The impact of international economic sanctions on Iranian cancer healthcare
Introduction
In this review, we aim to provide an update on Iran's healthcare system and discuss how sanctions have made an impact on the health status of the Iranian population, the infrastructure of health services, and the availability of resources, specifically in cancer care.
Iran has been subject to international sanctions by various entities since 1979 [1]. However, in 2012, the Iranian economy collapsed under the economic strain of sanctions imposed to stop Iran from violating the international Nuclear Non-Proliferation Treaty [2]. While the current sanctions imposed by the United States, the European Union, the United Nations, and various other countries, do not formally target healthcare or patients’ access to drugs, the sanctions have indirectly led to serious healthcare concerns and medication shortages for people residing in Iran. Namely, lack of and inadequate access to capital in the country has severely limited cancer patients’ access to pharmaceuticals and other necessary lifesaving treatments [3]. Iran has the highest incidence of cancer in the Middle East, and this region is predicted to face the most exponential increase in cancer incidence in the next decade [4]. The fallout of sanctions imposed on the Iranian population must be considered while developing policies to deter Iran from developing deadly warfare without imposing grave danger to its citizens.
Sanctions are tools of foreign policy used to isolate an offending country from the global marketplace and force the country to take an intended action. Often sanctions are specific punitive economic actions, usually the refusal to sell goods to an offending state in order to inhibit trade and the movement of capital [5]. In the 20th century, economic sanctions became a common prelude or alternative to warfare and were considered a peaceful and effective method to enforce international law [6]. The goal of sanctions in the past has been to improve and protect human rights [7]. Article 41 of the United Nations (U.N.) Charter explicitly authorizes the international community to “apply measures not involving the use of armed forces to give effect to its decisions,” including complete or partial interruption of economic relations for a specific objective [8].
Despite this intention, however, there is mounting evidence that sanctions impose hardships that affect a country's ordinary population far more than their leaders [6]. Sanctions result in a decline in economic activity, which works to reduce imports and causes far reaching health effects that target the most vulnerable populations, especially women, children, the elderly and those with chronic illnesses [5], [9].
In 1995, past U.N. Secretary General Boutros Ghali called sanctions “a blunt instrument,” and stated that “They raise the ethical question of whether suffering inflicted on vulnerable groups in the target country is a legitimate means of exerting pressure on political leaders whose behavior is unlikely to be affected by the plight of their subjects” [10]. Indeed, experts have argued over the past 20 years that the economic effects of sanctions do not directly translate into a political impact [7].
Modern sanctions almost always include specific exemptions for medicines and food. Despite this, through their intent to harm the economies in targeted countries, they inevitably lead to disruption in health services for citizens. This appears to be the current situation in Iran, and sanctions, in addition to political mismanagement, have placed the country at the brink of a humanitarian health crisis.
Section snippets
Economy
In 2013, the Gross Domestic Product (GDP) per capita when adjusted by purchasing power parity (PPP) in Iran was $15,090.05 U.S. dollars (USD), equivalent to 85% of the world's average. GDP per capita in Iran averaged $12,093.93 USD from 1990 through 2013, reaching an all-time high of $16,233.53 in 2012 and a record low of $8679.08 in 1990 [11]. In 2011, between 44.5% and 55% of Iran's urban population was estimated to be living below the poverty line [12].
Healthcare system
The Ministry of Health and Medical
International economic sanctions on Iran
Sanctions in Iran exist on banking, shipping, insurance, ports, trade, commodities, and energy transactions and ventures [27]. Recently, the Society for Worldwide Interbank Financial Telecommunication (SWIFT) has stopped its electronic communication services for Iranian financial institutions and other transactions in order to comply with the EU sanctions [2]. As it follows, this act has rapidly resulted in severe negative humanitarian impacts [28].
A brief timeline of the sanctions imposed on
Discussion
Sanctions lead to unpredictable outcomes in foreign policy, and factors such as the duration and thoroughness of trade interruptions, the economic independence of the embargoed state, and impact on targeted groups in state must all be considered. Threats to health and a healthcare system caused by sanctions are only apparent after years of resource shortages [1]. As noted, “controversies surrounding the application of economic sanctions cannot be ignored or fully resolved” [63].
The underlying
Conclusion
This is the first report on the impact of international sanctions on Iranian cancer health care using current evidence-based literature. It is apparent that, at the least, economic warfare should be guided by rule of humanitarian law to reduce effects on civilians. Sanctions on trading in goods and services should have clearly defined and uniform exemptions. Beyond that, the indirect effects of sanctions are crucial considerations — economic sanctions hinder the building of a modernized
Conflict of interest
The authors have declared no conflicts of interest.
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