Patients in Iran are left without protection due to Trump's sanctions, inflation and the collapse of the economy

When Sima, 35 years old, entered a pharmacy in Tehran, her eyes scanned the shelves behind the counter in search of the medicine that would protect her kidneys from failure. Without her, time was running out. Finally, she found the medicine in the seventh pharmacy she visited, which was located in an upscale neighborhood in Tehran.

But her relief faded when the pharmacist told her that the price had risen again, leaving her with no choice but to reduce the prescribed doses of this life-saving medication. In light of the US sanctions that are strangling the Iranian economy, ordinary citizens - who suffer from chronic and serious diseases - face great difficulties in finding the medicines they depend on to survive.

In the face of severe shortages and daily increases in prices, many - like Sima - were forced to reduce doses, postpone doctor visits, or resort to self-treatment. Sima, who did not reveal her real name to Ofoq News so that she could speak freely, said: “They have stopped using cancer drugs for patients who are classified as being in the late stages or terminally ill; their use is now limited to those who are in the very early stages of the disease.”

In Tehran, a mother who lost her only daughter had to replace her depression medication with a locally produced, less effective one. Seasonal influenza vaccination campaigns were also canceled this year after the government failed to import vaccines from Europe, while cancer patients are forced to sell televisions and refrigerators in their homes to buy medicines at exorbitant prices.

A 55-year-old cancer patient - who preferred to remain anonymous - said that her options were also running out. The patient, who lives in Tehran, told Ofoq News Network : “I have asked visitors or those returning from abroad to bring my medications with them, especially those that we do not find here or cannot obtain.

“Suffering from illness and the uncertainty associated with the war, I find it very difficult to know what I should do.” Pharmacies in Iran contacted by Ofek News confirmed that there were shortages and price hikes across multiple categories of medications, including heart medications that are now sold as local brands (generic alternatives) instead of the original prescription brands, cholesterol-lowering tablets that are available but at much higher prices, and migraine medications that have completely disappeared from pharmacy shelves.

However, Iranian media reports indicate that the shortage crisis is much broader, affecting everything from antidepressants to insulin and pregnancy medications. There are other medicines that have become completely impossible to obtain, leaving patients in Iran with two choices: either pay very high prices or use less effective local alternatives.

The shortage affected nearly 800 pharmaceutical items, according to Shahram Kalantari, head of the Iranian Pharmacists Association, in a press conference held last month, as pharmacies were unable to provide alternatives due to high costs. The cancer patient added in a phone call: “Everyone says we are brave, but I don’t know if courage means anything when one is facing death.”

Debt Accumulation Mehdi Pir Salehi, head of Iran's Food and Drug Organization, said in February that Iran currently manufactures more than 97% of its pharmaceutical needs by volume. Imported specialty medicines - which require payment in hard currency - are the most affected by this situation.

Shortages of these drugs have worsened under US President Donald Trump's "maximum pressure" campaign, which has tightened controls on Iranian banks and disrupted oil exports, the Islamic Republic's main source of hard currency. “This high level of local production does not necessarily mean achieving complete self-sufficiency, as local manufacturing still depends on imported materials, equipment and technologies, while some specialized and high-cost medicines must be imported,” says Bevand Bastani, a senior lecturer at Flinders University and co-author of research examining the impact of sanctions on drug purchases in Iran.

According to Iranian officials, pharmacies are unable to replenish their drug stocks because insurance companies have stopped paying their dues. Although millions of Iranians have insurance coverage, submitting an insurance-covered prescription at a pharmacy is often ineffective, or the patient is forced to pay the cost out of pocket.

Rampant inflation, the collapse of insurance payments, and the government's inability to sell oil and obtain the hard currency needed to pay pharmacies have fractured the supply chain. In a press conference held last month, officials at the Iranian Pharmacists Association stated that more than 18,000 private pharmacies across the country are currently waiting to receive their dues from insurance companies, as insurance debts owed to pharmacies amounted to approximately 800 trillion rials (equivalent to $300 million).

War Devastation Mohammad Hashemi, spokesman for Iran's Food and Drug Administration, told Iranian state media in June that US and Israeli air strikes on Iran earlier this year damaged more than 40 pharmaceutical companies, equipment suppliers and distributors. In late March, Israel bombed a factory for a major Iranian pharmaceutical company called Tawfiq Daro, which produced the active ingredients for cancer drugs and medical drugs.

The Israeli army claimed that the company supplied “fentanyl” to an Iranian party conducting “research and development of chemical weapons,” which the company denied. The air strikes also damaged the historic Pasteur Institute, which was founded more than a century ago.

The Lancet medical journal reported that the attacks destroyed “vital reference laboratories, including those specialized in genomic surveillance, rabies, HIV/AIDS, viral hepatitis, and vector-borne diseases.” Last month, US Treasury Secretary Scott Besent announced that the United States would tighten its measures against the complex network that Iran has built over the years to enable its entities to circumvent wide-ranging US sanctions. This is a step aimed at increasing pressure on Iran in the absence of a diplomatic solution.

Washington has permitted transactions involving “agricultural goods, food, medicines, or medical devices destined for Iran,” but has added some safeguards to ensure that the Iranian regime does not “divert these goods to finance its malicious purposes.” In 2019, the United States imposed sanctions on the Central Bank of Iran, and has since asked foreign governments and institutions seeking to secure payment channels to voluntarily provide Washington with more information about any pharmaceutical shipment destined for Iran, including details of the buyer and a written pledge not to resell the shipment to any individual or entity subject to sanctions.

Last week, the US administration tightened the rules regarding other licenses, adopting a position of “presumptive denial” towards some types of licenses, and announcing that applications would be reviewed on a case-by-case basis. Experts say these arduous bureaucratic procedures have discouraged international companies from doing business with Iran.

Although leading Iranian pharmaceutical companies are not subject to sanctions themselves, many of these largest companies are linked to charitable groups or sanctioned individuals. For example, Barakat Pharmaceutical Group — one of the country's largest pharmaceutical manufacturers and leading efforts to produce a COVID-19 vaccine domestically — is linked to the Imam Khomeini Implementation Authority, a sanctioned body that reports directly to the Supreme Leader.

“Over-compliance” is another problem, noted Eric Ferrari, founder of a Washington, D.C., firm that specializes in sanctions and enforcement issues. Banks or trading partners may view a transaction as too high a risk. “Even if you can identify non-sanctioned parties and intermediaries, you still have to find banks that are willing to complete transactions, facilitate trade and bear the risks,” Ferrari told Ufoq News.

“The banks might say: ‘We don’t really know who the actors are in Iran, or how the money is going to move, or where it’s coming from, so let’s avoid this deal.’” Iran has been negotiating with the United States to release some of the funds held in Qatar for humanitarian purposes.

However, those talks have faltered, as Tehran is currently focusing on negotiating the future of the Strait of Hormuz, while Washington has returned to focusing on the diplomatic track. Ferrari noted: “It is getting more difficult day by day.

“In fact, I am very surprised that the Iranians have been able to hold out this long, given how harsh the sanctions regime is.”