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Sanctions' Ill Effects | Part 2: A Looming Catastrophe

by CORRESPONDENT

09 Nov 2012 23:33Comments
20120904134226_16.jpg Part 1: The Disappearance of Lifesaving Drugs

The most vulnerable could pay a grave price for the standoff over Iran's nuclear program.

[ series ] "For anyone or any group to say sanctions don't target the people of Iran is childish."

So said Fatemeh Hashemi of the Foundation for Special Diseases in an interview with Al Jazeera last month. The head of the major Iranian charity group continued, "They're well aware that sanctions put people under pressure, not the government.... If a drug can't be imported at all, or only in insufficient quantities, it is the people who will be traumatized." She said that the constriction on imports of medicine and medical equipment is imperiling the health of up to six million patients.

In a letter sent to U.N. Secretary-General Ban Ki-moon in mid-September, Hashemi, daughter of former President Akbar Hashemi Rafsanjani, wrote, "The importation of medicines that can't be produced in Iran and certain basic ingredients have become impeded, and it will lead not only to the scarcity or complete absence of certain medicines, but also to the halt of production at several drug manufacturing plants in Iran within a month or two." She called on Ban to act to prevent further harm to the ill in Iran.

In a U.N. report made public in October, the secretary-general observed, "Even companies that have obtained the requisite license to import food and medicine are facing difficulties in finding third-country banks to process the transactions."

Patients with cancer, muscular dystrophy, and amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease) are among those most at risk, according to Mojtaba, the proprietor of a 24-hour pharmacy in east Tehran. He talks to me in particular about ALS, a neural system disease that damages the brain and spinal cord. It leads to a slow loss of muscle control and eventually near-total paralysis. Most of those stricken with it don't survive for very long -- British physicist Stephen Hawking is a renowned exception. ALS medication, whose production requires advanced technological processes, has never been manufactured in Iran, which relies entirely on its importation.

I ask Mojtaba what happens if an ALS patient loses access to the medication. "Paralysis sets in," he replies. "Suddenly your legs lose strength, and eventually your body weakens to the point that you can't inhale or exhale."

He adds, "You also have to include hemophiliac patients. If they miss their drugs, they will have unstoppable bleeding. There is an enzyme in the blood that helps it coagulate. People with hemophilia don't have this enzyme -- drugs make it up for them. Imagine what would happen if there was no drug available?"

All I can do is shrug in resignation.

"A cut on a hemophiliac's hand will not stop bleeding, not tomorrow, never. He will bleed until he dies," says Mojtaba.

I ask him how things currently stand in terms of access to medicine, especially for those with such critical illnesses. "Fortunately we have not reached the condition where the ill have to be turned away from hospitals, being told, 'Go away and die, there are no drugs available for you.' But drugs with the quality of foreign-made ones don't exist any longer. At least I don't see any. High-quality domestic drugs have become rare too. Now they are being replaced by mediocre drugs. Thus, patients' response to the drugs diminishes and the probability of death rises."

In his estimation, if the current sanction regime continues, at what point will drug shortages yield a human catastrophe?

"In a year!"

He pauses and then offers an even more dire assessment. "If the rate of importation and production of drug remains as is, between six months to a year.

"It is impossible for me to think this government cares about the people. The solution is to barter oil for medicine with India. At least the catastrophe would be prevented. Indian drugs are of higher quality than domestic ones."

Payman, a young man waiting for his medicine at an adjacent window, joins our conversation. "Yes, the government is ineffectual, but we didn't have to struggle with such a catastrophe between 2005 and 2011. The E.U. and the U.S. say we have not been forbidden medicine. We are not children. When they block all financial transactions and there is no possibility of trade," he says, the truth of the matter is apparent.

"It's an insult to human intelligence," he continues. "They try to justify themselves ethically. 'We haven't prohibited medicine, we only imposed sanctions on banks.'"

Mojtaba laughs in agreement and offers an analogy. "It's like going to a pharmacy to buy medicine and the pharmacist says that he will sell it to you and you have to pay, except that he won't accept your payment! You have to pay, somehow, but he will not accept your payment in any form."

A commotion breaks out at another of the pick-up windows. A spectacled woman in her 50s is arguing with the pharmacy assistant about her order. I approach them to hear better.

The woman begs in a haunting voice, "This is a medicine for the nerves. I need it for my child in high school." The assistant responds, apparently repeating herself, "This drug has not been around for a long while."

The mother utters a plaintive Persian expression, "What kind of dirt should I pile on my head?"

Mojtaba advises her, "You should visit a few other 24-hour pharmacies. You may find a few doses."

Tears well in her eyes. "My son responds only to this drug. Other drugs don't affect him. He has been taking this medicine for many years." She adds with a sob, "What am I to do now?"

She leaves the pharmacy crying. Mojtaba turns to me. "There are a dozen of such cases each day," he says. "My job has become torturous."

I ask him what illness was involved in this case. "Epilepsy," he responds. There are "four or five different types of epilepsy, and each type requires a specific drug, but now, medicine for two types are nonexistent and they have to take drugs for other kinds. Its like using one type of antibiotic for all infections."

The incident has affected others around us. A middle-aged man says, "So, this is the land of the Imam Mahdi." Devout Shiites believe that the Mahdi, the last of the 12 Imams, will one day reemerge from centuries of occultation as a savior. To rouse popular support, conservative leaders in the Islamic Republic's ruling apparatus have often promoted veneration of the Mahdi.

Another lady adds sarcastically, "All thanks to Ahmadinejad for his handiwork. We have truly reached independence." She turns to Mojtaba and asks, "Doctor, isn't nuclear energy helpful for our sick?" Laughter erupts across the pharmacy.

Later, a conversation I strike up with a car salesman who is smoking outside his showroom in Shahrak-e Gharb, an upper-middle-class neighborhood in northwest Tehran, turns to conspiracy, as most topics with Iranians tend to do. Could President Mahmoud Ahmadinejad, by not allocating foreign reserves to the purchase of drug purchases, be trying to incite a humanitarian backlash against the international sanctions?

"I think they are playing a vicious game, because a year's medicine needs can be met with a couple of billion dollars. Iran's foreign currency reserves have declined, no doubt of that, but saying that it is unmanageable, this is doubtful. It is possible that they have intentionally created circumstances that cause drug shortages."

I ask him if he thinks that the United States would ease economic sanctions in response to international pressure over the issue.

"Improbable," he says. "The U.S. has embarked down a road which it will follow to its end. It has realized that there are two options: either wipe out Iran's nuclear program with a military attack, or through economic pressure on food and medicine. And there are no other choices on America's desk. It has chosen the latter."

Copyright © 2012 Tehran Bureau

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