In a world facing a pandemic, Iran’s struggles with the coronavirus stand out. The country currently has more than 17,000 confirmed cases of COVID-19—growing at about 1,000 per day—and more than 1,000 deaths. State media has warned that up to 3.5 million Iranians could die. And Iran’s outbreak is not only a threat to Iranians. Roughly 9 in 10 of the 18,000 confirmed cases of the virus throughout the Middle East can be linked back to Iran. Getting the country’s outbreak under control fast ought to be a global priority.
This dire situation has prompted prominent activists and figures like Minnesota Rep. Ilhan Omar to call for the U.S. to lift at least some of the sanctions it has imposed on Iran over its nuclear program, sponsorship of foreign terrorism, and human rights violations. Many blame the sanctions for shortages of much-needed medication and medical equipment.
Both President Hassan Rouhani and Foreign Minister Javad Zarif have blamed U.S. sanctions for the virus’s out-of-control spread, with the latter referring to them as “medical terrorism.” U.N. Secretary-General António Guterres has supported Iran’s position. China’s foreign ministry has called on the U.S. to lift sanctions in response to the virus, tweeting, “Continued sanction is against humanitarianism and hampers Iran’s epidemic response & delivery of humanitarian aid.”
But would lifting sanctions really help?
The U.S. maintains that Iran’s failures are its own, not the result of sanctions, and point out that policy includes exemptions for humanitarian imports—Iran can import food, medicine, and medical devices without penalty. A new mechanism to facilitate these imports was introduced by the Treasury Department last fall and in January, and an agreement was reached to allow Swiss companies to export food and pharmaceuticals to Iran via a secure payment channel. Pompeo referred to these measures recently when asked about the coronavirus response, saying, “The U.S. government is prepared to assist the Iranian people in their response efforts. This offer of support to the Iranian people, which has been formally conveyed to Iran through the government of Switzerland, underscores our ongoing commitment to address health crises and prevent the spread of infectious diseases.”
But in practice, sanctions are cutting off supplies of life-saving medicines and equipment. Since the Trump administration reimposed sanctions on trade with Iran in 2018, after withdrawing from the 2015 nuclear agreement, and began enforcing “secondary” sanctions on non-American entities that trade with the country, Iran’s economy has been in a tailspin. This is by design. As former National Security Adviser John Bolton put it, the goal is to “squeeze them until the pips squeak,” to ramp up economic pressure to the point that the Iranian regime makes drastic policy changes or simply collapses.
Currently, large swaths of the Iranian financial sector are under sanction, making financing purchases impossible. The aggressive U.S. sanctions on Iranian imports and financial activities have deterred foreign banks and other companies from participating in any sort of business involving Iran, including exempted humanitarian trade. The risk of a business falling afoul of sanctions regulations—or of the U.S. simply changing those rules again like it did after leaving the nuclear deal—are too great to make doing any sort of business with Iran worth it.
The renewed U.S. sanctions were having a deleterious effect on Iranians’ health long before the virus hit. “U.S. sanctions are killing cancer patients in Iran,” wrote one Iranian doctor in Foreign Policy last year. A U.N. special rapporteur on human rights in Iran warned in 2019 that “sanctions and banking restrictions will unduly affect food security and the availability and distribution of medicines, pharmaceutical equipment and supplies.” The International Court of Justice has ruled that the humanitarian sanctions exemptions are insufficient and that sanctions are having a “serious detrimental impact” on Iranians’ health.
An October Human Rights Watch report described how people with treatable conditions have suffered because they cannot access certain medicines or medical supplies:
Some of the worst-affected are Iranians with rare diseases and/or conditions that require specialized treatment who are unable to acquire previously available medicines or supplies. This includes people with leukemia, epidermolysis bullosa (EB, a type of disease that causes fragile, blistering skin), or epilepsy, and individuals with chronic eye injuries from exposure to chemical weapons during the Iran-Iraq war.
The consequences for these individuals can be catastrophic: people with severe forms of EB are now unable to access specialized bandages and are at significantly increased risk for bacterial infections, sepsis, fusion of fingers, and contractures of joints. Individuals with epilepsy who are resistant to common treatments and unable to access foreign-made medicines may suffer frequent, uncontrolled seizures that risk injury and result over time in severe, permanent brain damage. Shortages of essential medicines can affect a much broader range of patients as well. For example, an Iranian journalist has reported on severe complications after a Caesarean section believed to be related to the use of a “non-standard” anesthesia medicine because of lack of access to higher quality medication.
At this point, it’s probably not enough for the U.S. to say that companies are allowed to sell drugs and medical equipment to Iran to help battle the coronavirus—they’re already technically allowed to sell those things. But that doesn’t mean the U.S. can just sit back. “There are small and large steps the United States can take to try to speed aid to Iran,” says Elizabeth Rosenberg, a former Treasury Department official who is now a senior fellow at the Center for a New American Security. “They could do more to broadcast that it put this license in place and encourage those in a position to support Iran’s public health response to do so. We could get there and counter the narrative that Iran is pushing.” It’s not just a matter of lifting some sanctions, in other words; it’s a question of publicly backing efforts to support Iran’s crisis response.
To put it mildly, this is not the response we should expect to see from the Trump administration.
Despite the real impact of sanctions on Iranians’ health, it’s also fair to say that Iran is using them as a convenient scapegoat for its own failures. Sanctions can’t be blamed for the government’s weeks of denying that the coronavirus posed a risk to Iran, even as the number of cases was spiraling out of control—the denials included a memorable televised briefing from a coughing, sweating deputy health minister who later tested positive for the virus—or its refusal until recently to close public gathering places in Qom, an important holy city for Shiite Muslims. Sanctions are not to blame for the corruption and regime power struggles that have undermined public trust in government at a time when it’s needed most.
Iran’s struggles in the face of this crisis are a corrective to any notion that authoritarian governments are inherently better at handling disease outbreaks than democracies. The response to the virus shows the danger that the country’s sclerotic regime poses not only to its own citizens but to the world.
But, as Rosenberg points out, “Like it or not, we are all in this pandemic together. We all have an interest in excellent health measures being in place everywhere.”
There are reasons to be skeptical about the excuses Iran is making for its own public health failures, but this is a virus that doesn’t recognize national borders, ideologies, or regime type. We could fight it a lot more effectively if we could cooperate.