Since graduating as a junior doctor from university in her hometown of Mashhad two years ago, Sanaz has treated some of Iran’s most underprivileged patients, who benefit from a healthcare system brought in by President Hassan Rouhani.

Known as Rouhanicare, the system is seen as his greatest unsung domestic achievement, offering protection to almost 11 million people.

Now a new round of US sanctions, which came into effect overnight on Tuesday, is putting her patients’ lives at risk, Sanaz said.

“The price of a lot of medicines has already soared, some have become scarce to find, others are not covered by insurance and are difficult to purchase,” the 27-year-old said by telephone.

“It’s no more only about shortages in drugs for cancer or special diseases such as haemophilia or thalassemia, but also normal drugs that were abundant in Iran previously,” she said. “A normal drug like Warfarin, which stops blood clotting, is becoming difficult to find, which means patients’ lives are at risk if we as doctors can’t get these medicines. Another example is Amlodipine, which is for treatment of blood pressure. Amlodipine is produced internally but companies have problems with importing its ingredients due to banking restrictions or other sanctions.”

The sanctions follow Donald Trump’s unilateral decision in May to withdraw the US from the 2015 Iran nuclear deal, in spite of opposition from the EU. They are hitting Iran’s access to the dollar, gold and precious metals, and will be followed by additional, and more stringent, measures by 4 November, including an embargo on imports of Iranian oil and sanctions on its banking sector.

The sanctions are compounding Iran’s economic woes. Since Trump withdrew the US from the nuclear deal, the national currency has gone into a tailspin, halving in value since April and shaking Iranians’ confidence in their government. Weeks of street protests over economic grievances have become more political as they spread around the country.

“There’s a sense of worry among all Iranians,” Sanaz said. “Every day the price of the dollar is changing and even ordinary people in villages who don’t need to buy dollars are worried and constantly ask about its fluctuations. These sanctions are affecting Iranians at all levels.”

Rouhani gave a live interview on national television on Monday night to reassure people that his administration was prepared to withstand pressure from the US. But many in Iran have their doubts.

“You can’t describe the scale of the crisis the country is facing,” said Homeira, a 31-year-old graduate of management who lives in Chalus, northern Iran. “Life goes on, but how it goes on is the issue. Inflation and currency depreciation has made life so costly – it’s as if you have to pay even for the oxygen you’re breathing.

“But worse than all of this is you don’t have a right to say anything in protest. A lot of people think there should be another revolution, but I believe another revolution will make things worse. We need to fix the current situation.”

The situation is dreadful, said Ehsan, who sells vehicle parts in Karaj, a city west of Tehran that has been the focal point of recent protests. “In a country that is sitting on oil, copper, gold, gas, people are left without electricity and water for four hours per day,” he added.

At least one person is reported to have been killed during clashes between protesters and security guards in Karaj in the past week.

In response to the sanctions, Iran’s central bank has eased foreign exchange rules, allowing the dollar to be traded in secondary, often black markets. Local agencies reported markets responding positively to the change in policy. The rial recovered some of its value against the dollar on Tuesday, but it was too soon to say how the policy would play out in the long run.

Mohammad Eslami, director of international affairs at Shenasa Venture Capital, said fluctuations in the exchange rate have made it “really hard to have an investment plan” in Iran.

Eslami said the purchasing power of ordinary peoplewas likely to decrease further under sanctions. “It will make life harder,” he predicted. The sanctions will pose a challenge for Rouhani and other moderate politicians, he said.

Sanaz said her neediest patients still had to pay for much of the equipment used in their care, despite the improvements made to the system in recent years.

As prices fluctuate, so too does people’s ability to pay. “One of my patients needs an operation that cost 500m rials [around $5,000], which was much cheaper months back,” she said. “Now the patient can’t afford it. It’s a matter of life and death.”



