Many Cuban refugees purposefully injured themselves or feigned illness in an attempt to be sent to the United States for treatment, according to doctors who treated them. Examples of the injuries include self inflicted burning, injection of diesel fuel, and ingestion of metal objects (New England Journal of Medicine 1997; 336:1251-3).

Frustrated by deteriorating economic conditions spurred by the collapse of the Soviet Union and dwindling economic support from Russia, thousands of Cubans attempted to sail to the United States aboard crude rafts only to be captured by US military forces and sent to Guantanamo Bay naval base, where they were held indefinitely.

While the US had previously allowed Cubans to immigrate relatively easily, in November 1994, Attorney General Janet Reno issued a policy allowing entry to only those under age 18, pregnant women, or anyone who had a medical condition that could not be treated at the base. The latter provision led to several hundred detained Cubans attempting to gain a “medical parole” by injuring themselves.

The majority occurred when a detainee …