When nature calls: Cuba’s public health infrastructure exposed

Sherri Porcelain in UM’s Institute for Cuban and Cuban American Studies’ Focus on Cuba:

When Nature Calls: Cuba’s Public Health Infrastructure Exposed

A disaster will not spontaneously trigger an outbreak of disease, unless, of course, a highly infectious disease such as Ebola is the reason for the emergency event. Countries are vulnerable to both newly emerging and remerging communicable diseases when collapsing infrastructure and continuing neglect threatens the health of residents and tourists visiting the country.

Cuba’s current challenges with cholera, dengue, and its viral relative, chikungunya, are good examples. Cholera and dengue continue to spread throughout the island, while the Cuban government claims that all the reported cases of chikungunya have been imported to the island from Haiti and the Dominican Republic. According to the Pan American Health Organization’s (PAHO) Update on Chikungunya Fever in the Americas (August 8, 2014), Cuba has officially reported 11 imported cases with no suspect or confirmed locally acquired cases since the start of the outbreak in the Americas. (1)

Chikungunya, a viral disease transmitted by an infected mosquito, has reached this hemisphere for the first time in history in December 2013 when it arrived on the Caribbean island of Saint Martin and spread throughout the region. Recent data shows local transmission of chikungunya has been identified in 29 countries and territories in the Caribbean, Central, South and North America, including the United States with a cumulative total of 508,122 suspected and 5,271 laboratory-confirmed cases, as of August 1, 2014. (2) Cuba rebuffs what independent journalists, rumors, and local health professionals describe on the island.

Here we go again.

Most likely Cuba’s failure to report chikungunya is intentional and not due to poor data gathering capabilities. Cuba has an advanced epidemiologic surveillance system with highly skilled scientists and dedicated health professionals. However, the government’s failure to release timely outbreak data threatens health security today.

A brief discussion on the relationship of climate change, failing infrastructure, and the frequency and intensity of natural disasters is considered below to identify both the challenges and realities with such diseases as cholera, dengue, and chikungunya in Cuba.

Climate Change

  • Scientists project that climate change will impact both the frequency and intensity of extreme weather patterns. The Caribbean region, and islands like Cuba, could expect rise in sea levels, and this combined with more intense weather events will make flooding more common.
  • Cuba’s coastal regions will be impacted the most, however, Cuba could experience protracted seasons of both droughts and flooding, and reliable potable water could become scarce.
  • According to José Rubiera, top Cuban Meteorologist, the “seawater temperature is rising and the conditions in the upper atmosphere are favorable to rapid intensification. These cases are now somewhat more frequent; it means something is changing.”(3)
  • The vibrio cholera bacteria has been known to survive in brackish waters and estuarine environments, attaches to zooplankton and moves along the ocean currents as it is carried into new areas,(4) continuing the threat to Cuba and Hispanola.
  • This danger is especially problematic in countries where fragile water, sanitation, sewage, and housing systems are further threaten by climate change and rising water temperatures where the multiplication of the cholera bacteria has been documented.(5)


Even though Cuba’s official reporting on their health status indicators match developed world measures, I suggest that the earlier investment in the Cuban public health infrastructure is eroding quickly and without greater attention, the likelihood of infectious diseases spreading spatially and temporarily will continue.

  • As reported in New England Journal of Medicine article earlier this year, the reality is that, “Any visitor can see that Cuba remains far from a developed country in basic infrastructure such as roads, housing, plumbing, and sanitation.” (6)
  • According to Relief Web, PAHO warned Cuba a week before Hurricane Sandy (October 2012) struck that further damage to the sanitation system could be problematic in the areas previously affected by cholera and other illnesses related to water use and handling of food.
  • It is no surprise that “Drinking water is contaminated in most Cuban cities,” and neighborhoods have ongoing problems with sewage in the streets. (7)
  • Let’s not overlook the poor hygienic conditions in hospitals and clinics. Cuban independent journalists along with dissident physicians have described water and vector borne disease outbreaks associated with the government’s failure to meet basic sanitation standards. (8)
  • Current water treatment facilities seem to lack the chemicals, equipment, and appropriate filter units, along with the inconsistent availability of chlorine for safe water. (9)
  • Furthermore, a failure to maintain continuous water pressure will hinder the amount of water and contributes to the contamination of the water supply. (10)
  • Lastly, a valuable engineering report on Cuba’s infrastructure reminds us “more than 50% of the water pumped through the distribution system is lost due to leaks in deteriorated piping.” (11)

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