Iranians forced to fight for life-saving medications amidst sanctions chaos

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As a child patient during Iran’s war with Iraq in the 1980s, Younes Arab got used to undergoing hospital treatment while the missiles rained down outside. Today, he said, anyone suffering from a serious illness in Iran faced an even bigger threat, as the country endured a dire shortage of life-saving medicines.“The war we’re in right now is much harder,” said Arab, who heads the Iranian Thalassaemia Society, which represent those with the blood disorder. “Innocent people are dying, not because of injuries, but because sanctions have choked off their medicine supply.”The ITS said some 1,100 thalassaemia patients have died due to a lack of drugs access since 2018, when then-US president Donald Trump withdrew from the 2015 nuclear deal that Iran had signed with world powers and reinstated economic sanctions. About 280 patients died last year alone, it said, compared with average annual mortality from the disease of fewer than 30 before 2018.Parliament’s health committee warned in April that Iran faced shortages of more than 200 medicines, while others put the figure at 300. Pharmacists say treatments for cancer, immunodeficiency disorders, multiple sclerosis, haemophilia and mental illnesses are particularly scarce. New president Masoud Pezeshkian, a practising heart surgeon, seized on the issue during the election campaign, saying he would not “talk slogans that would leave the Iranian people vulnerable to medicine sanctions”.Pezeshkian, the first reformist president of the Islamic Republic in two decades who was sworn in on July 30, told local media that the sanctions had inflicted “untold suffering, death and destruction on the Iranian people”.His proposed health minister, Mohammad-Reza Zafarghandi, who has promised to tackle the health sector’s huge problems, is struggling to get a vote of confidence this week from a hardline parliament that has cast doubt on his loyalty to the theocracy. He told lawmakers on Sunday that fixing the medication shortage was a top priority, so patients “will have no worries other than dealing with the suffering evoked by an illness”.Younes Arab, head of the Iranian Thalassaemia Society, says domestically produced treatments have serious side effects © Thalassemia SocietyIranians blame the medicines crisis both on sanctions and domestic mismanagement, analysts say. Tehran and Washington both deny sanctions are hitting drug supplies. The Islamic Republic, which subsidises medicine imports, is keen to avoid panic and says Iran’s pharmaceutical needs are almost entirely met by domestic producers, while the US maintains that food and medicine are exempt from the restrictions. But patients and doctors say the sanctions have dramatically increased costs and the risk to patients, as measures targeting Iran’s oil exports and banking transactions limit its ability to pay foreign suppliers. Many also argue that the US humanitarian exemptions exist only on paper. “All this is a big lie. They use any political incident anywhere in the world as an alibi to delay the delivery of drugs,” Arab said. “The Swiss brand supplier of thalassaemia medicine only accepts payments in select currencies (which Iran can no longer access) and then takes months to fulfil the order. Many companies even refuse to deal with Iran for fear of US punitive measures.” A thalassaemia patient receives treatment in an Iranian clinic. Health experts warn that drug shortages are putting sufferers’ lives at risk © Thalassemia SocietyHundreds of thalassaemia patients filed a lawsuit against the US government in a Tehran court in May, alleging “unfair sanctions” had obstructed their access to medicines.Iran has also been unable to access $6bn in Iranian assets earmarked for humanitarian use, which were unfrozen and transferred to Qatar after a prisoner swap deal between Washington and Tehran last year. The US has held up approval of transfers to Tehran because of Iran’s support for Hamas following the outbreak of the militant group’s war with Israel last October. The Iranian government insists the country can produce enough pharmaceuticals for 99 per cent of its needs. “There are difficulties in procuring the remaining one per cent due to sanctions, but we manage to ensure a consistent supply,” Iran’s deputy health minister Heidar Mohammadi told journalists last year. But Arab said a fifth of the 23,000 Iranians with thalassaemia were at risk of dying because foreign drugs had run out. Those treated with Iranian products were suffering “a gradual, painful death” because of side effects, he alleged. Iran’s Food and Drug Administration denies domestically produced therapies are inferior, saying they meet international standards.Iranians collect prescription medication from a Tehran pharmacy. Iran subsidises medicines but many patients face ruinous costs © Ata Kenare/AFP via Getty ImagesIran has traditionally relied on European medical imports, but the scarcity has created a market for substandard foreign products, say industry professionals. “We prefer to produce drugs domestically rather than import poor-quality Chinese or Indian alternatives,” Arab said. “India has good medicines, but some Indian cancer drugs ending up in Iran are of poor quality,” Yasha Makhdoumi, president of the Iranian Society of Radiation Oncology (ISRO), a Tehran-based NGO, told the Financial Times. Cancer services are free or cheap in public hospitals but patients have to pay part of the cost for diagnostics and treatment. Some patients and doctors also continue to seek reliable foreign pharmaceuticals that are largely only available on the black market at exorbitant prices or in expensive private clinics. But with inflation hovering around 40 per cent for years, a depreciating rial that has pushed up the price of imports and widespread poverty, many patients and their families face ruinous costs. Breast cancer treatment costs around $17,000 in private clinics — and more if newer foreign therapies are used — say health professionals. The annual minimum wage in Iran is about $2,000. “When sanctions prevent foreign pharmaceutical companies from setting up offices in Iran, (unofficial) brokers selling at inflated prices take over,” said Ali Motlagh, former head of the health ministry’s cancer department. Physicians were also unable to guarantee the authenticity of illegally procured drugs, he added. Critics also point the finger at government mismanagement. “We shouldn’t hide behind sanctions all the time. It’s true they have impeded banking transactions, but we should have worked harder to facilitate the import of essential medicine and technologies,” Motlagh told the FT. But they pin most of the blame on sanctions. Apart from the immediate impact on imports, there are concerns about the broader consequences for Iran’s health sector. Motlagh cited the impact on foreign investment. “After the nuclear deal, international firms planned to build cancer centres and hospitals in Iran. Those plans fell apart, and so did our chance for education and research.” Sanctions had also curtailed interaction with global peers, said Makhdoumi. “They prevent us from keeping up with advances in treatment. We also have few opportunities to attend international conferences.”Arab added: “Sanctions never hurt politicians, but they harm ordinary Iranians and patients . . . These sanctions are a weapon of mass destruction without the world really paying any attention.”