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

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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.”

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.

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“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)

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“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.

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.

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“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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35岁的西玛走进德黑兰一家药店，目光迅速扫过柜台后面的货架，寻找能阻止她肾衰竭的药盒。没有它，她的时间就不多了。

她终于在第七家药店找到了所需的药物，这家药店位于德黑兰一个富裕的街区。然而，当药剂师告诉她药价再次上涨，她别无选择，只能减少服用这种救命药的剂量时，她的欣慰之情顿时消失殆尽。

由于美国制裁重创伊朗经济，患有慢性病和重症的普通民众正艰难地寻找维持生命的必需药品。药品严重短缺，价格每日上涨，许多人，像西玛一样，被迫减少剂量、推迟就医或自行用药。

“他们已经停止对那些被他们称为晚期或病情很严重的患者使用抗癌药物了，”西玛说道，她没有向CNN透露自己的真实姓名，以便畅所欲言。“他们只对那些处于癌症早期阶段的患者使用这种药物。”

德黑兰一位痛失独生女的母亲被迫将抗抑郁药换成疗效较差的本地产药物。由于政府未能从欧洲采购到流感疫苗，今年的季节性流感疫苗接种活动已被取消。癌症患者不得不变卖电视机和冰箱来购买价格高昂的药品。

一位要求匿名的55岁癌症患者表示，她也正面临无药可医的困境。

“我问过来探望我或从国外回来的人，能不能帮我带些药回来，特别是那些我们在这里找不到或无法获得的药品，”这位住在德黑兰的病人告诉CNN。“疾病加上战争带来的不确定性，让我不知所措。”

CNN联系到的伊朗药店证实，多种药品出现短缺和价格上涨，包括心脏病药物（现在只能买到当地仿制药，而不是处方品牌）、降胆固醇药（虽然有售，但价格贵得多）以及偏头痛药物（已经完全从商店货架上消失了）。

然而，伊朗媒体报道称，药品短缺的范围远不止于此，从抗抑郁药到胰岛素和孕期用药，几乎无一幸免。其他一些药物则完全无法获得，导致伊朗患者要么面临天价药费，要么只能使用疗效较差的仿制药。

伊朗药剂师协会主席沙赫拉姆·卡兰塔里上个月在新闻发布会上表示，药品短缺已影响到近 800 种药物，由于价格上涨，药店无法采购替代品。

“大家都说我们很勇敢，”这位癌症患者在电话里补充道，“但我不知道，当你即将死去的时候，勇敢还有什么意义。”

伊朗食品药品组织负责人迈赫迪·皮尔萨莱希 (Mehdi Pirsalehi) 今年2月表示，伊朗目前97%以上的药品为国产。受影响最大的是必须以外币支付的进口特种药品。在美国总统唐纳德·特朗普的极限施压政策下，这些药品的短缺问题日益严重。该政策加强了对伊朗银行的审查，并阻碍了石油出口——石油是伊朗的主要外汇来源。

马吉德·阿斯加里普尔/瓦纳通讯社/路透社

“国内生产水平如此之高并不一定意味着完全自给自足，”弗林德斯大学高级讲师、研究制裁对伊朗药品采购影响的论文合著者佩万德·巴斯塔尼表示，“本地生产仍然可能依赖进口原材料、设备和技术，而一些特殊且价格昂贵的药品则必须进口。”

据伊朗官员称，由于保险公司停止支付费用，药店无法补充库存。数百万伊朗人享有医疗保险，但即使出示医保处方，患者通常也无法在药店取到药，或者需要自费。

恶性通货膨胀、保险支付崩溃以及政府无力出售石油并获得偿还药店所需的外汇，导致供应链断裂。

伊朗药剂师协会官员上个月在新闻发布会上表示，全国有超过18000家私人药店正在等待保险公司付款，保险公司拖欠药店的款项总额接近800万亿里亚尔（约合3亿美元）。

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联合国报告指出，美国对伊朗学校的致命袭击可能构成战争罪。

“这些药店再也负担不起继续投入自有资金，然后等待一年才能收到拖欠的款项了，”该协会负责人沙赫拉姆·卡兰塔里当时表示。

伊朗食品药品监督管理局发言人穆罕默德·哈希米在6月份告诉伊朗官方媒体，今年早些时候，美国和以色列对伊朗的空袭破坏了40多家制药公司、设备供应商和分销商。

3月下旬，以色列袭击了伊朗一家大型制药公司托菲格·达鲁（Tofigh Daru）的工厂，该公司生产抗癌药物和麻醉剂的活性成分。以色列军方声称该公司向一家从事“化学武器研发”的伊朗实体提供了芬太尼，但该公司否认了这一指控。

空袭还破坏了拥有百年历史的巴斯德研究所。《柳叶刀》医学期刊报道称，袭击摧毁了“重要的参考实验室，包括基因组监测、狂犬病、艾滋病毒/艾滋病、病毒性肝炎和虫媒传染病实验室”。

上个月，美国财政部长斯科特·贝森特宣布，美国将严厉打击伊朗多年来建立的复杂网络，该网络允许伊朗的实体规避华盛顿的广泛制裁——此举旨在外交解决不力的情况下向伊朗施加压力。

华盛顿允许向伊朗进行涉及“农产品、食品、药品或医疗器械”的交易，但增加了一些保障措施，以确保这些货物“不会被伊朗政权挪用，用于资助其邪恶目的”。

2019 年，美国制裁了伊朗中央银行，此后要求寻求支付渠道保护的外国政府和机构自愿向华盛顿提供有关任何向伊朗运送药品的更多信息，包括购买者的详细信息以及不会将药品转售给受制裁个人或实体的书面承诺。

上周，美国政府收紧了其他许可证的审批规则，对某些许可证采取了“推定拒绝”的态度，并表示将逐案审查申请。

专家表示，繁琐的官僚程序阻碍了国际公司与伊朗开展业务。

弗林德斯大学的巴斯塔尼表示：“制裁会阻碍融资和国际支付，降低外国银行和供应商与伊朗买家合作的意愿，并使药品、医药原料和制造技术的采购和进口变得更加复杂。”

尽管伊朗主要的制药公司本身并未受到制裁，但其中一些规模最大的公司却与受制裁的慈善集团或个人存在关联。例如，巴尔卡特制药集团是伊朗最大的制药企业之一，曾主导该国新冠疫苗的生产，而该集团与“执行霍梅尼命令”组织有关联，该组织是受制裁机构，直接向最高领袖负责。

伊利亚·叶菲莫维奇/法新社/盖蒂图片社

这些以色列人想飞回国投票。内塔尼亚胡正试图阻止他们。

华盛顿特区一家专注于制裁和执法事务的律师事务所创始人埃里希·法拉利表示，“过度合规”是另一个问题。银行或贸易伙伴可能认为某笔交易风险过高。

“即使你能找到未受制裁的交易方和中间人，你仍然需要找到愿意处理交易、愿意承担风险的银行，”法拉利告诉CNN。“银行可能会说，‘我们并不真正了解伊朗的来龙去脉，也不知道资金将如何流向，资金来源是什么，所以我们还是不要做这笔交易了。’”

伊朗曾与美国谈判，希望解冻存放在卡塔尔的部分用于人道主义援助的资金。但由于德黑兰将重心放在霍尔木兹海峡的未来谈判上，而华盛顿则回归外交途径，这些谈判陷入僵局。

“情况一天比一天艰难，”法拉利说。“考虑到制裁制度的严苛程度，伊朗人能够坚持这么久，我真的很惊讶。”