Trump’s sanctions, inflation and a collapsing economy leaves Iran’s sick exposed

By Mostafa Salem, Leila Gharagozlou, Aida Karimi, CNN

(CNN) — When 35-year-old Sima walked into a Tehran pharmacy, her eyes raced across the shelves behind the counter, searching for the box that would keep her kidneys from failing. Without it, she was running out of time.

She finally found the medication in the seventh pharmacy she visited, in a wealthy Tehran neighborhood. Her relief faded when the pharmacist told her that the price had once again gone up, leaving her with no choice but to underdose the lifesaving medication.

As US sanctions suffocate Iran’s economy, ordinary people with chronic conditions and serious illnesses are struggling to find the medicine they depend on to survive. With severe shortages and daily price increases, many, like Sima, have been forced to cut doses, postpone doctor visits or self-medicate.

“They’ve stopped using cancer medication for people who they say are terminal or far along,” said Sima, who did not give CNN her real name so she could speak freely. “They only use it for those who are in the very early stages.”

A mother in Tehran who lost her only daughter has been forced to change her antidepressant medication to a less effective locally produced version. Seasonal flu vaccinations have been called off this year after the government failed to procure them from Europe. Cancer patients are selling their televisions and refrigerators to buy overpriced medication.

A 55-year-old cancer patient, who asked to remain anonymous, said she, too, is running out of options.

“I’ve asked if people who come visit or come back from abroad can bring my medicine back, especially the things we can’t find here or get access, too,” the patient, who lives in Tehran, told CNN. “Between the illness and uncertainty of the war I have a hard time knowing what to do.”

Pharmacies in Iran contacted by CNN confirmed shortages and price increases across several categories, including heart medication, which is now offered as a local generic rather than the prescribed brand, cholesterol-lowering pills, which are available but far more expensive, and migraine drugs, which have completely vanished from shop shelves.

Iran media reports, however, suggest the shortages are far more wide-reaching, affecting everything from antidepressants to insulin and pregnancy medications. Other drugs are completely unobtainable, leaving Iran’s sick facing astronomically higher prices or a less effective generic version.

The shortages have affected almost 800 medications, the head of the Iranian Pharmacists Association Shahram Kalantari told a press conference last month, with pharmacies unable to procure alternatives due to the rising costs.

“Everyone says we’re brave,” the cancer patient added in a telephone call. “But I don’t know if being brave means anything when you’re dying.”

Mounting debt

Iran now manufactures more than 97% of its medicines by volume, Mehdi Pirsalehi, head of the country’s Food and Drug Organization, said in February. Hardest hit are imported specialty drugs that must be paid for in foreign currency. Shortages of these drugs have grown under US President Donald Trump’s maximum-pressure campaign, which has intensified scrutiny of Iran’s banks and impeded exports of oil – the main source of the foreign currency for the Islamic Republic.

“This high level of domestic production does not necessarily mean complete self-sufficiency,” said Peivand Bastani, Senior Lecturer at Flinders University and co-author of research examining the effects of sanctions on pharmaceutical procurement in Iran. “Local manufacturing can still depend on imported materials, equipment and technology, while some specialized and high-cost medicines must be imported.”

Pharmacies cannot replenish their inventories because insurance companies have stopped paying them, according to Iranian officials. With millions of Iranians covered by insurance, presenting an insured prescription at a pharmacy usually produces nothing, or requires the patient to pay out-of-pocket.

Rampant inflation, the collapse of insurance payments, and the government’s inability to sell oil and obtain the foreign currency needed to repay pharmacies have fractured the supply chain.

More than 18,000 private pharmacies across the country are now waiting to get paid by insurance companies, officials from Iran’s Pharmacists Association said at a news conference last month, with insurance debts owed to pharmacies reaching almost 800 trillion rials ($300 million)

“These pharmacies can no longer afford to continue investing their own capital and then wait a year to receive their outstanding payments,” the head of the association, Shahram Kalantari, said at the time.

War destruction

US and Israeli airstrikes on Iran earlier this year damaged more than 40 pharmaceutical companies, equipment suppliers and distributors, the spokesman for Iran’s Food and Drug Administration, Mohammad Hashemi, told Iranian state-affiliated media in June.

In late March, Israel struck the factory of a major Iranian pharmaceutical company, Tofigh Daru, which produced active ingredients for anticancer drugs and anesthetics. The Israeli military claimed the company provided fentanyl to an Iranian entity conducting “research and development of chemical weapons” – something the company denied.

Airstrikes also damaged the historic Pasteur Institute, founded more than a century ago. The Lancet, a medical journal, reported that the attacks had flattened “crucial reference laboratories, including those for genomic surveillance, rabies, HIV/AIDS, viral hepatitis, and vector-borne diseases.”

Last month, US Treasury Secretary Scott Bessent announced that the US would clamp down on the complex network built by Iran over years to allow its entities to evade Washington’s wide-ranging sanctions – a move designed to add pressure on Iran amid a lack of diplomatic resolution.

Washington has permitted transactions involving “agricultural commodities, food, medicine, or medical devices to Iran,” but have added some safeguards to ensure such goods are “not diverted by the Iranian regime to fund its nefarious purposes.”

In 2019, the US sanctioned Iran’s Central Bank and has since asked foreign governments and institutions seeking protection for payment channels to voluntarily send Washington more information regarding any shipment of medicine to Iran, including details on who is buying it and a written commitment that it will not be resold to a sanctioned individual or entity.

Last week, the US administration tightened the rules on other licenses, adopting a “presumed denial” stance on certain licenses and saying applications would be reviewed on a case-by-case basis.

Experts say the laborious bureaucratic process has discouraged international firms from doing business with Iran.

“Sanctions can obstruct financing and international payments, reduce the willingness of foreign banks and suppliers to engage with Iranian purchasers, and complicate the procurement and importation of medicines, pharmaceutical inputs and manufacturing technology” Bastani of Flinders University said.

Although Iran’s leading pharmaceutical firms are not themselves under sanctions, several of the largest are connected to sanctioned charitable conglomerates or to sanctioned individuals. For example, Barkat Pharmaceutical Group, one of the country’s biggest drug makers that led the nation’s vaccine production for Covid-19, is linked to the Execution of Imam Khomeini’s Order, a sanctioned body that answers directly to the Supreme Leader.

“Overcompliance” is another issue, said Erich Ferrari, founder of a Washington D.C firm focused on sanctions and enforcement. Banks or trade partners may view a transaction as simply too risky.

“Even if you can identify the parties and intermediaries that are not sanctioned, you still have to find banks that are willing to process the transactions and willing to process the trade and take the risk,” Ferrari told CNN. “Banks might say, ‘We don’t really know who’s who in Iran, how the funds will go, where the money is coming from, so let’s just not do the trade.’”

Iran was negotiating with the US to unfreeze some funds held in Qatar for humanitarian spending. Those talks have since stalled as Tehran focuses on negotiating the future of the Strait of Hormuz and Washington turns back to diplomacy.

“It’s getting harder day by day,” Ferrari said. “I’m actually pretty amazed that Iranians have been able to survive this long given how onerous the sanctions regime is.”

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