May 2022


The US Trafficking Victims Protection Act, WHO, PAHO, the UNHRC and the Cuban Mais Medicos Program

By Anna Engelhard-Barfield, J.D.


The US Trafficking Victims Protection Reauthorization Act (TVPRA) and the current litigation of trafficked Cuban physicians against the Pan American Health Organization (PAHO), a subsidiary of a United Nations World Health Organization (WHO), under the TVPRA and the Racketeering Influenced and Corrupt Organization Act (RICO) hopefully will gain public attention and illuminate the suffering and abuse the TVPRA is designed to address and instigate a public discussion regarding the practice of international organizations such as WHO and PAHO to facilitate international human trafficking. 


This class-action, Matos Rodriguez et al. v. Pan American Health Organization, No. 20-7114 (D.C. Cir. 2022), was filed by four (4) Cuban physicians in 2018 in the Southern District of Florida after they managed to escape from Brazil. The complaint consists of three (3) TVPRA claims and one (1) RICO claim alleging that they were trafficked by the Cuban government to perform forced labor in Brazil under a contract for the time period from 2013 to 2018, with PAHO acting as financial intermediary between Brazil and Cuba. The D. C. Court of Appeals determined that “PAHO entered into a bilateral agreement with the Cuban government to guarantee it would transfer resources from third parties as a way to compensate Cuba for the utilization of its medical professionals”. …Brazil made payments to PAHO’s Citibank account in Washington, D.C. and then forwarded 85% to Cuba, 10% to the physicians and retained 5% for its services.” 


In 2020 the case was removed to the District Court of Washington, D.C. On the second TVPRA claim, the D.C. District Court rejected PAHO’s claim that they were immune under the International Organization Immunity Act (IOIA) and the WHO Constitution. On March 29, 2022 the U.S. Court of Appeals for the District of Columbia Circuit unanimously affirmed the District Court’s denial of the defendant’s motion to dismiss and held that PAHO had “the role of financial intermediary transferring money among Mais Medicos participants” when it converted Brazilian reais to dollars and sent the dollars to the Cuban government, that “the funds constituted a financial benefit in violation of § 1589 (b) TVPRA”. The Court extensively discussed PAHO’s claims of immunity under the International Organization Immunity Act (IOIA) and the WHO Constitution. The Court of Appeals confirmed that Art. 67 (a) of the WHO Constitution did not render PAHO immune, since the provision is not self-executing. Art. 68 of the WHO Constitution provides that the privileges and immunities “shall be defined in a separate agreement to be prepared by the Organization in consultation with the Secretary-General of the United Nations and concluded between the members” – special actions which were not taken. 


It has been reported that Cuba has been supplying Cuban workers to foreign governments in exchange for money for a long time. Exploiting medical professionals generates more revenue than exploiting less educated workers. The State Department 2016 Trafficking in Persons Report rated Cuba as a Tier 2 Watch List country. “Tier 2 Watch List” means that the country requires special scrutiny because of a high or significantly increasing numbers of victims. The report states that the government is the primary employer in the Cuban economy, including in foreign medical missions that employ more than 84,000 workers and constitute a significant source of Cuban government revenue, with participants in foreign medical missions alleging forced or coerced participation, withholding of passports and restriction of movements by Cuban authorities, threats to revoke their medical license and threats to retaliate against family members (if they did not stay in the program), substandard working and living conditions and surveillance outside of work.


 The State Department 2019 Trafficking in Persons Report downgraded Cuba to a Tier 3 country. “Tier 3” means that the country neither satisfies the minimum standards nor demonstrates a significant effort to come into compliance. Countries in tier 3 are subject to potential non-humanitarian and non-trade sanctions. The State Department reported that traffickers exploit Cuban citizens in forced labor and that “according to government officials the Cuban government employed between 34,000 and 50,000 healthcare professionals in more than 60 countries in Africa, the Americas, Asia, the Middle East and Portugal in foreign medical missions through contracts with foreign governments and in some countries, with international organizations serving as intermediaries”. 


The 2019 report states that “in November 2018 Cuba ended the five-year-old “Mais Medicos” medical mission program in Brazil which was facilitated by a UN-affiliated organization, following demands from Brazil’s then-president-elect (Bolsanaro) to improve the treatment and employment of Cuban healthcare professions after allegations of coercion, non-payment of wages, withholding of passports and restrictions on their movement”, referencing the above-referenced class action filed in the Southern District of Florida under the TVPRA and the Racketeering Influenced and Corrupt Organization Act (RICO). The report notes that “the Cuban government collected approximately $7.2 billion in annual revenue from the export of services, including foreign medical missions in 2017”.


Cuba continued to be rated a Tier 3 country in 2020 and 2021. The 2021 trafficking profile reiterates that the Cuban government employs 34,000 to 50,000 health care professionals in more than 60 countries, and that in some countries international organizations serve as intermediaries or provide funds for their work, with 75% of its exported workforce consisting of medical professionals and experts, estimating that the Cuban government collected $6 billion to $8 billion annually from its export of services, namely the foreign medical missions program.


The 2021 Trafficking in Persons Report for Venezuela, another Tier 3 country, notes under “prioritized recommendations: Given significant concerns about forced labor indicators in Cuban Medical Missions, screen Cuban medical professionals for trafficking indicators and refer those identified to appropriate services”. It is obvious Cuba continues its trafficking and forced labor campaign of medical professionals in the Americas. 


Cuba, Venezuela and China, all Tier 3 countries, are members of the United Nations Human Rights Council (UNHRC). It is no wonder that the reputation of the UNHRC has been considered tarnished by many people. In 2020 Jiang Duan, a minister at the Chinese Mission in Geneva was appointed to the UNHRC’s Consultative Group where he will serve as one of only five (5) representatives to select inspectors on health, freedom of speech, arbitrary detention and enforced disappearances. Hillel Neuer, the Executive Director of U.N. Watch, a Geneva human rights organization, responded to the appointment by saying: “Allowing China’s oppressive and inhumane regime to choose the world investigators on freedom of speech, arbitrary detention and enforced disappearances is like making a pyromaniac into the town fire chief.” China’s brutal enforcement of “zero-covid” lockdowns against 27 million citizens in Shanghai, leading to starvation and death, with 30 out of 31 provinces and major cities in full/partial lockdown since March 2022 (Wall Street Journal, 5-7-22) should certainly alert other UNHRC members to raise questions about the direction of the Council and its organs. Mr. Neuer addressed the “U.N.’s Toxic Alliance of Radical left NGOs & Dictatorships” in an interview of 4-27-22: “It’s Orwellian; it’s the complete opposite of what the United Nations was meant to do, what the founders of the Human Rights Commission, such as Eleanor Roosevelt and the French philosopher Rene Cassin, helped draft…” Mr. Neuer also rightfully asked on March 24, 2022 why the “UN named Iran one of the world’s worst oppressors of women as a world judge and guardian of gender equality and the empowerment of women?” 


Already in October 2015 Mr. Neuer had voiced concerns regarding the recurrence of politicization and subversion of the human rights concepts of the Council: “In 2006, the Council was created to replace its morally corrupt predecessor, the Commission on Human Rights which was criticized by former Secretary General Kofi Annan for its politicization and declining credibility. Next week’s likely election of major human rights abusers means we are back to square one. Instead of reform, we have regression.” (Hillel Neuer, October 2015). 


The WHO, under the guidance of Director-General Tedros Adhanom Ghebreyesus (Tedros) since 2017, in early 2020 supported China’s version of the origin of Covid-19, down-playing the seriousness of the virus and denying human-to-human transmissibility, thus preventing effective containment of the virus. He praised China for their response to the outbreak and inhibited any meaningful investigation of the origin of the virus. Tedros, the first non-physician WHO Director-General, is a former Ethiopian government official with a colorful political history who has been accused of being China’s man. 


Since 2000 China has increasingly invested in Ethiopian construction and infrastructure projects. As of 2019 Ethiopia’s debt to China amounted to about $14 billion. In February 2019 Prime Minister Abiy told parliament that his government has successfully renegotiated the repayment period for 60% of its external debt (the, Ethiopia’s China challenge, 3-27-19). 


 Critical voices in Ethiopia have considered the debt to China insurmountable, with China disproportionately benefitting from the infrastructure projects in Ethiopia, also blaming the TPLF for using the Chinese Industrial zone in Duken as coverage for illegal export and for underpaying local labor involved in opal mining (Global Voices, China in Ethiopia, 9-24-21).


What Tedros is about can be gleamed from the fact he named Robert Mugabe in 2017 as “goodwill ambassador” to help combat communicable diseases in Africa even though President Mugabe was considered responsible for the collapse of the public health care system and major rights abuses in Zimbabwe. It was only when human rights organizations and medical professionals expressed outrage that he rescinded his decision. 


Tedros was a politburo member of the TPLF which was a ruling party until 2018 and served as minister in the Ethiopian government from 2006 to 2016. Since 1976 the TPLF has been listed as terrorist organization in the Global Terrorism Database (GTD), with less frequent listings during their period from 1991 to 2018 as state-actor. The GTD only records terrorist acts committed by state-actors.  Annual reports from Human Rights Watch (HRW) and Amnesty International for 2006 to 2016 reveal abhorrent war crimes and human rights abuses by the Ethiopian government’s security forces and police: torture (including children), rape, burning of villages, kidnapping, arbitrary detentions, extrajudicial executions, etc.) 


On December 1, 2020 the American economist David Steinman, a 2019 Nobel peace prize nominee, filed a criminal complaint requesting an investigation by the International Criminal Court in the Hague, Netherlands of the actions by Tedros Adhanom Ghebreyesus “that are inconsistent with international criminal law”. Mr. Steinman served for 27 years as a senior foreign advisor to Ethiopia’s democracy’s movement until its victory in 2018 and has strongly criticized Tedros, warning against his re-nomination as WHO Director-General.


Mr. Steinman alleges “crimes against humanity as defined by the Rome Statute of the International Criminal Court, that the crimes were committed by Tedros himself, jointly with others and/or by individuals he effectively controlled, including but not limited to the Ethiopian security forces, civil servants, regional paramilitaries, and local police (Subordinates)”.


The Complaint’s allegations are:


• Tedros “was one of the major decision makers for the Tigrayan People’s Liberation Front (TPLF)”, “an ethnic based political organization that effectively controlled” the government from 1991 to April 2018”. “The TPLF’s hold on power in Ethiopia relied on election fraud, violence and intimidation”.  “Tedros was complicit in and a major actor in these activities during the regime’s latter years”. “Tedros was from 2012 to 2016 Ethiopia’s third highest official as foreign minister and a member of the eleven-person TPLF Excutive Committee that controlled the actors who carried out the actions”.


• “Tedros and those under his control” committed genocide in violation of Article 6 by “killing, and causing serious bodily and mental harm to members of the Amhara, Konso, Oromo and Somali tribes with intent to destroy those tribes in whole or in part.” 


• Tedros’ subordinates committed crimes against humanity in violation of Article 7, such as “murder of political dissidents, forcible transfer of populations to make way for real estate transactions benefitting the TPLF political elite”, “unlawful imprisonment, including children, in cruel and inhumane conditions that violated fundamental international law”, “torture of political prisoners….Also, putting political prisoners in cells with wild animals by Liyu police”, “mass rape by Ethiopian soldiers and/or controlled regional paramilitaries, including “break and rape (the practice of rape after breaking limbs)”, “forced sterilization of Amhara women”, enforced disappearance of persons kidnapped or murdered by security or paramilitary forces”.


• “Tedros’ crimes were part of a plan or policy pursuant to Article 8(1). Tedros’ actions were not isolated incidents. They were part of crimes that the totality of human rights reports establish so widespread, frequent, and predictable so as to demonstrate the existence of a plan or policy or a part of a large-scale commission of such crimes that demands prosecution pursuant to Article 8(1) of the Rome Treaty”.


• “Despite Ethiopia being a non-signatory state to the Rome Statute, the ICC has territorial jurisdiction over Tedros’ crimes in Ethiopia under the “effects doctrine” which gives the ICC jurisdiction when a signatory state has been injured in some way by the crime of the non-signatory state (Ethiopia)”. The complaint cites the ICC decision in the case of Rohingyas deported from Myanmar to Bangladesh where the Court accepted jurisdiction although the crime had been committed in Myanmar which is not a State Party (ICC Dec. No. ICC-01/19, November 14, 2019) and several other examples of cases involving harm to member states alleging that “Tedros’ crimes took place directly in African member states’ territory”. Jurisdiction may also be derived “pursuant to Articles 12 and 13 of the Rome Statute”, since “one or more countries injured by the crimes are signatories, including Switzerland where Tedros resides, works and often is present”. 



As of May 22, 2022, the website of the International Criminal Court does not list Tedros as one of the 47 defendants. There are no decisions or orders available that refer to Mr. Steinman’s complaint or criminal charges filed against Tedros. The ICC does not issue a formal statement if no investigation is opened. The only way to obtain a formal statement would be to send an inquiry to the Office of Prosecutor (OTP), an independent organ of the court. The OTP conducts preliminary examinations and investigations. It can be assumed that the ICC punted this criminal matter, since the WHO is well-connected with international organizations. The website states that “political considerations never form part of the Office’s decision making”. This statement contradicts recurrent accusations of political partisanship made by various authors and international entities that the ICC prioritizes politics over law.


Mr. Steinman believes that it is vital that the public understands the risks of allowing Tedros a second term: “To leave a man with a long and proven history of cover-ups in charge of an organization that’s supposed to alert the world to grave danger would be insane. We could have another pandemic.” Tedros was nominated to serve as WHO Director-General in 2021 and will most likely be re-elected at the World Health Assembly (WHA) in May 2022. 


The fact that the WHO has proposed that they should become the global arbiter for any and all future pandemics and epidemics in the world should scare everyone. Main-stream media has ignored reporting about the World Health Assembly (WHA) vote on amendments to Articles 12 and 59 of the International Health Regulations during their meetings from May 22 to 28, 2022. These amendments will render Tedros the sole arbiter in case of a “health emergency”. The amendments provide that the “WHO Director-General can declare a health emergency in a country without consulting with the country, without getting any information from the country, and if the country resists, he can go ahead and, within 24 to 48 hours, begin to mobilize all of the resources of the UN against the country….He doesn’t even have to know the source or the exact nature of the emergency, so they are making him a dictator over declarations of health emergencies.” (Dr. Peter Breggin). The mere suspicion of a “health emergency” of possible concern to other nations would suffice for the WHO to take action. This new tool can be used to issue economic or financial actions against the targeted nation by nations aligned with WHO. These amendments were proposed by the United States and are supported by the European Union, Canada, UK, Switzerland, Norway and sixteen other nations. A simple majority of the 194 member countries of the WHA will make these amendments binding international law as of November 2022. Any member country can withdraw their approval within six months (under the current regulations the grace period is eighteen months). 

It is time to either rehabilitate the United Nation and its organs (UNHRC, WHO, PAHO, etc.) or to realize that the United Nations no longer serves the purpose that they were founded for, namely: “To achieve international cooperation in solving international problems of an economic, social, cultural, or humanitarian character, and in promoting and encouraging respect for human rights and for fundamental freedoms for all without distinction as to race, sex, language, or religion “, United Nations Charter, Chapter 1, Art. 3 (3).


It is time to take action to enforce human rights in the world and to give meaning to the Human Rights Council by ensuring that the most basic human rights are protected, instead of protecting human rights abusers while promoting mere political correctness. It is understandable that informed people consider the United Nations to have outlived their usefulness and to question their existence and viability.