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For more than 30 years the US government has maintained a crippling trade embargo against Cuba. Although the terms of the embargo have altered with successive administrations, the most important recent developments are the Cuban Democracy Act (CDA) of 1992 and the Helms-Burton Act of 1996. By prohibiting foreign subsidiaries of US companies from trading with Cuba, the CDA reimposes controls that were relaxed in the 1970s. Direct flights between the 2 countries are banned, and aircraft carrying emergency medical supplies for Cuba are prohibited from landing in the US. In addition, foreign vessels are prevented from loading and unloading freight in US harbours for 6 months after having stopped in Cuba. The Helms-Burton Act threatens with prosecution in US courts any foreign investor who has interests involving property in Cuba that was confiscated from a US citizen by the Castro government.(f.1,2) In direct violation of international law, the embargo explicitly prohibits the sale of food to Cuba by US companies and their foreign subsidiaries. Medicines and medical supplies are nominally excluded from the embargo, but the almost insuperable bureaucratic restrictions imposed by the CDA on such shipments lead to inordinate delays, cost increases and limited access to some of the most important medical products. These obstacles amount to a de facto embargo on medical supplies.(f.1,2) In 1992 Cuba was in a severe economic depression, largely resulting from a loss of preferential trade with the Soviet bloc. Cuba turned to US foreign subsidiaries, from whom it received $500-600 million per year in imports -- 90% of which was food and medicine. The American Public Health Association warned the US government that tightening the embargo would lead to the abrupt cessation of this supply of essential goods and result in widespread famine.(f.1) Indeed, 5 months after passage of the CDA, food shortages in Cuba set the scene for the worst epidemic of neurologic disease this century. More than 50 000 people suffered from optic neuropathy, deafness, loss of sensation and pain in the extremities, and a spinal cord disorder that impaired walking and bladder control.(f.1) The tightening of the embargo by the CDA has precipitated the deterioration of what the American Association for World Health (AAWH) describes as a "model primary health care system."(f.2) In this...