“Even if an item is not under U.S. sanctions, banks and foreign vendors shy away from doing business with Iran because they’re afraid they could still fall afoul of the U.S. and lose access to the U.S. market,” says Adnan Mazarei, an Iran expert at the Peterson Institute for International Economics, a Washington think tank.
President Trump reimposed economic sanctions on Iran after he pulled the United States out of a 2015 international agreement limiting Iran’s nuclear activities. Trump said he did so in hopes that it would force Tehran to return to the negotiating table for a more stringent agreement halting Iran’s ballistic missile programs and support for violent proxy groups in the region, as well as its nuclear activities.
Although humanitarian items are supposed to be exempt from the sanctions, pharmacies, clinics, hospitals and their patients across Iran face growing shortages. Most imports of medicines or ingredients needed to manufacture local versions of drugs have halted. Meanwhile, imports of lifesaving medical equipment, such as lasers, X-ray machines and blood centrifuges remain under sanction because the United States considers them dual-use items that can be used for civilian and military purposes.
Iran experts say the sanctions have hit the economy hard overall but have been particularly devastating for those struggling to secure medicines. Even if people can find medicines, the country’s soaring inflation rate, last gauged at more than 40 percent, puts them beyond the reach of most Iranians, whose median monthly salary is around $1,200.2 Economists say many have taken second and third jobs to afford their prescriptions—if they can be found. Others have been forced to forgo treatments to avoid financial ruin.
A woman named Sarah, who declined to give her last name, told The Washington Post she must buy imported nutritional supplements for her elderly father, who suffers from macular degeneration, an age-related deterioration of the retina. Before the sanctions, she said, the supplements cost around $7. Once the sanctions kicked in last November, however, the supplements disappeared from many pharmacies and cost $70 where they could be found.
“All the prices have gone up,” she said, “and we can’t find many products anymore.”3
Muhammad Sahimi, an Iranian-born chemical engineering professor at University of Southern California, said a relative in Iran cannot find medicine for her multiple sclerosis at any price. Sahimi and his wife, an Iranian-educated medical doctor, are still in touch with medical colleagues in Iran.4
“Every single member of this network has been telling us the same thing: that the shortage of critical medicine is so severe that people are losing their lives,” he said.5
Without official statistics on how many Iranians have died from sanctions-related shortages of medicine, data on the number of people suffering from various diseases help define the scope of the shortage. According to Iranian health officials, 5.2 million Iranians have diabetes, more than 248,000 have cancer, and some 70,000 have Alzheimer’s disease. Another 23,000 suffer from thalassemia, a genetic blood disorder; 7,000 suffer from multiple sclerosis; and some 6,000 are registered AIDS patients, although experts believe that number is low.6
To help alleviate the medicinal shortages, the Trump administration could issue clearer guidelines to banks and vendors for handling humanitarian exports to the Islamic Republic, says Ariane Tabatabai, an Iran analyst at the RAND Corp., a Washington think tank. But the administration says that is Tehran’s problem, not Washington’s.
“The burden is not on the United States to identify the safe channels” for humanitarian exports to Iran, Brian Hook, the administration’s point man on Iran, told reporters at a briefing last November. “The burden is on the Iranian regime to create a financial system that complies with international banking standards to facilitate the provision of humanitarian goods and assistance.”7
But Tabatabai and others point out that the administration used the threat of sanctions to quash a European plan to activate just such a channel—a so-called special purpose vehicle—that the Europeans created to use barter rather than dollar transfers to facilitate humanitarian trade with Iran. The Trump administration said the vehicle could undercut the effectiveness of sanctions, not only on Iran, but on other countries in the future. Facing U.S. sanctions on them, the Europeans backed away from their plan.
In a later briefing, Hook lashed out at Iranian officials for portraying the administration’s exemptions for medicines as disingenuous. “The regime’s attempts to mischaracterize these humanitarian exemptions are a pathetic effort to distract from its own corruption and mismanagement,” he said. “The regime has enough money to invest in its own people.”8
Nevertheless, the sanctions have fostered deep resentment toward Washington among ordinary Iranians, many of whom had expressed admiration for the United States after the U.S.-brokered 2015 nuclear accord lifted nuclear-related sanctions and allowed foreign goods to flow into Iran. Now, polls show, a majority blame the United States for seeking to prevent humanitarian products from reaching Iran.9
“It’s remarkable how poisoned public opinion has become in Iran toward the United States,” says Esfandyar Batmanghelidj, an economist and publisher of Bourse & Bazaar, a London-based Iranian business magazine. “My big concern is that the United States may not be able to repair its image in Iran at the end of this episode. I don’t think there’s an awareness in Washington of how detrimental it is to take a population that admired the U.S. and then tarnish America’s image to no obvious end. That’s the political impact that Washington needs to worry about.”
—Jonathan Broder
1 Somayeh Malekian, “As US sanctions hit Iran, residents complain of medicine shortages,” ABC News, June 25, 2019, https://tinyurl.com/yxwke2lx.
2 “Average salary in Iran 2019,” Salaryexplorer.com, undated, https://tinyurl.com/y59s47q6.
3 Erin Cunningham, “Fresh sanctions on Iran are already choking off medicine imports, economists say,” The Washington Post, Nov. 17, 2018, https://tinyurl.com/y7b4ejx4.
4 Muhammad Sahimi, “Economic Sanctions will Kill Tens of Thousands of Innocent Iranians,” Lobelog.com, July 30, 2019, https://tinyurl.com/y3aqttoc.
5 Ibid.
6 “Concerning statistics of diabetics in Iran,” Khabaronline.ir, Jan. 1, 2019, https://tinyurl.com/y5cglst6; “Iran, Islamic Republic of,” International Agency for Research on Cancer, World Health Organization, 2018, https://tinyurl.com/y5h5gsvf; “70,000 people in Iran have Alzheimer’s,” BBC Persian Service, May 6, 2018, https://tinyurl.com/yydqjomc; “Thalassemia Patients at Passage of Suffering and Hope,” Islamic Republic News Agency, May 1, 2019, https://tinyurl.com/yysmp7bn; “MS Statistics in Iran,” alef.ir, June 1, 2019, https://tinyurl.com/yxd4kcaq; and “The latest AIDS statistics in Iran and the world,” Shahid Beheshti Medical Sciences Agency, Nov. 5, 2018, https://tinyurl.com/y4xtyko7.
7 Cunningham, op. cit.
8 Ibid.
9 “Iranian Public Opinion under ‘Maximum Pressure,’ ” Question No. 8, Center for International and Security Studies at Maryland, Oct. 1-8, 2019, https://tinyurl.com/y3n48t8a.
The war ended in 1988 after a U.S. warship shot down an Iranian civilian airliner over the gulf, killing all 290 people aboard.44 Exhausted after eight years of fighting and convinced the airliner downing signaled the U.S.’ entry into the conflict, Khomeini accepted a U.N-brokered ceasefire, ending the war he had pledged to wage until Iran’s total victory.
After Khomeini’s death in 1989, hard-liner Ayatollah Ali Khamenei ascended to the supreme leader’s post, and moderates Akbar Hashemi Rafsanjani and Mohammad Khatami served as president from 1989 to 2005. The two presidents allowed Iranians more freedoms and improved relations with other countries, including the United States.
In 1995, Democratic President Bill Clinton