Philadelphia – It’s not every day that an American physician gets asked to function as an international pharmaceutical supplier, but for some, it’s becoming a regular occurrence.
A doctor I know told of a patient getting ready for a trip to Istanbul, where he would connect with Iranian friends. The patient asked for a prescription for a diabetes medication, “The most you can write for,” he said. The doctor was puzzled: his patient did not carry a diabetes diagnosis. “It’s for my mother,” came the response. “It’s getting very difficult to find this medicine in Iran, and she’s going to run out soon.”
Healthcare professionals report acquaintances, family of family, and others recently approaching and asking for all sorts of medical supplies, ranging from anti-maceration medications for the bedridden, to insulin pumps.
Reading the news in the comfort of my home, I’ve come across more troubling stories — patients dying from shortages of needed medication, or waiting years for organ transplants only to find themselves without the medication needed to prevent rejection of the donor organ.
Why are the people of Iran in the midst of a medicine shortage?
In 2010, then-Secretary of State Hillary Clinton stated that the United States had begun discussions with allies regarding methods of “pressure and sanctions” to counter Iran’s nuclear program, emphasizing that the goal was to stop the Islamic regime without harming innocent civilians. Specifically, she said the U.S. government’s aim was “to pressure the Iranian government … without contributing to the suffering of ordinary [Iranians].”
More recently, David Cohen, Undersecretary for Terrorism and Financial Intelligence at the U.S. Treasury Department, made similar comments, saying that “we have no quarrel with the people of Iran” and that “the ultimate objective is to try and slow down the development of Iran’s nuclear program … not to make food and medicine scarce.”
In clinical medicine, design and implementation of interventions, ostensibly in the service of improving care, is a common undertaking; when we see that an intervention is not achieving its stated goals, or in fact harming patients, substantial corrective action is indicated, even if it means abandonment of the intervention altogether.
In this vein, how do the intended effects of sanctions imposed on Iran by the U.S. government and others compare with the actual effects?
The value of Iran’s rial has plunged, and its economy is in shambles; Iran’s nuclear program, on the other hand, is alive and well. Vice President Joe Biden practically bragged of the economy-crippling effects of the latest round of sanctions during last year’s vice presidential debate, even as his Secretary of Defense acknowledged that despite U.S. efforts, Tehran remained intent on advancing its nuclear program. Indeed, the IAEA’s latest report shows that if anything, Iran is likely expanding its enrichment capacity.
Iran’s civilians, however, find themselves in the midst of one of the worst medical supply shortages in the nation’s long history.
Several prominent health professionals within Iran have called attention to the plight of vulnerable patients as a result of the sanctions. Ahmad Ghavidel, head of the Iranian Hemophilia Society, a nongovernmental organization that assists some 8000 patients, characterized the situation as “a blatant hostage-taking of the most vulnerable people.” Fatemeh Hashemi, of the Charity Foundation for Special Diseases, has publicly voiced concerns about impaired access to life-saving treatments for patients with multiple sclerosis, cancer, end-stage renal disease and other illnesses, as a result of the sanctions.
Many diseases such as hemophilia require advanced medicines that are simply not available in Iran for a variety of reasons including patent laws and access to specialized raw materials and technology for manufacture — such medications and materials have to be imported, mainly from Western nations.
While the U.S. government states that there are exemptions for food, medicine and remittances, the timely receipt of the right quantity of medicines is not as simple as submitting a request to the Treasury Department. A Wilson Center report found that it is the sanctions affecting the majority of large Iranian banks (and the international and US-based banking institutions that would do business with them) that have most affected the availability of medicines for purchase and use.
“Iran’s own mismanagement of the situation has aggravated the problem, but it is not the root cause of it,” the authors stressed. “While the list of issues leading to the supply crunch is long and complicated, at the heart of it all are the obstacles that sanctions have created in denying Iran the necessary banking operations and limiting its access to hard currency.” Simply put, “the pronounced role of sanctions in creating shortages of life-saving medical supplies and drugs in Iran may have been unintentional, but it is also irrefutable.”
The report goes on to say that the main beneficiaries of the sanctions have been Iranian government-owned businesses, which often get preferential access to currency, as well as smugglers and black market dealers who are buying up medicines and selling them (or knockoffs of them) to civilians with high markups.
Others are now beginning speaking out. Ahmad Shaheed, the United Nations special rapporteur for human rights in Iran, who has been vilified by the Iranian government for his investigations, feels that sanctions could “absolutely” worsen the human rights situation in Iran. In a situation where shortages of medical supplies are created, he said, “the most vulnerable people suffer immediately, and over the long term there is wider suffering caused.”
As a citizen, I wonder how this is accomplishing the stated objective of the U.S. government to pressure the Iranian regime while preventing the suffering of Iranian people. As a clinician, an Iranian-American, and most importantly a human being, I am wondering when substantive corrective actions are going to be taken by our government to modify the sanctions (the recommendations of the Wilson Center report are a good start) and attempt to alleviate the harm done to innocent civilians.
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