Havana, Cuba - "El Bloqueo" has cost the Cuban economy $1.1 trillion over the past 55 years and contributed to the deaths of an unknown number of people who otherwise could have lived.
Cuban officials have used the words "genocide" and "barbaric" to describe it. Yet, after five decades of failing to remove communist rule, the US trade embargo - or "the blockade" as it's called here - continues to prevent life-saving medicine, nutritious food, and vital agriculture equipment from reaching the people of this majestic Caribbean island.
As Cuba and the United States hammer out the fine details on normalising diplomatic relations, the most important question remains: When will the devastating decades-old economic sanctions against Cuba finally be removed?
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"It's very difficult to predict," Carlos Alzugaray Treto, a former Cuban diplomat and professor of political science at the University of Havana, told Al Jazeera.
"The right-wing hardliners [in US Congress], they have a lot of influence and they have what one may call a 'blocking minority'. But it's very difficult to gauge what impacts Obama's position has had on this political equation."
US President Barack Obama's position has been crystal clear since the December 17, 2014 simultaneous announcement with President Raúl Castro that formal reconciliation attempts were under way.
"These 50 years have shown that isolation has not worked. It's time for a new approach," Obama said.
Proponents of the trade embargo insist, however, it remains necessary until human rights are respected by the Cuban government and democracy takes hold on the island of 11.3 million people.
The embargo was codified in law in 1992 and 1996, meaning only US Congress can abolish it.
|The embargo has affected children who've been denied many medicines and vaccines [Robert Kennedy/Al Jazeera]
The debilitating effects of the Cold War-era trade embargo are hard to justify, critics say. With restrictions on the import of food, it has contributed to malnutrition - especially among women and children - and water quality has suffered with chemicals and purifying equipment banned.
Deadly consequences have resulted from the blocking of much-needed medicine and healthcare equipment, including antiretroviral HIV drugs and vaccines for infants.
One of the most comprehensive studies of the embargo's effects was published by The American Association for World Health (AAWH) in 1997.
"Few other embargoes have so restricted medical commerce as to deny the availability of life-saving medicines to ordinary citizens. Such an embargo appears to violate the most basic international charters and conventions governing human rights," it said.
The AAWH found "a humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a healthcare system designed to deliver primary and preventive healthcare to all of its citizens".
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No hard data exists on how many Cubans have died because of the embargo, but Cuban officials do not mince words when asked about the death toll.
"It's not only a blockade, it's an act of genocide," Dr Antonio Gonzalez Fernandez, director of the health ministry's international relations division, told Al Jazeera.
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Trade sanctions were first imposed in 1960 after the Castros' socialist revolution overthrew US-backed dictator Fulgencio Batista and the new Cuban government nationalised American corporations.
The move has long been unpopular among the international community. Last October, 188 countries backed a UN General Assembly resolution demanding the US lift its embargo on Cuba. It was the 23rd straight year the assembly voted to do so. Only the US and Israel voted against the resolution.
"The embargo is clearly recognised as unlawful under international law as an illegal form of coercive economic intervention," said Nigel White, author of The Cuban Embargo Under International Law: El Bloqueo.
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But the professor from the UK's University of Nottingham told Al Jazeera that Cuba would be wise to steer clear from "genocide" accusations.
"The Cuban government's labelling of 'genocide' by the US is obviously hugely controversial since it implies that the US intended to destroy the Cuban population - or a significant part of it - and will not help normalisation," said White.
"The Cuban government would be better to argue for other breaches of international law since the blockade has clearly violated rights to health and life - both recognised as principles of customary international law binding on all states."
|A bronze statue of American writer Ernest Hemingway, who frequented Cuba before the embargo, at Havana's La Floridita bar [Robert Kennedy/Al Jazeera]
Support in the United States for the sanctions has also fallen in recent years. A Gallup poll in February showed 59 percent of American respondents want the embargo ended, up from the 50-percent range in surveys taken during the 2000s.
But anti-Castro politicians such as Speaker of the House John Boehner and Florida Senator Marco Rubio, a possible 2016 Republican presidential candidate, don't appear ready or willing to follow Obama's lead on détente.
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"I don't care if the polls show that 99 percent of people believe we should normalise relations in Cuba," Rubio, the son of Cuban immigrants, said in December. Requests for comment from the senator's office went unanswered.
Directorio Democratico Cubano is a US-based NGO that supports human rights efforts in Cuba.
"Whereas the Obama administration has made an important series of unilateral concessions to the Castro dictatorship, the regime in turn has not made any concession in the key areas of human rights and democracy," the group said in an email.
Asked about the embargo it added: "Replacing this policy with one of unilateral openings to the regime and unconditional investment will only strengthen a dictatorship which has oppressed the Cuban people for the past 56 years."
|Last October, 188 countries voted at the UN General Assembly demanding the US lift its embargo on Cuba [Robert Kennedy/Al Jazeera]
A joke - but a reality
Since the December 17 announcement of rapprochement, four rounds of formal talks have been held. The US removed Cuba from its list of state sponsors of terrorism in May, and the next step is opening embassies in the respective capitals. Reports have suggested that may happen in early July, however, it's far from a done deal.
Opponents such as Rubio could block funding for the US embassy and the appointment of an ambassador.
Negotiations between Havana and Washington over the freedom of movement and activities by diplomats also appear to be a sticking point.
For Cuba, it is an ultrasensitive issue, said the University of Havana's Alzugaray, noting US embassies have long been used around the world to stir up trouble.
"I don't know if you know the joke about the American embassy, it goes like this - 'Question: Why can there never be a military takeover in the United States? Answer: Because there's no American embassy in Washington,'" Alzugaray said with a laugh.
"It's a joke, but it's also a reality. Batista [the dictator] was created by the American embassy here… The Americans always want to push the limits of what an embassy can do. But we must be ready to take that risk."
|Tourism is expected to skyrocket once the embargo ends and Americans stream into Cuba [Robert Kennedy/Al Jazeera]
Meanwhile, for ordinary Cubans long caught up in Cold War geopolitics, most are champing at the bit for normalisation to take hold - and for El Bloqueo to mercifully come to an end.
While denouncing the embargo, some also blame Cuba's communist system for their economic suffering.
"It's the government's fault, even with the blockade. They buy goods but we never see it. It's a double blockade," said construction worker Miguel Lopez Barrera, 29, who told Al Jazeera he earns just $10 a month.
"People are wondering if the Americans come will they give them good-paying jobs. We really hope they come and give us better paying jobs," said Lopez.
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The prevailing sentiment on the island is that American tourism will provide an immediate boost to Cuba's moribund economy, creating employment and hiking salaries. But some here remain sceptical.
"The government makes money off the Cuba that it wants tourists to see, but it hides the poverty we must endure," said Limmet, 24, a waitress in an Old Havana pub who gave only her first name.
"Tourists, they come and go. Housing needs to be fixed - many things need to be fixed. We need salaries we can survive on," she said.
|The US embargo has cost the economy $1.1 trillion over the past 55 years [Robert Kennedy/Al Jazeera]
Source: Al Jazeera