José Ángel Portal Miranda: Key Figure in Cuba's Healthcare Crisis

It's not enough to simply state that Cuba's healthcare system is in turmoil; there are individuals accountable for this decline. One of the most prominent figures—whose authority is grounded in medical discourse—is José Ángel Portal Miranda, who has served as the Minister of Public Health since July 21, 2018. Under his leadership, the disintegration has not been incidental: it has been orchestrated, permitted, and legitimized. This article aims to critically assess the situation, assign responsibility, and reveal how his actions have directly and indirectly contributed to the healthcare collapse, population vulnerability, and international medical exploitation.

From Recognition to Structural Collapse

In July 2025, during a session with the National Assembly's Health and Sports Commission, Portal Miranda acknowledged that Cuba is enduring an "unprecedented structural crisis," with basic medication coverage hovering around 30%, and recovery depending on external funding. He also reported that infant mortality reached 8.2 per thousand live births, and maternal mortality climbed to 56.3 per 100,000 births—significant setbacks for indicators that were once revolutionary symbols.

The minister unveiled 13 strategic actions with 33 goals and indicators, but he was candid: “not all will show immediate results.” In other words, he recognized the severity of the issue but admitted lacking an immediate solution. This admission itself exposes inefficiency, passivity, or complicity.

Empty Pharmacies, Promises of Exports

Portal Miranda has repeatedly acknowledged that the pharmaceutical shortage will not be resolved swiftly. In 2024, he informed lawmakers that the scarcity of medicines in the state pharmacy network would persist. His stark admissions contrasted sharply with his and his team's ongoing promises of investments and commitments to produce more medications.

Simultaneously, in international forums, he touts vaccines, biotechnological products, and technical cooperation, as if Cuba had surplus resources to donate, while much of the country suffers from shortages. This dichotomy between external donations and internal crisis is an unjustifiable contradiction, further highlighting the disconnection of the regime's elites from the population. This reveals not just normalized inequality in Cuba, but also the immorality and indifference of leaders more focused on generating revenue from exports than addressing citizens' needs.

Mosquitoes, Emerging Viruses, and Urban Insalubrity

The health pressure is not limited to chronic diseases or medication access: Cuba has witnessed a resurgence of arboviruses and emerging viruses. The Ministry of Public Health (MINSAP) reported over 400 confirmed cases of the Oropouche virus from May to August. This official figure indicates that the virus has spread to all provinces, highlighting the precariousness of epidemiological control.

Dengue fever remains active in various areas, respiratory epidemics multiply, and digestive outbreaks emerge due to urban insalubrity, deteriorating sewage systems, contaminated water, and uncollected garbage. Adding to this is the reappearance of chikungunya cases, another arbovirus transmitted by the Aedes aegypti mosquito, alerting vulnerable provinces.

Many Cubans live in conditions that, in any other country, would prompt immediate protocols and mobilization. When the national healthcare system operates as a vulnerability system—more reactive than preventive—not only is it exposed to epidemics; preventable deaths become normalized.

Medical Exportation: Exploitation Under Official Disguise

A cornerstone of the Cuban regime's international legitimacy is the exportation of medical services. However, under Portal Miranda's leadership, this activity has shown signs of modern slavery, as UN rapporteurs have identified "indications of forced labor" in these programs.

In 2025, the minister himself admitted that the passports of doctors on international missions were retained by brigade leaders "so they wouldn't get lost." This official confession confirms what exiled doctors and activists have denounced: collaborators receive a fraction of what contracting countries pay, with controlled mobility, forced dependence, and restrictive labor conditions.

Independent media and non-governmental organizations have found that the regime withholds up to 70% of the salaries of doctors on missions, which some describe as an exploitative work model. This massive export not only undermines the labor rights of professionals but also leaves MINSAP institutions within the country understaffed, as many hospitals and clinics face chronic medical personnel shortages due to the mandatory or voluntary dispatch of doctors abroad.

The population, therefore, bears the cost of the export strategy with more precarious public health services, longer waits, more negligence, and less access to specialized treatments and medications.

Avoidable Deaths, Daily Suffering, and Institutional Collapse

For thousands of Cubans, illness has become a sentence without appeal. In a non-ventilated waiting room, a mother holds her feverish child, hoping for an antibiotic or antipyretic that will never come. In Havana, a pregnant woman loses her life due to supposed medical negligence (rarely investigated and often dismissed as "presumed"). In any neighborhood, an elderly person with hypertension stops treatment because pills vanished from pharmacies months ago.

These are avoidable deaths. Pain that should not exist.

Mental health patients wander the streets of Cuba without treatment or are cared for at home in inhumane conditions. Psychiatric centers are genuine hells from which numerous complaints emerge about the deplorable conditions they offer, as well as mistreatment and abuse of patients.

Hospitals, once showcases of the Cuban model, are now dilapidated buildings. There are wards infested with cockroaches, unusable bathrooms, out-of-service equipment, lack of water, lack of supplies, and lack of doctors. The ambulance service is reduced to a minimum, and in many areas, urgent transfers depend on favors or unofficial payments.

Doctors and nurses, overwhelmed by stress and lacking basic conditions, do what they can. But the professional exodus is massive: each month, dozens of specialists leave the system, emigrating or being sent abroad on "missions" that deplete national staffing. The result is fragmented, chaotic, often negligent care.

In centers where lives should be saved, patients are no longer a priority but another burden in a collapsed system. Complaints pile up. Some professionals put it bluntly: "this is no longer a hospital, it's a sty."

Those who can, pay. They pay for a private consultation, an injection, a treatment, a catheter, a cataract operation set, a syringe, sterile suture thread, or bandages. They pay a messenger, a nurse, or a doctor who no longer earns from the State because the state salary is insufficient. Those who can't, wait. And sometimes die.

The plight of kidney patients is emblematic. In 2024, the newspaper El País documented a case of a girl needing hemodialysis: her desperate mother was brutally advised: "If you want your daughter to live, you have to get her out of the country." Cuban civil society is familiar with this mantra and has witnessed several dramatic cases confirming it.

This phrase encapsulates the current state of healthcare in Cuba: a system that can no longer care, cure, or protect. And those who suffer its consequences do not appear in the minister's speeches, official reports, or dressed-up statistics. They are the faces of collapse: a vulnerable population, trapped between scarcity, poor management, corruption, and resignation.

Díaz-Canel's Responsibility

Keeping Portal Miranda at the helm of the Ministry of Public Health (MINSAP) is no accident; it's a political decision. The ultimate responsible for this healthcare catastrophe is the leader Miguel Díaz-Canel, who appointed and retains him, despite the devastating results.

The minister's continuance not only represents an example of impunity but also sends a message of continuity: Cuban public health will continue to be managed as a political resource, not as a citizen's right.

Urgent Change Begins with Accountability

For Cubans, the question is no longer whether the healthcare system is in crisis; it's who will take responsibility and how it will change. José Ángel Portal Miranda has been a central figure and necessary accomplice in the decline during Díaz-Canel's administration.

More than speeches, Cuba needs a radical overhaul of the healthcare system: policies of transparency, independent auditing, reinvestment of exported medical revenues, recovery of the pharmaceutical industry, labor rights for health professionals, prioritized preventive care, and accountability for those who profit from others' suffering.

Only then can the disaster begin to reverse. The country cannot endure longer with a minister who, aware of the catastrophe, manages and legitimizes it. Nor can it continue with a leader, a "continuity," a failed system, and a regime that prioritizes its grip on power over citizens' well-being.