Planning for Cuba's transition

The Lancet 2006; 368:554

DOI:10.1016/S0140-6736(06)69171-X
Planning for Cuba's transition

Since Fidel Castro's Aug 1 decicion to temporarily delegate leadership
of Cuba to his brother, there has been an escalation in rhetoric aimed
at influencing the transition to a post-Castro state. Uncertainty
abounds, but if there is any consensus on what the future holds it is
that Cuba will experience a period of rapid and uncomfortable change.

For health, the consequences are potentially dire. The central
importance of Cuba's purportedly efficient health system to its national
identity means that health indicators will be the most sensitive measure
of decline. Castro's death, even if years from now, could herald a
complex emergency: a difficult period of violence and internal divisions
that put Cuba on the road to becoming a failed state. Cuba's citizens
are likely to require immediate humanitarian assistance to meet water,
health, food, and shelter needs that have built up over years of
neglect. Injustices and inequalities, although already present, will
become more obvious and could lead to social unrest. For these reasons,
it is essential to national stability that a functioning health system
is maintained.

As Cuba's closest neighbour, the USA must be ready to help meet
immediate humanitarian needs, if the worst-case scenario arises. If
suggestions made last month, by the US Presidential Commission for
Assistance to a Free Cuba, are heeded, resources of US$80 million could
be set aside for the task. But the challenges are immense. A massive
influx of aid will overwhelm Cuba's decrepit distribution network, and
chaotic responses by Cubans in south Florida could undermine a
coordinated response.

To help ward off instability, what is most needed from external actors
is a considered plan to strengthen Cuba's coping mechanisms. But because
of the myriad uncertainties about how robust the Cuban health system
actually is, planning for transition must be based on a careful
analysis—better than the current guesswork—of what Cuba's citizens will
need the most.

http://www.thelancet.com/journals/lancet/article/PIIS014067360669171X/fulltext