The paper is a proof. Castro is real. He is wearing makeup to make him look less pale. That is the simplest explanation.
Sometimes we miss the forest for the trees. Why would Castro pose for these shots, including pictures of him on the phone, when he could have just as easily have had someone film or tape him giving his birthday message? Why pose with a dated newspaper? To me, this is all phony.
The newspaper is an undated proof of a special edition insert that was ready to be issued whenever they needed it to go with these photos.
It could have been issued next week, or month, or year. Whenever the Commies needed to "prove" Castro's existence. It wouldn't matter as the content is not "newsy."
So I say real photo, taken sometime in the past months, before the recent surgery when his health began to deteriorate. He's probably either dead or in a coma.