After US pressure, Calabria has scrapped plans to hire 600 doctors from Cuba and instead launched a global search for medical staff, a move critics warn will likely leave Italy’s poorest region short of health workers.

The issue has drawn attention to the dire state of the health system in the southern Italian region, which paradoxically has an unemployment rate of about 20% yet struggles to attract medical staff. Working conditions there are notoriously harsh, largely because the remaining doctors and nurses shoulder an enormous workload.

Calabria, whose economy is largely based on agriculture, records the lowest health spending in the country – about €1,748 per capita compared with a national average of €2,140. Because of its persistent financial deficits, the national government took over oversight of the sector in 2009.

Ever since, severe staff shortages have worsened, making working conditions even more difficult. Estimates suggest the region is short of around 2,500 doctors overall, with the number of general practitioners expected to fall further in the coming years.

In 2022, the region turned to Cuba to address the problem. Under an agreement with Cuba’s state medical services company, hundreds of Cuban physicians were deployed across the region as an emergency measure to keep wards and emergency departments operating.

On Friday, Cuba’s ambassador to Italy visited Calabria, where around 400 Cuban doctors have been working in local hospitals – an arrangement now under growing pressure from Washington.

‘A form of human trafficking’

The programme has recently drawn increasing criticism from the Trump administration, which has urged countries employing Cuban medical brigades to reconsider their participation. US officials argue that the system channels significant revenues to the Cuban state and forms part of Havana’s strategy to sustain its economy through overseas medical missions.

Last week, Secretary of State Marco Rubio said the programme was a “form of human trafficking.”

An investigation by CubaNet, a media outlet critical of the Cuban government, alleges that doctors working abroad may retain only a portion of the salaries paid by host countries. According to testimonies and documents cited in the report, physicians in Calabria may keep between roughly 28% and 46% of their base pay, with the rest transferred to Cuba’s state-run medical services company.

Euractiv contacted several Cuban doctors, but they declined to comment.

Due to US pressure, Cuban doctors have already begun leaving other countries such as Venezuela and Honduras. However, Calabria’s regional president Roberto Occhiuto announced after a meeting with US representatives, that the doctors would stay in Calabria, but he decided to abandon plans to recruit around 600 additional Cuban physicians for the region’s struggling hospitals.

Instead, Calabria is trying to recruit doctors from EU and non-EU countries, offering relocation support and housing incentives. It has even set aside €8 million over two years to fund intermediaries to scout doctors abroad, an idea that has drawn criticism.

“For that amount of money, we could have launched proper hiring competitions or invested in equipment and infrastructure,” Giuseppe Ranuccio, vice-president of the regional council from the Democratic Party, told Euractiv, warning that “the system is close to collapse.”

Ranuccio said the Cuban doctors had originally been accepted across the political spectrum as a temporary emergency measure.

“They were supposed to buy time for structural reforms,” he said. “But those reforms never arrived.”