Health service disruptions under economic sanctions: evidence from Iran

BACKGROUND: Unilateral economic sanctions are increasingly recognized as factors associated with structural determinants of health, yet their implications for health service delivery require in-depth examination. In Iran, these pressures appear to extend beyond medicine shortages to affect financing, procurement, infrastructure, workforce capacity, and continuity of care. MAIN BODY: This policy commentary offers an in-depth analysis of how economic sanctions influence health service delivery in Iran, drawing upon a synthesis of existing literature and expert understanding of the Iranian context. The analysis highlights how sanctions may be linked to disruptions in multiple dimensions of service provision. Reported effects include weakened preventive and immunization services, fiscal and administrative pressures on health institutions, workforce constraints, reduced access to medical equipment and technologies, and diminished patient access to care. These pressures are associated with undermining procurement stability, delay service provision, increase waiting times, and exacerbate existing inequities, particularly in underserved populations and regions. CONCLUSION: Economic sanctions appear to act as profound structural pressures on Iran's health system, which may weaken its financial, organizational, and operational capacity. Strengthening health system resilience and safeguarding equitable access to essential services, informed by the challenges identified in this analysis, should therefore be central to policy and humanitarian responses.