In Iran, nuclear issue is also a medical one

By Thomas Erdbrink and William Branigin
Washington Post Foreign Service
Sunday, December 20, 2009; A20

TEHRAN -- Ruhollah Solook, a retired electrician living in Santa Monica, Calif., was in a desperate bind. He urgently needed a kidney transplant, as well as a series of radiation therapy diagnoses and treatments. The nuclear medicine was available in the United States, but the kidney was not.

Solook, 78, an Iranian Jew who emigrated decades ago, never expected to find both in his native country. But there he was this month, recovering in an isolated room in Tehran's oldest hospital with a new kidney donated by a friend.

"They have saved my life here," he said. "Now I hope they can cure me."

In Iran, an estimated 850,000 kidney, heart and cancer patients are facing a race against time. Although these patients are in need of post-surgery treatment with nuclear medicine, doctors and nuclear scientists here say domestic production will dry up when a research reactor in Tehran runs out of fuel, perhaps as soon as this spring.

"We have thousands of patients a month at our hospital alone," said Gholamreza Pourmand, a specialist who treated Solook using technetium-99, a nuclear medicine used for diagnosis by body scanners. "If we can't help them, some will die. It's as simple as that."

At the heart of the looming shortage of nuclear medicine is a continuing controversy over Iran's nuclear program, notably a dispute over a deal with world powers that would supply fuel for the research reactor.

Like many other aspects of the program, the specifics regarding nuclear medicine are in dispute. Iran asserts that U.N. Security Council sanctions aimed at curtailing its uranium-enrichment activities also effectively target its medical sector. For example, Iranian officials say they are not allowed to import modern U.S.- and European-made body scanners, which can detect cancer tumors, because some of the parts might assist the nuclear program, and they assert that sanctions in 2007 barred Iran from importing medical isotopes.

U.S. and United Nations officials say Iran remains free to buy the isotopes it needs; a Security Council exemption allows imports of nuclear-related items "for food, agricultural, medical or other humanitarian purposes." They suggest Iran wants to produce its own medical isotopes to ensure a cheaper and more reliable supply in view of recent global shortages.

In any case, after the imports stopped in 2007, Iran fully powered up a 40-year-old, U.S.-supplied nuclear research reactor in Tehran. Initially operated half a day a week for tests, the reactor now is almost continuously in use.

In June, Iran informed the International Atomic Energy Agency (IAEA) that fuel obtained from Argentina in 1993 would run out by the end of 2010 -- a projection now apparently moved up. But the U.N. sanctions prevent Iran from buying more fuel on the world market.

Iran says it can produce its own fuel, although that could provoke an international furor because it would need to enrich uranium to 19.75 percent -- a level technologically closer to weapons-grade material.

"We prefer to buy the fuel, in the shortest possible time," said Mohammad Ghannadi, vice president of the Atomic Energy Organization of Iran (AEOI).

From his headquarters protected by antiaircraft guns, Ghannadi overlooks Iran's only working reactor, its two brown chimneys emitting white smoke. As the head of the AEOI's research and development department, Ghannadi is prohibited from traveling abroad under the international sanctions.

"We could enrich the fuel ourselves," the British-educated scientist said in an interview. "But there would be technical problems. Also, we'd never make it on time to help our patients."

U.S. nuclear experts say Iran's main difficulty is that it cannot fabricate fuel assemblies for the research reactor. They regard Iran's fuel problems as largely self-inflicted.

Under a proposed deal brokered by the IAEA, Iran would hand over 1,200 kilos of the low-enriched uranium it has stockpiled, ostensibly for use as fuel for nuclear power plants. In return, Russia would enrich the uranium to 19.75 percent, and France would turn it into fuel assemblies for the Tehran reactor. The United States would help ensure the safe operation of the aging reactor. World powers fear that unless Iran hands over the stockpile, it could convert it someday into highly enriched uranium, which can be used as fissile material in nuclear weapons.

After initially accepting the proposal in principle Oct. 1, Iran has demanded more guarantees that the reactor fuel would be delivered. Iran also complains that the process would take more than a year -- too long, in its view.

Last week, Iranian Foreign Minister Manouchehr Mottaki proposed swapping small amounts of the uranium in batches rather than all at once. Iran has suggested that the trade take place on Kish Island, an Iranian tourist destination in the Persian Gulf. The Obama administration considers that proposal inconsistent with the U.N. plan.

"If Iran wants to produce those medical isotopes itself, then the best way to do that is to accept the IAEA proposal" and receive the reactor fuel, a senior Obama administration official said. As part of the deal, he noted, the parties pledged to deliver the initial assemblies in time to keep the reactor running.

Ghannadi frames the debate as a humanitarian issue, not a political one. "This is about human beings. . . . When someone is sick, we should give medicine. Give us the fuel; we will make the radiopharmacy," he said, referring to the use of radioactive pharmaceuticals in nuclear medicine.

In the past, Ghannadi said, sanctions have spurred advances in Iranian nuclear medicine, which is offered at 120 hospitals. "When the shipments of medical isotopes stopped," he said, "we were forced to make them ourselves." But for two months, doctors recalled, no patients could be treated, throwing the hospitals into turmoil.

Today, nuclear medicine patients at Tehran's Shariati Hospital sit in a small waiting room next to a dilapidated German body scanner that needs replacement.

"When they speak of human rights and Iran at the U.N., they should not forget that our patients have rights, too," said Mohsen Saghari, an internist who studied at Johns Hopkins University. "The U.S. now tries to prevent me from using in Iran what I learned in the States," he complained.

Solook, the Iranian-born patient from California, said he plans to write a letter to U.S. health officials, explaining what happened to him in Iran.

"I don't believe in these sanctions," he said, his voice frail after the kidney transplant. "They hurt normal people, not leaders. What is the use of that?"

Branigin reported from Washington. Special correspondent Kay Armin Serjoie in Tehran contributed to this report.

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