In April 2018 Iran’s government fixed a subsidized rate of 42,000 rials to the dollar for essential imports. By mid-2019 the open market price had slid to about 116,000. Human Rights Watch tracked what that did to families, and it is the clearest window into what the US sanctions campaign meant after Washington left the nuclear deal in 2018.
Inflation ran at roughly 30 percent a year, with 37 percent predicted for 2019. Wages and savings bought less each month. Hospitals and clinics, which pay for imported drugs and equipment in foreign currency, were hit the same way.
Medicines on the margin
Iran makes about 97 percent of its own medicines. But a third of those depend on imported ingredients, and the imports that remain matter more than their volume suggests: 3 percent of the market by volume, about 30 percent by value. Think cancer and rare-disease treatments.
Patients felt it first. In a study of people with epilepsy, 72 percent of those using imported drugs reported serious trouble getting them between August 2018 and February 2019. Among users of domestic brands the figure was 30 percent. Children with leukemia faced shortages of chemotherapy drugs including pegaspargase and mercaptopurine.
Humanitarian trade is formally allowed, so the obstacle is money. HRW says banks around the world practiced “overcompliance” and turned down even permitted transactions, afraid of secondary sanctions. French, German, Swedish and Italian drug makers ended Iranian contracts. The Norwegian Refugee Council reported in August 2019 that after spending hundreds of thousands of euros on legal advice it still could not find a bank to move aid money into Iran. It described “brick walls on every side.”
The state could not fully fill the gap. Iran’s health insurance covers about 90 percent of citizens, yet health spending was projected at 19.6 percent of the 2019-2020 budget, down from 23.6 percent. In June 2019, 79 drugs were reclassified as “over the counter,” which moved their cost onto patients.
The fuel-price protests
Economic strain reached the streets in November 2019. On November 15 Iran’s Supreme Council of Economic Coordination raised petrol prices by 50 percent, to 15,000 rials a liter, and capped private cars at 60 liters a month. Al Jazeera reported that tens of thousands protested, blocking highways and abandoning vehicles, and that a “near total internet shutdown” followed.
The death toll is contested. Al Jazeera counted at least 11 dead, five security personnel and six civilians. Amnesty International reported at least 106 and called the response “a brutal and deadly crackdown.”
The IMF had projected a 9.5 percent contraction for the economy that year, with inflation above 40 percent. Supreme Leader Ayatollah Ali Khamenei called violent protesters “thugs,” while President Hassan Rouhani promised financial help and warned against “anarchy and rioting.”
Sources
- "Maximum Pressure": US Economic Sanctions Harm Iranians' Right to Health
- Iran's protests: All you need to know in 600 words
