By Mohammad Reza Farzanegan,
Ruth Gibson and Maziar Moradi-Lakeh
In international diplomacy, economic sanctions are often portrayed as a clean and humane alternative to war, a supposedly civilised way to pressure governments into compliance with international law without shedding blood. Yet this reassuring narrative hides a devastating truth: sanctions can destroy the health and wellbeing of ordinary people. While they are intended to weaken regimes, they often end up crippling the targeted state’s ability to provide basic healthcare to the very citizens those measures claim to protect. The mechanisms meant to safeguard civilians and allow humanitarian aid frequently collapse, leaving the most vulnerable to pay the highest price for political decisions made far from their reach.
The result is a form of economic warfare that kills not through bombs or bullets, but through the slow erosion of health systems, medicines, and human dignity.
Our recent correspondence in The Lancet examines this reality in the context of the United Nations Security Council’s decision on September 28, 2025, to reimpose multilateral sanctions on Iran. In the piece, we do not take a position on the Security Council’s decision to reimpose multilateral sanctions; rather, our focus is squarely on the potential consequences of this move for Iran’s population, particularly given the severe health impacts seen under previous sanctions. Drawing on evidence from the pre-2015 sanctions period, our analysis in The Lancet shows how these measures shattered Iran’s health system and reveals a deeper structural failure within the international sanctions regime to protect the fundamental right to health.
The findings reveal that sanctions are not merely diplomatic instruments; they are public health interventions with deadly consequences.
The impact of sanctions on public health is not theoretical; it is measurable in years of life lost. A comprehensive cross-national analysis has shown that the imposition of UN sanctions is directly linked to a significant decline in life expectancy. On average, countries under such sanctions experience a reduction of around 1.2 to 1.4 years in life expectancy, with women disproportionately affected.
This is not collateral damage. It is evidence that sanctions function as a weapon against the health of entire populations. The deprivation is slow and often invisible, with hospitals running out of medicines, treatments delayed, and patients dying not from disease itself but from policies that make care inaccessible.
On paper, sanctions regimes almost always include “humanitarian exemptions” to allow the import of essential goods such as food and medicine. In practice, these safeguards often exist only in name. As our Lancet correspondence highlights, during previous UN sanctions on Iran, there was no dedicated UN mechanism to verify whether these exemptions were actually functioning.
The result was catastrophic. The sanctions disrupted medicine imports, driving price spikes of up to 300 percent for some antiepileptic drugs. As millions of patients were forced to forego reliable treatment, counterfeit and expired medicines flooded the market, endangering countless lives. These were not unintended glitches; they were the predictable outcomes of a sanctions system designed without accountability or monitoring.
The UN bodies responsible for overseeing the sanctions on Iran also operated with a dangerously narrow focus. The Sanctions Committee and its panel of experts were primarily concerned with tracking compliance with nuclear restrictions, such as monitoring uranium enrichment, while failing to assess how these measures affected people’s access to medicine, medical equipment, or healthcare more broadly.
Their reports contained no systematic evaluation of the sanctions’ humanitarian impact, revealing a persistent institutional blind spot. Technical compliance was monitored down to the last centrifuge, yet the suffering of ordinary Iranians was left unrecorded. This oversight is not unique to Iran; it reflects a wider pattern in global sanctions policy, where the political objective takes precedence over the human cost.
The opinion piece can be read in full at https://www.aljazeera.com/opinions/2025/11/12/sanctions-are-not-a-humane-alternative-to-war.
Mohammad Reza Farzanegan is a Professor in Economics of the Middle East, Philipps-Universität Marburg, Germany
Ruth Gibson is a Scholar at Stanford University, Center for Innovation in Global Health and Center for International Security and Cooperation, USA.
Maziar Moradi-Lakeh is a Professor of Community Medicine, Gastrointestinal and Liver Diseases Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Iran.
