Voices from the Middle East: Doctors, COVID-19 Patients and Dilemmas of Treatment under Sanctions in Iran

Sima Shakhsari, a professor at the University of Minnesota, conducted this interview on April 2, 2020 with two pediatricians in Iran. Dr. Sahar M. works at a hospital in Ahwaz and Dr. Bahar M. works at a small provincial hospital. Both were educated in Iran. Their experiences highlight the hardships that medical personnel are currently facing due to US sanctions on Iran, which the coronavirus pandemic has amplified.

Even before the pandemic, however, the sanctions had devastating effects on the lives of ordinary Iranians, while doing little to change the Iranian government’s foreign policy or to drag it to the negotiating table after the Trump administration withdrew from the nuclear deal (JCPOA) in 2018. The Iranian state’s home-grown oil refining industries, built in response to the sanctions, have resulted in unprecedented air pollution and high rates of cancer. Limited access under sanctions to life-saving medicine, such as chemotherapy, has subjected many Iranian people to a slow death. This interview was edited for clarity.

Q: How have the US sanctions affected your work as doctors in Iranian hospitals? How has the coronavirus pandemic changed that?

Sahar: In my experience, the lack or shortage of necessary hospital equipment and drugs is the most disturbing problem that we are facing after the sanctions were imposed. It leads to less effective treatment for our patients and it puts them at risk of many side effects. When you have restricted access to medicine, you have to make difficult choices for treating patients from a limited pool of available drugs. You cannot choose the best option, but have to go with what is available. And that is not something that any physician likes to confront. You want to do the best for your patients, but under the sanctions that is impossible. You know the disease, you know the treatment, but you do not have the drugs you need for that treatment. This is devastating for us and for our patients.

After the coronavirus outbreak, the number of people who need critical care has increased very quickly. Treating a coronavirus patient in critical care requires a lot of equipment, such as ventilators for respiratory support, which are not readily available in our hospitals because of the sanctions. Even if we have some ventilators (purchased before the sanctions), these machines need many special connectors, tubes and monitors to work properly.

Bahar: We have the same problem—ventilator tubes and connectors, which hospitals elsewhere in the world can find easily, are not available to us because of the sanctions. We are supposed to use disposable ventilator parts once, but because we have limited supplies, we have been disinfecting and using them three times, which increases the chance of spreading infections. And we only have access to low quality imports from China and India that are not the best choices for treatment.

We have the same dilemma with medicine. For example, chemotherapy medicine is really hard to find, and the brands imported from China and India cause many more side effects (such as nausea). The better brands are only available on the black market—that is if you can find and afford them. During the coronavirus pandemic, Oseltamivir—an antiviral medication for treating and preventing influenza A and B—is also given to coronavirus patients. But it is not available in the syrup form in Iran. For small children who cannot take pills or capsules, we have to dissolve the capsule in water instead.

The US sanctions have not been relaxed after the pandemic. To the contrary, things have gotten worse. For example, now the Ministry of Health has told us that Oseltamivir is not a part of the treatment. But in our conversations in my hospital, many doctors believe that we should give it to our patients. Many of us think that the reason they have eliminated this medicine from the treatment plan is most likely because the national reserve is low or depleted. Another example is Kaletra, an antiviral medicine that is given to HIV patients. We have been giving this drug to coronavirus patients in critical condition. Now Kaletra is very hard to find because of the pandemic. This jeopardizes the health of HIV patients who need the medicine and who can access it even less than before.

Q: Has the World Health Organization (WHO) shipment of medicine and kits alleviated the situation?

Sahar: Well these shipments can help, but they are not enough. We have so many sick people here, and a very restricted supply of drugs. For now at my hospital we have enough beds, nurses and personal protective equipment (PPE), but we are lacking medicine and equipment. Shipments here or there can help, but they are temporary solutions. The Ministry of Health should be able to buy the necessary drugs and supply hospitals all over the country. This can only be done after the sanctions are lifted. Mosques and charity organizations around Iran are doing what they can to help, for example, by cooking and delivering food and juice to hospital staff.

Bahar: I am not sure if the WHO shipment has reached other hospitals, and if so, how it has been distributed.

I can tell you that our hospital in a small province did not receive any of it even though we get coronavirus patients every day. Our hospital was able to provide PPE for the staff only with the support of individual donations from civilians. But that supply will run out in a couple of months. I have heard from colleagues in other hospitals that individuals and charity organizations are sewing cloth masks and selling or donating them to hospitals. But cloth masks are not safe because they can’t stop virus particles and so do not adequately protect the hospital personnel. The N-95 masks are hard to find and their price has increased significantly.

Q: What kind of support is needed at this point?  

Sahar: Lifting the sanctions would be the best support at this time. If drugs and medical equipment are sold to our Ministry of Health, they can supply our hospitals and we can take better care of our patients.

Bahar: What is really needed is an end to the sanctions so that we can access equipment such as ventilators and medicine. At this point, the sanctions have deteriorated the economic situation to the point that I am not even sure that if the sanctions are lifted, the Iranian government would have the ability to import medicine and equipment. It’s a bleak future.