Rosa Valentina Perez has been waiting for nearly three weeks at Cuba’s principal cancer clinic in Havana for a CT scan to diagnose the cause of her progressive leg paralysis. Having undergone surgery for breast cancer two years ago, Perez is urgently seeking confirmation on whether the disease has spread to her spine. However, the only functional CT scanner in Havana is located at the city’s neurology hospital, where the backlog of patients awaiting scans remains extensive.

Perez’s situation reflects the growing strain on Cuba’s healthcare system, once a flagship achievement of the country’s 1959 revolution, which provided universal free healthcare and was internationally recognized for its medical outreach. Today, however, the system is facing severe challenges due to multiple converging crises, including persistent power outages, dwindling supplies of medicine, aging and malfunctioning equipment, and a significant loss of medical personnel to abroad or private sector employment. These difficulties have been intensified by the Covid-19 pandemic, economic tightening from renewed U.S. sanctions, and a longstanding fuel blockade.

At the National Institute of Oncology and Radiobiology (INOR), the crisis is acute. Director Luis Eduardo Martin reported that radiotherapy treatment waitlists have climbed beyond 1,200 patients, while 80% of diagnostic and therapeutic equipment is outdated or broken. The lack of reagents and inability to monitor treatment effects compromises patient care. Pediatric oncology in particular is under threat. According to government data, childhood cancer survival rates have dropped from 85% in earlier years to approximately 65% currently. Mariuska Forteza, head of INOR’s pediatric oncology unit, highlighted that essential blood tests are frequently curtailed due to equipment shortages and inadequate fuel supplies needed to transport samples between facilities.

Healthcare workers have resorted to improvised measures to maintain services. Repair technicians often work late into the night to keep vital machines operational. Alexis Amado Dominguez described arriving at hospitals after midnight to fix equipment so that cancer treatments can continue. Similarly, at the National Institute of Cardiology and Cardiovascular Surgery, the annual number of heart surgeries has plunged from over 400 in 2018 to about 100 today. Approximately 130 patients are awaiting pacemaker implants, a procedure delayed by equipment shortages and maintenance backlogs.

Luis Alexis Duncan, a technician in the hospital’s maintenance department, pointed to a growing inventory of broken machines including anesthesia devices, cardiopulmonary bypass machines, and monitors, many of which have been cannibalized for spare parts. Despite their efforts to innovate and maintain equipment, the health system struggles against a persistent shortage of skilled staff, driven by low state wages and the devaluation of the Cuban peso.

In the dialysis unit of the Hermanos Ameijeiras Hospital, medical staff are overwhelmed. Iamara Castro, head of nephrology, said treatment sessions have been shortened from four to two hours in some cases to accommodate more patients, a decision made with great reluctance. “When you shorten the hemodialysis period, you are shortening life,” she said. Patients like 81-year-old Nelson Companioni live with constant fear of equipment failure during treatment, observing nurses attempting to restart malfunctioning machines with makeshift repairs.

Cuba’s healthcare crisis poses serious risks to patient outcomes as the country grapples with resource scarcity and systemic challenges that threaten to unravel decades of medical achievements.