War, sanctions and inflation leave Iran short of hundreds of medicines

Iran's pharmaceutical sector is facing shortages of hundreds of medicines, a near-six-fold price hike for basic drugs and collapsing supply chains, as the war with the US enters its seventh month and the effects of sanctions and a naval blockade accumulate.

The shortages include roughly 90 medicines classified as essential or life-saving, according to Iranian media.

Hadi Ahmadi, spokesperson for the Iranian Pharmacists Association, told domestic media last week that around 400 of the scarce medicines are produced domestically — evidence that local manufacturing has not insulated the sector from disruption, because many domestic producers rely on imported raw materials.

Ruhollah Lak Aliabadi, a member of parliament's health commission, told Tabnak news site that access problems for imported inputs were feeding directly into production and distribution failures.

Vahideh Mahmoudkhani, head of the health department at Iran's trade centre in Shanghai, told the newspaper Hamshahri that the war had completely shut down some supply routes and made others significantly longer.

"Even some medicines that have run out are stuck in transit," she said.

Tehran, the economic outcast

Medicines and humanitarian goods are typically exempt from direct sanctions under international law.

But banking restrictions, difficulties transferring foreign currency and blockade-related transport disruption can prevent Iranian companies from purchasing drugs and raw materials abroad regardless of their formal legal status.

The US naval blockade of Iranian ports and cargo vessels imposed in April was briefly lifted following the framework agreement before being reinstated after talks collapsed.

Washington launched what it called Operation Economic Outcast in late August, designed to further restrict Tehran's access to international financial networks.

Mehdi Pirsalehi, head of Iran's Food and Drug Organisation, said on Tuesday that 44 companies in the medicines and medical equipment sector had been targeted in attacks since the war began, with staff killed and wounded.

He made the remarks at the opening of a pharmaceutical exhibition in Tehran, while stressing that two companies struck directly by several missiles were present at the event and had resumed production.

One of those companies was Tofigh Daru. In late March, Israeli officials announced they had struck it because of what they said was its role in supplying fentanyl to a research body within Iran's defence ministry.

Tofigh Daru rejected the allegation, saying it produced only fentanyl citrate in limited quantities and exclusively for authorised medical uses including surgical anaesthesia.

Prices rising beyond reach

The physical shortage of medicines is compounded by price rises that are pricing patients out of treatment.

Mehr state news agency has reported that gabapentin — used to treat epilepsy and nerve pain — rose 220% in price over a year.

Paracetamol rose 375%, amoxicillin 285% and fluoxetine 100%. Insulin, which diabetic patients require daily, has in some cases reached six times last year's price.

The continued depreciation of the rial on the open market is feeding further price increases across the sector.

Salman Es'haghi, a member of parliament's health commission, said more than 70% of healthcare costs in Iran are paid directly out of patients' pockets.

Ahmad Ariayi Nejad, also on the commission, said the financial pressure was already showing in fewer patients attending clinics and doctors' surgeries.

He cited the case of a labourer and tenant who needs two injections a month costing approximately 74 million tomans — a sum that amounts to several months' wages for many Iranians.

The consequences are most acute for patients with serious conditions. When treatment for heart disease or cancer is interrupted or delayed for financial reasons, the harm is often irreversible.

"Some people, because of economic hardship and lack of financial means, abandon their treatment part-way through," Ariayi Nejad said.

Tehran has maintained that the pharmaceutical industry continues to operate and that some shortages have eased since the war.