By Stefano Pozzebon, CNN

Bogota, Colombia (CNN) — Hector Zelaya walks cautiously in an abandoned ophthalmology clinic in Honduras at the slow pace of someone who is still learning to see again.

The stout, middle-aged man, was due to have cataract surgery in April at the clinic in Catacamas, which sits on the lowest slopes of a bushy hill some four hours east of Tegucigalpa, the country’s capital.

But his surgery was abruptly canceled when the Honduran government terminated its contract in March with “Mission Miracle,” a Cuban public health program that sends thousands of medical staff to developing nations yet has also been criticized by the US and others as involving forced labor.

The order came from President Nasry “Tito” Asfura, a conservative backed in last year’s election by US President Donald Trump, who said the deployment of Cuban doctors, nurses and other medical specialists in Honduras was not compliant with local regulations.

Honduras is among several countries in the Americas to announce the cancellation of their contracts with the Cuban medical missions – which is a foreign policy cornerstone and key source of foreign cash for the socialist island-nation.

Jamaica, Guyana, Guatemala and even Venezuela – which has seen by far the largest deployment of Cuban doctors in the past 20 years – have also severed or are in the process of cancelling their contracts with the Cuban medical missions.

Havana has criticized the decisions, claiming they are “edicts from Washington” as the Trump administration has pushed an all-out diplomatic and economic pressure campaign on Cuba. Last week, the US government indicted 94-year-old former Cuban President Raúl Castro, in a move that echoes steps taken ahead of the ouster of Venezuela’s former President Nicolas Maduro.

US Secretary of State Marco Rubio, who is the son of Cuban immigrants, has been outspoken against the program, saying in February 2025, that the US would impose visa restrictions on third-party government officials responsible for the Cuban medical missions.

Action rapidly followed: in the last year, he has announced visa restrictions for officials from Central America, Africa, the Caribbean, and Brazil.

The State Department has “taken steps to restrict visa issuance to Cuban and complicit third-country government officials and individuals responsible for Cuba’s exploitative labor export program. We will promote accountability for the Cuban regime for oppressing its people and those who profit from forced labor,” Rubio said.

But for many low-income rural workers like himself, Zelaya said the Cuban program was the only chance to receive affordable healthcare.

Depending on the area, the average monthly wage in Honduras ranges from $400 to $800, and the Cuban clinic in Catacamas was the only public health option for eye surgery in the largest province in the country.

Zeleya ended up spending $2,250, paid for with the help of his family, at a private clinic for the operation, he said.

“Most of the people here wouldn’t be able to pay for that,” he said.

Mixing politics and health

Cuban medical missions have long been the subject of debate: on the one hand the brigades –– as these deployments are known in Cuba –– are seen as a vehicle to expand public health to remote locations such as Catacamas. Meanwhile, critics see them as a PR tool at the service of an authoritarian dictatorship dating back to the 1960s.

In April, a lengthy report from the Inter-American Commission of Human Rights tried to set the record straight, recognizing the positive contribution from the brigades while at the same time alleging forced labor practices and coercive methods at the hands of the Cuban leadership.

Medical staff are routinely underpaid and receive a fraction of what their host countries pay for their services, they are not allowed to leave or to establish relationships with the communities they are sent to, and are asked to voice political messages on behalf of the revolution or the local governments, the report wrote.

Cuba has long denied similar accusations and the Cuban government did not respond to a series of questions related to the missions from CNN.

Mission personnel who speak openly from Cuba, where freedom of expression is limited, say they support the brigades as channels to foster international solidarity.

In 2022, leftwing portal Breakthrough News interviewed a Cuban doctor who worked in Guatemala, Liberia, as well as Italy and Portugal, when European Union countries welcomed the missions during the Covid-19 pandemic.

“Our philosophy is to help anyone we can,” Dr. Juan Aleman said, outlining the history of the medical brigades since their inception in the 1950s as an altruistic gesture by the late Cuban leader Fidel Castro.

Though the reality is more complex, as Cuba also uses the brigades to raise funds for the government. A State Department website estimates Cuba earns as much as $4 billion per year, a figure Havana disputes.

Last year, Cuban President Miguel Diaz-Canel defended his country’s “right to use medical cooperation as a source of income.” As Cuba is under a US -embargo and trade opportunities are limited, the medical brigades have become an export like any other good, he argued.

Doctors come forward

Two former Cuban medical professionals working in Venezuela confirmed the IACHR allegations to CNN. Asking to speak anonymously to protect their families, both said they joined the missions looking for economic opportunities unavailable in Cuba but grew disillusioned with the exploitation at the hands of superiors and the system.

One of them, a 35 years-old physiotherapist, served in two different missions to the state between 2017 and 2024, before returning to Cuba at the end of his deployment. He left the country for good last year.

“In Cuba, we joke that your salary can either cover your food, your clothes or your shoes, but not the three of them at a time… Through the mission I was able to save money, but then I decided to leave,” he told CNN.

The physiotherapist was 26-year-old when he first traveled to Venezuela –– it was the first time he had set foot out of Cuba. Venezuela was in an economic crisis in 2017, but it still made an impression on him. “I remember the first time I went to a supermarket, I could not believe I could buy whatever I wanted with my own salary,” he told CNN.

He was able to save over $6,000 during his first deployment, a substantial amount of cash for any Cuban.

He has since moved to Colombia where, thanks to the training from the missions, he has been able to find a job in a private clinic.

The brigades’ medical skills are still relevant, but the idea of public health missions at the service of a country’s geopolitical interests is out of date, he said.

“Cuba is like a bubble, and when you’re inside, they tell you the rest of the world is bad. When actually, it’s only when you leave that you start opening your eyes,” he said. “My dream is to return, one day, but to go back it needs to be a different Cuba.”