Food and medicines for Cuba are exempt under US law. Even so, they often do not arrive. The reason is rarely a prohibition and often caution.
An exemption that does not exempt
Since the Trade Sanctions Reform and Export Enhancement Act of 2000, agricultural goods, medicines and medical devices have been exempt from the embargo. The exemption comes with conditions: licences are valid for one year at a time, payment is made in advance or through a letter of credit from a bank in a third country, and US financing is prohibited. Many goods also need an authorisation from the US Commerce Department with its own deadlines. Each condition can be managed on its own. Together they deter.
Four bolts on an open door
Licence, payment, banks’ fear and the origin of components interlock. A cross-border payment runs through correspondent banks; if the word Cuba appears in the data, automatic screening systems are triggered, and many institutions refuse because the return on a single transaction bears no relation to the risk. Cuba’s renewed designation as a state sponsor of terrorism in 2021 deepened this fear. And many medical devices contain US components or software that even a supplier from a third country may not simply pass on to Cuba.
What supervisors and the United Nations say
On 5 January 2022 the European Banking Authority warned that unwarranted de-risking can exclude legitimate customers from the financial system. After her visit to Cuba in November 2025, the UN Special Rapporteur Alena Douhan reported that fear of high penalties keeps companies away even where licences exist. A 2023 study by LexisNexis Risk Solutions shows how costly caution is: complying with financial crime rules cost financial institutions worldwide 206.1 billion US dollars.
The harm runs in two directions
One direction is well known: Cuba finds it harder to obtain medicines, spare parts, reagents and financing. The other is often overlooked. Cuban research has produced treatments such as the lung cancer vaccine CIMAvax-EGF and the wound healing drug Heberprot-P; for years patients in the US had no regular access to them. Patient numbers vary widely by source, from around 165,000 to over 400,000 for Heberprot-P. That is why the working paper gives only the order of magnitude.
What cannot be attributed to the embargo
Not every empty pharmacy is caused from outside. Central planning, scarce foreign currency and administrative failings create shortages of their own. The right question is which part of the shortage would disappear if the friction ended, and which part would remain.
And in the EU?
For companies in the EU, pre-emptive compliance with the listed US laws is not merely cautious but prohibited: that is how the Court of Justice of the EU interpreted the Blocking Statute in the Bank Melli ruling. Refusing what is permitted can itself be a breach of the law.
Sources
- Trade Sanctions Reform and Export Enhancement Act of 2000, Title IX Public Law 106-387; 31 CFR Part 515
- European Banking Authority (EBA), opinion on de-risking, press release of 5.1.2022 (EBA/Op/2022/01)
- OHCHR, statement of Special Rapporteur Alena Douhan at the end of her visit to Cuba, November 2025 (report by Devdiscourse, 24.11.2025)
- LexisNexis Risk Solutions, “True Cost of Financial Crime Compliance”, press release of 26.9.2023
- Flores Vega et al., Journal of Cancer (2023), doi:10.7150/jca.67189
- CJEU, judgment of 21.12.2021, C-124/20, Bank Melli Iran
accessed 2 November 2026