Iran’s pharmaceutical market was worth IRR1.06 quadrillion (about $2.12bn at current open exchange rate) in the last Persian calendar year (March 2022-23), the head of the Iranian Food and Drug Administration (IFDA) told Fars news agency on August 9, adding that domestic products accounted for 99% of the sum.

According to Heydar Mohammadi, Iran is self-sufficient in terms of food and supplements and imports in the pharmaceutical sector are restricted to drugs for rare diseases. Although US sanctions against Iran exempt humanitarian trade, in effect, there are transactional obstacles that prevent the import of certain medicines. Thalassemia, haemophilia, and cancer patients have been among the hardest hit as a result of sanctions.

“In the medical equipment field, there are 350,000 IRC’s (Iran Registration Codes), for 150,000 of which we have continuous production,” Mohammadi said,

He added that production in this field is on a growth path. However, in terms of medicines, some products are completely produced domestically while others rely on foreign-sourced raw materials.

Exorbitant pricing structures

The significant increase in the prices of pharmaceutical raw materials in recent years has led to the exorbitant rise in the prices of medicines and people’s out-of-pocket expenses.

According to Majlis Research Centre, the research arm of the Iranian parliament, between March 2019 and March 21 Persian calendar years the prices of domestically-produced pharmaceutical raw materials climbed by 300% to 800%, much higher than the average inflation rate of other industries.

A report by the Ministry of Cooperatives, Labour and Social Welfare has regarded high levels of out-of-pocket financing for health as a significant problem in Iran’s healthcare system.

Iran has been registering growth in all health status indicators to stand above the global average over the past years.

Infant mortality rates and under-five mortality rates in Iran stand at 9 and 14 per 1,000 live births, both above the average of upper middle-income countries (7 and 13, respectively).

The number of reported pregnancy-related deaths stands at 16 per 100,000 live births in Iran. Better than the average upper middle-income countries (57 per 100,000 live births.)

Immunisation (vaccination) coverage in children less than one year of age in Iran is also above the global average (99% in the year ending March 2021).

EB patients suffering from US sanctions

Among those suffering from the effect of sanctions in Iran are children diagnosed with epidermolysis bullosa (EB), often referred to as “butterfly kids” (because their skin is as fragile as a butterfly's wings).

EB is a rare genetic condition that causes fragile, blistering skin. The blisters may appear in response to a minor injury, even from heat, rubbing or scratching. The disorder is so painful that the patients tend to liken their skin's burning sensation to that experienced in third-degree burns.

Due to the US sanctions, there has been a lack of necessary dressings for EB children in Iran.

A beneficial dressing produced under the brand name of Mepilex by the Swedish company Molnlycke can, to a good extent, alleviate these patients' pain and suffering, making life easier for them.

In fact, these patients' survival depends entirely on the timely use of the dressing. However, the US sanctions have deprived EB patients in Iran of this temporary yet palpable relief due to banks being unable to deal with Iranian counterparts.

Over a dozen EB young patients in Iran have reportedly died of the disease in the absence of much-needed medical supplies. Others suffered from severe physical injuries, including amputation.

Iran has been under US sanctions for the past four decades. Sanctions intensified following the US unilateral withdrawal from a 2015 nuclear deal in May 2018, formally known as the Joint Comprehensive Plan of Action (JCPOA).

Regarding the US sanctions' negative impacts, Hamidreza Hashemi Golpayegani, the founder of Iran's EB Home -- an NGO for children suffering from EB -- said, "Previously, we had easy access to the (Mepilex) dressings.”

However, following the US unilateral withdrawal from the JCPOA, "we felt the intensity of the sanctions on us to a greater extent," he said.

"When the Mepilex dressings are applied to the wounds, they allow EB patients to wear clothes and remove the dressings from their wounds without detaching the flesh and skin and with less pain,” he said.

"The dressings also help EB patients feel less irritation and enable them to lie down on their back when resting or sleeping at night," he added, noting that the dressings are, in a way, a very basic requirement of EB patients.

He said the EB House once wrote a letter to Molnlycke, but the drugmaker replied it would not be able to provide the dressings needed for EB patients in Iran because they are sanctioned by the United States.

The issue of inaccessibility to vital drugs was also raised by Alena Douhan, UN special rapporteur, following her visit to Iran in May 2022.

"Of particular concern is the significant challenge faced in the procurement and delivery of life-saving medicines and medical equipment, produced by foreign companies and destined for the treatment of rare diseases," she said in her report to the United Nations (UN) Human Rights Council.

Douhan's report also challenged Washington's claim of so-called humanitarian exemptions.

The UN expert found that although the sanctions' documents announce that medicines and medical equipment are not affected due to humanitarian exemptions, their delivery to Iran is "severely undermined by the effects of sanctions on finance, trade, shipping and insurance companies, restrictions on international payments, and by foreign businesses' and suppliers' over-compliance.”