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Consensus on Iran Sanctions Cripples Iranian Health Sector

Health Letter Article, January 2013

The third debate of the 2012 presidential election served as a microcosm of the long-standing bipartisan consensus on foreign policy. The issue of Iran’s nuclear program was predictably front and center in that debate, as President Barack Obama refused to let Republican challenger Mitt Romney outflank him in hawkish rhetoric, continually bragging of his success in isolating Iran from the West for acting within its rights to pursue civilian nuclear power.

The candidates used a common terminology to describe their favored policy toward Iran: Both endorsed what they called “crippling” sanctions on Iran. The sanctions on Iran have indeed been crippling to the people on the receiving end, and the unfortunately accurate health undertones of this particular choice of words should not go unnoticed.

Iran’s health care system, and millions of patients, threatened

U.S.-led sanctions on Iran were decisively expanded this year, targeting that country’s financial sector with predictable consequences for its economy. An increasing number of media reports have documented hyperinflation, mass unemployment and unprecedented shortages of basic food staples, such as milk, rice and chicken.

Perhaps the most vulnerable sector has been the country’s health system. As was the case in Iran’s neighbor Iraq prior to similar U.S.-led sanctions imposed in 1990, Iran has one of the most advanced health care systems in the Middle East. And like Iraq, that system is now unraveling in the face of the sanctions.

Following the 1979 revolution that overthrew the U.S.-backed dictatorship of the Shah, the new Iranian government (although repressive in its own right) implemented a national primary care network. Based around community health workers, the network brought health care to 23 million people, many of whom had never before seen a doctor. The program won praise from the World Health Organization and was largely responsible for a 75 percent reduction in rural infant mortality. The experiment proved so successful that a team of health care specialists from Mississippi visited the country a few years ago to learn from and apply Iran’s system to better care for their state’s notoriously underserved rural population.

Since the 1980s, the government also realized “the largest and fastest drop in [birth rate] ever recorded” through, among other measures, the public dissemination of free contraception. Many of these birth control pills were manufactured by the country’s domestic pharmaceutical industry, which was developed over a period of decades and has made the country largely self-sufficient in the production of these and many other essential medicines.

Following the imposition of the U.S.-led sanctions, that industry, like many others, is now facing imminent collapse related to a lack of the raw materials necessary for manufacture. Newer, more advanced medicines, for which Iran previously relied on the West, are also now disappearing from pharmacy shelves at alarming rates. Herceptin, Paclitaxel and other cancer drugs are among the vital medicines now only sparingly available, or completely absent, as a result of the sanctions. The New York Times reports that families of Iranian cancer patients have resorted to traveling hundreds of miles across the country to obtain drugs such as Herceptin for their ailing relatives, often to no avail.

The supplies for modern anesthetics for surgery also are dwindling, forcing doctors to turn to outmoded, riskier drugs prior to operating. “Drugs for anaesthetic that have been removed from lists because of their poorer quality are now being used because of the shortage in the market. These drugs can have severe side effects ... this is a real danger,” reported Mohamad Mehdi Ghiamat, head of the Iranian Society of Anaesthesiologists. Hemophilia medicines have been similarly reduced to a third of their previous availability, with a 15-year-old hemophiliac boy reportedly having died from lack of access to necessary medication.

According to a Nov. 21, 2012, article in England’s The Times newspaper, Iran may only have a three-month supply of certain pharmaceuticals remaining, even with a rationing system in place: “Iran is coming to the end of its emergency stores of medicine. At the rate the Government is rationing the remaining supplies they will be past their expiry date in just over three months,” said one Iranian source cited in The Times.

The head of Iran’s Charity Foundation for Special Diseases, Fatemeh Rafsanjani, appealed to the United Nations Secretary-General to intervene in hopes of allowing urgent humanitarian shipments of medicines and other medical goods. The appeal, made out of concern for the 6 million patients whose lives may be put at risk from the shortfall, has thus far fallen on deaf ears.

A humanitarian policy that helps no one

In response to news reports of the dire medication shortages caused by its policies, the U.S. Treasury Department stated that “it has been the longstanding policy of the United States not to target Iranian imports of humanitarian items, such as food, medicine and medical devices.”

This statement is correct: The U.S.-led sanctions do grant exemptions to allow for the export of food, medicine and other humanitarian supplies to Iran. In fact, the Treasury Department recently replaced its policy of case-by-case approval of such shipments with a “standing authorization” to companies wishing to export humanitarian supplies to Iran.

However, the original humanitarian exemption and subsequent policy change amount to little more than a public relations gesture: Medicines and other supplies are not reaching Iran because American exporters are predictably unable to find banks willing to finance these transactions. The sanctions against Iran’s Central Bank and other Iranian banks all but guaranteed from the outset that no lines of credit could be opened to engage in commerce with Western financial institutions, regardless of the goods being traded. Indeed, as a Nov. 2, 2012, article in The New York Times states, “Virtually no American or European bank wants to be involved in financial transactions with Iran, no matter what products are involved.”

A tragic history repeats itself

The ultimate effects of the sanctions on the civilian population are easily anticipated. One need only look to similar historical U.S. policy with respect to Iran’s neighbor to the west, Iraq, to find an apt analogy to Iran’s current situation.

The U.S./U.K.-led sanctions across the border in Iraq, beginning in 1990 after its invasion of Kuwait and continuing for 13 years until the U.S. invasion of Iraq, were imposed in similar circumstances and with almost identical justifications as the current Iran sanctions. Ominously for the Iranians, the effects of the sanctions on Iraq were devastating. By the time of the U.S. invasion in 2003, the sanctions were estimated to have killed at least 200,000 to 500,000 children under age 5. Two consecutive United Nations envoys appointed to oversee the humanitarian impact of the sanctions resigned in protest at what they called a “genocidal” policy of collective punishment against the civilian population.

Like President Obama today, the administration of President Bill Clinton at the time disavowed any responsibility for the civilian suffering from the Iraq sanctions, instead blaming the Iraqi government. Clinton’s Secretary of State, Madeleine Albright, infamously went so far as to conclude that the “price” of the sanctions was “worth it.”

A cursory examination of the historical sanctions regime on Iraq also exposes the absurdity of the current “humanitarian exemptions.” Despite the enactment of the Oil for Food program, ostensibly designed to relieve the humanitarian burden on civilians while keeping the tight blockade in place, the Iraqi deaths continued unabated. As documented by Joy Gordon in her book “Invisible War,” this was almost entirely due to the U.S. routinely blocking “dual-use” items, such as childhood vaccines and water treatment equipment, that could theoretically be converted to military use by the Iraqi government.

Superficial debate ignores clear solution

The so-called debate on Iran today is tactical rather than moral, with its two poles arguing whether to launch a military strike now or to wait to strike when the conditions are more favorable to the U.S. (meanwhile continuing to strangle Iran economically).

Some serious analysts, such as the U.S.’s own intelligence agencies, find the most basic questions related to the Iranian nuclear issue absent from this narrow discussion. While developing nuclear power is wrongheaded, Iran does have a right under international law to enrich uranium for civilian purposes. While it is certainly possible that Iran’s goal is to ultimately acquire nuclear weapons capability, one obvious question is why Iran might attempt to obtain a nuclear weapon in the first place and to obviate that rationale, if possible. Both the Defense Intelligence Agency and the Central Intelligence Agency have stated on numerous occasions that Iran’s primary motivation to acquire nuclear weapons is to provide it with a “deterrent” against “external threats.”

One clear solution that is rarely discussed in the fog of U.S. discourse — and one that is supported by Iran — is to work toward eliminating all nuclear weapons from the Middle East. But because Israel and the United States, as the region’s only nuclear-armed powers, have historically refused to go along with such a proposal, it has been dead on arrival ever since it was agreed upon by 189 nations in 2010.

The Obama administration even canceled a December 2012 conference that would have addressed ways to implement such a nuclear weapons-free zone in the region. Iran and the Arab countries had agreed to attend the conference, which was co-sponsored by the U.S., Britain and Russia, but Israel’s refusal to attend presumably precipitated the U.S. withdrawal.

If Americans continue to give Obama a free pass on a dangerous foreign policy, the lethal sanctions on Iran will remain in place for the foreseeable future. If that happens, as reports of the first confirmed deaths resulting from Obama’s policy trickle out of Iran, the analogies with Iraq will continue on to their inevitable conclusion.

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