Forty-eight years after Fidel Castro entered Havana at the head of a triumphal guerrilla army, Cubans in the island’s largest cities are still proud of his revolutionary government’s achievements in health care and education but they are overwhelmingly negative when asked questions about their personal freedoms and daily life.

Cubans are also divided about the communist state that has ruled the island nation for nearly five decades. A little less than half (47%) say they approve of their government and 40 percent say they disapprove. Approval is highest among those aged 55 to 59 (61%) and lowest among young adults aged 25 to 29 (38%).

These are some of the findings of a rare independent survey of 1,000 Cubans in Havana and Santiago de Cuba. Gallup’s Costa Rican affiliate—Consultoría Interdisciplinaria en Desarrollo (CID)—conducted face to face interviews in the two cities from Sept. 1-15.

The September poll took place during a period of uncertainty in Cuba. Fidel Castro, who has dominated Cuban politics since the 1959 revolution, has not been seen in public since July 26, just before he underwent surgery for intestinal bleeding. He handed over power during his recovery to his brother, Raúl, in late July.

A near unanimous 96 percent of respondents say that health care in Cuba is accessible to everyone. Gallup polls in other Latin American cities have found that on average only 42 percent believe health care is accessible.