Under Trump, US Sale of Medical Goods to Iran Down Nearly 40%

With just two weeks until Trump reimposes secondary sanctions on Iran, administration officials are under increasing pressure to prove that the returning sanctions will not adversely impact humanitarian trade.

Secretary of State Mike Pompeo has declared that “sanctions and economic pressure are directed at the regime and its malign proxies, not at the Iranian people.” But a review of US trade data shows that humanitarian exports from the US to Iran have withered under the Trump administration, lending credence to claims that while sanctions exemptions for humanitarian trade persist in principle, companies are struggling to avail themselves of these exemptions in practice.

In August, US exports to Iran surprisingly surged to nearly USD 150 million dollars, levels not seen since late 2008, when the Bush administration oversaw the sale of a significant volume of wheat to Iran, pushing monthly exports above USD 100 million for several months. The sudden increase in US exports to Iran was even reported upon by Iranian media outlets.

Looking into the content of those exports, just over USD 140 million dollars of the August trade is attributable to the sale of American soybeans to Iran, the number one destination for the crop that month. Due to Trump’s trade war, the export of soybeans to China has collapsed 95 percent, making commodities traders eager to offload supply to Iran.

But August’s sharp increase in exports to Iran remains exceptional for the Trump administration. Looking to data for the twenty months of the Trump presidency, a clear pattern emerges—along with overall trade, the export of humanitarian goods like food and medicine remains significantly lower than average monthly values registered during the Obama years.

Isolating humanitarian trade within United States Census Bureau export data can be done by analyzing twenty-one of ninety-nine standard “Schedule B” commodity codes, used to categorize trade in live animals, cereals, food oils, pharmaceuticals, and medical devices, among other goods that may fall under sanctions exempt or readily licensed trade.

Looking to the average monthly export value for goods in these categories, the Trump administration’s average of USD 15.4 million is actually about 6 percent higher than the monthly average of 14.5 million dollars registered during the Obama years. However, the Trump average is significantly distorted by the bumper trade in soybeans during July and August. When excluding these two months from the calculation of the Trump average, the monthly export value falls to just USD 7.1 million dollars, about half the level seen during the Obama years.

The significant decline in humanitarian trade is also evidenced by looking to the median monthly export value, which may better account for the natural volatility in US exports to Iran. In the 96 months of the Obama presidency, the median value of humanitarian exports to Iran was USD 9.4 million dollars per month. In the 20 months of the Trump presidency so far, the same figure has fallen to USD 5.8 million dollars per month, a 40 percent reduction.

The most regular kind of humanitarian trade between the US and Iran is the export of pharmaceutical goods. There was just a single month during the whole Obama presidency in which no exports of pharmaceutical products to Iran were registered. Likewise, pharmaceutical exports to Iran have so far been registered in every month of the Trump presidency. However, even in this routine trade, the Trump administration is falling short.

Under Obama, the United States exported an average of USD 2.1 million in pharmaceutical products to Iran each month. Under Trump, that monthly average export value has collapsed to just USD 720,000, a paltry one-third of the former level.

Importantly, in the last few years, the trade in medical devices to Iran has outpaced trade in pharmaceuticals, which may point to Iran succeeding in finding other suppliers of key medications while also boosting domestic production. The shift begins around March 2014, shortly after the January 2014 implementation of the Joint Plan of Action (JPOA)—the precursor of the nuclear deal—in accordance with which the Obama administration began to expand secondary sanctions relief for humanitarian trade, including pharmaceutical exports to Iran. It is likely that European exports continue to offset the fall in American exports, including the reexport of American-made products from European divisions of American companies.

However, when adding medical devices and equipment into an overall calculation of exports of medical goods, the picture remains dire. During the Obama years, the US exported an average of USD 6.3 million in medical goods each month. In the first 20 months of the Trump administration, that figure has fallen to USD 4.6 million, a significant 37 percent drop.  

The decline of medical exports to Iran is unlikely to reflect falling Iranian demand. There were no exports of medical devices or equipment to Iran during the first nine months of the Trump presidency. But in October 2017, the same month when Trump “decertified” the JCPOA nuclear deal, exports of medical devices and equipment began again, and have recently reached the highest monthly level since 2015, despite the fact that the sharp devaluation of the real has made such imports much more expensive. Add to this the clear evidence from Iran that sanctions are beginning to result in shortages in key medicines and foodstuffs, and it is obvious that there remains significant scope for the Trump administration to expand its humanitarian trade with Iran.

It would seem that the Trump administration has reached a kind of crossroads when it comes to its strategy for humanitarian trade with Iran. It has publicly insisted that it will allow trade to flow and export volumes in the last few months are more consistent with the decade-long pattern of exports in food and medicine sustained by the US concurrently with the imposition of secondary sanctions.

At the same time, moves such as the recent sanctions targeting Parsian Bank, suggest that the administration is unwilling to send reliable signals to those companies and financial institutions engaged in vital humanitarian trade with Iran. Whether the administration will make good on its own reassurances and meet its moral obligation to facilitate humanitarian trade with Iran remains to be seen.

Photo Credit: IRNA

Iran: The Case for Protecting Humanitarian Trade

This article has been republished with permission from the European Council on Foreign Relations. 

A crisis is looming in Iran’s healthcare sector: patients are reporting shortages in life-saving medicine. The situation is expected to worsen once US sanctions on Iran are reimposed in November. European and US companies that can provide the advanced medicine and equipment needed to treat chronic diseases inside Iran are grappling with how to sustain their operations. The goods that are making it into Iran are being sold at soaring prices due to a sharp currency downturn following Donald Trump’s sanctions decision.

Millions of ordinary Iranians are bracing themselves for the impact of these sanctions. The UN special rapporteur for human rights warned that the sanctions will undermine human rights in the country, drive people into poverty, and make imported goods unaffordable. The impact of incoming sanctions on the humanitarian sector contradicts the US administration’s repeated statements in support of the Iranian people.

Iranians experienced similar hardship between 2012-2013 when the United States and Europe introduced the severest of sanctions to pressure Iran to restrict its nuclear program. At the time, the US Treasury provided broad authorization and exceptions for the sale of medicine and medical devices. Yet only a limited number of Western companies managed to operate under these conditions. Many were forced to halt or downsize trade due to disruptions in banking and high operational costs.

A repeat of this situation must be prevented. Unilateral US sanctions must not be allowed to needlessly cause suffering to millions of Iranian citizens. This is especially the case given that Iran continues to implement restrictions on its nuclear program under the 2015 deal. Europe, China, and Russia have also vowed to uphold the agreement.

The overarching hurdle facing many companies that export medical goods and services to Iran is related to securing banking services and finance to enable such transactions to happen. This includes a recent foreign currency shortage with which to reimburse European companies. The lack of clarity over how the US will enforce its sanctions has exacerbated these problems. For example, while the latest US OFAC guidelines reaffirm that there is broad authorization for humanitarian transactions, there is ambiguity over how extensively the US will use secondary sanctions to target private Iranian banks.

Since the nuclear deal, such banks were clearly exempt from secondary sanctions. That meant that non-US companies could establish ties with such banks to facilitate payments for the sale of humanitarian goods to Iran. Their position is now unclear. The US has outlined plans to sanction the Central Bank of Iran (CBI); but it is inevitable that any local private Iranian bank will have to transact with the CBI. Under the current US sanctions framework it is unclear if this would trigger a designation for that local bank, meaning that European banks would most likely refuse to transact with that entity.

Such uncertainty can effectively block payment channels into Iran and prevent life-saving assistance from reaching doctors and Iranian patients. Indeed, several leading pharmaceutical companies currently engaged in Iran have shared with us their concerns that banks, insurance companies, and distribution channels that have facilitated humanitarian trade with Iran are getting cold feet, fearing they could fall foul of US sanctions. Competing interpretations of the OFAC guidelines also are causing over-compliance by European companies whose board members are reluctant to accept reputational damage in the US even for humanitarian exchanges with Iran.

For Iranians, access to basic healthcare is a constitutionally protected fundamental human right. In recent years, health conditions in Iran have been gradually improving for underprivileged patients. In part this has been due to the easing of international sanctions that have made healthcare products more affordable and easily accessible. President Hassan Rouhani’s government also introduced new reforms that offer healthcare to almost 11 million previously unprotected people.

Treatment for chronic diseases is a major challenge for Iran where successful treatment requires advanced devices, training, and pharmaceuticals that are often provided through Western companies. Protecting access of such companies to Iran is therefore imperative.

As global powers look to salvage the nuclear deal despite the US withdrawal, they should seek to preserve humanitarian trade with Iran. Despite opposing views between Europe and the US on the nuclear agreement, saving the lives of Iranians should not be a topic of debate. Brian Hook, the newly appointed US special representative for Iran, recently stated that the US and Europe should be working together to “find lasting solutions that truly support Iran’s people”. Europe should press the US to fulfill this offer by working to immediately facilitate and remove obstacles to humanitarian trade with Iran.

European governments should urge the US Treasury to quickly clarify the ambiguities created by its latest guidelines and ensure that a reasonable number of Iranian private financial institutions remain exempt from US secondary sanctions. The European Union should double down on efforts to ensure payment channels with Iran are preserved, including Iran’s access to the SWIFT financial messaging service. As a matter of priority it should aim for banks in Europe to remain open for humanitarian trade with Iran. To help foreign companies sustain the profit margins of operations inside Iran, the Iranian government could also offer cost-saving incentives for companies that import medicine and medical goods into the country.

The European Commission recently announced it will provide an €18m economic package for the social benefit of ordinary Iranians. If required, it should introduce similar new provisions after November to bridge any gaps in funding and payment facilities for medicine exported by European companies. This lending mechanism (in euros as opposed to US dollars), should be large enough to at least cover the import of life-saving medicine into Iran and should be flexible enough to respond to new needs. The EU and Iran could also consider establishing a medical fund for donating pharmaceuticals and equipment to Iran. In such instances, no banking transactions will be required and therefore the risks to European companies will be reduced.

The EU could also encourage expanded scientific cooperation with Iran in medical research and training. Relative to many countries in the Middle East, Iran has advanced public and private medical research institutions that are likely to welcome such bilateral cooperation. In fact, Iranian and US scientists have long engaged in successful health diplomacy projects. European governments can support and facilitate such humanitarian-focused projects. Such measures from Europe can demonstrate that their commitment to the humanitarian needs of Iranian people goes beyond rhetoric.

Many Western governments view sanctions as an effective economic tool to alter the actions of adversary states. Yet sanctions have repeatedly hit ordinary people the hardest and resulted in a negative impact on health in the targeted country. The human cost of sanctions in countries such as Iraq, Iran, Syria, and Venezuela has been severe. Going forward, the international community must implement safeguards to fully protect humanitarian sectors of trade. As Europe pledges to demonstrate its commitment to the Iran nuclear deal, it could take a lead in this dialogue and provide concrete solutions.

Photo Credit: IRNA

Ambiguity in Trump Sanctions Could Put Humanitarian Trade with Iran at Risk

In the years prior to the nuclear deal, when Iran was under broad international sanctions, the country saw shortages in key foodstuffs and life-saving medicines. Despite attestations to the contrary by proponents of the economic blockade, who spoke of its "targeted" nature, international sanctions hurt the Iranian people in cruel ways.

According to Iran's Food and Drug Administration, the list of medicines subject to shortages in Iran extended to 350 drugs in the sanctions period. Shortages were precipitated by a number of factors. Several multinational corporations downsized their operations or withdrew from the Iranian market. Interruptions in banking channels saw payments turn from the use of industry-standard letters of credit and deferred payment terms to cash-in-advance payments using exchange houses. Transaction and operational costs skyrocketed, with costs being passed on to the consumer, whose buying power was eroded by currency devaluation. 

After the lifting of international sanctions as part of the Iran nuclear deal, the situation improved dramatically. Today, the number medicines subject to shortage has dropped to 65 drugs. Yet, it is important to realize that the shortages precipitated by sanctions would have been even worse had it not been for specific carve-outs for humanitarian trade established by the United States’ sanctions enforcement agency, the Office of Foreign Assets Control (OFAC),  part of the Department of Treasury.

As per OFAC’s own guidance on the matter, “the U.S. maintains broad authorizations and exceptions that allow for the sale of food, medicine, and medical devices” to Iran by both U.S. and non-U.S. persons. During the sanctions period, the more committed multinational companies, often those with longstanding ties to the Iranian market, took advantage of these exemptions to maintain their sales to Iran. While a commercial incentive reigned supreme, the Iranian people benefited to the extent that the country was not under a total blockade. 

Now, with U.S. sanctions poised to return, more suffering seems to be on the horizon. The Trump administration has announced that it will be reinstating all primary and secondary sanctions removed as part of the Joint Comprehensive Plan of Action (JCPOA). This total reapplication of sanctions, which is to take place despite Iran’s proven compliance with its commitments under the nuclear deal, has taken many by surprise given its extreme and unjustified breadth. But take a closer look at the mechanics of the so-called “snapback” and what the Trump administration is seeking to do could prove much more dangerous than anything Iran has been subjected to before.

There is exists an important caveat to OFAC’s exemptions for humanitarian transactions with Iran. These sales “do not trigger sanctions under U.S. law… so long as the transaction does not involve certain U.S.-designated persons (such as Iran’s Islamic Revolutionary Guard Corps or a designated Iranian bank) or proscribed conduct.” The emphasis on banks is what matters here. 

Iran’s private sector banks play a vital role in facilitating humanitarian trade. The major multinational corporations selling and manufacturing agricultural commodities (eg. Cargill, Bunge), food (eg. Nestle, Danone), and medicines and medical devices (eg. Sanofi, Novartis, GE Healthcare) depend on these types of banks to access the financial services necessary for day-to-day operations in Iran. 

Importantly, while Iran’s private sector banks were targeted as part of efforts to isolate Iran from the international financial system and were included on the SDN list, this was done under designations for which secondary sanctions did not apply.

Foreign companies and financial institutions were prohibited from transacting with Iranian financial institutions under the Iran Freedom and Counter-Proliferation Act (IFCA) in 2012 and Executive Order 13645 in 2013. However, there was a notable carve-out created for those "Iranian depository institution[s] whose property and interests in property are blocked solely pursuant to E.O. 13599." The Iranian financial institutions included in the E.O. 13599 list include the country's private sector banks. The unique status of the banks on this list partly reflects that these entities maintain higher compliance standards and clearer governance structures, lack exposure to government or IRGC shareholders, and have no known history of financial crime or terrorist financing.

The Trump administration has made clear that it intends to re-list all of the entities that had been removed from the SDN list as part of the JCPOA (these entities are listed in the attachments to Annex II of the nuclear deal). What remains unclear is whether Trump’s intended re-listing of these entities means returning them to their precise status prior to the nuclear deal. Legal experts and former government officials are coming to different interpretations of the relevant sanctions guidance.  OFAC’s FAQs document issued following Trump’s announcement of the U.S. withdrawal from the JCPOA addresses precisely this question for entities on the E.O. 13599 list. The entry reads:

Will the persons that were placed on the List of Persons Identified as Blocked Solely Pursuant to Executive Order 13599 (E.O. 13599 List) on JCPOA Implementation Day (January 16, 2016) be put back on the SDN List?

The provided answer is concerning (emphasis added):

No later than November 5, 2018, OFAC expects to move persons identified as meeting the definition of the terms “Government of Iran” or “Iranian financial institution” from the List of Persons Blocked Solely Pursuant to E.O. 13599 (the “E.O. 13599 List”) to the SDN List. OFAC will not add these persons to the SDN List on May 8, 2018, to allow for the orderly wind down by non-U.S., non-Iranian persons of activities that had been undertaken prior to May 8, 2018, consistent with the U.S. sanctions relief provided for under the JCPOA involving persons on the E.O. 13599 List. The Government of Iran and Iranian financial institutions remain persons whose property and interests in property are blocked pursuant to E.O. 13599 and section 560.211 of the ITSR, and U.S. persons continue to be broadly prohibited from engaging in transactions or dealing with the Government of Iran and Iranian financial institutions. Beginning on November 5, 2018, activities with most persons moved from the E.O. 13599 List to the SDN List will be subject to secondary sanctions. Such persons will have a notation of “Additional Sanctions Information – Subject to Secondary Sanctions” in their SDN List entry.

The guidance indicates that the entities moved from the E.O. 13599 list to the SDN list “will be subject to secondary sanctions." In practical terms, the guidance can be interpreted to mean that all of Iran’s private sector banks will be listed with a designation more restrictive than was the case prior to the nuclear deal. In this scenario, after November 5, 2018, any company that transacts with Iran’s private sector banks will be exposed to U.S. secondary sanctions.

Several sanctions experts, speaking on background given the sensitivity of the subject, pointed to this concerning lack of clarity. In the assessment of an attorney specializing in U.S. sanctions, "It is not clear whether the mere placement of persons identified on the E.O. 13599 List back on the SDN List will subject private Iranian banks—not otherwise designated pursuant to an authority other than E.O. 13599—to secondary sanctions. If it returns to the pre-JCPOA sanctions, then it will revert to the rules established by IFCA and E.O. 13645." But if the new guidelines do reflect an intention to make secondary sanctions for Iranian banks that were previously exempt, "OFAC has the discretion to do so," the attorney noted. 

This reading was echoed by a former U.S. government official: "One could read [the FAQs] to suggest the pre-JCPOA identifications, which is what E.O. 13599 was created to address, are all becoming SDNs. This would be a significant escalation. Most of the private banks on E.O. 13599 were never subject to secondary sanctions because we never had evidence of bad behavior."

If this interpretation holds, the typical exemptions for humanitarian trade will no longer apply for the multinational companies bringing vital foodstuffs and medicines to Iran. This is because the private sector banks that they have customarily used to facilitate this trade will be considered “a designated Iranian bank" exposing their counter-parties or clients to secondary sanctions. Re-listing Iran’s private sector banks in this manner would prove devastating to humanitarian trade. 

Several major international law firms are advising clients that the re-listing will not exceed the restrictions of the pre-deal designations. In this assessment, the transactions that were not sanctionable pre-JCPOA should not be sanctionable on November 5. The problem is that such a fundamental question, with a direct bearing on humanitarian trade, should not be a matter for interpretation. OFAC has historically offered clear and reliable guidance is these fundamental areas.

It remains possible that OFAC has simply made a mistake in leaving things ambiguous regarding E.O. 13599 entities. In the assessment of many sanctions attorneys, the FAQs released on May 8 are sloppy and incomplete—perhaps an indication of the last-minute nature of their preparation as President Trump announced his decision on the nuclear deal earlier than expected. If this is just an error in the guidance, OFAC must immediately update its FAQs and provide clarity on the matter.

However, if the re-designation is intended as an escalation, and the United States does aim to designate Iran’s private sector banks as SDNs and target their multinational clients with secondary sanctions, the international community must use all available means to compel the Trump administration to restore full and unfettered humanitarian exemptions for Iran trade. Thousands of lives are at stake. 

Photo Credit: IRNA

Iranian-Made Exoskeleton Highlights Potential for Hardware Start-Ups

A new crop of entrepreneurs are making Iran a hub for hardware development, drawing on the country’s deep pool of mechanical and electrical engineering talent.

Iran’s burgeoning startup ecosystem has enjoyed extensive international attention over the last few years, but the focus has remained almost exclusively on app developers and software creators. Behind the scenes, a crop of inventors and engineers have been launching new companies that seek to bring “made in Iran” into the 21st century.

One such company is Pedasys, which was founded in 2013 by a group of researchers from Tehran University, Sharif University of Technology, and Tarbiat Modares University. In 2015, the group was accepted into SATI, Sharif University’s prestigious technology incubator.

The company has designed and manufactured a lower-body exoskeleton called Exoped, which is currently being trialled in clinical settings around Iran. The robotics in Exoped allow paraplegic or elderly individuals who are lower-limb disabled to walk, helping these individuals break free of the limitations of wheelchairs.

There are just a handful of companies worldwide that have developed such technology, but Iran may prove an ideal environment. In addition to engineering expertise, Iran boasts an advanced healthcare system. From the standpoint of social impact, Exoped can make a meaningful difference in the lives of Iranians living with spinal cord injuries, including the elderly, those injured in natural disasters such as earthquakes, war veterans, and those suffering from musculoskeletal degenerative diseases. One 2015 study on the prevalence of spinal cord injuries in Iran estimates the figure at 320 per million individuals. But the researchers note that this is likely an significant underestimation.

A sense of social responsibility is a key motivation for Mostafa Naghipour and his fellow Pedasys co-founders. After nearly a decade of collaboration in robotics research, the team decided to establish a company to bring a new exoskeleton solution to the market. They secured seed capital from Shenasa, the venture capital arm of the Pasargad Financial Group. Shenasa has focused on hardware companies as it builds out its portfolio, which includes a company developing a 3D-printer for industrial applications and a start-up developing new technologies for cochlear implants.

To date, foreign investment in Iran’s start-up ecosystem has focused almost exclusively on software. With lower capital requirements, shorter research and development timeframes, and scale-driven business plans, software can seem a safer bet for foreign investors. But Naghipour believes that while hardware development is more difficult, the business potential with hardware is often greater. He notes, “investing in hardware can create businesses with protected market share and export potential. While it is unlikely that international markets would adopt Iran’s clones of already popular apps, Iran can create hardware technologies that are competitive globally on pricepoint and core capabilities.”

Naghipour believes that Pedasys’ addressable market in the Middle East is six million individuals. For this market, an Iranian product will have an inherent cost advantage. Pedasys’s creators expect their technology to be up to fifty percent less expensive than comparable American, European, or Japanese technologies, without compromising on functionality.

Moreover, as Naghipour explains, the cost of treatment isn’t limited to the cost of the exoskeleton. He notes, “patients require as many as twenty clinical sessions to customize the exoskeleton for their use and to teach them how to operate it effectively. Being able to provide this clinical care is a crucial part of the offering and is almost as important as the technology itself.”

The clinical approach is being refined in Iran to meet local needs. “Four medical centers have purchased their own Exoped unit for research purposes, and we are about to begin the application process for approval by the Iranian Food and Drug Administration,” says Naghipour. The approval process will take about one year. With the FDA approval in hand, Naghipour plans to “begin negotiating with insurance companies to get Exoped covered. We hope to demonstrate to insurance companies that the overall improvements to quality of life are worth their coverage.”

Importantly, applications for Exoped extend beyond rehabilitation. Similar solutions are now being tested by industrial companies worldwide as a means to improve comfort and reduce the risk of injuries for manufacturing workers. Exoped could find a large market in Iran’s automotive manufacturing sector, where chronic lower back pain is a major occupational health issue on assembly lines. Iranian workers who suffer from lower back pain self-report considerably lower overall quality of life scores.

To achieve these ambitions, Pedasys will seek to raise its Series A funding from both domestic and foreign backers. Although the company declined to disclose its fundraising target, Naghipour assures that is it “significantly lower than what Western companies are seeking to raise even before they have a working prototype. In Iran we do much more with much less and we think investors can see that.”

Photo Credit: Bourse & Bazaar

A Case for Public-Private Partnerships: Supporting Iran's Disabled

The situation currently afflicting many in Iran’s disabled community is difficult to say the least. A staggering 400,000 of these disabled individuals—primarily men— are veterans who fought against Iraq during the 1980’s.

These brave ex-servicemen do have support of government agencies like the Social Welfare Organization of Iran and the Iranian Red Crescent Society, along with other charitable and religious organizations. However as time moves on these men’s medical needs will inevitably increase with their age. It is time we rethink how healthcare and funding for these men is provided

Care for the disabled community has primarily been in the hands of the state from the outset the Islamic Revolution of 1979. This top down approach to care was a necessary structure during the first years after the war and while the country was rebuilding itself through the Rafsanjani presidency. However, in recent years the needs of these disabled people have increased considerably, thus putting a strain on the existing medical support structure.

Moreover, the situation in the wider community of those with limited physical ability continues to be burdened under the weight of claimants coming forward with long-term issues seeking adequate care and support over long periods of time.

The State Welfare Organization (SWO) the government body which provides welfare benefits to the veterans, defines disability through four types: physical, auditory, visual, and mental. On the outset, this breakdown seems rather elementary, however the organization role is all-encompassing. The role of the SWO has expanded so much over the years that they must now care for the recently disabled as well as the groups like the veterans. Their budget—like for any organization of its kind worldwide— is finite. To overcome challenges and provide the best care possible, the Iranian government and the SWO must now understand that help can be provided in partnership with the Iranian private sector and international specialists.

Through my company, KTMA, working with the help of occupational therapists in Europe, we have spent two years researching the needs of the physically disabled, while also considering the budgets of the funding authorities. One thing I have found in my time building our company is the lack of support for more than the basics. Yet it is understandable that budgets are limited, and clearly the government, which has helped so many people, needs help itself sometimes.

What Can Be Done

This is where a unique form of public-private partnerships (PPPs) comes in. KTMA has teamed up with both the Social Welfare Organization along with the Red Crescent Society to assess the needs of the disabled and to offer solutions with its growing catalogue of equipment. 

The Paralympic Committee of Iran is another worthwhile organization with which we have worked in partnership. They have been invaluable for their excellent understanding of the current needs of the physically disabled. As part of continuing efforts, they also introduced me to one paraplegic veteran whose 24-hour carer was his wife. He shared his story with me.

“Everywhere I go am I with my wife” the man said, adding "I really need more assistance in my daily activities and maybe my wife would like a day off, I hate to be a burden on her."

What surprised me most was that considering the man's severe disabilities, he was still able to get out and about. This is mainly due to the recent introduction of disability access DAF buses by the Tehran municipality. The rest of the help the family receives is either from charitable organizations or from religious groups who help with food and utility costs.

As these caring costs rise further, and Iran's revolutionary generation continue to age, there now is an opportunity for groups like my own, to help in the assistance of the disabled in Iran. However it will take a comprehensive action-plan and cooperation between the public and private sector.  

Ultimately this would require the government to overhaul how it distributes its funding for the disabled and those of limited ability. It has been proven time and again that the large state organizations lose effectiveness as they grow, it is just a consequence of the burdens placed upon them. There has been no systematic review of how funding is provided to the organizations and this in itself adds another layer of inefficiency to the system.

Another serious issue afflicting the disabled is the lack of employers willing to take them on. The government did however pass a bill in 2003 that urges large state companies and state bodies to make allowances for the disabled and to get at least a small proportion of them back in to work.

How PPPs Can Help the System

What can, or rather what must be done, is that governmental agencies should relinquish some of their overall responsibilities to third party agencies to carry out specific jobs based on deep expertise. By this method, the country's coffers remain intact and waste which would normally remain in the system would be reduced. The overall quality of care provided to disabled Iranians would also likely increase, as new therapies, equipment, and even personal development opportunities are made available. 

Through PPPs we can serve the needs of the disabled by empowering specialized companies to provide for each client’s specific needs.

Moreover, if partially disabled people were able to earn a living, their overall costs are reduced over a period of time. This is particularly advantageous as not only do the financial benefits mean less reliance on the state, but they also give the veterans and other disabled individuals a sense of self-worth, something that many of them have said to me would help their case.

Innovating PPPs to tackle welfare challenges is most achievable. It both helps the state and helps these men and women in many more ways. But the general hesitance of the state to deal with private organizations is holding back the quality of care and service otherwise available. Europe has shown the way in this regard and by learning from their experience we can help Iran’s veterans and disabled people by reorganizing the way these individuals are provided for from the point of first contact. 

Photo Credit:  Morteza Nikoubazl/Reuters