"Talk of sanctions on Iran reemerged, and my essential medicine was no longer available," said Masoud Mir who suffers from thalassaemia, a genetic blood disease common in Iran. Mir, 36, is one of many patients in the Islamic Republic who not only have to deal with their disability, but also the consequences of trade sanctions reimposed in August by the US, as well as a battered economy with a free-falling currency, a foreign drug shortage and price hikes.
His essential medicine, a Swiss-made anti-iron overload drug, is now rationed by the government and can only be freely purchased at exorbitant prices on the black market. The same is true for other crucial drugs for treating multiple sclerosis, cancer and cardiac problems and even simple anaesthetics required for surgery.
On Wednesday, the UN's top court stepped in, and ruled in favour of Iran which had called for the US sanctions to be suspended. Judges at the International Court of Justice in The Hague unanimously ruled Washington should remove barriers to "the free exportation to Iran of medicines and medical devices, food and agricultural commodities" as well as airplane parts.
Official Iranian statements acknowledge the shortage of medicines and say imports of certain drugs are no longer subsidised. "We are currently short of 80 pharmaceutical items," Mohammad-Naeem Aminifard, a member of parliament's health commission, told semi-official news agency ISNA. "The government and insurers have removed the support for foreign drugs that have a domestic equivalent which intensifies the pressure on patients."
Iran produces 96 percent of the drugs it uses, according to the Syndicate of Iranian Pharmaceutical Industries, but imports more than half the raw materials to make them. The double-whammy of banking sanctions and a collapse in the value of its currency make total self-sufficiency difficult if not outright impossible. For others with family health concerns, sanctions are adding to their burden.
Ali, an electrical technician in his mid-30s, was fired from one job for spending too much time on hospital visits for his son. His next company went bankrupt, and his current employer, a Dutch-Iranian firm, is stalled because they cannot import equipment and has stopped paying staff.
He spoke to AFP outside the busy 13 Aban pharmacy in central Tehran, where he had been hoping to buy a medicine for fungal infections caused by his son's cancer treatment.
"They're not giving me any because of insurance problems," he said. "They said even if they could it's less than I need due to rationing. My son could die if his medicine is delayed for even a day." Managers at the pharmacy, a state-owned outlet focusing on rarer diseases, declined to comment. But others in central Tehran said there was "a notable shortage" in some anticoagulants, beta-blockers or drugs to treat blood pressure problems.
"The local versions are cheaper, but not as effective," one pharmacist told AFP. "Things will get worse if sanctions continue." Many patients cannot afford black market prices and risk side effects from locally-made equivalents, the head of Iran's thalassaemia society, Meysam Ramezani, told the conservative Tasnim news agency recently.
Seven thalassaemia patients died in March alone, he said, blaming "either a lack of injections or low-quality drugs." Iranians on social media are blaming many people: the US for its crippling sanctions, government economic mismanagement, and pharma firms for skyrocketing prices. Surgeon Hamidreza Vafayi said the refusal of international banks to work with Iran was the biggest challenge.
The United States pulled out of the 2015 nuclear deal and reimposed sanctions targeting key parts of Iran's economy including international banking ties and transactions in US dollars.
"As far as I know, there is no official statement on sanctioning medicine trade with Iran," Vafayi told AFP. "Yet when we cannot have banking ties (with the world) we are in fact under an undeclared medicine sanction regime. The truth is that no company would sell us drugs now."
Thalassaemia patient Masoud Mir also angrily recalled that when sanctions were imposed between 2010 and 2016, pharmaceutical firms exploited the situation by hoarding goods and manipulating prices. The same thing is happening today, he claimed.
Medicine importers get subsidised currency rates from the government, but their names are not publicly available, making it difficult to hold them to account if drugs do not appear in state-owned pharmacies. "In 2011, they kept saying that there was none (of his drug) in the market because of sanctions. But I could just walk out of the pharmacy and buy some from a street dealer at crazy prices," he said. "Not everyone can pay that, so they may face a slow death."