The State Department mishandled its initial response to the mysterious health incidents that have affected U.S. personnel in Cuba, according to a newly released review.
The previously classified report, which was completed in June 2018, is at times heavily redacted, but it provides new key details about the Trump administration's response to what have been called "health attacks" on diplomats and spies, including similar incidents in other countries, and the CIA's decision to shut down its mission in Havana.
The Biden administration is reviewing the United States' policy toward its communist neighbor Cuba, including whether to re-staff the embassy after former President Donald Trump's State Department ordered the departure of almost all American personnel.
But to ensure the issue of health attacks receives top billing, Secretary of State Antony Blinken just this week "elevated" the official coordinating the U.S. government response to a "senior level position," a State Department spokesperson told ABC News.
U.S. personnel have been battling the U.S. government to provide greater support to them, including for the lingering health issues that many suffer under what has become known as the "Havana syndrome." Medical doctors have found the Americans suffered traumatic brain injuries, with symptoms ranging from headaches and vision problems to cognitive deficits and dizziness.
The internal report, written by an Accountability Review Board (ARB) after a four-month investigation, is highly critical of the Trump administration's response, including veiled swipes at then-Secretary of State Rex Tillerson. The report, which was provided to Tillerson's successor Mike Pompeo on June 7, 2018, was declassified and released to the National Security Archive at George Washington University.
"The Department of State's response to these incidents was characterized by a lack of senior leadership, ineffective communication, and systemic disorganization," the report found, with no senior official in charge and activity "stove-piped and largely ad hoc."
In May 2018, shortly after Pompeo took over, the department launched an interagency task force to better coordinate the government's response -- a year and a half after the first Americans began experiencing symptoms in November 2016.
Prior to the task force, the failure to designate an "official at the Under-Secretary level to manage the response" was the "single most significant deficiency in the Department's response," the ARB said, citing as well the confusion over who was authorized to act given that Trump left so many top posts vacant at the department.
To prevent similar problems, Blinken's "high-level official will be empowered to advise senior Department leadership, coordinate the Department's interagency response to the health security incidents, and to provide continuing support to affected personnel," State Department spokesperson Ned Price said Thursday. He declined to provide more details on the role at this time, including who will fill it.
Blinken has previously said the issue would be a top priority, and he is being regularly briefed on the issue, the spokesperson added.
"The priority is making sure that our diplomats are safe and secure, but also that we find out who is responsible, if a state actor or others are responsible, having accountability and making sure that we put the protections in place so that our folks are safe and secure," Blinken told the Senate Foreign Relations Committee during his confirmation hearing. He said that he'd also brief the committee within weeks of being confirmed -- a meeting which hasn't happened yet.
By the time the report was shared with Blinken's immediate predecessor Pompeo, the department still had not identified a cause behind over two-dozen employees falling ill.
"The mechanism for the cause of the injuries is currently unknown. We do not know the motive behind the incidents, when they actually commenced, or who did it," the report said.
Price confirmed Thursday that remains the case.
"The U.S. Government is working to determine what happened to our staff and their families and to ensure the well-being and health of our officials going forward. That investigation remains underway, it remains a high priority," he said during the department's daily briefing.
There were other deficiencies in the Trump administration's initial response, according to the ARB.
While Tillerson ordered the departure of non-emergency personnel, leaving just a skeleton crew behind, the report said the department never conducted a risk-benefit analysis to determine the appropriate staffing levels -- a break with department procedure.
The ARB said senior department leaders could not explain why, except to suggest one possibility, which is redacted.
The panel also found it difficult at times to trace what action was taken and why because of the "informal" ways Tillerson and his team communicated with senior officials.
"Normal Department reporting channels and methods were routinely disregarded in the response to the Cuba incidents," it said, which "contributed to the lack of coherence in the response."
Tillerson was accused during his one-year tenure of siloing himself on the building's seventh floor with a small coterie of advisers.
The ARB itself was long delayed by the Trump administration, which didn't convene it until early 2018 -- over a year after the first incidents and only after months of pressure internally and from Congress. The panel interviewed over 100 officials, reviewed thousands of documents and even traveled to Cuba for its classified investigation.
Its report had not been released, although members of Congress were briefed, and the State Department released a fact sheet about what recommended measures had been adopted.
"As the Biden administration assumes responsibility for the continuing investigations into the 'Havana Syndrome,' complete transparency is needed to clarify what actually happened," said Peter Kornbluh, a senior analyst at the National Security Archive, which obtained the declassified report through a Freedom of Information Act request.
Beyond Cuba, the report noted that similar incidents have been reported "elsewhere" -- in Uzbekistan, China and one redacted country -- although the department at the time only acknowledged the evacuation of some personnel from China.
Marc Polymeropoulos, a now-retired CIA officer, has spoken publicly about his "health attack" in Russia, awakening in the middle of the night to vertigo, dizziness and tinnitus. He's said another CIA colleague traveling with him at the time and other officers working on issues related to Russia elsewhere around the world have suffered similar health problems.
The State Department report confirms for the first time that the CIA withdrew its personnel from the U.S. embassy in Cuba in September 2017 "for the foreseeable future." It's unclear if any have returned to the post, and CIA spokesperson Nicole de Haay declined to answer specific questions Thursday.
"CIA's first priority -- has been and continues to be -- the welfare of all of our officers," said de Haay.
The CIA's involvement may have also made the U.S. response more difficult, as the spy agency was reticent in sharing information about its affected personnel, the report said.
"Both at Post and in Washington, response to the incidents was characterized by excessive secrecy that contributed to a delayed response," it said, calling for "complete transparency and prompt notification regarding any episode that results in harm or increased danger for USG (U.S. government) employees."
ABC News' Cindy Smith and Josh Margolin contributed to this report.