Iran
A woman holds her cancer medication in Tawhid Hospital in Sanandaj, Iran in August 2019. Photo: Rudaw English
SANANDAJ, Iran — There was a huge crowd at the Oncology department at Tawhid Hospital in Sanandaj, Iran on the scorching August day. Desperate patients waited for overworked physicians to come give them their chemotherapy in the crowded ward. One woman in her fifties said she found out she had cancer nine months ago. As Rudaw approached her in the predominantly Kurdish city’s hospital, she covered her head with a scarf, not wanting to show her falling hair.
"As my breasts became itchy and I felt pain in them, I visited a physician. The physician informed me that there is a lump" the woman, who identified herself as Chiman, told Rudaw English, adding that the bad news "destroyed" her.
Sanctions imposed by the US to deter Iran from building a nuclear weapon have affected all aspects of life in the Islamic Republic. Foreign medicine supplies have dwindled, causing the prices of domestically-produced meds to skyrocket.
Chiman has difficulties paying for her chemotherapy at the hospital in Sanandaj, which Kurds refer to as Sena. Though her husband is a policeman and receives armed forces’ insurance, they still find it hard to afford the expensive medication.
"For any chemotherapy, I pay one million toman [$90]. They are expensive and the insurance covers half the cost,” she said. “And for any imported medicine which Iran does not support supplying because it is not from Iran, it is hard to get.”
“I cannot afford the [Paclitaxel] medication.”
Paclitaxel is a chemotherapy medication used to treat a number of types of cancer including ovarian cancer, breast cancer and lung cancer. It is administered by injection into a vein.
“In Tehran they told my husband that we could get it for eight million tomans, but we did not manage to afford it due to our poverty,” said Chiman. “I need this medication every 15 days."
Iran is suffering from the crippling sanctions the US reimposed last year after withdrawing from the 2015 Iran nuclear deal. The US insists the measures do not target the medicine and food sectors. However, the situation in Tawhid Hospital shows the degree of suffering sick Iranians deal with as they struggle to pay - and live.
‘My sons are destitute’
A 55-year-old woman suffering from womb cancer was in the bed next to Chiman. She is from the marginalized Faraja neighborhood of Sanandaj.
Speaking on condition of anonymity, she described Chiman's economic situation as much better than hers.
"At least they enjoy the insurance that they have,” she told Rudaw English. “My husband is a [construction] worker, suffering from spinal pain and nowadays cannot even work. How can I afford my medications?"
Rudaw English did not use the full names of the interviewees for security reasons. People in Iran are loathe to speak to foreign media due to the likelihood of being arrested for criticizing the government.
The woman’s daughter, 30, is forced to work only for 700 thousand tomans ($60) a month at a market in the town.
"Only for one pill, we sometimes pay 400 thousand tomams ($35), which I have borrowed from my brothers, sisters and relatives," she said.
Her situation has forced her to prefer death over life.
"Let me die," she said. "In addition to my poverty, even my sons are destitute. They do their utmost to save me, yet my medications cannot be covered."
‘We could not afford it’
Poverty has forced patients to seek treatment independent of physicians, which can be dangerous.
Soran is a pharmacist who owns pharmacies in Sanandaj and Mahabad - another mostly Kurdish city.
Since last year, a lack of medicine has haunted people, especially after the dramatic deflation of the Iranian currency the toman in the wake of the US sanctions.
"The sanctions restricted access to imported medications," Soran told Rudaw English, adding that this allowed for “smugglers to bring in medications and patients pay large amounts of money to afford medications.”
More basic medicines have gotten pricier as a result of the sanctions, according to Soran.
“Even some flu antibiotic medications have decreased in the markets, partly because pharmacies were not selling them so they get expensive and then they would sell at a later time,” he said.
People are also buying medicine without a prescription, according to Soran.
“People buy medications without physicians writing their prescriptions because they know if they visit a physician, they will be charged some money to see the doctor,” he said. “So they do not want to do it."
"This is extremely dangerous, leading to the death of patients sometimes.”
At a corner of the courtyard of the hospital, there was a depressed woman sitting.
Gulbagh, 48, is from the Diwandara city in the Kurdistan Province. She said her husband died two months ago.
"Ten years before he died, he started to suffer from asthma. His medications were very expensive. He often would not buy them," she told Rudaw English, adding that to make a living for his family, he was forced to "do farming.
Gulbagh burst into tears when recounting her husband’s inability to afford an asthma spray in his final days.
"The last time when his asthma extremely deteriorated, he visited a doctor. When he returned in the evening, I saw him empty-handed. I asked him why, he replied 'the price of breathing spray has become expensive to the extent that I refused to buy,’" she said while sobbing.
"That night, he appeared to be very exhausted. After he ordered a glass of water from me, he died while I was trying to get him the water. If he had had the spray, he would not have passed away."
“In the past, the price of one spray was 20,000 tomans ($2), but it increased to 120,000 ($12) so we could not afford it."
Related: Chronically ill Iranians struggle to access medicine under US sanctions
‘Mafias’
Another pharmacist who declined to give his name said smugglers are taking advantage of the short supply of medicine.
There are two types of smuggled meds in Iran, according to the pharmacist.
"The first one; those mafias associated with the authorities, smuggle medicines by lorry from border crossings from Armenia, Turkey, Iraq and Ukraine, making abundant profits,” he told Rudaw English. "The second one is minor medicines who European and Turkish tourists bring in to Iran while travelling. They sell them for huge amounts of money.”
Iran Judiciary Chief Ebrahim Raisi has launched an anti-corruption campaign since his appointment by the Supreme Leader Ali Khamenei in March and dozens of top officials including judges have ended up sacked with some ending up in prison.
Some Iranian officials have acknowledged the economic hardships Iranians face vis-a-vis medical payments. In July, the Deputy Health Minister Iraj Harirchi said around 30 percent of Iranian patients are forced to buy medicines without a prescription as they cannot afford to pay doctor fees.
The US maintains that the sanctions do not target the health sector. In a video entitled “Dispelling Myths About U.S. Sanctions on Iran” posted on the US State Department’s YouTube channel, US Special Representative for Iran Brian Hook said the Iranian “regime” waspromoting the “myth” that medicine is sanctioned.
“Under our laws, a general license is in place today that allows medical devices to be exported from the United States to the Iranian people,” said Hook. “The United States has a great respect for the people of Iran, and does not seek to prevent them accessing medical supplies or care.”
“The Iranian people know all too well that the real issue preventing access is the regime itself.”
Approximately 97 percent of Iran's pharmaceutical doses are covered by about 100 local pharmaceutical companies, the bulk of which belong to the private sector, according to Akbar Barandegi, the Director General of Iran's Food and Drug Administration.
For now, Chiman is waiting to be able to afford chemotherapy again, if she ever can.
“I have so far received four chemotherapies,” she said. “It has been three months.”
Written by Jabar Dastbaz Sena
Translated by Zhelwan Z. Wali
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