By Alexander Main, Joe Sammut, Mark Weisbrot, Guillaume Long – Apr 27, 2026
Press Release
New Report Shows That Hardening of US Sanctions on Cuba Since 2017 Fueled a Sharp Increase in Cuba’s Infant Mortality Rate
Executive Summary
A country’s infant mortality rate (IMR) is often considered a key barometer for a population’s overall health as well as its access to quality health care.1 In Cuba, where for decades the state has invested substantially in health care services, the IMR was, until recently, among the lowest in the Western Hemisphere and lower than in the US. Since 2018, however, Cuba’s IMR has increased from an annual rate of 4.0 per 1,000 live births to a rate of 9.9 as of 2025,2 representing an increase of 148 percent. If the rate of infant mortality had remained unchanged, then approximately 1,800 fewer babies would have died since 2018.
This striking increase in Cuba’s IMR, which is at variance with trends seen in other countries in the region, has taken place over a period (2017–2025) that has seen an unprecedented expansion and tightening of the US commercial and financial embargo that has been in place since the early 1960s. It is worth noting that, in the years following the global COVID-19 pandemic and again in contrast with nearly all of its regional neighbors, Cuba failed to experience a substantial economic rebound, averaging 0.4 percent annual per capita GDP growth between 2020 and 2024 versus 3.2 percent for the Latin American and Caribbean region as a whole.3
Recent studies show a strong causal relationship between sanctions imposed and increased death rates. In August 2025, a Lancet Global Health study estimated, based on a panel regression incorporating data from 152 countries, that broad, unilateral sanctions resulted in approximately 564,000 deaths annually over the years 2012–2021.4 The study also found that children under five years old accounted for 51 percent of these deaths. Infant mortality is generally about three-quarters of under-five mortality. These numbers therefore reflect a profound disproportionality in the impact of sanctions on infants and children under five years of age as compared with other age groups; infants are only about 1.6 percent of the world population.5
Sanction measures adopted by US administrations since 2017 are designed to cause economic damage to Cuba by further reducing its access to foreign exchange and international financial markets; such measures can, and appear intended to, cause recessions, depressions, balance of payments crises, and higher inflation, even hyperinflation — as similar sanctions have done in other countries. A 2022 paper published by the Bank for International Settlements found that “child mortality rises in a highly significant way in recessions in EMDEs [emerging market and developing economies], by about 6 deaths per 1000 births.”6 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, so an additional 5.9 deaths per 1,000 births).
The unparalleled hardening of US sanctions against Cuba during the first Trump administration, the Biden administration’s decision to largely maintain these policies, and the further expansion of sanctions during the second Trump administration, including a devastating fuel blockade, is very likely the primary cause of the current economic and humanitarian crisis in Cuba, which is widely considered to be the worst in the island’s contemporary history.
Among the most harmful measures imposed over the last eight years are the following:
• The Cuba Restricted Entities List, prohibiting transactions with most of Cuba’s major hotels and many other state-run businesses (created in 2017 by President Donald Trump).7
• Reduction of the de minimisthreshold on Cuba to 10 percent, blocking all exports of foreign-made products to Cuba that include more than 10 percent US-origin content (tightened from 25 percent to 10 percent in October 2019).
• Far-reaching restrictions on US travel to Cuba, including ending the main travel license allowing travel to Cuba for individuals (June 2017) and for groups (June 2019; rescinded in 2022, reinstituted in 2025) and the banning of cruise and most private vessels/aircraft from calling at Cuba (June 2019).
• Re-inclusion of Cuba on the State Sponsor of Terrorism****list,8 triggering potential onerous fines for international financial institutions that do business with Cuban entities and blocking citizens of 42 Electronic System for Travel Authorization-applicable countries (EU, UK, Japan, Australia, South Korea, etc.) from traveling to the US visa-free if they travel to Cuba (instituted on January 12, 2021).9
• The nonrenewal of the presidential waiver on Title III of the Helms-Burton Act, allowing US citizens and entities to sue third-party individuals and companies — including non-US companies — that engage in business with Cuban entities benefiting from nationalized properties (President Trump let the waiver expire in May 2019).10
• Measures restricting the flow of remittances, including caps on family remittances ($1,000 per quarter), bans of all donative remittances (ordered by President Trump on September 9, 2019; removed by Biden on June 9, 2022), and the addition of the Cuban firm that processes remittances for Western Union and other US companies to the Cuba restricted list in 2020. Operations resumed with a new Cuban partner in 2023, but this firm was also added to the list in January 2025, again closing the main channel for formal remittances and forcing reliance on costlier alternatives.11
• Sanctions and other pressure targeting officials of governments hosting Cuban international medical missions, leading to the departure of many of these missions and the steady erosion of Cuba’s primary source of foreign income (pursued by both Trump administrations).
• US fuel blockade — by far the most damaging US unilateral measure to date — consisting in the blocking of nearly all oil shipments from Venezuela through the use of coercive tactics employed by the US military, including the interception of tankers destined to Cuba by the US Coast Guard,12 as well as threats, including threats of tariffs directed at countries considering exporting oil to Cuba (pursued by President Trump since early January 2026).
In the aggregate, these measures have — by fueling steep reductions in export earnings from tourism, medical services, foreign investment, remittances, and so on and by cutting Cuba off from most international credit — stifled economic growth and significantly contributed to major balance of payments difficulties, leading to increased inflation, reduced imports of essential goods, and reduced economic growth. Given these conditions, it is unsurprising that Cuba is experiencing an acute economic crisis that has led to a major decline in living standards that has, in turn, resulted in an unprecedented number of departures from the island over the last few years. This crisis has been compounded by this year’s fuel blockade, which has prompted increasingly frequent and prolonged power outages and brought many essential services and economic activities to a halt.
While there aren’t available data to begin measuring the impact of this year’s fuel blockade yet, the other sanction measures cited above played a very large, sometimes predominant, role in the following developments:
• Tourist arrivals in Cuba fell by 53 percent between 2018 and 2024;13 neighboring countries with similar volumes of tourism experienced increases in arrivals or no significant change.
• Income from tourism fell 59 percent, from $3.2 billion in 2017 to $1.3 billion in 2024.14
• Export earnings from medical services (international medical missions) fell 23 percent, from $6.4 billion in 2018 to around $4.9 billion in 2022, the last year for which there are data.15
• Remittances fell 42 percent from $4 billion in 2018 to just $2.3 billion in 2024.16
• Domestic spending on goods imports fell from $11.5 billion in 2018 to $8.1 billion in 2024,17 a steep fall of 30 percent (or 19 percent in per capita terms) that is likely understated in the official data.
According to Cuba’s National Statistics Office, Cuba’s population fell by 13 percent from 11.2 million in 2020 to 9.8 million in 2024,18 a rate of out-migration that far surpasses all prior episodes of intense out-migration from Cuba (such as the Mariel Boatlift in 1980).
These and other similar data reflect a rapidly deteriorating social and economic reality that has taken a major toll on the Cuban people. The human consequences of this decline include widespread undernourishment, a significant worsening of sanitary conditions, a rise in disease and sickness, and — as underscored above — an increase in deaths, particularly the deaths of infant children.
CEPR staff has also observed in situ how US sanctions measures have directly contributed to the deterioration of Cuba’s once exemplary health care sector, which is undoubtedly a factor that has contributed to the marked increase in Cuba’s IMR. During a 2024 trip to Cuba to assess the impact of the hardening of US sanctions, CEPR visited Cuban health care facilities and spoke to numerous health care providers. The visit confirmed that, as a result of the reduction of the de minimis threshold in 2019, Cuban medical importers were no longer able to obtain at affordable prices many basic medical supplies, such as syringes, inhalers, and even saline solution; more sophisticated medical equipment, such as imaging and ultrasound systems; and inputs for the manufacturing of pharmaceuticals. The re-designation of Cuba as a State Sponsor of Terrorism in 2021 has made it extremely challenging to obtain financing for the purchase of these goods — at any price — or to simply execute international payments to purchase them. The end result of these multiple barriers generated by these sanctions has been massive shortages of medical goods — supplies, equipment, medicines — that had once been far more readily available in spite of the long-standing US embargo.
The situation in Cuba has declined even further since last year and could devolve into an even more severe humanitarian crisis as a result of the US fuel blockade. As a number of recent media reports have noted, the blockade has had a particularly dire effect on Cuba’s health care infrastructure, with frequent power outages interrupting the use of critical equipment for the treatment of patients, including incubators for premature babies and ventilators to help sick newborns breathe.19 There is virtually no available fuel to transport sick patients, whether by ambulance or in private vehicles — NBC reported in March that 300 ambulances are sitting idle for lack of fuel or parts, leaving only 25 electric ambulances to serve the entire island.20 Public transportation is paralyzed,21 leading to an even greater absence of medical workers in key facilities.22 None of this is surprising. In fact, these are precisely the consequences that could be expected from a fuel blockade targeting an island nation that only produces roughly 40 percent of the energy required to meet its domestic needs.
Given the effects of the US energy blockade, it is highly likely that Cuba’s infant mortality rate has increased significantly since December 2025 when it had reached 9.9 per 1,000 live births. Other key health indicators, such as life expectancy and maternal mortality, have also very likely deteriorated since the beginning of the year.
A Dramatic Increase in Cuban Infant Mortality
A country’s infant mortality rate (IMR) — defined as the number of deaths of infants under one year of age per 1,000 live births — is often considered a key barometer for a population’s overall health as well as its access to quality health care.23 Until recently, Cuba’s IMR was among the lowest in the Western Hemisphere — lower even than the rate for the US — with, for instance, a rate of 4.3 in 2015 according to Cuba’s health authorities, or 4.8 according to World Bank/UN estimates versus an average regional rate of 15.6 and a US rate of 5.8.
Cuba’s exceptionally low rate, particularly for a country that has lagged behind the majority of the rest of the region economically, was attributable in part to significant public investment —over many years — in health care. For decades, Cuba’s government has spent proportionately more on health care than nearly all of its regional neighbors. Among other things, it greatly expanded preventive primary care services, increased the number of health care facilities, and trained large numbers of health care professionals, resulting in one of the highest rates of physician density in the world.24 This robust and consistent investment in health care explains, at least in part, why Cuba has had, until recently, higher average life expectancy, much lower maternal mortality, and far lower infant mortality than the Latin American and Caribbean average (see Table 1). Table 1 uses internationally comparable World Bank data for these indicators to show how, in 2017, Cuba had superior results than the regional average as well as a sample of its neighbors.
Since 2019, Cuba’s IMR has increased dramatically — rising from a rate of 4.0 that year to 9.9 for 2025 (Table 2), an increase of 148 percent. If the mortality rate had remained at its 2018 level, then approximately 1,800 fewer babies would have died between 2019 and 2025. This is a very different trajectory to other countries in the sample. For the countries that have published recent infant mortality rates (Argentina, Brazil, Colombia, Mexico, and Jamaica), only Brazil saw an increase in the mortality rate, which rose by 3 percent from 11.9 in 2019 to 12.3 in 2024.25 All of the others saw declines or stagnation in the rates.26
In Table 2 we use official government statistics — which, unlike the World Bank database, provide data for 2024 and 2025 — to provide a picture of the sharp increase in Cuba’s IMR between 2017 and 2025.
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 Healthby 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 minimisrule).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.
Cuba Seeks Mutual Understanding With US, Denounces Intensified Blockade
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
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