Washington has been clear from the beginning that its wide-ranging sanctions on Iran do not include medicine, medical devices, food, and agricultural commodities.
However, sanctions have hit the price of everything, from bread to vital medicines. Around a dozen patients, pharmacists, and carers who spoke to Rudaw English from inside Iran say the sanctions are having a direct and indirect impact on their medical bills.
“My father has suffered from asthma for 15 years and needs a new inhaler every month. But the inhaler he used to buy has totally disappeared from the market,” Rebwar Mohammadi, originally from the city of Sanandaj and now living in Paris, told Rudaw English.
Rebwar’s father Mohammad, 55, used to pay 50-100,000 tomans [$1 equals 12,000 tomans] for an inhaler before the US reimposed sanctions.
“My sister is a nurse, but there is nowhere to find the inhalers in Iran anymore,” Mohammadi said. “There is a place in Tehran called Naser Khosrow where you can find any drug, legal or illegal, but we could not find it there either.”
“These days in Naser Khosrow, you need to know people and have connections and deep pockets to be able to obtain what you need.”
The family obtained the inhalers from Sulaimani in the Kurdistan Region of northern Iraq, which has become a corridor to supply the medical needs of Iran. The inhalers were out of date, but better than nothing.
Mohammadi has sent at least 13 GlaxoSmithKline-made “Seretide 500” inhalers from France to his family in Sanandaj.
“I paid 60 euros for each one of them, a big sum in Iran,” Mohammadi told Rudaw English.
Despite the hardships placed on ordinary Iranians, Iran’s supreme leader Ayatollah Ali Khamenei is adamant Tehran can’t afford to back down in the face of relentless US pressure, which has left his country locked out of the international financial system and reduced its oil revenues to a trickle.
Ordinary Iranians are carrying the weight of sanctions. Those who work for the government enjoy state provided insurance, which lessens the burden. The armed forces, and in particular the Islamic Revolutionary Guard Corps (IRGC), receive the most generous insurance policy from the state.
Fear is palpable in Iran. Almost everyone who contributed to this report agreed to do so on condition of anonymity, allowing them to speak freely and avoid a visit from state security forces.
“I take seven kinds of drug. One is specifically for MS, which I take every day,” said Bahar Fatehi, a 30-year-old married woman in the western city of Mariwan. She was diagnosed with the disease eight months ago.
Bahar takes Fingolid, an Iranian version of Fingolimod, an immunomodulating drug used to treat MS. She takes a Fingolid capsule every night alongside six other tablets – a mixture of tranquilizers and vitamins.
Locally manufactured medication is provided by the state free of charge to patients who suffer from designated illnesses and conditions, including MS. However, patients often complain about the low quality of these medications, which can cause serious side effects.
“Eight months ago a pack of 30 capsules was 500,000 tomans [$40], but now because of the intensification of sanctions, they are asking for 1,250,000 tomans,” Bahar told Rudaw.
Although she receives the medication from the government free of charge, she must pay when there are shortages.
“If I don’t take the medication, it impacts my whole body. First I become breathless and then all my limbs become paralyzed,” Bahar said.
The medication she takes has side effects for her heart, kidneys, and circulation, but she cannot afford foreign variants.
Iran has a robust health sector and manufactures 97 percent of its needs.
“The shortages of drugs at this time in the country [impact] fewer than 20 items, while this time last year the medical shortages were nearly a three figure number,” said Mohammad Reza Shanasaz, the deputy minister of interior for food and medicine.
“The items that people mention as having a shortage are the foreign drugs, which of course have a locally manufactured version… We have no problem in meeting medicine demands and if the patients cannot find their medicines, they can call 1490 to be given the nearest pharmacy to where they live,” he added.
The deputy minister acknowledged the sanctions have made it difficult for Tehran to obtain pharmaceuticals from abroad.
“If the European mechanism [INSTEX] becomes operational, medicine will be the first priority for designating funds [to purchase], despite the [American] claims that food and medicine are exempted from the sanctions, [the process of] wiring money to obtain medicine” faces the same obstacle as other items, Shanasaz said.
Despite Tehran’s claims, the country is on the verge of a health crisis. Rudaw asked about the availability of medication for MS in five cities across Kurdistan, Kermanshah, West Azerbaijan, and even in a number of pharmacies in Tehran. It found the drugs are in seriously short supply.
Iraj Harirchi, the deputy minister of health, said earlier this month that economic hardship has forced around 30 percent of patients to buy their medicines over the counter without a prescription as people cannot afford to pay the physician fees.
US pressure also appears to have had a chilling effect on pharmaceutical suppliers in Iraqi Kurdistan.
“Kurdistan’s companies are being careful in exporting medicine to Iran,” Sheikh Mustafa Abdulrahman, head of the Union of Importers and Exporters of the Kurdistan Region of Iraq, told Rudaw English.
Medicine is exported in two ways, he said. One way is through partnerships between a Kurdish company and an Iranian company. Another is Iranian companies using the Kurdistan Region as a transit point.
“There are no accurate numbers on how much [medicine] is exported [to Iran], but there has been an increase,” said Abdulrahman. “Most traders deal in secret with Iran.”
Rudaw English contacted the US consulate in Erbil for comment on medicine shortages, but did not receive a response.
For Kamran Mohammadi, 28, who suffers from thalassemia major, the situation is far more serious as his body lacks the ability to produce normal, adult hemoglobin. As a result, he suffers severe anemia.
He needs blood transfusion once every 20-30 days. But before this he requires chelation therapy to reduce iron levels in his blood.
“I take Deferasirox [Osveral] to reduce the iron in my body,” said Mohammadi. “The one I consume is foreign-produced and it was easy to get it in the past. Even the government used to give it to us. But now it is in short supply.”
The medicine market is volatile, he said. Sometimes the drug is in short supply or unavailable.
“I am the lucky one because many people are from the low income group and cannot afford to buy the foreign drugs,” Mohammadi said. “The Iranian version is available but the foreign drug is much better.”
A one-month supply of the foreign drug costs 300,000 tomans. This is too much for many, he said.
The reason for short supply is partly the result of sanctions, but also the insistence of health officials in Iran on patients using Iranian-made drugs, despite problematic side effects, Mohammadi said.
“I know a family who have three children who are all suffering from thalassemia and they have to pay 9,000,000 tomans,” he said. “How can they afford that?”
Pharmacists and doctors who spoke to Rudaw warn there is a growing trend in Iran where economic hardship makes it difficult for average-income families to complete their treatment cycles or avoid visiting their GP to avoid extra costs. Criminal networks are cashing in on the demand.
As the sanctions bite deeper into the fabric of Iranian society, life becomes increasingly difficult for patients suffering from chronic diseases and conditions. For the time being, the Iranian government provides for some of their needs. But as state revenues dry up, the government may have to reduce its commitments.
US officials claim the sanctions do not target humanitarian goods and medicines, but people on the ground in Iran say otherwise.
“Even if you have the money, you can’t find the drugs,” Rebwar Mohammadi said. “It is a fact that this is a direct result of sanctions.”
Additional reporting by Adnan Naseri
