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In the video we published last week, we mentioned that at the peak of the Cuba-Venezuela deal, Cuba was sending around 40,000 doctors, teachers, and security personnel abroad in exchange for oil.

What we didn't get into is that sending personnel abroad was a business for Cuba — a big one — and Venezuela just happened to be its largest customer.

Forget cigars, rum, or nickel. For most of the last two decades, Cuba's largest source of foreign currency has been renting out its own workforce.

So how much money are we actually talking about?

The US State Department puts total service-export revenue at $6 to $8 billion a year. Medical missions make up most of that on their own: $4.9 billion in 2022 — 69% of the total. In 2018, medical service exports alone reportedly hit $7.7 billion, Cuba's largest single source of export income that year.

Even at the low end, that's more than the island earns from some of its most important industries.

Tourism, Cuba's other headline earner, brought in $3.2 billion in 2019, its best year on record, and has since collapsed to roughly $1.2 billion in 2023.

And every physical good Cuba actually ships abroad — cigars, rum, nickel, all of it — adds up to just $1.39 billion in 2024.

Now, at its peak in 2015, Cuba had roughly 50,000 medical professionals stationed abroad on medical missions. That's fallen to about 24,000 across 54 countries today, but doctors still remain the country's most valuable export.

Cuban President Miguel Díaz-Canel has defended the programme, arguing that Cuba has a "right to use medical cooperation as a source of income." And that with the US embargo limiting the country's other trade options, the medical missions have simply become an export like any other good.

So what does this export actually look like, in practice? Spoiler: it's not what you'd assume from the phrase "medical mission."

A host government pays the Cuban government directly for the services of each doctor it receives. Not to the doctor. To the government.

Brazil's Mais Médicos programme is the best-documented example. Brazil's federal government paid the Pan American Health Organization (PAHO) roughly $4,167 a month for every Cuban doctor working in the country.

PAHO kept 5% for administration and passed the rest to Havana, and Cuba's government kept nearly 75% of each doctor's salary for itself, leaving the doctor with roughly a quarter of what Brazil had actually paid for their work.

Doctors of every other nationality in the same programme, working the same hours in the same clinics, received the full payment. Only the Cuban doctors had their pay garnished by their own government before it reached them.

And Brazil wasn't an isolated case.

During the pandemic, Mexico paid $3,750 a month per doctor, and the Cuban professional received about $200 of it. In Qatar, the Cuban state reportedly charges around $13,000 per specialist while paying them a maximum of $1,200. In Italy, the host government paid €4,700 per professional, and the doctor kept €1,200.

Pro-government Cuban media called the withholding a tax, and pointed out that a top-bracket earner in Belgium hands over roughly 53% of their income too.

But the comparison stops working once you notice that the Belgian worker keeps the other 47%, chooses their own employer, and can quit.

Cuban doctors don't have that option.

By the U.S. State Department's own account, Cuba had barred 40,000 professionals from returning home for eight years by 2021 for leaving a mission early, and separated roughly 5,000 children from a parent as a result by 2022.

The UN Special Rapporteurs on contemporary slavery and on human trafficking warned Cuba that the conditions faced by workers on these missions "could amount to forced labor," measured against the International Labour Organization's own indicators.

Whether the US is exaggerating, or Cuba is lying by calling all of it a lie… honestly, we don't really know.

The arrangement genuinely helps some doctors and their families. But it also runs on a degree of state control over people's lives that no normal labour market would tolerate.

What we do know is that the doctors programme is a pressure point for Cuba's government. And Washington’s goal, it seems, is to weaken the regime to the point it is forced to strike a deal with Trump, or release its grip on power.

In August 2025, the Trump administration revoked or restricted visas for government officials in Brazil, Grenada, and several African countries over their involvement in these programmes.

Then, in February 2026 Congress passed a law empowering the State Department to sanction any country that keeps paying Cuba for medical missions with loss of US aid, travel bans, and asset freezes for officials.

It's already working: Guatemala, Jamaica, Guyana, St. Vincent and the Grenadines, Paraguay, and Honduras are reducing or outright ending their use of Cuban doctors.

Venezuela itself is doing the same. And that raises an obvious question: why would Cuba's biggest customer turn on it too?

Havana just calls it "edicts from Washington." But whatever's actually driving it, the effect is the same: the country that once absorbed more Cuban medical personnel than anywhere else is winding the programme down.

Which is exactly why losing Venezuela hit Cuba so much harder than a simple oil-supply shock.

Cuba wasn't just losing subsidised fuel. It was losing its biggest customer for its actual biggest export — the one that never even shows up in a conventional trade balance, and that had spent two decades quietly outearning the beaches, the cigars, and the rum combined.

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While we're on the subject of Venezuela, it's been just over 200 days since the US struck Venezuela and captured President Nicolás Maduro. And one of the central justifications was that the country's oil could pay for everything: rebuilding the country, repaying its debts to international creditors, and getting more crude into international markets.

So where has that oil actually gone?

In our latest video, we follow where Venezuela's oil and oil money have actually ended up, why a reported $100 billion infrastructure investment plan hangs in the balance, and why China isn't happy about any of it.

Is this the start of Venezuela's recovery, or just a new version of the same problem?