Unexplained Health Incidents in Havana, Cuba - Report by Global Affairs Canada

August 2024

Table of contents

• Overview
• Background
• Collaboration with Unites States and findings
• Global Affairs Canada response
  • Government partnerships
  • Health and Safety
    • Nova Scotia Health Authority memorandum of agreement
    • Golder Associates’ environmental assessment report
  • Security investigations
    • RCMP investigation
• Conclusions

Overview

This report outlines the work undertaken by Global Affairs Canada and the Interdepartmental Task force to protect Canada-based staff members and their families from further “unexplained health incidents” (UHI) experienced in 2017-18 by Canada-based staff members (CBS) and their dependants in Havana, Cuba.

Global Affairs Canada (GAC) reiterates its support for the CBS and their dependants, and the authenticity of the symptoms they experienced has never been questioned. GAC acknowledges the struggles faced by employees and their dependants affected by UHI while the department was working to identify the cause, put in place mitigation measures and provide the necessary support to those affected.

After several years of extensive investigation outlined in this report, GAC, in consultation with the Interdepartmental Task Force and external experts, has concluded that the UHI were not the result of a malicious act of a foreign actor or foreign actors and that pre-existing medical conditions, environmental factors and conventional illnesses were likely to have been important factors in many of the symptoms experienced. The UHI will therefore continue to be carefully managed as a health issue by Occupational Health and Safety experts of the affected employees’ home departments, rather than by a security task force.

This report outlines the multifaceted approach to the UHI undertaken by GAC, our partners within the government of Canada, our partners outside government, as well as our international partners . It explains and highlights the coordination efforts, resources and time dedicated to responding to the circumstances of the UHI, as well as how the conclusions were reached, which influences our approach moving forward.

Key contributors to this report include GAC’s internal Health Incidents Task Force, People and Talent Management Branch (HCM), as well as members of the Interdepartmental Task Force, the Royal Canadian Mounted Police (RCMP), the Canadian Security Intelligence Service (CSIS) and Health Canada (HC).

Background

In April 2017, the Government of Canada received verbal reports from U.S. officials that a number of their employees were experiencing unusual health symptoms in Havana, Cuba that had begun in the fall of 2016. Despite the limited information available at the time, Canada began assessing the risks for Canadians and working to ensure the safety of its staff members. At the end of May 2017, some CBS first came forward with possible symptoms. The Government of Canada coined the term “unexplained health incidents” to describe the constellation of these physical health symptoms.

All stakeholders strove to identify the root cause and resolve the issue. This matter was elevated to the most senior levels within GAC, and action taken swiftly to reduce risks to CBS and dependants.

Dependants were removed from Havana, and CBS were allowed to end their assignments early. In January 2019, Canada’s diplomatic footprint was officially reduced by half to mitigate risk and reduce exposure to potential injury.

From 2017 to 2020, policies, administrative and compensatory measures were put in place, including the following:

• The mission was reclassified as an “unaccompanied” post with no visitors permitted
• The posting duration was reduced from three years to one year
• The mission’s hardship level was increased from Level III to V, with commensurate increases to allocations under the Foreign Service Directives
• A rest and respite policy was implemented, in recognition of the additional hardship that this situation conferred on staff members
• Medical support was increased
• Pre-departure and periodic medical testing at Dalhousie University’s Brain Repair Centre was offered to CBS and adult dependants
• Briefings on health and safety, including UHI, were put in place for all government officials visiting the mission

In response to the reports of UHI, two main lines of investigation into the causes were pursued. One line, led by the RCMP and other security agencies, related to some form of pulsed radio frequency. A second line of investigation, in the form of a health study financed by GAC was initiated to better understand the health affects suffered by some CBS and their dependants. GAC signed an agreement with the Nova Scotia Health Authority and an investigation team led by Dr. Cynthia Calkin and later by Dr. Alon Friedman at Dalhousie University’s Brain Repair Centre to conduct this study. The Investigation team’s research included baseline and ongoing health monitoring of adults posted and/or on temporary assignment to the Embassy of Canada to Cuba. Following an interim study finding’s report from the investigation team, a comprehensive environmental assessment was conducted to review the pest management protocol in Havana.

Collaboration with Unites States and findings

Canada and the United States have worked very closely and collaboratively on the UHI file from the start. As the only two countries with staff members who reported health symptoms consistent with UHI, both countries had a vested interest in collaborating while at the same time protecting the private information of all individuals.

Canada and the United States collaborated and met throughout the years to share hypotheses and findings.

Canadian officials met with the U.S. researchers who developed an initial health study. Subsequently Canada conducted its own study based on the proposed working diagnosis from those initial studies.

GAC representatives also participated in the initiatives undertaken by the National Academies of Science, Engineering and Medicine (NASEM) who put in place a standing committee to advise the U.S. Department of State on Unexplained Health Effects on U.S. Government Employees and their Families at Overseas Embassies. They published a report “An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies” in December 2020.

The U.S. National Intelligence Council released a report on March 1, 2023, examining whether foreign actors were responsible for “anomalous health symptoms” reported by U.S. government officials from seven U.S. intelligence bodies. The report, which reviewed around 1,000 cases, focused on three main areas: data indicating the involvement of foreign adversaries; the feasibility of deliberate mechanisms; and medical analysis.

The conclusion drawn by most intelligence agencies in the Council was that it is “very unlikely” that a foreign adversary is responsible for these incidents. They based this on analysis of intelligence, open-source information and scientific literature and found no credible evidence linking foreign adversaries to the reported symptoms. Additionally, pre-existing medical conditions, environmental factors and conventional illnesses were identified as plausible explanations for many of the incidents, further diminishing the likelihood of foreign involvement.

In March 2023, GAC, CSIS and the RCMP met to discuss the Council’s report. The RCMP indicated that since no criminality was uncovered, its criminal investigation would be concluded. CSIS informed that it would also be concluding its investigations for similar reasons and that a joint report on conclusions would be drafted.

On June 16, 2023, the U.S. Department of State announced that responsibility for this file would move to the Bureau of Global Talent Management’s Care Coordination Team which had been providing health-related support to employees and family members.

On March 18, 2024, the U.S. National Institutes of Health released a study using magnetic resonance imaging metrics to identify potential brain lesions. The study concluded that there was no significant difference between the participants and control group.

Global Affairs Canada response

Government partnerships

Efforts were coordinated across the Government of Canada to determine the best options for addressing the health concerns of CBS in Havana. The Public Service Occupational Health Program at HC provided occupational health and medical advice and guidance on managing reported cases and on the application of health care travel as per the Foreign Service Directives. 

In March 2018, GAC’s associate deputy minister of foreign affairs mandated the assistant deputy minister (ADM) of the Consular, Security and Emergency Management Branch (CFM) to lead GAC’s task force on unexplained health incidents, with participants from all relevant GAC branches to ensure that decision-makers and stakeholders were informed of all developments related to this file. An interdepartmental task force, led by GAC, was also struck to ensure close interdepartmental coordination with other departments and agencies, including the RCMP, CSIS, the Department of National Defence (DND), HC, Immigration, Refugees and Citizenship Canada, and the Privy Council Office.

Health and Safety

In spring 2017, GAC approached HC to assess the occupational health situation in Havana. In response, an overseas medical officer from HC’s Public Service Occupational Health Program promptly provided advice to GAC on managing reported cases. Additional members of the program travelled to Havana to assess staff members and dependants and to make appropriate recommendations. HC also undertook a general health assessment of all children 12 years of age and under.

Urgent access to medical testing was facilitated at the University of Miami, as well as at the Canadian Forces Health Services Centre Ottawa. Referrals to specialist physicians, such as ear, nose and throat specialists and neurologists, were made. In addition to the testing arranged at the University of Miami and through DND, a screening approach that involved baseline testing was developed. GAC hired a dedicated physician to serve as the health care case manager. The physician coordinated with provincial health care providers to assist with a more efficient provision of screening and primary care services for affected employees and their dependants. They were in contact with affected families and tracked the testing they received. The physician also facilitated connections with various medical professionals, including neurologists, an otolaryngologist, a paediatric neurologist, a physiatrist, a neuropsychologist specializing in neuro-cognitive assessments and acquired brain injuries and optometrists.

In April 2019, an interdepartmental letter of agreement was signed between GAC and HC establishing an Intergovernmental Health Advisory Task Force (IHAT), led by HC, to provide expert health advice to GAC on the medical information and various reports received. The IHAT also included medical representatives from DND, including Canadian Armed Forces, as well as the RCMP and the Public Health Agency of Canada.

While CBS were abroad, GAC provided coverage for and reimbursement of medical and related expenses, in accordance with the Foreign Service Directives, for CBS and their dependants. Reimbursement was also provided for additional expenses that were not covered by the Public Service Health Care Plan.

Upon their return to Canada, arrangements for medical tests for CBS and their dependants continued, access to further medical care and treatment in the Canadian medical system was facilitated, and funding was provided for related tests and treatment not covered by provincial health care plans and the employee’s health care plan.

Work-related injury or illness necessitating medical treatment or resulting in absence from work must be reported to the Federal Workers’ Compensation Service at Employment and Social Development Canada (ESDC). In alignment with requirements, GAC submitted reports to ESDC when incidents were reported by employees.

At the same time, employees were informed of their rights for compensation under the Government Employees Compensation Act and provided with information on how to file a claim with the Workplace Safety and Insurance Board (WSIB) should they choose to do so. Under the Government Employees Compensation Act, the WSIB is tasked with adjudicating claims for employees working abroad and it determines the appropriate compensation in cases where the injury or illness occurred during the course of employment.

Benefits available to employees during their recovery from work-related injuries or illnesses may include additional health care coverage for medical treatments and devices, wage recovery through injury-on-duty leaves as well as the potential for non-economic loss benefits.

In 2022, GAC awarded a contract to an independent company, Bayshore Medical Personnel Limited, to review and recommend an overseas health services framework for the department. Their review and recommendations will be completed in March 2025 and will include all aspects of the posting cycle related to the health of our employees and their dependants in our missions around the world, from pre-posting assessments to the evaluation of access to health care while abroad and upon return to Canada. Its recommendations will be shared with employees, bargaining agents and partners as part of GAC’s consultations on its overseas healthcare model.

Nova Scotia Health Authority memorandum of agreement

In August 2018, GAC entered into a memorandum of agreement (MOA) on UHI with the Nova Scotia Health Authority and the principal investigator at Dalhousie University’s Brain Repair Centre (referred to as the “Nova Scotia Health Authority memorandum of agreement”).

The MOA had two objectives: to assess CBS and their dependants posted to Havana for possible brain injury and to establish a baseline assessment and provide ongoing monitoring of staff members who had been or were posted to Havana.

The objective of this initiative was to assist GAC to understand the health effects suffered by employees and dependants, to help ensure that GAC could take steps needed to protect the health and safety of employees, and to provide employees and dependants with information to help them to seek appropriate treatment. All staff members posted to Cuba from August 2018 to January 2023 participated in this initiative. CBS who were posted to HAVAN prior to the signing of the MOA, as well as adult dependants, were also invited to participate.

The investigation team produced several interim reports on its findings which it provided to GAC and to individuals participating in the research. In its initial report in 2019, it linked the health incidents to possible exposure to organophosphates found in pesticides. GAC immediately commissioned an independent environmental assessment in Havana (described further below).

The study ended on March 31, 2024, and the investigation team has now completed its findings. It concludes that approximately half of the participants experienced symptoms associated with mild brain injury . It also noted that such symptoms were most often reported to have developed within the first 6 months of their assignment in Havana , mostly between 2017 to 2019, and persisted over the next three years of follow-up. Both structural and functional evidence supported the occurrence of mild brain injury in some participants. Its report also states that individuals with pre-existing health conditions were more likely to develop symptoms. It notes that mass fumigation in Havana might have contributed.

Golder Associates’ environmental assessment report

When GAC received the initial interim report and associated findings from the investigation team at Dalhousie University’s Brain Repair Centre, it entered into an agreement with Golder Associates to complete a human health risk assessment on the potential health risks that may be associated with pesticide use in the vicinity of Canada’s embassy and the living quarters of CBS in Havana. This assessment, completed in November 2019, focused on the potential health risks, specifically related to pesticides, for GAC employees and their families at the mission.

Samples were collected and analyzed for various pesticides in soil, food, indoor air, outdoor air, water, residue, textiles, insect tissue and samples taken of pesticides themselves. Samples were collected with the purpose of either understanding potential human exposure or verifying the types of pesticides that could be in use at the mission and the Staff Quarters.

Based on the data collected in support of this risk assessment, and in contrast to the evidence found by the investigation team at Dalhousie University’s Brain Repair Centre, Golder Associates concluded that health risks related to pesticides were at acceptable levels. The report highlighted that “in [the] context of the project objective there were no obvious hazards identified as likely sources of CBS health issues”. The Intergovernmental Health Advisory Task Force (IHAT) reviewed the assessment and found its methodology to be robust and sound, and the conclusions well supported.

Security investigations

RCMP investigation

An RCMP-led investigation (Project Spectre) began in June 2017 led by the RCMP’s Integrated National Security Enforcement Team (INSET).

GAC and RCMP officials began travelling regularly to Cuba as part of the investigation to detect the possibility of malicious attacks and to implement monitoring and detection strategies. Canadian officials cooperated with foreign partners, including the United States, offering potentially salient information on the events in question.

In parallel, security measures were increased in Havana. A security working group and response team, as well as security protocols, were established and all staff members were advised of the steps being taken. Additionally, security guards were posted at all hours at each of the staff quarters and instructed to increase patrols around the properties.

In 2019, during Project Spectre, instruments designed to detect and capture evidence of acoustic and radiation surges and to measure environmental effects, such as temperature, humidity, barometric pressure, and ozone levels, were installed in the living quarters of CBS. The data collected from the instruments did not provide relevant and probative information to identify a cause for the symptoms. As such, in 2022, the instruments were removed.

In 2021, employees reported symptoms consistent with UHI in countries other than Cuba, which led to further RCMP investigation. In October 2021, GAC encouraged employees in its global network to report any UHI-like symptoms to their respective departments as well as to INSET.

INSET has concluded its investigations, including of the incidents reported beyond Cuba. It concluded that there was no criminality and no evidence attributing these health symptoms to a foreign actor. In their conclusions, the RCMP and other domestic partner agencies assess that there is no known criminality, no known attribution for UHI and no patterns related to symptoms, age, gender, location, or other variable. During its investigation, the RCMP also received full cooperation from the Cuban authorities, which facilitated Canadian investigations on the ground.

Conclusions

The Interdepartmental Task Force has determined that there is no evidence to attribute the health symptoms experienced by Canada-based staff members and their dependants in Havana, Cuba to a foreign actor or foreign actors. GAC arrives at these conclusions after having investigated the reported incidents and symptoms, including the theory of attacks from unknown or malicious entities, through various initiatives, including the RCMP’s investigation, environmental assessments, and the Nova Scotia Health Authority MOA. These efforts have not uncovered a clear common cause of the symptoms experienced by Government of Canada employees. Canada’s findings are aligned with the conclusions of the United States on their various health studies and the security report published by the National Intelligence Council.

These findings do not cast doubt on the authenticity of the symptoms reported by staff members and their dependants. The Government of Canada recognizes the impact these symptoms have had on the CBS and their dependants, as well as on the broader GAC and partner department communities. GAC remains committed to assisting staff members and dependants impacted by any health symptoms, with employee and dependant well-being remaining a departmental priority.

To continue the important work in support of GAC’s employees, this file will now be managed as a health and occupational safety matter within GAC’s Corporate Health Programs Division. Mission operations will continue to be adjusted while close monitoring of employee health continues.