Both Tehran’s priorities and Washington’s sanctions leave ordinary Iranians struggling for medicine and dignity.

By mid-September 2025, Iran’s medicine crisis had entered a new and harsher phase. Official sources reported that roughly 300 essential drugs were in short supply, with 100 simply unobtainable. The reinstatement of broad UN “snapback” sanctions, coupled with new US restrictions on networks channeling Iranian oil revenues through Hong Kong and the UAE, has further limited Tehran’s ability to pay for imports. 

European governments have also tightened the squeeze, linking any relief to Iran’s full compliance with the International Atomic Energy Agency. For ordinary Iranians, these sanctions are not distant diplomatic maneuvers but part of their daily life—walking into pharmacies with empty shelves, waiting weeks for treatment, paying exorbitant prices on the black market, and making heartbreaking choices between medicine and other basic needs.

Missiles are paraded in Tehran, but pharmacies across the country have run out of insulin and cancer drugs. Hospitals keep machines running long after they should have been replaced. Doctors and nurses leave for steadier work abroad. Families cut back on food so they can pay for medicine. In Tehran, leaders insist weapons are vital for defense. In Washington, officials say sanctions are the only way to apply pressure. Between those two arguments are millions of Iranians, left to exchange dignity for survival.

The Shadow of Sanctions

Western policymakers often insist that humanitarian goods are exempt from sanctions. Technically, they are. However, when banks, insurers, and shippers fear multi-million-dollar fines for any transaction with Iran, the exemption holds little value. The chilling effect has made it harder to buy heart medication than to buy oil on the black market. In practice, financial sanctions function like a blunt weapon. They choke off the entire system of imports and payments. The intended targets—the Revolutionary Guard and its networks—find ways around them. The unintended targets are cancer patients, diabetics, and children with rare genetic disorders.

Doctors and patients in Iran describe the health system as close to the breaking point. A 2025 study in BMC Health Services Research found that sanctions have made cancer treatment increasingly unaffordable and unreliable. Hospitals struggle to find essential chemotherapy drugs, and when they do, the prices are often far beyond what ordinary families can pay. The researchers note that shortages of equipment and trained staff compound the crisis, leaving many patients waiting for care that, in some cases, never comes. Consequently, families turn to the gray market, where drugs cost several times the official price and are sometimes counterfeit. Wealthier Iranians travel abroad for treatment. For most, there is no alternative.

Domestic Strains Add to the Burden

Yet, sanctions alone do not explain the crisis. Iran has a substantial pharmaceutical industry, but it still relies heavily on imported ingredients and specialized components. Mismanagement and corruption worsen the shortages. Patronage networks ensure that insiders profit, even from scarcity. The government has invested heavily in military projects and regional influence while neglecting hospitals and clinics. In this sense, the suffering is the result of two forces colliding. Sanctions create the bottleneck. Mismanagement makes it worse. Ordinary people bear a double weight.

The middle class, once the backbone of Iran’s reformist politics, is dissolving. The rial has lost more than 90 percent of its value over the last decade, consuming wages and savings. The Islamic Republic’s promise to defend the mostazafeen (“the oppressed”) is contradicted by the daily reality of scarcity. But the West’s promise to use sanctions as a surgical instrument rings equally hollow. Both sides justify their policies in the name of security. Both sides leave Iranians with fewer options for a decent life.

Iran’s younger generation has grown up under both sanctions and repression. They watch the world through digital windows while facing limits at home. The “Woman, Life, Freedom” protests after Mahsa Amini’s death revealed their anger, their courage, and their creativity. Yet, their caution is equally telling. They have seen Syria, Libya, and Iraq collapse. They want change, but not chaos. For them, both the government’s insistence on militarization and the West’s reliance on maximum pressure feel like traps. Neither offers a path to dignity.

The Narrowing of Peaceful Options

Protests in recent years—over fuel prices, water shortages, and hijab enforcement—have been met with harsh repression. Amnesty International documented hundreds of deaths and thousands of arrests during and after the 2022 protests. Tehran believes that harsh responses prevent chaos. However, every crackdown reduces peaceful channels of dissent, leaving only anger and despair.

Here too, the role of outside pressure is complicated. When sanctions intensify or Israel strikes, nationalism often kicks in. Citizens who resent the regime still resent the idea that outsiders dictate their future. The effect is to strengthen hardliners at home while narrowing the political space for moderates.