Officials at the Ministry of Health and Medical Education have lauded the efforts of frontline medical staff in fighting Covid-19 this year. These brave health professionals have spent the best part of 12 months treating countless patients with a highly infectious and sometimes deadly disease, often practically empty-handed. But at the same time, doctors and nurses are now being made to turn up at work after testing positive for coronavirus, putting patients at risk becoming sicker themselves as a result.
Medical staff working on the ground in Iran have spoken to IranWire about the myriad pressures they have endured this year. Despite all the challenges, they say, they have received no shred of empathy, encouragement or support from their superiors, and any applause and appreciation is for the media’s benefit only.
In the present climate, an untold burden has fallen on the shoulders of frontline medical workers. Health workers who were already dealing with the impact of sanctions, staffing and bed shortages, and a lack of medicine and medical equipment with which to care for Iran’s growing population, have now been forced to face the full impact of Covid-19, exacerbated by the danger posed to themselves and the inattention of the public to health protocols. But they are also facing sabotage within the system. From unpaid wages to parking fines, and worst of all, being made to work with Covid-19, the complaints of medical staff against their own bosses are mounting day by day.
A midwife living in the city of Khorramabad in Lorestan told IranWire of her incredulous reaction to the praise heaped on health workers in the media. Parisa says she has been working two to three intensive shifts in a row on maternity wards, for months on end. Even after she contracted coronavirus herself she was told to come into work due to low staffing levels.
"I work at two hospitals in Khorramabad," she says. "The corridors of both hospitals are crowded with patients and the ICUs are full of critically ill people. Most hospital doctors and doctors are infected – either they themselves, or their family members.
“Last week I realized I was not in good shape. The symptoms of coronavirus disease and seasonal flu are similar, and for a day or two I thought it was just the flu. But when I took a test, unfortunately I tested positive for Covid-19. I should have been sent home that day, but because several pregnant women were waiting for help in the delivery room and we could not find a colleague to replace me, they told me to stay on! I protested that there was a risk of these women contracting Covid-19, but my manager just told me to be ‘very careful’.”
Due to staff shortages, Parisa said, she then had to remain on the maternity ward until 11pm at night. "After that I took a taxi home,” she says, “but as soon as I got home, I fainted due to fatigue.
“This time my family came with me to hospital. I don’t know whether my line manager made the decision [to keep me at work] by himself or whether he consulted with his superiors. But it’s terrifying as a medical professional to deal with such an important event as childbirth, and having direct and face-to-face contact where the patient is exposed, after testing positive for coronavirus.”
Official statistics published by the Ministry of Health state that 54,310 people have died from coronavirus disease in Iran so far, while 5,809 people are in a critical condition in hospital. The overall death toll is likely to be significantly under-reported. Meanwhile, the Ministry of Health has published no data at all on the number of medical staff who have been infected with coronavirus, at a local or national level.
The International Council of Nurses believes that globally, about seven percent of all cases of Covid-19 have been in medical staff. But in some cities in Iran, such as Mashhad, it has been reported that up to 40 percent of the medical workforce have been infected with coronavirus.
Parisa is far from the only health worker to report having been made to come into work with Covid-19. The journalist Shahed Alavi writes on his Twitter account that two doctors at Rajaei Shahr Prison have also been forced to return to work despite suffering from coronavirus disease. Another Iranian Twitter user, Arvin Moradi, claimed that his friend – a nurse at an ordinary hospital – was also made to work with coronavirus.
Iman Hosseinzadeh, a doctor who lives in the Mehrshahr district of Karaj city, is currently being treated for severe Covid-19 at an expensive private hospital. He was told to come into work despite already being seriously ill, and his condition deteriorated further as a consequence. "Even after he had a fever, body aches and all the symptoms of the disease, and tested positive for Covid-19, he had to go to hospital in this awful condition," his wife, Tina, told IranWire. "It was on the fourth day of Iman's illness that they called from the hospital and told him to return to work. He said he was in a terrible state and, in addition, it would be unethical to attend and endanger the patient. But they said, 'Come here and sleep on one of the beds whenever you get tired’.
“They insisted they had no replacement doctor and did not know what to do with the critically ill patients. I took the phone from my husband and demanded again that they agree to let him stay at home. But in the end our protestations went nowhere, and he did return to work. That evening, when he returned home, he couldn’t stand upright.
“I immediately took him to a hospital near our house. They said that that an ICU bed would cost 20 million tomans [$800] per night, and since we could not find a single empty bed in the government hospitals or even at the hospital where he works, we had to admit him there.
“They aren’t talking to me now. His blood oxygen level has dropped. His condition is totally unknown to me.”
Earlier on in the pandemic, Alireza Zali, the head of the Coronavirus Combat Taskforce in Iran, had warned about the dangers of burnout affecting medical staff. Iran, Russia and the US, he claimed, were the three countries that had experienced the highest rates of infection among medical workers. “The key reason for this,” he said, “is that chronic exhaustion, which is unavoidable, has reduced their level of immune defense. Naturally, when people get tired and their energy diminishes, their immune system is more vulnerable.”
Banks Demanding Arrears from Doctors and Fines Issued in Error
The immediate danger of becoming ill is not the only obstacle doctors are facing during coronavirus. In a time of severe economic hardship and sporadic periods out of work, some doctors are being harassed by if their finances are not completely in order.
A young doctor from Mashhad emailed IranWire to say that Bank Mellat agents had physically come into his workplace to inform him that he was behind on loan repayments. “The banking sector does not realize that doctors are not to blame for their situation,” he wrote, “and those working in medicine, like other professions, are affected by the pandemic. I haven’t been able to pay for several months due to sporadic office closures.
“It’s painful when you see a country like Canada paying its citizens up to $2,000 a month during the pandemic, and countries like the United States stopping loan repayments due to the exceptional situation. Our incompetent government sends a police officer to our place of work to collect the debts from a doctor, even as they constantly talk about repayment waivers and supporting the medical community."
Frontline health workers are also being slapped with improper fines for travelling into work. After restrictions were announced on night traffic from 9pm to 4am in cities with high coronavirus transmission rates, the government emphasized that health workers were specifically exempt from fines. Officials took steps to register the license plates of all doctors, nurses, pharmacists and other medical staff to ensure they could travel unimpeded during the curfew. But IranWire has received numerous reports from health workers who say they have been sent fixed penalty notices in error for driving into work.
A nurse in Tehranpars told IranWire that she had contacted Tehran Traffic Police about her erroneous fine. They told her to obtain a letter from the local medical association and the hospital, and to come back to them the following day for the fine to be cancelled. “I had to miss out on a day of work,” she said, “to explain the situation to the police, and now I’ll have to go again [with the letter] so they’ll be satisfied and cancel it.”
Other doctors and nurses report being hit with an automatic 500,000-toman [US$20] fine after returning home from work, because their license plates do not match the city where they live. A student on Shiraz University’s medical fellowship program says he regularly travels to and from the hospital to follow up on his patients, and recently received a text message from the local Coronavirus Combat Taskforce to ask why he had gone on a “trip” during restrictions – because his number plate was not issued in Shiraz. Another doctor, who lives in Amol in Mazandaran province, said even though both his home and workplace are located in the city he was fined 500,000 tomans because his license plate was issued in Tehran. His attempts to appeal the fine fell on deaf ears.
“We bow to the doctors and nurses,” President Hassan Rouhani said in May 2020. As far back as March, the Supreme Leader of the Islamic Republic of Iran, Ayatollah Ali Khamenei, called the efforts of frontline workers in Iran’s hospitals “dazzling”. Months down the line, what is truly dazzling is the level of disregard with which these hard-working professionals say they are being treated. Doctors, nurses and midwives having to come into work with Covid-19 is a red line that should never be crossed; the crossing of it shows these platitudes are and have only been for the cameras alone.