Without robust, built-in health protections, sanctions kill civilians as surely as bombs and bullets, as Iran’s broken health system makes clear.
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.
Sanctions can literally shorten lives
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.
The illusion of humanitarian exemptions
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.
An institutional blind spot
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 hidden harm of overcompliance
The damage caused by sanctions does not end with the official restrictions themselves. A more subtle but equally destructive process, known as “overcompliance”, often magnifies the humanitarian crisis. This happens when companies and banks become excessively cautious, refusing to engage in transactions that are in fact legally permitted, including those involving medicines and medical equipment, for fear of breaching complex sanctions rules.
Our correspondence in The Lancet highlights how this excessive caution deepens the suffering of ordinary people. Overcompliance by pharmaceutical and medical device companies and financial institutions unnecessarily raises prices, fuels corruption, and opens the door to low-quality or counterfeit alternatives. It also creates a shadow market of intermediaries who claim to know how to move medical supplies under sanctions, increasing both costs and risks. In some cases, even legitimate distributors seeking to import approved medicines have found themselves inadvertently caught up in unlawful activities.
The result is a further tightening of the blockade on a country’s health system, even where humanitarian exemptions supposedly exist. Overcompliance has become one of the most insidious and least accountable aspects of modern sanctions regimes, quietly cutting off access to life-saving care while allowing policymakers to deny responsibility.
A call for a health-conscious foreign policy
The evidence is unambiguous. Without strong and actively monitored safeguards, sanctions become a blunt instrument that inflicts immense suffering on those least able to bear it. These are not unfortunate side effects, but direct and foreseeable consequences of policies applied without regard for their human cost.
The lesson from Iran, and from decades of similar experiences elsewhere, is that economic sanctions must never be imposed without independent systems to protect the right to health. This means establishing effective humanitarian payment channels, monitoring the real-time availability of essential medicines and medical supplies, and assigning oversight to a technical panel capable of assessing the full health impact of sanctions on civilian populations.
Sanctions are often justified in the name of human rights, yet they can quietly destroy the very lives they claim to defend. The international community must recognise that the protection of health is not an optional consideration, but a fundamental obligation. If sanctions are to remain part of global diplomacy, they must be reimagined with public health at their core, not left to erode it.
The views expressed in this article are the author’s own and do not necessarily reflect media’s editorial policy.
