U.S. intelligence agents were among the first and most severely affected victims of mysterious sonic attacks targeting American officials in Cuba, which began shortly after President Donald Trump’s election in November, according to a new report.

U.S. embassy personnel in Havana suffered injuries, including brain trauma and hearing loss, from some kind of device in November, and the U.S. has said the situation is ongoing, the Associated Press reported Monday. The Trump administration has described the 21 victims as embassy personnel or “members of the diplomatic community,” but officials told the AP that many of the reported cases involved American intelligence workers under diplomatic cover.

The attacks appear to have had their greatest effects on U.S. spies, who have suffered permanent damage to their health, but some diplomats were also affected. The attacks initially involved high-pitched sounds that have affected victims’ hearing, although others reported symptoms later despite not hearing any noises.

Investigators are concerned that these attacks are possibly becoming more sophisticated, but the environment in communist-run Cuba poses difficulties for verifying what exactly has occurred. The State Department has confirmed 21 cases, though it is unclear where the symptoms have come from and whether they are all connected.

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