place with higher prices. “I can no longer afford the coffee at the Sala White, much less the Hotel Velazco, and I do not count on those in the Paseo de Narváez. I don’t have the 200 pesos to spend,” laments Nilda, another matancera who needs her daily dose of caffeine. “It looks like they made this one early, because it’s lukewarm. That’s what there is for the poor,” she asserts.

The employee keeps the sugar bowl under the counter and administers only one spoon per cup. She is not allowed to add more because the most emblematic product that comes out of the Cuban fields also suffers a drop in production. “A pound is 270 pesos,” explains the worker. At one side of the stove, where the coffee sits on a burner, is a package with the label “Florida Crystals,” containing sugar from those cane plantations that, in Florida and at the hands of Cuban-American entrepreneurs, also supply the island.

Translated by Regina Anavy

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COLLABORATE WITH OUR WORK: The 14ymedio team is committed to practicing serious journalism that reflects Cuba’s reality in all its depth. Thank you for joining us on this long journey. We invite you to continue supporting us by becoming a member of 14ymedio now. Together we can continue transforming journalism in Cuba.