“It means our hands are tied,” said Nasrin, a doctor at a government-run hospital in the central city of Shiraz. “We’ve been given a list of over 120 drugs that we are not to prescribe, because we simply don’t have them.”
Nasrin said that drugs to treat heart problems, diabetes and cancer are particularly scarce. Like others interviewed for this story, she gave only her first name because of the sensitivity of the issue.
While there is an ample supply of over-the-counter drugs and pharmacy shelves are still well-stocked, patients suffering from more serious conditions are increasingly unable to get treatment for their illnesses.
The scarcity derives from a complicated set of circumstances that includes both a heavy dose of Western sanctions, which are aimed at forcing Iran’s leaders to halt their uranium-enrichment program, as well as what critics here say are missteps by the government. While some of the anger over the shortages has been directed at the United States and other global powers, there has also been an internal backlash.
Hosseinali Shahriari, the head of parliament’s health committee, said this month that “the government is playing with our people’s health and is not assigning the approved finances.”
Shahriari noted that the cost of chemotherapy has quadrupled in just the past year, and is now approximately $67,000 — out of reach for all but the wealthiest Iranians. “Practically speaking,” he said, “we have to tell a majority of such patients to go and die.”
The health-care crunch comes as Iranian officials debate whether to pursue a deal with the United States that would involve nuclear concessions in exchange for an easing of the sanctions.
Iranians have demonstrated a resilience to the impact of sanctions in many sectors of the economy. But Iranians have grown accustomed to receiving highly subsidized medical treatment from the government, and they hold authorities responsible for rising prices or unavailable medicines.
At the start of each year, Iran’s annual budget is submitted by the president’s office to the parliament, which amends and ultimately approves cash allotments to be paid by the central bank to various state ministries.
With oil exports down and Iran’s ability to conduct international financial deals severely hamstrung, the bulk of those funds have not been delivered by the central bank this year. As a result, the health ministry has received only a fraction of its budget, and care has suffered.
Under normal times, the funds are distributed to state-run hospitals and companies with licenses to import medical equipment, supplies and pharmaceuticals.
Rasoul Khezri, a member of parliament’s health committee, said that according to the health ministry’s standards, “we should always have a surplus of medicine for the next six month. But our reports indicate the medicines in reserve are only sufficient for the next two months.”
Iran’s minister of health, Marzieh Vahid Dastjerdi, explained in a recent nationally televised interview that authorities have begun to import supplies of vital medicines by commercial flight because they cannot wait for the usual cargo-ship deliveries. Of the $2.5 billion called for in Iran’s annual budget to import medicine and medical supplies, she said, only $600 million had been delivered by Iran’s central bank this year.
The problem has been compounded by a collapse in the value of Iran’s currency, the rial, meaning that the cost of medicine and other imported supplies has risen dramatically.
The chiefs of Iran’s medical schools recently wrote a letter to the government in which they complained of a 350 percent increase in the price of medical equipment, delays to essential medical projects and overdue payments to insurance companies.
Ordinary citizens, too, have expressed frustration with their government.
Zohreh, a 60-year-old housewife, said the price for her daughter’s epilepsy drug has doubled in the past three months. “When I ask why they have raised the price, they say we have a shortage of the medicine,” she said. “The government must help poor people like us.”
Mojtaba, who has a thriving private family practice in central Tehran, said: “This isn’t a situation that can persist for more than a couple of months. The human cost and the potential national expense of caring for too many sick people can’t be ignored.”
Some industrious Iranians near the border with Turkey are advertising their ability to deliver hard-to-find medicines. They simply cross the border, purchase the medication and use couriers to make deliveries throughout Iran. Meanwhile, some doctors are advising their patients to fly to neighboring countries to purchase the drugs they need.
But for the millions of Iranians who cannot afford such arrangements, it has been hard to adjust to a world of diminished health resources.
One of the tenets of the Islamic republic since its inception in 1979 has been universal health care. Any working Iranian is entitled by law to insurance coverage from their employer. Even privatized health care is greatly subsidized and had been relatively affordable until the past several months.
While sanctions have forced many Iranians to adjust their consumption habits, accepting less from the health-care system is a sacrifice few seem willing to make.
“I can reduce our family’s intake of certain foods and utilities, even basic things like chicken and rice, and still survive,” said Massoud, a 28-year-old office worker. “But when someone in my family or I gets sick or needs surgery, it’s not something I can just ignore.”