After more than 60 years of communism, Cuba’s population is suffering with a broken health care system, plummeting birth rates, and economic collapse.
By Autumn Spredemann | Epoch Times
Cubans continue to flee a worsening economy in record numbers while the elderly have been left behind, fighting to survive on the communist regime’s $10 monthly pension and a critical lack of basic supplies.
Food, power, medical equipment, and pharmaceutical shortages have ignited persistent protests this year and driven Cuba’s ongoing exodus of working-age adults.
The result has been nothing short of devastating for the country’s retirees.
“It’s a nightmare in every direction. This is an SOS. Cuba is about to collapse in a fatal way,” said Ramon Saul Sanchez, a long-time anti-Cuban regime activist and president of the Democracy Movement in Miami.
“People can’t really imagine, especially from outside, making elderly people live in such inhumane conditions,” Sanchez told The Epoch Times.
“Because of the deterioration of the economy and the lack of interest of the Cuban regime, they aren’t helping those who need it,” he said. “Retirement pension maybe allows you to buy a dozen eggs a month. That’s it.”
With one of the oldest populations in Latin America, Cuba ranks high in its number of citizens older than 65 years, according to the Cuban Research Institute and Florida International University report.
The report noted the number of elderly dependents for every 100 working-age adults could soon reach 28 with the soaring volume of migrant outflows that began in 2022 expedited the problem.
U.S. Border Patrol agents apprehended nearly 425,000 illegal immigrant Cubans during fiscal years 2022 and 2023, according to Customs and Border Protection data.
An additional nearly 200,000 have been arrested in fiscal year 2024 through July.
These numbers have eclipsed previous large-scale migrations from Cuba to the United States, including the 1965–1973 Freedom Flights (approximately 300,000 Cubans) and the 1980 Mariel Boatlift (about 125,000 Cubans).
Plummeting birth rates have also fueled the acceleration of Cuba’s aging population for decades.
The trend became noticeable in the 1980s, but Cuba has been below replacement birth rates since 1978, according to an analysis published in the journal JSTOR.
The study authors stated that fertility rates climbed past 30 births per thousand citizens for several years following Fidel Castro’s 1959 revolution.
However, once the initial optimism of the communist regime faded, that rate declined by the late 1960s.
As of 1980, Cuba’s birth rate plummeted to a historic low of 14 per thousand.
An elderly woman shows a “libreta,” a ration card, which since 1963 has allowed Cubans to buy basic food supplies at subsidized prices, in Santiago de Cuba on July 10, 2013. The deterioration of the economy is leaving many struggling for survival. –/AFP via Getty Images
As of 2024, the site Macrotrends observed Cuba’s birth rate now stands at just over nine per thousand.
In 2023, the deputy head of Cuba’s state-run National Office of Statistics and Information, Juan Carlos Alfonso Frag, appeared on the television program “Mesa Redonda” to address concerns over Cuba’s aging population.
Frag said the country has endured low fertility and high mortality rates for four years straight.
Meanwhile, relatives of Cubans living on the island say the lack of food and medical supplies is creating daily survival challenges for their loved ones.
Living on as little as $10 a month from their government pension, Sanchez explained that people who are too old to work often lack proper medication and nutrition.
Sanchez said the country’s communist party isn’t interested in helping its most vulnerable citizens, many of whom are former supporters of Castro’s revolution or even worked for the communist party.
Sanchez said Cuba’s entrenched regime now complains it doesn’t have enough money to pay out the pensions, claiming the country’s finances are too tight.
“People are dying. Elderly people are fainting in the streets from a lack of nutrition,” he said.
The daily survival fight for Cuba’s older residents is personal for Sanchez.
Sending Help
Of retirement age himself, Sanchez has a close friend to whom he has sent medical equipment and other supplies on many occasions.
Most recently he shipped health care items after his friend broke a leg.
Even the most basic medical supplies are scarce in Cuba.
Sanchez described the situation his friend dealt with upon arriving at a hospital with his leg broken in three places.
Exiled activist Ramon Saul Sanchez (3rd R), leader of the Democracy Movement, speaks during a press conference at a local restaurant in the Little Havana neighborhood of Miami on Aug. 3, 2006. Roberto Schmidt/AFP via Getty Images
“They took a used cast they had propped up in the corner and put it around the knee. Then they put a piece of clothing to hold it in place and sent him home.”
When the leg didn’t heal, Sanchez’s friend was told by a doctor he’d need surgery.
“I had to send him everything for them [doctors] to do the surgery,“ Sanchez said with a heavy sigh. ”I’m literally talking about everything you need to do surgery.”
Without an urgent care package of antibiotics, bandages, stitches, and even anesthetics, Sanchez said his friend’s surgery wouldn’t have been possible.
Like so many, most of his friend’s family have either left the island or passed away.
Sanchez said his organization helps hundreds of Cubans in the same situation. Some have families in the United States that can ship supplies, but others are trapped and have no lifeline at all.
“We get calls like this every single day,” he said.
Author, co-founder, and spokesperson for the Cuban Democratic Directorate, Orlando Gutiérrez-Boronat, confirmed this.
“There is a severe shortage of medication because the regime is bankrupted and has no credit anywhere in the world,” he told The Epoch Times via text.
Boronat said the elderly are now paying a disproportionate price for years of economic mismanagement at the hands of Cuba’s regime.
This is especially concerning in healthcare, given the higher number of medical conditions that afflict the elderly.
In response to the mounting crisis, Cuba’s President Miguel Díaz-Canel fired economic minister Alejandro Gil Fernández in March.
This is underscored by multiple reports of health care worker and water shortages at Cuban hospitals.
An elderly patient lies in a bed in the geriatric ward of Comandante Manuel Fajardo Hospital in Havana on July 6, 2017. Hospitals in Cuba are experiencing a severe shortage of basic medical equipment. Yamil Lage/AFP via Getty Images
Boronat said there’s an acute lack of health care staff due to the number of doctors sent abroad by the regime, while others leave voluntarily.
He added that it’s a common practice to have medical students in charge of emergency services in most hospitals in Havana.
It’s an image that exists in sharp contrast to Cuba’s alleged status as a model example of government health care.
The Victims of Communism Memorial Foundation said the contradiction exists because Cuba has a multi-tiered approach to health care and access to high-quality treatment is reserved for medical tourists and high-ranking members of the communist party.
For locals, the story is quite different, the foundation said in a report.
“The Cuban health system is collapsed and does not have adequate facilities or supplies,” the report stated.
It cited field research that observed a “widespread reliance on the black market, or the informal economy, to meet the basic needs of consumers” delivered from friends, family, or charities from overseas.
The analysis further noted common items Cubans usually get from outside the health care system include cold and flu medicines, surgical and dental equipment, and painkillers.
The impact of Cuba’s failing health care system is even more profound on the elderly.
One analysis observed almost 95 percent of adults 60 and older have at least one chronic condition. Nearly 80 percent have two or more, according to research from the National Council on Aging.
“It is a well-known fact that the elderly population in Cuba able to be fed and dressed are receiving remittances from their families abroad,” Boronat said. “No retiree can live on the pension they receive.”
He added many of the homeless in Cuba are retirement-age individuals who lack external support.
Sanchez said even regime members are being abandoned as they age out of the workforce.
“People who fought for the [communist] revolution are coming forward now and saying ‘I gave my life for the revolution,’ we see it everywhere now,” he said.
An elderly man passes by a wall with a Cuban flag painted on it in Havana on May 22, 2023. The elderly in Cuba are paying a high price for economic mismanagement under a communist regime. Yamil Lage/AFP via Getty Images
Working Around the Regime
For Sanchez and other Cubans living in exile abroad, he said he has to be careful not to put his name on anything he sends to loved ones on the island.
He said that is because if you’re a persona non grata with the ruling party, whatever is sent will be confiscated.
Sanchez explained he has helped collect and ship containers of food, but it has to be done “in a concealed way,” so the items make it past Cuban customs.
He recently sent $500 worth of general supplies to the island.
In Miami, Sanchez said it’s common to find Cuba-specific stores that carry everything from medical supplies to appliances for those who want to ship items to their family.
“You’ll hear a lot, ‘Did you find someone to send the thermometer?’ or ‘How do I find someone to send orthopedic shoes?’” Sanchez said, echoing common conversations among Cuban exiles.
He said Cuba’s regime takes a sizeable cut of what comes into Cuba and the biggest challenge is getting critical supplies into the hands of those who need them.
While the United States doesn’t block efforts to send humanitarian aid, Sanchez said the communist party does.
“We are the main humanitarian source for the Cuban people. The American embargo doesn’t interfere with that.”
The group Human Rights Watch noted Cuba’s economic crisis is taking a heavy toll on residents. In addition to food and medicine shortages, blackouts are a significant problem.
In a 2023 events analysis, the organization stated Cubans suffered three-hour blackouts every day for several months, starting in February.
Illegal immigrants from Cuba line up to board a bus that will take them to a U.S. Customs and Border Protection station in Marathon, Fla., on Jan. 5, 2023. Joe Raedle/Getty Images
Some Cuban officials blamed the U.S. embargo for the inability to obtain critical medicines, which has been a catch-all excuse for the government for decades.
But this explanation rings hollow for many since countries have been trading with Cuba for years, including biotech giants like China and Brazil.
“The health care of the population is not a priority to the regime. The segment of the people most severely hurt is the aging one, who need the most medications,” Boronat said.
Life expectancy in Cuba dropped from 78.07 years between 2014 and 2016 to 77.7 years between 2018 and 2020.
When asked why older residents don’t flee Cuba with their families, Sanchez said. “Many of them in retirement don’t have the resources to buy the tickets to get out. They live in a very dire condition.”
He said younger generations sell everything they own, except the clothes on their backs, just to leave.
Others roll the ultimate dice and cross the dangerous Straits of Florida for a shot at living outside the reach of communist Cuba.
Even older residents are willing to risk crossing the treacherous waters between Cuba and Florida, according to Sanchez.
He described a recent incident where he organized help to evacuate an abandoned elderly man who was starving in his home.
Tragically, the man died just two days after being taken to a hospital.