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Iran seems to be constantly in the news. First, it was bloody protests last November against a hike in petroleum prices. Next, it was the assassination of a hugely popular warlord, whose killing was mourned by 1.5 million Iranians, with crowds so enormous that 56 were trampled to death in a stampede at his funeral. Then, it was the possibility of a hot war between the United States and Iran in one of the most sensitive regions in the world. Yet another day, a civilian plane was shot down by the country’s own air defense system. If you follow events more closely, you may have heard of a couple of major floods, a train derailment, and two buses crashing and killing most of their passengers. Finally, there was an earthquake not long ago. All this in a just a little over two months. Ad Policy

There is, however, another story, the story of ordinary people’s lives caught in the maelstrom; of tens of millions of people seeing their savings evaporating overnight or having their business go belly up or seeing their dreams dashed. The reality of life here under the devastating impact of the US “maximum pressure” sanctions campaign is the one big story from Iran that’s mostly missing in the headlines.

If you haven’t heard about this, you are not alone. Nobody, certainly not the main protagonists, seems the least bit interested in talking about the devastation of human life in Iran today. It is as if a conspiracy of silence has been cast over the whole issue.

Trump administration officials are understandably indisposed to discuss the topic because it is bad PR. The rather large Iranian expatriate community in North America is reluctant to broach the issue because many of its members believe the suffering visited upon their sometime compatriots is worth the price of shortening or ending the life of a state they have come to loathe. As for the government of Iran itself, all its multitudinous factions are united in diverting attention from the human toll the sanctions are exacting on ordinary people. Related Articles Sanctions Are Economic Warfare John Nichols The Long-Term Consequences of Trump’s Middle East Blundering Mohamad Bazzi

This is bizarre, to put it mildly. During the period of Iraq sanctions, from 1990 to 2003—another comparably harsh sanctions regime—the Baghdad government had every reason to exaggerate the human toll on its citizens. Today the Iranian government has every reason to underreport the human impact of the sanctions. Why is that? One would think the leaders in Tehran could only gain from adverse publicity about the effects of the US sanctions.

There seem to be two main governing factions in Iran, the moderate-reformists and the radical-conservatives—the first represented by President Hassan Rouhani, the second by Supreme Leader Ali Khamenei. Each of these has its own parochial reasons for not publicizing the plight of ordinary people. Rouhani’s circle, who run the executive branch and hence control what passes for economic policy, is fearful that if the true dimensions of the sanctions’ impact were revealed, mass panic and/or loss of morale would ensue, and the entire governing edifice might be destabilized, opening the way for takeover by the radicals.

The radicals’ reasons seem more complicated. First, their mantra for the past four decades has been that no adversity can divert the will of the faithful from building a religious utopia in Iran, not even comprehensive financial and economic sanctions. Second, admitting the harrowing success of the sanctions wouldn’t just show weakness against their mortal enemy, it would also focus the mind of the person in the street on a nagging question: Why is Iran—that is, no other country, but Iran alone—the target of the most onerous and punitive sanctions in recent memory? Naturally the mind moves to the next question: What on earth is the regime doing in the region and throughout the world to justify the Trump administration’s cruel and inhumane sanctions—and to allow the administration to get away with it with little global outrage? This is the question that the radicals prefer not to be asked, under any circumstances. Current Issue View our current issue

Mass starvation—as was widely reported during the sanctions regime imposed against Iraq—has so far not materialized in Iran for the simple reason that, unlike Iraq, Iran is an agriculturally rich country. However, because of Iran’s closer integration into the global economy in the past few years, everything from soy for animal feed to spare parts for trucks and tractors to pesticides has partly or wholly disappeared from the market, causing skyrocketing prices for foodstuffs. Even though the official inflation rate stands at 41 percent, inflation for foodstuffs is running at 74 percent. In addition, the rent for housing units increased last year by more than 95 percent in Iran’s major cities. Meanwhile, the government has proposed raising wages by a meager 15 percent this coming fiscal year. This yawning discrepancy between wages and the cost of living has led to a catastrophic drop in living standards across the board, but especially for the more than 60 percent of the population categorized as poor or in the lower income brackets.

The plight of those sliding into the category known as “absolute poverty” is even more tragic. According to the Iranian Parliament’s Research Center, in fiscal year 2016–17 (calculated in the Iranian calendar), 16 percent of the population lived in absolute poverty, defined as living on or less than $1.08 a day. In 2017–18, the figure increased by an average of 30 percent. That figure must have risen even higher in the past year. This means at least another 10 percent of the population has fallen into absolute poverty in just two years.

All you have to do to see the impact of the sanctions is observe buyers’ behavior in municipal stores reserved for fruits and vegetables. “Before, except for the homeless people, you would hardly ever see anyone asking for rotting produce from us,” said a manager at one of these stores. “We just threw them into giant bins to be picked up by garbage trucks the next day. Today, for every individual buying our ‘normal’ produce, twice, sometimes three times as many people could be seen scurrying about until the closing hours when we offer our rejected produce at reduced rates.” He said the competition to grab this rejected produce could get quite fierce. “They just need to feed themselves and their family no matter what, pride be damned,” he added wryly.

Available data for the economy are hard to come by, but from what is published, the emerging picture is of a society on the brink. For instance, according to the Central Bank of Iran, after a 12 percent growth in GDP in 2016, the first year after the conclusion of the multilateral nuclear agreement (officially, the Joint Comprehensive Plan of Action), it dropped to 3 percent growth in 2017, followed by a 4 percent contraction in 2018 and a further projected 10 percent contraction in 2019, showing the effect of the new sanctions imposed after Trump’s 2018 withdrawal from the JCPOA. This is a cumulative contraction of nearly 14 percent in just two years, which, when combined with the impact of the previous sanctions regime, easily surpasses the Great Depression in its severity and devastating consequences (this year’s conditions are expected to be worse than those of the previous two years).

It seems that, for once, Trump is not exaggerating when he describes the sanctions against Iran as “the most severe ever imposed on a country.” Indeed, the situation is uniformly bleak for all social and economic indicators. From suicide rates to divorce rates to substance abuse to air and water quality to crime rates, the story is the same.

The public health situation is particularly shocking, warranting immediate action by the international community. Technically, medicine and medical supplies are exempted from US sanctions. However, sanctions on Iranian banks as well as on all forms of financial transactions have meant that even if Iran were to buy imported items with its now-meager petrodollars, it can no longer reimburse importers for their sales. Of course, the government can resort to clandestine means to do so, but the purchased items in that case would be far more expensive. The end result is the same: It is as if there is a near-total sanction placed on medicine and medical supplies for Iran.

While Iran produces many drugs domestically, on average some 40 percent of chemicals used in the ingredients are imported. That may not seem like a terribly high figure, except that even with just 2 percent of its chemicals missing or tainted, a drug is usually rendered practically useless. This means that the government must either devote its dwindling foreign exchange income to buying from international suppliers at much higher rates, or else use shoddy sources instead. Both options have been disastrous. The first has led to severe scarcity and black markets, while the second has led to a shocking toll in human lives and general health.

If the intention of the “maximum pressure” campaign was to inflict maximum pressure and pain on the populace (no doubt in the hope of inciting it into revolting against the government), the result has been fabulously successful, as the appalling case of public health indicates, a situation worsened by the rampant factionalism now plaguing the ruling establishment.

The case of H1N1, a not particularly dangerous strain of swine flu that ravaged Iran last fall, provides a telling example of how all these dynamics can play themselves out on a voiceless population in a most frightful and chilling manner.

H1N1 can generally be prevented by a flu vaccine. Once you catch it, it can be successfully treated by several antiviral drugs. One of these is called Oseltamivir, known in Iran by its brand name Tamiflu.

Recently the Rouhani government granted, or rather was asked to grant, exclusive rights for nationwide distribution of Tamiflu to a large Iranian pharmaceutical firm located in western Iran. As it happens, two of the company’s chief shareholders happen to be connected to the conservative clergy. Once the first outbreak of H1N1 was reported last September, the firm simply announced that it was no longer able to honor its end of the bargain. In other words, it couldn’t distribute any of the consignments of Tamiflu it had pledged in its contract with the government. The firm said in its legal brief that the government had failed to deliver most of its requested raw materials in a timely fashion, or at economically feasible rates. The firm had a point: In the past two years, the government-regulated prices for drugs have increased half as fast as the prices of the raw materials that go into them. However, it is also true that these are not normal times, by any stretch of the imagination. No economic enterprise is operating as before. Of course, the company in question did not have to wait until the last moment to announce its intentions, and, according to subsequent published reports, it was getting preferential treatment by getting cheaper inputs, compared with other pharmaceutical companies or pharmacies.

At first, the government tried to address the public health threat by distributing limited medicine from alternate sources. However, by November the disease was spreading rapidly to every corner of the country and infecting hundreds of thousands. It was clear the infection rate was accelerating and could become a major pandemic. At this time, government officials went on national TV warning the public of the serious health hazards. Schools were ordered closed for a few days at numerous localities and people were urged to stay home if they could.

In tandem with this, the government imported huge quantities of Tamiflu from international networks, no doubt at several times the normal price. However, according to a report by the website Aftabnews, which is close to the government, something unexpected happened. The firm originally assigned the task of distributing the drug sued the government for breach of contract and, astonishingly, won a temporary injunction (the judiciary is aligned with the conservative clerical faction) to stop the distribution of Tamiflu for a few days; this, while patients were dying in record numbers in hospitals throughout Iran.

This wasn’t the end of the story. The public announcements did help prevent further spread of the disease, but it also caused panic, with the result that those who didn’t need the vaccine (influenza mostly strikes old and very young people) rushed to the nearest pharmacy to buy up as much of the vaccine and antiviral drug they could lay their hands on. The resulting shortages caused needless deaths and a thriving black market, in which Tamiflu fetched 10 times its regular price.

A simple extrapolation of death tolls compiled for two hospitals in two medium-sized towns indicates that a combination of punitive economic sanctions, mismanagement, and political machination may have caused the death of at least 1,600 people last fall. The official death toll is placed at 81.

In today’s world, 1,600 may not appear to approach the threshold of a calamitous national crisis, but unfortunately, the case of H1N1 exemplifies the whole health system, from preventable diseases like measles to other afflictions like diabetes, cancer, heart disease, respiratory ailments, etc. Last year, for example, several thousand cancer patients died because their regular medication was either no longer available on the market or had quadrupled in price. Technically, insurance agencies must cover 70 percent of the cost of the drugs, but nowadays they don’t approve of brands that are new to the market, which means if you are not well off, you can forget about being able to get that kind of drug. For this and a variety of other reasons, many cancer patients last year resorted to using inferior substitutes, which for some had dire consequences in the form of deadly allergic reactions.

Doctors in Iran’s hospitals tell countless horror stories about making do with fewer drugs, fewer spare parts for their medical equipment, and a much larger pool of people with serious medical conditions. “It really seems like I’m in a field hospital in a war zone at times,” said a surgeon working in a midsize town in southwestern Iran. “We have daily quotas of how much anesthesia we can administer each day. At the same time, there are days when you just can’t turn away many patients. So what do you do? You become creative and do a lot of praying.” According to this surgeon, it is not unusual at his hospital for an ob-gyn to perform a C-section delivery with localized anesthesia.

Quite apart from the dire humanitarian consequences, anyone moderately familiar with the politics of Iran and the region can see that the sanctions campaign is detrimental to long-term US interests in the Middle East on purely strategic and geopolitical grounds, for multiple reasons:

1) It is alleged that the policy isolates Iran diplomatically. So far, the campaign has not isolated Iran at all. If anything, it has created a major diplomatic rift between the United States and its European allies. Moreover, in recent months, Saudi Arabia and the United Arab Emirates, two major regional adversaries, have moved to reduce tensions by reestablishing contact with Iran.

2) As for the containment argument, Iran’s aggressive activities in the region have not abated. If anything, as can be seen from attacks on marine shipping or the recent missile attacks on US bases or Saudi refineries, there has been a dramatic uptick in these activities.

3) Some claim that the campaign reduces the chances of Iran reaching the so-called nuclear breakout threshold. In fact, in the past year Iran has stepped up its nuclear enrichment, not reduced or stopped it.

4) While it is true that Iran’s financial prowess has suffered serious blows, leaving fewer funds for its allies in the region, this has not meant a smaller budget for the Islamic Revolutionary Guard Corps (IRGC), nor has it diminished the war-fighting posture or militancy of one of Iran’s key regional allies, Lebanon’s Hezbollah. This is also true for Iran’s other regional allies.

5) Some people in the Trump administration apparently believe this is the perfect time for payback for the seizure of hostages at the US embassy 40 years ago, the suicide attacks on the US Embassy and Marine Corps barracks in Beirut during the Reagan administration, and the use of IEDs in Iraq against US military personnel during the US occupation of that country. The problem with this argument is that while devising such policy might serve a cathartic purpose for its designers and the victims, substituting sentiment for sound policy is not a wise strategy.

6) It is sometimes alleged that no sensible leader of a country the size of Iran could possibly go to war against a superpower when his country’s economy is in a tailspin. Unfortunately, the opposite seems to be the more likely scenario, especially since neither the United States nor Iran can afford a prolonged hot war at present. Usually in such confrontations, the country in question is unified, economic woes are temporarily forgotten, and a new political or economic course can be set.

7) Those who support the “maximum pressure” campaign fervently hope it will weaken the regime from within, perhaps leading to its violent overthrow by mass revolt. Such Boltonian pipe dreams gained new adherents after last November’s petroleum protests, and the ongoing sporadic protests after the recent downing of the Ukrainian jetliner near Tehran.

Individuals advocating this line of argument clearly know nothing about the nature of the Iranian regime or Islamic radicalism in general. The Iranian regime has a more or less fixed number of religiously inspired core supporters that is several million strong. They would never, under any circumstances, abandon the regime and the leader they love and revere. The only conceivable scenario for this imbecilic model of regime change is not a successful revolution along the lines of what occurred in the USSR or Eastern Europe but a terrifying civil war that would, according to most experts, make the just-concluded Syrian civil war look like a picnic.

8) Finally, the chief rationale behind the maximum pressure campaign—to bring Iran to the negotiating table—is as elusive today as it was back in 2018, when it was first announced. Supreme Leader Ali Khamenei has been quite explicit on the issue, and he is not about to change his tune now. That is not what supreme leaders do. The ayatollah has set at least two conditions for a resumption of talks, neither of which Trump is disposed to accept. Last September Khamenei told a group of clerics, “If the US abjures and recants, and returns to the nuclear agreement which it has abrogated, it may be able to participate within the framework of the group of members countries [of JCPOA]. Otherwise, no negotiation is to take place between the officials of Iran and the United States at any level, either in New York or elsewhere.” Now, with the assassination of Qassim Suleimani, the chances of Iran going back to negotiations are remote.

While the people of Iran deserve any help they can get—just as, in many cases, Iran’s foreign policy needs to be confronted—the recent anti-government protests unfortunately have zero chance of toppling this regime on their own. Short of a military invasion and an occupation involving hundreds of thousands of ground troops, this regime cannot be dislodged from power.

There are also several downsides to the maximum pressure campaign that are seldom discussed by the media. To start with, for the first time in a generation, the campaign is leading to the departure of reformists from the political scene, perhaps on a permanent basis. The Rouhani government’s economic travails are failing with the electorate—every poll in Iran indicates that the public intends to punish the reformists at the polls by boycotting the parliamentary elections scheduled for late February, thus opening the way for a complete takeover of that body by radicals. The next speaker of the Parliament will almost certainly be the former hard-line IRGC general and former Tehran mayor Mohammad Bagher Ghalibaf. And one of the first legislative acts the new Parliament is expected to undertake is to pressure the government to speed up its nuclear enrichment activities. With the sanctions firmly in place, this same scenario will play itself out again in the same fashion next year for the much more important presidential elections. Once a radical takes the helm and all branches of government are held by the hard-liners, nothing will stop Iran from reaching nuclear breakout capacity in short order.

Secondly, small-scale civic and workplace-related actions by ordinary people—important steps in the course of building an indigenous democracy—are generally tolerated by the regime. Last year saw a dramatic decrease in such associations and activities compared to the year before. Severe social and economic deterioration is apparently not conducive to more social activism.

Regardless of the merits of Trump’s maximum pressure campaign on geopolitical grounds, there is a major humanitarian crisis in Iran today, one that is certain to deteriorate in the following months. At a minimum, the Trump administration must ease the suffering of ordinary Iranians by facilitating the shipment of much-needed medicine and medical supplies to Iran by third parties and/or ease the restrictions on financial transactions. At the very least, an oil-for-medicine program, modeled on the UN’s oil-for-food program for Iraq in the 1990s, could be established by the UN with tacit US support.

On January 12, some 1,300 protesting students staged a rally at the Shahid Beheshti University in Tehran. Angry at the death of their fellow students on the ill-fated Ukrainian Airlines flight from Tehran, they pointedly refused to walk over a huge US flag that was spread on the campus grounds by marching around it rather than over it. The march was captured on video. This is an important and welcome development that should not be squandered by misguided doctrines and policies.

While at present most Iranians blame the government for their misfortunes, sooner or later, the truth about the sanctions will come out. In 1953, perhaps no more than 10 percent of Iran’s population were incensed or directly affected by the US-engineered coup that toppled their democratically elected government. It took less than two decades, but when the truth finally came out for the average Iranian, it outraged millions, a development that is still bedeviling the US government.