Despite claims by Islamic Republic officials regarding pharmaceutical self-sufficiency, following the US and Israeli attacks on Iran, citizens, doctors, and healthcare experts are reporting severe shortages of vital medicines, a decline in drug quality, and increased financial pressure on patients. Several specialist physicians inside Iran who spoke with IranWire view the roots of this crisis not in the recent war, but in flawed pharmaceutical policies, financial corruption, and sanctions-related financial constraints that have plagued patients for decades, which the war has further exacerbated.
Reyhaneh, a specialist physician who has worked at a hospital in Isfahan for years, spoke to IranWire about the medicine shortages: "Years ago, pharmaceutical companies decided to import raw pharmaceutical ingredients and package the medicines inside Iran, given the low cost of Iranian labor. Before that, raw ingredients were imported from European countries such as Spain and especially Italy, and they possessed acceptable quality. However, with the intensification of sanctions and the growing difficulty of transferring foreign currency, the entry of medicines and the import of raw materials faced obstacles."
According to official reports from trade unions, specialized associations, and regulatory bodies, financing and liquidity within the country's pharmaceutical supply chain have faced serious challenges in recent years. Mohammad Abdeh-zadeh, Chairman of the Board of Directors of the Iranian Human Pharmaceutical Industry Syndicate, announced in June of this year that the country's strategic reserve of about 600 pharmaceutical items is sufficient for only one month, indicating a fragile state in production lines and medicine supply. Furthermore, the Vice President of the Iranian Pharmacists Association stated that the number of pharmaceutical items experiencing acute shortages is around 200, warning that if the liquidity crisis is not resolved, this figure could rise to 400 items.
The Footprint of the Economic Mafia in Medicine Shortages
The medicine shortage has deteriorated to the point where even a medication like codeine faces serious shortages in medical centers. Hadi Ahmadi, a board member of the Pharmacists Association, told the ILNA News Agency that the shortage of items such as codeine stems from the scarcity of raw materials.
Hamid, a specialist physician working in a well-known hospital in Tehran, spoke to IranWire about the shortage of raw materials: "In reality, medicine is not sanctioned; the issue is the inability to transfer foreign currency. In addition, with the introduction of a single-rate currency system and the removal of the tariffs and deductibles that the government used to provide for supplying imported medicines, the problems have multiplied. Due to the imposed sanctions, many European countries can no longer send raw materials to Iran as they did in the past. In this disrupted equilibrium, pharmaceutical mafias stepped in to reap massive financial profits by importing drugs. To this end, they import raw materials from countries like China and India, which are themselves home to massive pharmaceutical lobbies manufacturing counterfeit drugs. On top of that, there is no control or oversight. Consequently, in addition to the shortages, the quality of medicines packaged in Iran has declined."
Reports from economic newspapers such as Donya-e-Eqtesad corroborate Hamid's remarks. These publications have repeatedly emphasized that the elimination of the preferential exchange rate, without compensating for factories' liquidity, combined with the Central Bank's challenges in transferring currency, has practically paralyzed domestic manufacturers rather than direct sanctions alone. This is not a new issue; Iranian media outlets have frequently reported on the pharmaceutical mafia, rent-seeking surrounding currency flight, and the import of low-quality raw materials.
A hospital manager in Mashhad explained to IranWire how certain front companies secure government-subsidized foreign currency under the pretext of importing high-grade raw materials, but instead import substandard materials. He notes that even pro-government principalists agree on the existence of the mafia, a sentiment reflected in outlets such as Kayhan and Javan. However, they primarily focus on "private sector corruption" or "regulatory weaknesses within the Food and Drug Administration," maintaining that oversight must be rigorous enough to prevent the entry of counterfeit drugs.
According to this hospital manager, one of the most alarming findings in trade reports is the inability to conduct quality control on imported shipments. Under conditions where the market faces an acute shortage of medicine, regulatory organizations, at times under pressure from public opinion and in an effort to rapidly restock pharmacy shelves, exercise "leniency" in the quality assessment protocols for raw materials.
He further adds: "The import of fake or low-purity raw materials under the names of reputable companies is a direct result of this rushed approach, a phenomenon in which the final medicine comes in elegant packaging, but the active ingredient within it lacks clinical standards."
"Critically Ill Patients Are the Primary Victims of This Situation"
A specialist physician practicing in Shiraz told IranWire that under these circumstances, those suffering from special diseases bear the greatest burden because producing their medication is not profitable for pharmaceutical companies.
Regarding this, he says: "Some pharmaceutical companies try to maintain an acceptable level of quality, but they too must lean toward medications that have both higher demand and higher prices to be cost-effective. Consequently, medications used by a smaller number of patients are neglected, such as those for certain special diseases like dialysis patients, individuals with thalassemia major, hemophilia, and those suffering from refractory diseases such as cancer and organ transplant recipients. Naturally, when the number of patients is low, importing the drug is not economically viable for a pharmaceutical company unless the government provides a deductible or subsidy. Providing subsidies has also become extremely difficult under the current situation."
He further explains: "The introduction of a single-rate currency system is sound economic reform on paper, but its implementation in the healthcare sector without prior groundwork led to the elimination of government subsidies and supportive tariffs. This price shock has multiplied the liquidity required by pharmaceutical factories to purchase raw materials. In this financial deadlock, reputable, established companies pulled back, leaving the field open to lobbies that secure massive profits by making cheap, low-quality purchases from alternative markets, while patients pay the real cost of this defective chain with their lives and money."
Responsible Institutions Evading Accountability
Reyhaneh told IranWire that responsible institutions have been dodging the burden of procuring medicine for years, shifting the weight onto patients' shoulders.
Regarding this, she says: "Since my student days in the early 1990s, and with the ratification of the hospital self-sufficiency plan, a heavy burden of procuring medicines and medical supplies has practically fallen upon the patient. University hospitals have limited income due to very low tariffs and heavy obligations. On the other hand, they face the accumulation of extraordinarily heavy debts from insurance organizations, especially the Social Security Organization. When insurance providers fail to pay hospitals and hospital pharmacies lack liquidity, pharmaceutical companies refuse to sell us medicine or do not work on credit."
Criticising this plan, Hamid says: "What is the result of this vicious cycle? The hospital is forced to send the patient out to personally procure vital, expensive, or scarce medicines such as albumin, intravenous immunoglobulin (IVIG), chemotherapy drugs, or special medications like eculizumab from the open market. Insurance companies shirk covering these drugs under various pretexts, such as requiring manual verification or lengthening the commission approval process. Meanwhile, the university faculty has prescribed the drug based on up-to-date global literature, and a critically ill patient cannot wait for administrative approvals. To save their life, the patient has no choice but to trust the doctor and buy the medicine from outside at open-market prices."
What this physician narrates is a stark image of the collapse of the concept of "free" or "cheap treatment" in public hospitals. The root of this crisis dates back three decades to the inception of the "hospital self-sufficiency" policy, an economic idea that turned teaching hospitals into self-funding enterprises without providing them with the revenue-generating tools appropriate for government-set tariffs. Today, this concept has reached a dead end at the intersection of crises such as war, rising pharmaceutical demand, and insurance debts.
Hamid states regarding this: "When the Social Security Organization or other basic insurance providers delay paying their overdue debts to university hospitals for months, the vital artery of the medicine supply chain is effectively severed. Pharmaceutical distribution companies do not supply goods on credit either, leaving hospital pharmacies empty. In the midst of this, the weakest link in the chain—the critically ill patient—must bear the maximum pressure."
Nasser Khosrow, the Ultimate Destination for Patients
The greater contradiction, however, lies within the administrative structure of the insurance companies. While scientific guidelines and specialized faculty physicians view a patient's survival as dependent on the immediate use of a scarce or cutting-edge drug, the yardstick of insurance providers remains tied to outdated bureaucracies, lengthy approval processes, and cost avoidance.
In this hospital structure, where resources are limited and insurance is dysfunctional, the physician is caught between medical ethics (prescribing the effective drug) and economic reality (the patient's inability to afford it). The outcome is the forced migration of patients to the open market and the famous Nasser Khosrow Street, a phenomenon that completely invalidates all slogans about reducing out-of-pocket patient spending.
The hospital manager working in Mashhad explained this process to IranWire as follows: "Unfortunately, in Iran, low-quality and cheap raw materials are practically imported and merely packaged domestically. The result is that so-called domestically produced medicines lack efficacy, forcing the patient to consume higher doses, which increases side effects. The bitterness of the matter is that insurance companies no longer cover the original drug under the pretext that a domestic version exists. If a patient wants quality medicine, they must pay the entire cost out of pocket at open-market rates."
Accordingly, the war is not the primary cause of the current shortage or absence of many medicines in Iran, but rather an aggravating factor. It is the result of the intersection of hospital self-sufficiency policies, the heavy debts of insurance companies, and declining drug quality under the shadow of incomplete domestic manufacturing. It is a vicious cycle in which critically ill patients are abandoned between a worn-out insurance bureaucracy and the open market, forced to pay for their survival with empty pockets and, at times, with their lives.
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