“We don’t do politics,” a doctor at Cuba’s National Institute of Oncology said. “We just want to provide assistance to the population.” That was in 2024, during a research trip to Cuba in which we conducted interviews with weary, crestfallen doctors who explained how U.S. sanctions had made their job virtually impossible. They could not import crucial surgical supplies or replacement parts for radiotherapy machines, and they lacked the resources needed to treat large numbers of cancer patients.
Physicians in various Cuban medical facilities that we visited explained that the biggest problem during the COVID-19 pandemic was not, unlike in other countries, access to vaccines, which Cuba developed and produced in vast quantities. It was importing syringes and, crucially, lifesaving ventilators, after a U.S. business bought the two Swiss companies that had previously supplied Cuba. Medics everywhere complained that, as a result of U.S. sanctions, they faced shortages in dental prostheses, artificial limbs, and incubators, and they lacked the most basic medical equipment “from serum to intravenous bags, and even paracetamol.”
“We don’t do politics,” a doctor at Cuba’s National Institute of Oncology said. “We just want to provide assistance to the population.” That was in 2024, during a research trip to Cuba in which we conducted interviews with weary, crestfallen doctors who explained how U.S. sanctions had made their job virtually impossible. They could not import crucial surgical supplies or replacement parts for radiotherapy machines, and they lacked the resources needed to treat large numbers of cancer patients.
Physicians in various Cuban medical facilities that we visited explained that the biggest problem during the COVID-19 pandemic was not, unlike in other countries, access to vaccines, which Cuba developed and produced in vast quantities. It was importing syringes and, crucially, lifesaving ventilators, after a U.S. business bought the two Swiss companies that had previously supplied Cuba. Medics everywhere complained that, as a result of U.S. sanctions, they faced shortages in dental prostheses, artificial limbs, and incubators, and they lacked the most basic medical equipment “from serum to intravenous bags, and even paracetamol.”
That was before the current U.S. oil blockade, which U.S. President Donald Trump imposed on Jan. 30 and which has made Cuba’s situation much worse. Today, ambulances often lack fuel to operate, and never-ending power cuts make it impossible for hospitals to function normally. Cuba now faces a downward spiral that could lead to outright humanitarian collapse—particularly if Trump follows through with threats to further ramp up the regime change effort. In a recent speech to Florida Republicans, he even hinted at potential military action. Cuba, Trump said, is “in its last moments of life.”
Trump has tied Cuba’s fate to the January U.S. capture of Venezuelan leader Nicholás Maduro. In the immediate aftermath of the Jan. 3 attack on Venezuela, Trump said “Cuba looks like it’s ready to fall. I don’t know if they’re going to hold out.” By Jan. 29, he had invoked the International Emergency Economic Powers Act (IEEPA) and issued an executive order declaring that Cuba constitutes “an unusual and extraordinary threat” to U.S. national security. The order authorized tariffs and other punitive measures on countries supplying oil to Cuba. It remains to be seen whether the U.S. Supreme Court’s ruling on the Trump administration’s use of tariffs, which they deemed illegal, will take some teeth out of the efficacy of these threats.
Developments over the last few weeks, including the U.S. Coast Guard’s interception of oil tankers on their way to Cuba, add an unprecedented level of coercion and isolation. Even the Kennedy administration’s “quarantine”—it avoided the word “blockade” for international legal reasons—at the height of the Cuban missile Crisis in 1962 didn’t bar Cuba from access to essential imports and to oil; it was limited to intercepting military equipment.
The Trump administration’s goals are clear. The objective, spelled out in no ambiguous terms by U.S. Secretary of State Marco Rubio, is “regime change.” A particularly zealous congressional representative, María Elvira Salazar, has explicitly acknowledged that civilian suffering is an unfortunate but necessary trade-off in pursuing political transformation. Such statements confirm what decades of sanctions policy have demonstrated elsewhere: Harm to civilians is not accidental but is intentional as a mechanism of pressure.
Yet U.S. officials still employ an often-contradictory discourse. At times, they fully acknowledge the true purpose of U.S. sanctions, and at others, they deny U.S. responsibility for the resulting economic decline and daily deprivations of ordinary people.
Ultimately, the current oil blockade is an intensification of a U.S. embargo that has sought to suffocate the Cuban economy for decades. U.S. sanctions—and in particular the maximum-pressure variety imposed during Trump’s first presidency and largely maintained under the Biden administration—have restricted the Cuban state’s access to foreign currency and credit, led to chronic shortages and price hikes, hampered access to water and transportation, and degraded a health system that was, until recently, one of Latin America’s best.
Long-term U.S. economic sanctions against Cuba and other countries lead to structural ills that compound over years, constricting growth, undermining infrastructure, and hollowing out public services. They also prompt governments to seek ways to circumvent them with forms of financial and trade innovation that are both deinstitutionalizing and extremely costly.
Recent research has demonstrated that U.S. sanctions kill more than half a million people per year—equivalent to the annual global death toll of armed conflict.
One seldom mentioned consequence of U.S. sanctions is that they drive migration. This was true in Venezuela, where they were a root cause in displacing more than 6 million people between 2017 and 2023. Ironically, the migratory crisis resulting from the first Trump administration’s squeezing of Venezuela played into Trump’s demonization of migrants—a major factor that contributed to his reelection in 2024.
In Cuba, too, the first Trump administration’s rollback of former U.S. President Barack Obama’s opening and reimposition of an even more aggressive sanctions regime, which coincided with the onset of the pandemic, resulted in the largest mass out-migration in Cuba’s history. Many who migrate are highly educated, and their departure greatly weakens many essential services. One young doctor at Cuba’s leading cardiology clinic for children told us that nearly his entire graduating class had left the country. He was the only doctor of his generation working there.
Sanctions have also failed to deliver their stated political objectives. Cuba is perhaps the clearest case: A six-decade-long embargo still hasn’t delivered the outcomes that its architects promised. In Venezuela—which has experienced the largest documented economic collapse outside of war in modern history—sanctions exacerbated a devastating contraction that caused tens of thousands of deaths. In both cases, political leadership survived while civilian life deteriorated.
Beyond questions of efficacy lies a deeper legal problem. Through its actions, the United States has violated the prohibition of collective punishment, embedded in the Fourth Geneva Convention, and of economic coercion, enshrined in the Charter of the Organization of American States—both treaties that the United States is a party to. And the United Nations General Assembly has voted overwhelmingly for three decades to condemn the U.S. embargo on Cuba. There is a long roster of legal opinion on the brazen illegality of U.S. coercion against Cuba, including the latest condemnation from U.N. experts of Trump’s order imposing a fuel blockade.
Naval blockades are also illegal unless, as the U.N. Charter makes clear, they are enacted in self-defense in the face of an armed attack or are specifically authorized by the U.N. Security Council, as was the case of the blockade imposed on Iraq in 1990. Neither situation applies to Cuba.
These legal considerations may be moot in the context of weakening international law in the face of particularly virulent U.S. exceptionalism under Trump. But there is no doubt that the international community will be adding the United States’ unprovoked coercion of Cuba to its growing list of grievances. It is one thing to impose an illegal bilateral trade embargo, but the extraterritorial application of U.S. law and sanctions to other countries was previously resented by European states, and it eventually forced the Clinton administration to waive Title III of the Helms-Burton Act. The extraterritorial application of sanctions continues to vex states, with last year’s targeting of government officials from countries hosting Cuba’s international medical missions causing outrage.
For the time being, the Trump administration’s threats of retaliation on states that send oil to Cuba are working. But condemnations of what Mexican President Claudia Sheinbaum has called a “humanitarian crisis of great reach,” triggered by the United States, are piling up. Countries will be looking for any crack in the Trump administration’s capacity to make good on its threats and paying close attention to what the Supreme Court’s ruling against Trump’s tariffs means in practice.
Beyond Rubio’s deeply personal commitment to regime change in Cuba, it remains unclear what Trump stands to gain from crippling the island’s economy and social fabric. Cuba has long stood out in the Caribbean as a security outlier: It reports one of the lowest homicide rates in Latin America and the Caribbean, and it is not a producer or transit hub for drug flows in the region. There are no entrenched criminal gangs, private militias, or armed insurgent groups operating in Cuba, and the Cuban state maintains effective control over its borders and territory.
From a security standpoint, the abrupt collapse of the Cuban state could lead to internal conflict, mass exodus, and expanded trafficking routes in the Florida Straits. Aside from its tragic human cost, such a manufactured crisis could have lasting consequences for the security of the United States and the region as a whole.
