With people in Iran already suffering from the COVID-19 pandemic and crippling U.S. sanctions, the Trump administration earlier this month unveiled yet another set of sanctions that could restrict Iranians’ access to food and medicine even further.
This move has gone largely unnoticed in the United States, with the first presidential debate passing without mention of Trump’s disastrous “maximum pressure” policy on Iran. But for Iranians, it is impossible to ignore.
As the world confronts the global COVID-19 pandemic, economic crisis, and the longstanding struggle for racial justice, American officials are denying Iran’s residents the right to health and access to medications and medical supplies by imposing new rounds of racist and violent sanctions. While the Trump administration has thoroughly failed to protect Americans from COVID-19, Trump’s withdrawal from the Iran nuclear deal and re-imposition of open-ended economic sanctions in 2018 has expanded his destruction of the “right to health” beyond U.S. borders.
“Although my death is not free for my family either, it is certainly cheaper to die rather than live,” says Nasrin, my 31-year-old friend suffering from Sjogren's syndrome and cystic fibrosis. She cannot find her prescribed medicines in Mashhad, the second-most-populous city in Iran. Further, even if she could have found her medications on the black market, she was unable to afford them as their prices have quadrupled in the past two months due Iran’s the dramatic currency depreciation.
In 2015, 90 percent of Iranians were enjoying universal healthcare coverage, subsidizing the majority of medications at 70 percent, covering 90 percent of public hospital costs, and 100 percent of treatment expenses for all rare diseases. However, unsustainable financial resources and the loss of export revenue, the primary goal of financial and trade sanctions, have contributed to about a 40 percent decrease in government budget and a 25 percent decrease in its healthcare budget for the previous Persian Year of 1398 (March 2019-2020).
Data by the World Bank and the Central Bank of Iran has revealed that people’s mental health is severely impacted when sanctions are imposed. While economic sanctions have not changed the behavior of Iran’s government until now, they have significantly restricted the collective economic capability of the nation and widened the country’s health gap. As a result, Iran’s residents are becoming poorer and poorer on a daily basis which increases the “risk of mental illness through heightened stress, social exclusion, malnutrition, violence, and trauma.”
In a recent publication, U.N. experts, along with many activists and scientists have stated that sanctions are silent weapons of mass destruction during the COVID-19 pandemic and that U.S. humanitarian exemptions are not working. In short, civilians in Iran have no room to breathe under the catastrophic and life-threatening economic blockade.
Due to the intentional complexity and vague essence of humanitarian exemptions, non-U.S. companies and aid organizations are also prevented from assisting the population. Fear of legal issues and trade barriers has resulted in over-compliance with sanctions. A Human Rights Watch report has indicated that foreign pharmaceutical firms are no longer willing to have trade relations with Iranian companies and banks, preventing Iran from importing their medicines. Additionally, an international lawyer has revealed that the treatment of brain tumor patients in Iran is suspended due to the inaccessible cobalt resources.
Without access to a functional channel for financial transactions to purchase and import medications, there is no way left but to rely on domestic products. However, sanctions restrict domestic production as well.
Hamid, my fellow university student at Notre Dame, called me last week and asked if my friends in Tehran could find triptorelin, or Microrelin, a medication used for treating cancer patients. Hamid’s 36-year-old sibling, Hamed, lives in Isfahan, the third-largest city in Iran, and cannot find his medication in the whole of the Isfahan Province. Neither could I, and Hamed was left with no choice but to go with the domestic substitute, although his body reacted badly and rejected it.
Iran's inability to purchase Active Pharmaceutical Ingredients, or API, from mass-producing companies mostly located in China and India is the main explanation for the shortages of many domestically produced medications, experts say. API are the necessary component of the formulation phase in drug-producing procedure, meaning that Iranian pharmaceutical companies are no longer able to produce any “drug-like” compounds. Accordingly, a variety of conventional medicines are not produced anymore such as Ergotamine-c, used for migraine headaches; Cinnarizine, an antihistamine and anti-vertigo medication; Clomipramine, prescribed for medium to severe OCD; and Insulin.
Among 8 million people diagnosed with diabetes in Iran, 65-year-old Ehteram, a patient of a friend who is a clinical pharmacist, has been on Insulin pen injectors for the past few years. However, her medical device could not be found for 10 days, forcing her physician to change her medication to a vial dosage form. Instead of painless, easy to administer shots with fewer adverse effects, she had to use a syringe and two different types of vials. Living alone in her tiny apartment in downtown Tehran, it took only two days until she was rushed into the hospital with progressive loss of consciousness because of unintentionally administering too much Insulin. Though Ehteram survived the completely avoidable ordeal, she lost her eyesight and both legs.
According to a local pharmacist, the inability of Iranian companies to import drug coating materials is another barrier. Additionally, U.S. sanctions prevent Iranian manufacturers from repairing or replacing drug-production equipment when it breaks down.
Historically, economic sanctions, which are a form of economic warfare, have been a pathway to major conflict and even full-scale war in Iraq, Syria, and Libya. There is no remaining doubt that quiet — but no less deadly — war against civilians in Iran is proceeding as a result of Trump’s failed policies.
In a just and democratic society, we have a responsibility to keep our politicians and representatives accountable. While millions of Iranians will not be repaid for their lost health and lives, the opportunity to change the future of America’s relationship with Iran and its people does exist. Now is the time to end antagonistic and violent U.S. policies, abolish sanctions regimes, return to the nuclear deal, and take the diplomatic path toward multilateral peace agreements and development plans in the Middle East that truly benefit the human rights, health, and prosperity of ordinary people instead of the military-industrial complex.
Names have been changed to preserve subjects’ safety and anonymity.