A/HRC/28/74 1992 and the Helms-Burton Act of 1996, as well as other legislative and executive acts. These acts essentially impose an economic, commercial and financial embargo on Cuba.27 23. In the United States, Congress passed the Trade Sanctions Reform and Export Enhancement Act in October 2000. The Act eased somewhat the enforcement of the embargo and allowed the sale of agricultural goods and medicine to Cuba for humanitarian reasons. From 2005 onwards, exports to Cuba were required to be on a cash-in-advance basis, with full payment made before the products were shipped to Cuba; transactions had to be made through banks in a third country. In 2009, the Government of the United States eased the restrictions by allowing the Government of Cuba to pay for food and agricultural products after the shipment was made. 28 24. The embargo of the United States on medicines and technologies in Cuba has led to limitations of the enjoyment of human rights by citizens in Cuba. Amnesty International has shown, on the basis several fact-finding reports, that the embargo had contributed to malnutrition that mainly affected women and children, poor water supply and lack of medicine.29 The United Nations High Commissioner for Human Rights described the effect of the embargo on Cuban people as “disastrous”. 30 According to the American Association for World Health, which conducted a detailed health survey in Cuba, the embargo on food and the de facto embargo on medical supplies had wreaked havoc with the island’s model primary health-care system.31 25. According to the United Nations Children’s Fund (UNICEF), Cuba is unable to import nutritional products intended for children and for consumption in schools, hospitals and day-care centres.32 In addition, food shortages are linked to a devastating outbreak of neuropathy numbering in the tens of thousands. By one estimate, daily caloric intake dropped by 33 per cent between 1989 and 1993.33 26. The embargo also restricts the State’s access to water treatment chemicals and spare parts for the island’s water supply system. This has led to serious cutbacks in the supply of safe drinking water, which in turn has become a factor in the rising incidence of morbidity and mortality rates due to water-borne diseases. 27. Access to essential medicines and equipment has also been affected by the sanctions. Of the 1,297 medications still available in Cuba in 1991, physicians now have access to only 889, and many only occasionally. Because most major new drugs are developed by United States pharmaceutical companies, Cuban physicians have access to less than 50 per cent of the new medicines available on the world market. Owing to the direct or indirect effects of the embargo, the most routine medical supplies are in short supply or entirely absent from some Cuban clinics.34 In the case of patients with psychiatric disorders, 27 28 29 30 31 32 33 34 For more details on economic sanctions imposed by the United States of America on Cuba, see Benhamin Manchak, “Comprehensive economic sanctions, the right to development, and constitutionally impermissible violations of international law”, Boston College of Third World Law Journal, vol. 30, No. 2 (2010), pp. 421–424. Amnesty International, The US Embargo against Cuba: Its Impact on Economic and Social Rights, 2009. Ibid. A/HRC/4/12, para. 7. American Association for World Health, The Impact of the U.S. Embargo on Health and Nutrition in Cuba, March 1997, p.16. Ibid. Maria C. Werlau, “The Effects of the U.S. Embargo on Health and Nutrition in Cuba: A Critical Analysis”, Cuba in Transition, 1998. Ibid. 9