Germinares Cardero Céspedes lives in hilly Segundo Frente, a coffee-growing community at the eastern end of Cuba where Fidel Castro’s rebels established a second front in their 1959 revolution. At 89, Cardero seems full of vigor, but his heart is failing, just when his country is suffering its worst economic crisis since the revolution. He grew up working the land outside Santiago, Cuba’s second-largest city. He raised five children, who gave him 15 grandchildren and eight great-grandchildren. He retired from an agricultural cooperative with a pension of 1,550 pesos a month. That used to provide a meager living but now won’t even buy two bottles of cooking oil.

Two years ago, this man who’d hardly been sick a day in his life began having fainting spells, says his grandson Lisneydi Cardero Diéguez, 40, a physical education teacher. Doctors said he urgently needed a pacemaker—but there was a national shortage. The only option was to harvest a device from the chest of a patient who had died of other causes, sterilize it, and implant it in Cardero Céspedes. Afterward, the retired campesino felt as good as new. The catch was that the recycled pacemaker had just two years of battery life left.

The scarcity of such basic life-saving devices is one potentially lethal consequence of the United States’ hardening policies toward Cuba in the past several years. Because of sanctions, including President Donald Trump’s decision in 2021 to place Cuba on the list of countries that sponsor terrorism, American manufacturers won’t sell pacemakers bound for Cuba, says Bob Schwartz, the executive director of Global Health Partners, a New York–based nonprofit that raises money to buy medical supplies and medicine for Cuba. At the same time, Cuba’s own crashing economy has prevented it from buying enough pacemakers from other countries. Now people like Cardero Céspedes are suffering. The waiting list for pacemakers in the Santiago region grew to 112 people, including 25 who had to be tethered to external pacemakers in the hospital, says José Carlos López Martín, the director of the Center for Cardiology and Cardiovascular Surgery in Santiago.

Cardero Céspedes recently felt sick again, almost exactly when his two-year lease on life was set to expire. But he was in luck: Global Health Partners and a European NGO had launched a campaign to buy thousands of pacemakers outside the US. One would be for the retired campesino.

The new device was implanted on a morning in mid-December. Cardero emerged from the operating room in a green wheelchair, sitting ramrod straight in white pajamas. “I never thought I’d live to see this moment,” he said in a loud, clear voice. By coincidence, the date was December 17, the 10th anniversary of the deal announced by US President Barack Obama and Cuban President Raúl Castro to begin to normalize relations, a memory that never seemed more remote.

Cuba has contended with the US embargo on trade and travel since President Dwight Eisenhower imposed initial sanctions in 1960 and President John F. Kennedy broadened them in 1962, imposing a travel ban a year later. Cuba found ways to soften the economic blow, first with patronage from the Soviet Union until its collapse in 1991, and then later with oil subsidies from Venezuela and the authorization of limited private enterprise within Cuba’s socialist system.

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Those remedies aren’t sufficient anymore. Trump’s decision at the beginning of his first term to cancel Obama’s engagement policy and get even tougher on Cuba—and, later, to place Cuba on the terrorism list—coincided with the implosion of Venezuela’s economy and problems in Cuba’s own economic management to create mass hardship in the country. “We will not be silent in the face of communist oppression any longer,” Trump said in announcing his first round of renewed sanctions in Miami’s Little Havana in 2017. “We do not want US dollars to prop up a military monopoly that exploits and abuses the citizens of Cuba.” Obama had based his policy of easing restrictions on the opposite logic: Decades of Cold War antagonism had impeded political reform on the island; repairing the relationship was a better way of promoting American values.

Joe Biden, as president, largely failed to keep his campaign promise to “promptly reverse the failed Trump policies that have inflicted harm on the Cuban people,” as he told Americas Quarterly in March 2020. He did take marginal steps in 2022, such as loosening Trump’s clampdown on family remittances and easing restrictions on some types of group travel to Cuba. But he waited until six days before leaving office to remove Cuba from the US terrorism list—a gesture that Trump quickly canceled hours after taking the oath of office again. Biden’s lack of action earlier in his term likely was a result of political pressure not to be seen as rewarding Cuba after its crackdown on widespread street protests in July 2021, and he had to retain the support of former senator Robert Menendez, the Cuba hard-liner and powerful chairman of the Senate Foreign Relations Committee.

Of all the blockade reinforcements imposed by Trump and largely maintained by Biden, Cuba’s designation as a state sponsor of terrorism (along with North Korea, Iran, and Syria) is perhaps the most consequential. The Trump administration gave two reasons for putting Cuba on the list: its refusal to extradite Colombian guerrillas and its harboring of American fugitives involved in political violence in the early 1970s. But the guerrillas had been participating in internationally recognized peace talks, and Colombian President Gustavo Petro called Cuba’s inclusion on the list “an injustice.” The American fugitives were never connected with international terrorism, a defining feature of the list. Biden subsequently certified that Cuba has not recently supported terrorism and has been cooperating in the fight against it.

The terrorism designation has caused dozens of foreign banks and multinational corporations to stop participating in transactions involving Cuba, according to Cuba’s annual report on the blockade to the United Nations. While Cuba had been on the list before Obama removed it, its reinstatement is more devastating because a heightened fear of US sanctions has caused widespread “overcompliance” by foreign institutions, which now refuse to have anything to do with Cuba, even legal transactions, says Robert Muse, a Washington lawyer who represents clients seeking to do business or philanthropy with Cuba. Also, during the Biden administration, the United States for the first time began enforcing another consequence of being on the terrorism list: Tourists from more than three dozen countries, particularly Europeans, lost their privilege to visit the US without a visa if they visited Cuba. A visa costs $185 and requires an interview with an American consular official, which can take months to schedule. Vacationers who want to preserve their access to the United States must ask themselves if Cuba is worth the hassle. The number of travelers to Cuba from the seven top European Union countries dropped from 730,000 in 2019 to 324,000 in 2023, according to Cuban government figures.

Other measures imposed by Trump in his first term and maintained by Biden similarly cut Cuba off from foreign—not just American—cash, goods, and investment. The US sanctions ships carrying Venezuelan oil to Cuba, bars manufacturers from sending goods containing more than 10 percent of American content, and permits lawsuits in American courts against foreign investors in properties confiscated during the revolution. (One of Biden’s last-minute changes was to suspend this Trump-era lawsuit policy; the new Trump administration has reinstated it.)

The hit to Cuba’s resources has left it unable to import enough food or sufficient animal feed and fertilizer to support domestic agriculture; fuel to run its aging power plants, leading to frequent widespread blackouts; and medicine, medical supplies, and ingredients to support domestic pharmaceutical manufacturing, according to the Cuban government and independent analysts. “There’s a kind of a vicious-circle quality to this,” says William LeoGrande, a Cuba specialist at American University and a coauthor of Back Channel to Cuba: The Hidden History of Negotiations Between Washington and Havana. “Because they don’t have any foreign exchange earnings, they can’t buy seed, they can’t buy fertilizer, they can’t buy equipment. And so, lo and behold, domestic production then falls, and that makes the shortage even greater, the need for imports even greater, but the ability to import even less.”

Independent experts also say the hardened blockade amplifies and exploits Cuba’s own failures to make its economy more efficient. “They put all their eggs in the tourism basket, rather than really diversifying their economy more,” LeoGrande says. “They could have invested more in modernizing agriculture and been better about giving farmers more incentive to produce.”

Juan Triana, an economist at the University of Havana who has criticized some elements of Cuban economic policy, adds, “Trump’s measures attacked Cuba’s sources of income, attacked where they could damage the lives of the Cuban people in a surgical manner.”

A talking point on the right is that US culpability for hardship on the island is overblown. How can the US be responsible for the food crisis, for example, when, according to the US Department of Agriculture, US farmers are permitted to export more than $400 million in food (mostly chickens) to Cuba? But US farmers send more than $1.8 billion in food to the nearby Dominican Republic, with a similar population size. Without sanctions, US farmers’ exports to Cuba could quadruple, says Paul Johnson, the founder of the US Agriculture Coalition for Cuba.

Scarcity in Cuba is evident everywhere. Produce markets have empty stalls. There’s a lack of eggs, milk, and meat. When the shrunken monthly food-ration basket comes—if it comes—it’s often missing something: the rice, perhaps, or the cooking oil. The lights go out every couple of days, especially far from Havana. Drivers often wait more than 12 hours at gas pumps and are limited to about 10 gallons. The nation is short about 14,000 working public buses, according to the government’s blockade report, leaving the public transportation system all but collapsed. There are frequent sidewalk footraces as people sprint for a place on the already packed boxy American mini-trucks from the 1950s that serve as collective taxis.

The lack of healthcare supplies extends beyond pacemakers. The scarcity of medicine and equipment means surgeries must be postponed. “The limitations are tremendous,” says López Martín, the cardiologist, adding that there’s a waiting list of about 300 people in Santiago for cardiovascular surgery. Nationwide last year, there was a waiting list of more than 86,000 people for surgeries of all types, including 9,000 children, according to the government. Schwartz, of Global Health Partners, says he has a $1.9 million cargo of medicine that he has been unable to send for two months because shippers are leery of transactions involving Cuba.

“The objective of the Trump-Biden governments was regime change…and it was a failure in terms of the objective,” says Johana Tablada, the deputy director general for US relations in the Cuban Ministry of Foreign Affairs. “But it was successful in harming the Cuban people at a level that has no precedent.”

The privation is too much for many people. Over 1 million Cubans—almost 10 percent of the population—have left the country in recent years. That’s by far the largest migration since the revolution, Tablada says. About 670,000 of those migrants tried to cross the US border, according to US Customs and Border Protection figures, showing how one American policy priority sabotages another. An additional 110,000 Cubans arrived via the Biden administration’s humanitarian parole program, according to Refugees International.

With so many politicians claiming to act in the best interests of the Cuban people, it’s worth taking a bus ride across the island to see how those actions affect the lives of people like Cardero Céspedes—and how the people’s own resilience may be Cuba’s most precious resource.

Nolberto Moreno Borjas, 60, wears a floppy broad-brimmed hat against the midday Havana sun. He worked for 30 years as a metallurgic engineer in a nickel factory, but today he’s posted a few blocks from the domed Cuban Capitol, beside a two-tone white and black-cherry 1956 Ford Victoria convertible, offering tourists excursions around the city. He charges $20 a ride, sharing the revenue with the car’s owner, a young entrepreneur. Candy-colored vintage American cars conveying giddy visitors along the seaside Malecón were an emblem of the Obama opening, when a spigot of investment briefly poured a semblance of prosperity over the island. But now platoons of drivers sweat idly beside their nostalgic machines. Moreno will not get a single fare all day.

“It seems to me like a war the United States is making against Cuba,” Moreno says. “It causes a lot of damage, not to the leaders of the country, nor to the upper class, but to the poorest Cubans.”

The number of international travelers to Cuba dropped by more than half, from a record 4.7 million in 2018 to 2.2 million last year, according to reports citing official figures. The number of American visitors fell from a peak of 638,000 in 2018 to 163,000 in 2023, according to the Cuban government, with just 129,000 Americans visiting in 2024 through November. Tourism was one of Cuba’s top three sources of revenue pre-Covid, along with family remittances and income from sending thousands of Cuban doctors to serve in other countries. Anything that hurts tourism not only impoverishes legions of hospitality workers; it also cripples the national fund reserve needed to purchase vital goods from abroad, such as food, fuel, and medicine. Moreno digs into his pocket to show a handful of blister packs containing pills: hypertension medicine and Vitamin C for him, and stomach medicine for his father, who just had an operation. Moreno could not find these items in the state pharmacy, but he was able to buy them on the street, at a much higher price.

Moreno says his own government shares responsibility for the problems. Cuban officials equivocate in their attitude toward private businesses, loosening restrictions and then tightening them, causing bandazos (the lurching of a ship), he says. “The Cuban system isn’t working well. But the government of another country has no right to attack the country that has this system…. In the end, the ones who suffer are us.”

In a Havana neighborhood outside the city center, Oscar Fernández, 46, a cofounder of Deshidratados Habana, which dries up to 660 pounds of fruits and vegetables a day, stands behind the counter of his open-air storefront. The wall has racks of dehydrated mangoes, oranges, bananas, and more, selling for less than $1 per packet, which he dreams of one day exporting to the US.

American pro-embargo rhetoric is confused about Cuban entrepreneurs like Fernández. US policy is supposedly designed to support individual Cuban initiative, yet the private sector in Cuba is also said to be a myth, a front to raise money for the government.

“That’s crazy,” says Fernández, an economist who was a professor at the University of Havana before starting Deshidratados Habana during the pandemic. His business provides 22 jobs, creates a market for 20 to 30 suppliers, and enlivens the menus of about 100 bars, restaurants, stores, and small hotels. According to his fellow economist Juan Triana, the private sector generates 15 percent of Cuba’s gross domestic product and employs 35 percent of Cuban workers.

“The US blockade is the main obstacle for Cuban economic development,” Fernández says, particularly the measures taken after the Obama administration.

Fernández keeps samples of dried fruit packets from Whole Foods and Trader Joe’s in his desk. He’s sure he could compete with those outfits or become their suppliers if the embargo would allow it. He plans to build a small factory near the Havana airport and increase production capacity to five tons a day. With the help of an American partner, he has a request pending for a US license to export to the insatiable yet inaccessible market just 90 miles away.

For now, though, Fernández has had to halt production for two months because of the unreliability of the electrical power his drying machines depend on and the scarcity of the fuel he needs to transport fruit from the countryside.

“You cannot separate the government from the Cuban people,” Fernández says of US policies ostensibly aimed at punishing the government and helping the people. “You cannot say you want to help the Cuban people if you are putting pressure on the government.” Political and military leaders are personally insulated from the effect of sanctions, he adds, while “these restrictions are going to be impacting real people.”

Some entrepreneurs are losing hope, closing up shop, and leaving the country, a step that Fernández says he would never take: “This is my country.” While he thinks the government could have made better choices over the years—“Even with the embargo as it is, we could be in a very different situation if the Cuban government made proper decisions in spite of [it],” he says—he sympathizes with the economic ministers consumed with putting out daily fires.

“I don’t want state companies to be privatized,” Fernández continues. “I don’t want the healthcare system to be private, schools to be private. I want inefficient public companies to be closed, and I want private companies to emerge and to solve problems, to pay taxes, to sustain social goals. How do you want to call this model? Socialism? Capitalism? I don’t care about the labels, because we’ve [spent] too much time discussing empty labels. What I need is the Cuban people to be better off this year than last year.”

The 540-mile bus ride from Havana in the west to Santiago in the east takes 16 hours. The driver deftly skirts potholes and crumbling pavement. There’s a shortage of asphalt and trucks to make repairs. The government reports that 38 percent of the nation’s roads are in “fair or poor condition,” but that seems an underestimate.

Waiting in Santiago on the tree-canopied patio of his seven-room guest hostel is Reinaldo Suárez Suárez. Hostal la Hiedra sits a few blocks from San Juan Hill, where Teddy Roosevelt’s Rough Riders joined Cuban independence fighters to defeat the Spanish Army in 1898. While digging a cistern, Suárez, who is also a historian and law professor, found evidence of an American military trench and numerous shell casings. He leads the way to the top of the storied hill and sweeps his arm across the panorama of highlands and valleys where a succession of historical actors aspired to shape Cuba’s destiny—colonizers and slave traders, Spanish and American imperialists, Castro’s revolutionaries. In the current crisis on this land, he says, the rebel spirit of Santiago must respond with self-reliance and ingenuity.

To that end, Suárez grows nearly all the vegetables and fruit he needs for his guests and recently proposed to his neighbors a joint agroecological project to cultivate “alimentary autonomy” on their properties as well as an “anti-blockade culture.” Cubans must learn to grow alternative foods and eat the parts of plants they once discarded, Suárez says. He holds up a humble fruit known as the mouse pineapple. The size of a kumquat, it grows on wild shrubs. Suárez and the hotel’s chef, Elieser Jardinez, transformed the mouse pineapple into a sweet and tart breakfast fruit and a gourmet dinner dessert. While a traditional pineapple costs 250 pesos and serves eight people, a large bunch of mouse pineapples costs 100 pesos and serves 33 people. “It’s a total success and resolves an enormous problem for me,” Suárez says.

But there’s no escaping the blockade. Thanks in part to the US terrorism listing, occupancy has dropped from about 85 percent to 50 percent. Europeans are his main customers, but a German airline just announced that it will halt flights to Cuba. “For me, that’s a big blow,” Suárez says. He’s bracing for even fewer guests in 2025.

La Hiedra’s manager, Suárez’s 20-year-old nephew José Leandro Suárez Suárez, solemnly announces there is not an egg to be found in all of Santiago. For a hotelier, the inability to offer eggs is a professional disgrace. At a tourist hotel in Havana a few days earlier, the server had reported the absence of eggs with a sadness bordering on shame. Reinaldo Suárez Suárez contacts some incoming guests who are still in Havana to ask if they can buy eggs there before they travel to Santiago, to supply La Hiedra. Two dozen eggs in Havana can cost roughly half the average monthly salary paid by the state.

“What happens is every day you’re having to do the engineering of survival,” Suárez says. “Suddenly there are no eggs, then there’s a blackout, then it’s the water, then there’s no toilet paper. Every day is a struggle to keep alive what you care for, the project you have.” He pauses and adds, “But also, in the end, there’s something very beautiful: You carry on inventing yourself. Reinventing yourself. Reinventing reality—overcoming reality.”

Several miles away, on the rural outskirts of Santiago, Leandro NaunHung, 45, the pastor of the Catholic parish San José Obrero, seeks to lead his flock through a similar reinvention. Having no church sanctuary, the priest brings religious services, protein-rich foods, and community-building exercises to people living in remote communities over hundreds of square miles.

Faced with the lack of so much, “we have to transform ourselves, develop resilience to confront it, and not let it flatten us,” NaunHung says as he sets out on his pastoral rounds in a battered Toyota pick-up truck. He worries that people are so busy trying to survive that they’re losing the ability to imagine a future.

Wherever he goes, NaunHung carries a jar of what he calls mata hambre—“hunger killer”—and a pocketful of plastic spoons. It’s a thick paste of ground and toasted seeds and grains mixed with honey, a kind of homemade energy bar. A couple of spoonfuls can stand in for a meal, he says, something “you can store and serve when you don’t have electricity, in difficult times.” He dispenses spoonfuls to people hiking along the road, to anyone with an empty belly.

As the scarcities worsened last year, he began sharing other recipes that could be made from wild plants and the ingredients at hand. He gave lessons in how to make food blackout-proof by preserving it through canning or salting. He and parish supporter Leocadia Rivera Rivera, 75, a retired nurse who served on medical missions to Libya, Angola, and Haiti, turned the patio of their old mission house into a sustainable garden. Humberto David Téllez Zamora, a 20-year-old biology student, helped launch a large-scale bread-baking operation, repurposing discarded iron machine parts from a junkyard as wood-burning ovens and distributing loaves of what they call pan de la solidaridad—“solidarity bread.”

NaunHung switches from the Toyota to a large yellow truck with metal benches loaned by a parish member and heads into the hills. Every several miles, the truck picks up more people until there are 60 packed standing-room-only as they arrive at a disintegrating children’s park near the coast.

“Today we are going to kill hunger!” says parish volunteer Dasmary Marrero del Toro, 68, inviting everyone for breakfast spoonfuls of mata hambre.

The purpose of the gathering is to celebrate Mass and plan for the future. NaunHung has also brought a friend, a hospital psychologist, to give a workshop on personal resilience, which takes place in a crumbling amphitheater. They brainstorm ways to improve their communities, then act out a short Christmas skit. Lunch is pan de la solidaridad and cheese pizza.

Every day NaunHung encounters quiet individual struggles. Marrero del Toro tells him her November food basket never arrived. She had to wait in line much of the day for her December basket of rice, sugar, and cooking oil. After working 35 years as an economics technician for a cement plant, she receives a pension of 1,500 pesos a month. That’s worth less than $5 on the informal exchange market that Cubans use to change money. Inflation jumped 25 percent in 2023, according to government figures. Cooking oil costs 800 pesos, a bag of spaghetti 330 pesos, a can of beans 460 pesos, a pound of rice 180 pesos.

Margot Montoya Lahera, 64, says she sometimes has trouble collecting her pension of 1,600 pesos because the bank machine doesn’t work during blackouts. This year she was responsible for Christmas decorations in the open-air shelter behind her house at the top of a steep, eroded road. A few dozen gather there for Mass when NaunHung visits. Montoya made a Christmas tree out of a branch from a cherry tree and adorned it with deodorant balls wrapped in silver paper. “It’s not very beautiful, but I think God likes it,” she says.

During Mass, the power goes out.

To raise money, the parish collects beer and soda cans that NaunHung hauls weekly to a sheet metal shack in Santiago, where he gets 40 pesos per kilogram. Today’s 77 kilos yield 3,080 pesos.

The parish also relies on donations from Cubans living abroad. A couple years ago, NaunHung started making videos of parish life so the donors could stay informed. Video production turned into an effective way to engage the parish’s teenagers. More than 600 clips have been posted to NaunHung’s YouTube channel. These poignant and droll digital vignettes offer glimpses into forgotten lives on the receiving end of blunt policies devised in faraway capitals.

The young videographers are excited about their work, but their generation is abandoning the country. “Here, there aren’t many possibilities to do anything,” says Alberto Enrique Wilson Vidal, 18. “So the idea is to try to leave one day, the earliest possible.” Yunior Borrero García, 16, adds, “They don’t create the conditions for us to exploit our talents.”

As Trump retakes control of the United States’ Cuba policy, with arch Cuba critic Marco Rubio as his secretary of state and hard-liner Mauricio Claver-Carone named special envoy for Latin America, he may be tempted to see how much tighter he can turn the screws. For now, though, after reversing Biden’s last-minute changes, the administration has no further Cuba measures to announce, a State Department spokesperson told The Nation in late January, while false rumors of coming new, draconian restrictions course through social media.

“I’m very concerned because…things are going to get much tougher for Cuba,” says Ricardo Torres, a Cuban-born economist at American University who is a critic of Cuba’s economic model. “Trump and Marco Rubio?… It’s the worst nightmare.”

Rubio introduced a bill in 2023 to keep Cuba on the terrorism list until “a transition government in Cuba is in power.” During his confirmation hearing in January for secretary of state, he elaborated his conviction that US policy should not ease until Cuba allows for democratically elected leaders. “The moment of truth is arriving,” Rubio said. Cuban leaders are “going to have a choice to make…. Do they allow the individual Cuban to have control over their economic and political destiny, even though it threatens the security and stability of the regime? Or do they triple down and just say, ‘We’d rather be the owners and controllers of a fourth-world country that’s falling apart and has lost 10 percent of its population’?”

Trump will have to consider how much dissonance he can tolerate between the goal of eliminating illegal immigration and the aim of forcing regime change in Cuba. Recognizing a mutual interest in stemming the flow of Cubans to the US could be a starting point for engagement, suggests Johnson of the US-Cuba agriculture coalition. “I hope that this next administration works on three things,” he says. “They recognize there’s a food crisis, they recognize that there’s mass migration, and they recognize that there is a private sector within Cuba that we can work with Cuba to improve, in order to resolve migration and the food crisis. That’s the solution that we need to take.”

Cubans are bracing to draw on deeper wells of resilience. “We must demonstrate every day that the blockade is inhumane,” says Juan Triana, the economist. “But at the same time, we must demonstrate that even with the blockade, we can improve and continue living.” That will mean understanding that the private sector is not an enemy of the revolution but a compañero, he says, and realizing that “this society…must be managed not with the tools and instruments that we used 40 years ago but with the instruments of now.”

Johana Tablada, in the foreign ministry, recalls the economic crisis of the early 1990s, after the Soviet Union collapsed. “We were able to emerge with creativity, and I think we are about to do the same again,” she says. “The country keeps evolving. What hasn’t evolved is US policy.”