Iran is facing a worsening medicine crisis that has driven patients and their families to search pharmacies and unofficial markets for essential treatments amid the naval and air blockade and difficulties with imports and financing.
At a crowded pharmacy on Bahner Street in northern Tehran, she said she had spent the past few months complaining about rising treatment costs, but was now unable to find the medicine itself, forcing her to try to buy it at extremely high prices on the black market. Fereshteh began searching for the treatment around 10 days ago, visiting government and private pharmacies without managing to secure it.
She said the response was the same at every pharmacy she visited: the medicine was unavailable and there was no specific date for its arrival. Pharmacists told her its absence was due to the supplying company stopping imports because of the blockade imposed on the country. Fereshteh turned several times to Nasser Khosrow market, where black-market sellers offer imported medicines at prices she described as unimaginable.
The blockade deepens the fragility of Iran’s pharmaceutical industry
She said she had previously focused her conversations on her husband’s suffering from the disease, but they now also included the hardship and pressure she faced while constantly searching for the treatment and trying to raise the money to pay for it. Her ordeal comes amid a fragile truce between Washington and Tehran and the continuing naval and air blockade of Iran.
While bodies involved in Iran’s pharmaceutical industry say more than 97% of the country’s medicine needs are produced domestically, the crisis has shown that this proportion does not mean complete self-sufficiency or insulate the sector from external pressure. The fragility of the domestic industry is partly linked to its reliance on foreign sources for a significant share of its raw materials, excipients and production equipment.
According to sector observers, manufacturing medicines inside the country does not eliminate the need to supply these inputs, leaving production lines vulnerable to stoppages or slowdowns when transport or financial transfers are disrupted or import costs rise. Pharmacist Salah al-Din Khadivi said the medicine market received its first shocks during the 12-day war and the period that followed, when some medicines began gradually disappearing.
Supply delays expand the list of missing medicines
He added that the situation worsened after the Ramadan War, before the imposition of the naval and then air blockade turned medicine shortages from a limited phenomenon into a nationwide crisis. Khadivi said medicine prices had recorded increases he described as rocket-like, putting many items beyond the purchasing power of ordinary citizens.
He said the list of medicines that are difficult to find was expanding constantly, with a growing number of items moving daily from scarcity to complete unavailability in pharmacies. Alongside supply difficulties, Khadivi said the financial crisis facing insurance companies had increased disruption in the market, as those companies were no longer able to pay pharmacies what they were owed.
As a result, some pharmacies began refusing to dispense medicines through insurance and instead preferred to sell them for cash, in an effort to collect payment quickly and ensure they could continue buying new stock. The pharmacist pointed to major difficulties in securing specialist medicines, particularly cancer treatments and chemotherapy drugs.
Shortages extend to insulin and specialist treatments
He added that shortages had also spread to domestically manufactured insulin, indicating that the crisis was not limited to finished imported products but also affected medicines manufactured in Iran using materials and inputs from abroad. Khadivi attributed the suspension of some production operations in recent months to problems importing raw materials and rising costs.
He said the government’s cancellation of subsidised foreign-currency provision for the private sector had increased companies’ burdens, while exchange rates on the parallel market rose sharply, affecting the ability of factories, suppliers and pharmacies to finance their needs.
According to Khadivi, patients now face three difficult choices: buying medicine at an exorbitant price on the black market, turning to Iranian alternatives that may not be as effective as the imported medicine, or travelling to a neighbouring country to obtain treatment. He added that the black market had flourished recently as the gap widened between demand and the quantities available through the official distribution network.
Khadivi also warned of the risks to the cold chain for medicines transported by land through unofficial channels, explaining that some products may lose their effectiveness if they are not kept at the required temperatures. This possibility increases the concerns of patients who pay high prices for smuggled medicines without sufficient guarantees about the conditions in which they were transported, stored or kept safe.
Arrest of cancer-medicine smuggling network in Tehran highlights the scale of the crisis
As brokers resorted to bringing some medicines by road after flights were suspended, Tehran Prosecutor General Ali Salehi announced the arrest of a network accused of smuggling medicines to a neighbouring country. He said the main suspect was a woman from a neighbouring country and that quantities of smuggled medicines outside the official distribution network had been found in her possession.
Salehi added that investigations were continuing with people linked to the suspect in a case involving the smuggling of cancer medicines. The case highlights the pressures on the medicine market from two directions: shortages of products in official pharmacies and the movement of medicines through smuggling channels, both into and out of the country.
Former Iranian health ministry spokesman Kianush Jahanpur said the pharmaceutical sector had been affected by sanctions and the blockade because of difficulties with financial transactions. He added that Western companies and some Eastern companies had refused to sell medicines to Tehran, citing sanctions or financial-exchange problems, while other parties had declined to supply active ingredients or delayed fulfilling their obligations, citing transport problems.
Jahanpur said these obstacles had existed before the current crisis but had worsened recently because of the blockade. He noted that Iran had at times faced domestic difficulties in securing the foreign currency needed to import medicines.
He said food and medicines had in practice been affected by sanctions and economic pressure, contrary to Western countries’ stated policy that these two sectors were exempt, despite the resilience demonstrated by Iran’s pharmaceutical sector. Jahanpur revealed that Iran’s pharmaceutical industry had suffered damage and losses at various levels during the last two wars, particularly the Ramadan War.
He said some medicine manufacturers, including Tofiq Daru, had come under direct military attack, while academic institutions and research centres, including the Pasteur Institute, were also targeted. The institute is one of Iran’s largest research centres for vaccines and infectious diseases.
He added that more than 20 medicine-manufacturing companies and sites had suffered partial or total damage, alongside medicine shipments being targeted at sea. He estimated that nearly 10% of the country’s medicine-manufacturing companies and sites had been damaged to varying degrees as a result of the latest war, saying that part of the current medicine situation was due to military attacks that hit sector facilities and supply chains.
Jahanpur said Iran had prepared for the war by storing quantities of medicines, adding that official support for domestic production was one of the most effective solutions for overcoming the current period.
He stressed that quantities of essential medicines remained stored in different provinces and could be used when needed, despite the losses suffered by factories and research centres and the disruption to part of the import process. In Tehran, Fereshteh is still searching for treatment for her husband and is considering temporarily moving to a neighbouring country to continue his treatment there.
She said she could no longer bear watching him suffer because the medicine was unavailable, nor could she continue paying large sums on the black market without any guarantee that the smuggled treatment was safe. She added: “The war meant fear of bombardment for us, but today it means fear of treatment becoming unavailable. We are paying the price of this war twice: once in our lives and once in our health.”
