There is a line, often quoted, seldom practised, from the Christian gospels: “Love thy neighbour as thyself.” It is recited from the Americas to Africa, invoked in speeches, embroidered into national mottoes.

But like many moral injunctions, it has proven easier to proclaim than to live by. Across the Caribbean and Latin America, something extraordinary and shameful is unfolding.

Cuban doctors, emissaries of one of the world’s most besieged nations, are being expelled from host nations, contracts terminated, health programmes dismantled. And, in their absence, the poorest will pay – in untreated illnesses, unattended births, undiagnosed cancers. The region is, in effect, amputating its own lifeline – under pressure from the US.

On Friday the Cuban foreign minister Bruno Rodríguez accused the US of “extorting” countries by forcing them to cancel decades-old deals with Havana for the supply of doctors.

The tone was set in Donald Trump’s first term. In 2018, 8,300 Cuban doctors left Brazil after the country’s then president-elect, Jair Bolsonaro, closely aligned with Washington, threatened the programme and its payment structure, questioning the qualifications of the Cubans – issues that had never been raised when their services were indispensable.

Since then, the US has pushed countries across the region to terminate these agreements, branding them “forced labour” and even “human trafficking” because the Cuban state retains a share of salaries. Conveniently ignoring that these doctors were trained free of charge by the Cuban government, unlike their heavily indebted counterparts in countries such as the UK where medical graduates have the onerous burden of student debt for decades.

The consequences have been enormous. Guatemala, Honduras, Jamaica, the Bahamas, Antigua and Barbuda, Guyana and St Vincent and the Grenadines have all capitulated. Across the Caribbean and Latin America, programmes, some as old as 50 years, are being dismantled, doctors withdrawn and already fragile systems strained, all under the threat of US visa and diplomatic sanctions. Only St Kitts and Nevis and Trinidad and Tobago have yet to follow. Millions could lose basic healthcare, with Indigenous communities particularly exposed.

Cuba is the island that chose “doctors, not bombs”. For more than six decades, Cuba has practised something profoundly unfashionable in modern geopolitics: solidarity. When Ebola tore through west Africa in 2014, Cuban medical brigades arrived first. When hurricanes flattened Caribbean states, Cuban teams showed up. When Haiti collapsed, again, under the weight of history, debt and disaster, Cuban doctors were there. When Nepal was devastated in 2015, Cuba dispatched a medical brigade within days.

Cuba has built a global medical network of more than 50,000 professionals working across dozens of countries, generating billions in foreign revenue and sustaining its economy under embargo. In places such as Venezuela, where tens of thousands of Cubans once staffed community health programmes, these missions became central to public health. But that model is now under strain. As US pressure intensifies – disrupting oil, tightening sanctions and targeting allied governments – Cuban medical personnel are being withdrawn, cutting off one of the island’s few reliable sources of income while weakening healthcare systems abroad.

Cuba has also trained tens of thousands of foreign students, including from the Caribbean, at its Latin American School of Medicine. All free of charge. Yet this same island, 90 miles from Florida, under embargo since 1962, is being economically strangled into submission.

What is being brought down on Cuba is not “pressure”. It is economic warfare and the Caribbean and Latin America are complicit.

Sanctions, in reality, are blunt instruments. They restrict trade, finance, fuel and medicine, shrink economies, deepen poverty and punish citizens rather than governments. In Cuba, the effects are stark: blackouts, shortages and collapsing productivity. A steady erosion of daily life. Now, with fuel supplies disrupted, the country faces its most acute crisis in decades and, precisely when solidarity is most required, the Caribbean and Latin America have chosen distance.

There was a time when Caribbean leadership spoke differently. In the 1970s, Jamaica’s prime minister, Michael Manley, called Cuba “fundamental” to the region, a partner in the struggle against imperialism, a “brave and brilliant social experiment”. He knew that small states survive not by submission but by solidarity.

Today, the tone has shifted. Andrew Holness, the current prime minister of Jamaica, while acknowledging the value of Cuban doctors, speaks of compliance and legality. Pragmatism has a way of sliding into acquiescence.

More striking is the transformation in Trinidad and Tobago. The prime minister, Kamla Persad-Bissessar, once an admirer of Fidel Castro, now echoes Trump’s condemnation of her near neighbour while entertaining deeper US military presence, genuflecting to the dictatorial US president and fawning over his minion, Marco Rubio.

Against this tide stands Barbados, which although it does not currently have Cuban medical staff, benefitted from them during the Covid pandemic. Prime minister Mia Mottley has defended Cuba’s medical missions, rejected the insinuation of “trafficking” and made clear that Barbados would stand by what is right, even at the cost of US punishments. It is a reminder that sovereignty is not merely constitutional; it is moral.

So why are Trump and Rubio’s tentacles stretching towards Cuba? Strategically, Cuba sits astride vital shipping lanes, near the Gulf of Mexico, close to the Panama routes. Economically, it holds – but lacks the investment to extract – estimated offshore oil reserves of more than 4bn barrels. It has nickel, cobalt and huge tourism potential, making it another potential Trump Riviera.

Geopolitically, it remains a contested foothold, and historically has refused to yield. From the failed US Bay of Pigs invasion to decades of embargo and isolation, the objective has remained constant: regime change. What has changed is the method.

What is striking is not Washington’s predictable posture but the Caribbean’s response. Or lack of it. Caricom, once vocal in calling for the end of the embargo, appears hesitant. Aid arrives in Cuba from as far as Russia and Spain. Yet from neighbouring islands, those who benefited directly from Cuban doctors, there is little more than cautious diplomacy. This shows cowardly fear of US repercussions.

On 30 March, the chair of Caricom, Dr Terrance Drew, said the mechanism “is fully on the way” and “Caricom will update” to extend the promised humanitarian help to Cuba. For now, it remains just that – waiting for an update.

For decades, Cuban doctors have served, quietly and without fanfare, the Caribbean’s most marginalised: rural communities, underfunded hospitals, disaster zones. Now, as Cuba faces its own crisis, the region looks away, waiting on Trump’s approval.

Perhaps this is geopolitics. Perhaps it is realism. Or fear. But let us not pretend it is moral. “Love thy neighbour” was never meant to be conditional on visas, trade agreements or approval from distant powers. It was meant precisely for moments like this – when standing by a neighbour is inconvenient.

The Caribbean likes to imagine itself as a community, bound by history, culture and struggle. But in this moment, faced with the expulsion of those who healed us, the region must ask itself the question: when Cuba needed us, where were we?