Executives Describe Bottlenecks, Red Tape in Iran's Pharmaceutical Sector
In these interviews, two Iranian pharmaceutical executives detail an acute need for some medicines and shed light on some of the regulatory, operational, and integrity risks that foreign pharmaceutical companies face on the ground.
Iran has made strides in the development of its domestic pharmaceutical sector. When measuring by dosage, just 3 percent of pharmaceutical products consumed last year were imported. But when looking to sales value, imports accounted for USD 1.6 billion of the USD 3.6 billion in total sales last year. Many of the pharmaceuticals that Iran imports are expensive therapies, having been produced using advanced technology that Iran currently does not possess.
Given the importance of many of these imported medications are for the treatment of life-threatening diseases, Iran’s Ministry of Health and Medical Education (MoHME) regularly publishes a list of pharmaceuticals that the country needs and is allowed for import. The list for August included pharmaceuticals needed to treat a range of life-threatening diseases, including Lymphoma, Morquio syndrome, Crohn’s disease, and prostate cancer.
US sanctions have made the import of these pharmaceuticals and the raw materials needed to domestically manufacture more basic pharmaceuticals increasingly challenging. While US sanctions ostensibly do not target the humanitarian sector, international financial institutions remain wary of processing humanitarian transactions with Iran due to fear of falling foul to US sanctions, contributing to medicine shortages.
I interviewed two individuals working in Iran’s pharmaceutical sector in late August to discuss medicine shortages and some of the challenges that foreign and local companies operating have faced since the reimposition of US sanctions. Both interviewees, while highlighting an acute need for some medicines, shed light on some of the regulatory, operational and integrity risks that foreign pharmaceutical companies face on the ground.
Ara (A) owns a pharmacy and is a business development specialist for a company that manufactures pharmaceutical products. Fariba (F) works in pharmaceutics in the manufacturing and production of drugs. Their names have been changed to protect their identities.
Has there been an increase in medicine shortages in recent years?
F: Before, it was very easy to import some medicines like Paladix or Aspirin, but now their import is very limited. Branded pharmaceuticals are limited in availability. A lot of the products that are available in pharmacies are from prior to the reimposition of sanctions.
Do you have an example of a pharmaceutical product that witnessed a shortage in the market in recent years?
F: We had massive problems importing insulin pens, which used to be imported through a foreign pharmaceutical company because they cannot be manufactured in Iran. I believe we are still having problems importing them. When you go to pharmacies nowadays it’s very difficult to find insulin pens. We were forced to tell people who had diabetes and needed the pens to go back to their old ways of injecting insulin so that they don’t use insulin pens anymore. Now, Iran is moving towards the direction of manufacturing insulin domestically.
Are shortages of raw materials needed to produce pharmaceutical products contributing to medical shortages?
A: It’s even become more challenging for domestic companies to manufacture pharmaceuticals for which there is a shortage of in the market because they are having difficulty obtaining the raw materials needed to manufacture finished pharmaceutical products. Foreign companies have been less willing to send us raw materials. India and China are some of the big suppliers, but even importing raw materials form China has become increasingly difficult in the past year. Indian companies are better, but if we want to import raw materials from Europe or elsewhere, it’s very difficult. So even if companies have active licenses to manufacture a product, they are unable to because they don’t have the raw materials needed, causing medicine shortages. However, despite these shortages due to the inability to import raw materials, the IFDA [the Food and Drug Administration of Iran] sometimes won’t allow the finished product to be imported, citing companies that have an active license to manufacture the product in Iran. Part of the reason the IFDA does this is that it wants to spur domestic production—including for raw materials—in the pharmaceutical sector.
F: A huge problem is the import of the raw materials that we need. A lot of raw materials are made by our own chemists, but sometimes we don’t have the products we need to manufacture the finished pharmaceutical product (i.e tablets). For example, for my own work, I order some of my products from two foreign pharmaceutical companies, but it’s become harder for us to import it from them. The shipping times have become longer and there’s also the issues of sanctions and COVID-19. In another example, I wanted to work on Posaconazole, an anti-fungal medication for which the needed raw material is expensive. Posaconazole is needed for people who are in the ICU because they have a fungal infection that isn’t responding to routine medication. We are looking for a company that will be willing to ship it to us, even in small quantities, but we can’t find any willing company. Posaconazole is not being manufactured in Iran, and with the countries that do produce it, there are problems with the shipping and exchange rate. Before the sanctions, we were going to order some products from Spain, Italy, and Holland, but when the sanctions were re-imposed, all of these got cancelled.
Has it become more challenging to import drugs from foreign manufacturers in the past two years?
A: Yes. Foreign companies need to look at the list of pharmaceuticals published by the MoHME that Iran needs and is allowing to be imported. It has become very hard for pharmaceutical companies operating in Iran to import drugs that are manufactured in the country and the chances of importing them is very low. For the drugs that the country needs, like drugs that they cannot locally manufacture because they use advanced technology, IFDA will usually issue companies a conditional license to import the product. For example, the IFDA will issue a company a conditional license in which it will allow the import of a pharmaceutical product for a short period of time on the condition that next year the company will manufacture the product domestically. In some instances, when the renewal time comes for an active license to import a pharmaceutical product, if it is now being manufactured in Iran, the ministry will not renew the license.
F: The MoHME’s budget is now going more towards hospitals and ensuring that they have what they need to combat COVID-19, so the import of some drugs has reduced, especially the ones that can be manufactured in Iran generically.
Has it become harder for foreign companies to get the necessary license and permits for their operations and has it become easier for domestic companies in recent years?
F: No, you can’t say that exactly. It’s true that we are trying to locally manufacture some drugs, but for some drugs while we have the ability to manufacture the medicine, we currently don’t have the technology needed for the device needed to deliver the drug. For example, for insulin pens, the problem isn’t the medicine, it’s the technology of the pen. Sometimes, it’s not that that it’s too hard to locally manufacture a drug that’s the issue, it’s that it’s too expensive to produce, so it’s not worth it for the manufacturers to produce. However, when sanctions were re-imposed, local manufacturers were forced to try and make some drugs that they otherwise wouldn’t pursue, because there is a need.
What are some things that Iran has been doing to strengthen domestic production in the pharmaceutical sector?
A: If a company now wants to import a pharmaceutical product, the MoHME will sometimes, for example, give the company a license to import only 5 percent of the drug’s market share. In other words, they won’t let one company take control of the whole market for a drug. Before, it was more common that when domestic companies were manufacturing a drug that some companies could import the drug alongside it. But now, the ministry has made it much more difficult to do this. Because of this, the underground market has also become stronger.
F: One way that the government has been trying to drive domestic production of pharmaceuticals that we currently cannot manufacture is through a program called markaze roshd [Growth Center]. If university students have an idea to manufacture a pharmaceutical product, some public universities will provide them funding for up to two years to create it. The University of Tehran and Shahid Beheshti University currently have this program. If the students are not successful in creating the product, it is okay, but if they are successful, they will have to give the university a portion of their profits.
Has the underground market for pharmaceuticals become stronger in the past two years?
A: On the one hand, it’s become harder to import products, but on the other hand, the underground market has thrived in the past few years. Many doctors continue to only approve branded products, so when they prescribe patients pharmaceuticals, they’ll advise their patients to definitely opt for the branded version. Since branded products have become less available in pharmacies, the patient goes towards the underground market to find the product, which could pose a reputational risk to those brands.
How do pharmaceuticals enter the underground market?
A: A lot of kolbars [Kurdish porters who smuggle goods between the Kurdish areas of Iran, Iraq, Syria and Turkey] bring products from Kurdistan in neighboring Iraq. A lot of the products in the underground market come from Turkey, since the price for them is low there. Some travelers from other countries bring products to sell. There are many ways.
Photo: IRNA
Why Hassan Rouhani Ended Iran’s Lockdown
Iran could face a devastating second wave of coronavirus infections as the country re-opens, but keeping the economy closed down without a safety net would have likely led to unrest.
By Saheb Sadeghi
As businesses resume their activities in Iran at the behest of President Hassan Rouhani, many experts have criticized the government’s decision and warned of a second wave of the coronavirus outbreak. Some even have accused Rouhani of favoring the economy over the health of the people.
According to the latest official figures, there are more than 95,000 confirmed coronavirus cases in Iran, and the death toll has exceeded 6,000.
On April 22, Rouhani described the reopening of businesses as “a necessity for the country.”
To understand the reasons behind Rouhani’s risky and possibly dangerous decision, one needs to look back at the Iranian economy’s condition before the coronavirus outbreak. Iran’s economic growth rate was negative 7 percent. Stagflation had put the economy into a serious crisis.
After the United States’ 2018 withdrawal from the nuclear deal and reimposition of sanctions, Iran’s foreign trade and oil exports declined dramatically—and political tensions with Gulf neighbors spiked as the United States deepened the crisis.
In the meantime, the International Monetary Fund had predicted that Iran’s economy would shrink 9.5 percent last year, and according to the Central Bank of Iran, the annual inflation rate reached 41 percent, the highest level in 25 years. The number of unemployed people had already reached about 3 million before the coronavirus crisis, and some estimates would suggest the number to be even higher.
Then came the coronavirus outbreak. After the government’s decision to shut down businesses, at least half of Iran’s economy, which is dominated by service sector jobs, was seriously affected. The living conditions and welfare of an estimated 7.3 million people became precarious as millions lost their jobs and others had their wages or hours cut.
The shutdown came at a time when many businesses were expecting almost 50 percent of their annual income during the last two months of the Iranian year before Nowruz, the Persian New Year, at the end of March.
Every year during the last Iranian month of Esfand (beginning in February and ending in March) and before the New Year people usually do most of their shopping. Esfand is followed by the first month of the year, Farvardin (March 20-April 19), which is generally a month of holidays and tourism. During Farvardin, many businesses—including restaurants, travel agencies, and hotels—tend to witness a boom, but this year their revenues reportedly fell by more than 90 percent.
Estimates suggest that Iran’s GDP has now decreased by about 15 percent as a result of the disruption to businesses, and that the economy will shrink further compared to last year. Businesses have reduced their activities as well as their workforce, and statistics show that about 36,000 people are applying for unemployment insurance each day.
Although the increase in the unemployment rolls caused by coronavirus outbreak has not been officially announced yet, some estimates indicate that 1 million Iranians have lost their jobs during the crisis, while other figures put the number at 2 million.
Under such circumstances, government support could have eased the pain, but extending a safety net was not an option in Iran. While income support measures were introduced all over the world to deal with the economic consequences of the coronavirus outbreak, Rouhani’s government could not afford to assist affected businesses due to a lack of financial resources, largely because U.S. sanctions have denied Iran access to its assets and money held in foreign banks.
The financial assistance amount that Rouhani has so far promised to support affected businesses is 100 trillion tomans ($6.25 billion), most of which is supposed to be paid to businesses in the form of loans. (One toman is equivalent to ten rials. Although the rial is the official currency, Iranians use the toman in everyday life.)
These loans have a three-year repayment term with a 12 percent interest rate. In the event of a second coronavirus outbreak and a bad economic situation, the government will give these loans to businesses; in normal times, bank loans would come with a higher 20 percent interest rate.
According to the Iranian economist Mohammad Hashem Botshekan, this economic package was more like a monetary policy than an economic stimulus; if the government were seriously considering an economic survival package, it would need to give interest-free loans to businesses, and it would provide free economic assistance to the people. Furthermore, the amount spent by the government compared to the volume of Iran’s GDP was insignificant.
After all, the U.S. government’s package accounts for approximately 10 percent of the country’s total GDP, the German and Japanese support packages are equivalent to about 20 percent of their GDPs, while the economic packages of some Persian Gulf countries accounts for about 30 percent of their GDPs. But the offered economic survival package from the Iranian government only equates to 2 percent of the country’s GDP.
Rouhani’s government also announced that it would give a 1 million-toman loan (about $62) to low-income families—an interest-free loan that would be repaid in 24 monthly installments, sparking widespread criticisms. This amount is equivalent to half of the minimum monthly salary of a laborer in Iran and would not do much to help people with their economic hardships.
But the Rouhani government’s revenues have shrunk dramatically. Since the coronavirus pandemic began, demand for oil has declined, pushing prices down. Moreover, another source of revenue for the Iranian government—taxes—has been seriously eroded due to the closure of businesses. Indeed, the government has stopped collecting taxes from some businesses that have been financially damaged as a result of the coronavirus pandemic—but it is the government that will decide which businesses receive a three-month deferment of tax payment.
In the end, Rouhani had only two options: Either he could go on with the shutdown of businesses and government bodies until the virus is brought under control and the medical and health system of the country is restored to normal, or, due to the dire economic situation, he could allow the businesses and government offices to resume their activities.
He opted for the latter and reopened the markets and government offices on April 11, a decision that sparked a great deal of criticism from medical experts as well as some high-ranking government officials such as the head of the judiciary, who criticized the government for prioritizing the economy over the health of the people.
Rouhani ordered almost all economic sectors, including financial markets and shopping centers to fully resume their activities. Some high-risk businesses such as sports clubs, big restaurants, and cinemas are not still allowed to reopen. Even now, several weeks after the decision was implemented, Iranian health officials are still declaring their opposition to it.
Since the reopening of businesses and government bodies, social distancing measures in Iran have not been observed; in a matter of few days, people began to act as if the coronavirus crisis was over and life had returned to normal.
Although the pace of coronavirus-related deaths has decreased recently, more than 1,200 new cases and about 100 deaths from the virus are still being reported each day. According to health officials in some cities, such as Tehran, the number of people infected with the coronavirus is increasing. Many doctors and officials in Iran’s health sector are scared, saying that the government’s decision to lift social distancing restrictions may soon lead to a second wave of infections.
Indeed, a resurgence of the pandemic could have a much more devastating impact. The illness and death of tens of thousands of people in a second wave would force businesses to close once again, and the Iranian health care system would come under immense pressure. Under such circumstances, the government would barely be able to keep the economy alive and stable. The government’s revenues would further shrink, and it would probably not be able to support poor and low-income families. In such a situation, millions of people could lose their jobs and a greater economic recession might put Iran’s economy at risk of collapse.
While Rouhani’s move could lead to a new outbreak with all the devastating consequences it brings, his unpopular decision has, for now, saved the economy from further deterioration and possible protests.
Rouhani’s decision was based on the view that Iran has passed through the first major wave of the coronavirus outbreak and that continuing curbs on economic activity are no longer justifiable. According to this view, an ongoing economic lockdown would have dangerous consequences for the country. The unemployment rate would rise sharply, many businesses would go bankrupt, and social unrest could follow.
While Rouhani is well aware that there is a risk of a second wave, the country cannot keep the lockdown in place for another month or two because the government cannot make up for the losses suffered by businesses, as wealthier governments in Europe and North America have done. That is why he is insisting on bringing the economy and society back to normal as soon as possible.
The country has yet to leave behind last November’s public protests against the substantial increase in the prices of gasoline, fear of reemergence of public protests and riots was evident in a letter sent to Rouhani by 50 economists on April 3. They cautioned him that the economic consequences of the coronavirus crisis could lead to unrest in the second half of the Persian Year 1399, which has just begun, and that the next year, 1400, would be a year of crisis.
Saheb Sadeghi is a columnist and foreign-policy analyst on Iran and the Middle East. Follow him at @sahebsadeghi.
Photo: IRNA
Iran’s Nurses Are Martyrs to Trump’s Maximum Pressure
The Trump administration’s sanctions have made it impossible for Iranian medical personnel to keep themselves safe amid the pandemic.
By Negar Mortazavi
Narjes Khanalizadeh was a 25-year-old nurse in Gilan, a province along the Caspian Sea in northern Iran. In late February, after working with coronavirus patients at a hospital in the city of Lahijan, she fell sick. Within a few days, she was dead.
A week later, results from a coronavirus test that had been administered before her death came back positive, sparking anger and fear among the country’s nurses. Khanalizadeh, who had been working without adequate protective gear, is one of more than a dozen nurses who have died from the coronavirus since February, despite desperate warnings from nurses about shortages of personal protective equipment at hospitals, including at Khanalizadeh’s.
Upwards of 100 Iranian health workers have died from the coronavirus, prompting Iranian Supreme Leader Ayatollah Ali Khamenei to announce in March that doctors and nurses who die from the infection will be recognized as “martyrs,” an honorific usually used for soldiers who sacrifice themselves in battle and that authorizes the families of the deceased to receive certain benefits, such as subsidized housing and education. But Iran’s official response to the crisis has been slow and inefficient, and U.S. sanctions are making things worse. In 2018, U.S. President Donald Trump pulled out of the Iran nuclear deal and reimposed harsh economic sanctions on the country, hampering access to desperately needed medical supplies and equipment.
Now, Iran’s nurses—the majority of whom are women—are among those bearing the worst of the brunt of U.S. sanctions. Official death counts from the Iranian government aren’t broken out by profession and are widely believed to understate coronavirus fatalities. A group of doctors in Iran that has been tracking the deaths of health care workers puts the number of nurses who have died at at least 15 between late February and mid April, but even that almost certainly underestimates the toll as health workers have reportedly been instructed by government officials not to reveal information about shortages, infections, or deaths. Dozens more nurses have been infected, in part as a result of restrictions imposed by the Trump administration.
While food and medicine are exempt from U.S. sanctions, many medical supplies and certain types of equipment are not. To sell some protective items to Iran, including full face mask respirators and some decontamination systems used to sterilize them, companies need a special license from the U.S. Treasury Department (see here for a list of items requiring special authorization). In March, the Washington Post reported that the Trump administration has reduced the number of licenses granted to companies that export medical supplies to Iran.
Even when a license isn’t required to ship humanitarian items, some companies and banks avoid doing business with Iran altogether for fear of being penalized. The country also has far fewer financial resources available to purchase necessary supplies due to sanctions. “This year, Iran is running its largest ever fiscal deficit—50 percent of its budget,” said Hadi Kahalzadeh, a former economist for Iran’s Social Security Organization. “Iran’s health sector, especially hospitals and pharmacies, don’t have enough liquidity to purchase essential supplies. And the Iranian government doesn’t have the financial means to fill the gap.”
Alan Veisi, a biomechanics engineer at Baran MicroTech, a company in Iran that produces some medical equipment that the country isn’t able to import due to sanctions, said even one of Tehran’s most prominent hospitals, Imam Khomeini, has shortages of N95 masks, gloves, and protective gear. “They need 500 to 1000 masks every day,” he said. “But get only 300.” Other hospitals are experiencing similar shortages.
For Iran’s nurses, the risks of contracting the coronavirus are compounded by low wages, poor working conditions, and severe overwork. It begins with the fact that there are far too few of them. According to World Bank data from 2015, Iran has 1.9 nurses per 1,000 people, compared with 2.3 in China, 5.9 in Italy (in 2017), and 8.6 in the United States. Iran’s nurses are under intense psychological pressure, working long hours and even sleeping at hospitals. Some haven’t seen their children or families for days or weeks.
The toll hasn’t been merely psychological. Testing in Iran has so far been restricted only to severe cases, so the dozens of officially reported infections among nurses are likely a vast undercount. Meanwhile, the number of Iranian nurses who have died from the coronavirus is roughly on par with the number of nurses who have died in Italy, even though the official overall death toll there is more than four times higher, suggesting that Iranian nurses are disproportionately at risk. Many experts and human rights groups also believe the Iranian government is underreporting coronavirus deaths to dispel criticism of its response.
Where official mismanagement and harsh U.S sanctions are failing Iranian nurses and health care workers, nonprofit organizations are partially stepping into the void. Some of the need for protective equipment is being filled by humanitarian groups that already have licenses from the U.S. government to operate in Iran. One of these organizations, Relief International, has been importing N95 masks and Tyvek 400 protective coveralls. UNICEF Iran has also been importing two types of high-filtered respiratory surgical masks, N95 masks, and surgical gowns for Iranian health personnel. But even these organizations have had to overcome supplier reluctance to ship to Iran, and the need for protective equipment far surpasses what they are able to provide.
Domestic producers have picked up some of the slack, but many medical supplies produced in Iran still rely on foreign equipment and raw materials imported from abroad—at prices far higher than what they would get if they could buy from countries directly. “Iranian importers have to pay around 30 to 50 percent more for goods through third countries,” said Bijan Khajehpour, a managing partner at Eurasian Nexus Partners. “This means that for a total annual import figure of $50 billion, Iran will end up paying about $15 billion more than the value of the goods.”
There is bipartisan precedent in the United States for sanctions relief for Iran in times of crisis. After an earthquake devastated the country in 2003, the usually hawkish George W. Bush administration eased sanctions for three months to expedite aid and assistance. The Obama administration took similar measures after another earthquake hit Iran in 2012, easing sanctions for 45 days to facilitate humanitarian aid.
But despite both domestic and international calls for Trump to follow suit, the current administration is showing no signs of giving Iran any relief during the pandemic, other than vaguely worded offers to “assist the Iranian people in their response efforts.” Tehran rejected the overture as “insincere” and politically motivated. Last week, the State Department called the Iranian government’s requests for broader sanctions relief a “scam,” and the Trump administration has said it will block Iran’s request for $5 billion in emergency assistance from the International Monetary Fund to deal with the outbreak.
In March, Mohammad Sharifi Moghaddam, the head of a leading nurses’ union in Iran, told a local news organization that the death toll for nurses in Iran during the coronavirus pandemic has been “unnatural” compared with other countries that have been hit hard by the virus, blaming government mismanagement, staff shortages, and lack of protective equipment. While there is little question that the Iranian government’s response to the coronavirus has been a failure, U.S. sanctions have made the situation worse by disrupting other avenues for humanitarian aid—and the likely result is many more Iranian nurses and health care workers being made into martyrs.
Negar Mortazavi is an Iranian-American journalist covering Iran in English and Persian.
Photo: IRNA
In a Time of Crisis, Iranians Seek Comfort, Connection Through Music
The coronavirus outbreak has wrecked Iran’s cultural calendar, putting strain on finances of theaters and livelihoods of performers. But Iranian artists are rising to the occasion, finding ways to ensure their music reaches audiences at a time when it is needed most.
Iran is enduring one of the world’s worst outbreaks of COVID-19. Over 73,000 infections have been confirmed in official figures. Faced with uncertainty and isolated during a national lockdown, Iranians have sought comfort and connection through music.
The coronavirus outbreak has wrecked Iran’s cultural calendar, straining the finances of theaters and the livelihoods of performers. But Iranian artists are rising to the occasion, finding ways to ensure their music reaches audiences at a time when it is needed most.
Concerts are being given in empty performance halls, but streamed to millions online. Musicians are practicing in the solitude of their homes, but connecting with fans on social media.
Alternative band Bomrani, whose sound combines influences from traditional Iranian music, jazz, and gypsy punk, had planned to give four concerts in March—all canceled due to the outbreak. The band decided to experiment with an online concert
With Bomrani’s six members social distancing, they decided to release a recording of a concert performed last year on the grounds of Sa’dabad Palace. They used Instagram to stream the concert. The platform’s chat function allowed the band to connect with fans during the stream.
“It was really nice. The whole band was online. We were chatting with each other, making jokes, and fooling around. This created an intimate atmosphere,” said lead singer Behzad Omrani.
“People later told us that it felt as if Bomrani had thrown a party and we were sitting next to them listening to the music,” he added.
The band had tried live-streaming performances before. “But we didn’t take it that seriously. You can’t compare anything with the joy of performing in front of an audience but we have to make do with what we've got.”
Despite the serious times, Omrani explains that the band isn’t taking their online performances too seriously. “I don’t look at these concerts as doing society a service,” Omrani explained. “That’s not what art is to me. Giving online concerts is a way for me to express myself, to be myself, and to enjoy myself.”
Despite this, Bomrani do not shy away from difficult topics in their music. “We’ve got an album in the pipeline, ‘Probably There Is No Hero’. It’s about all we have been through over the past year both personally and as a country,” he said.
Iranians rang in Nowruz, the Persian New Year, three weeks ago, just as the coronavirus crisis mounted. Omrani describes the year just passed as “really harsh” and “totally unprecedented.”
He thinks the music industry in Iran will be changed by the experience of the coronavirus. “The outbreak has catalyzed a transformation. Five or six years ago no one would have believed that one day musicians would throw online concerts in Iran. Things are changing and they are changing fast.
Power of Music
Iranian authorities have also sought to use the power of music. But the concerts have not been without controversy.
As part of a broad “stay at home” campaign, Tehran Municipality organized a series of online concerts between March 27 and April 9. The concerts were recorded live at the central hall of Tehran’s iconic Milad Tower and streamed online, reaching a staggering five million viewers.
The popularity of the first concert caught the attention of the leadership of IRIB, the state broadcaster and de facto media regulator. Reports emerged that IRIB had prohibited the concert organizers from streaming video of the performers on stage.
On March 28, a performance by musician Omid Jahani was streamed with scenes from nature rather than video of the performer. But the following day, IRIB denied imposing any such rules and the concerts were streamed as originally planned, bringing performances from the likes of Roozbeh Bemani, Reza Yazdani, Sadollah Nasiri and Mohsen Sharifian into the living rooms of Iranians across the country.
Peace of Mind
Musician Siavash Mollaeian plays the kamancheh, a traditional string instrument that features in Iranian, Kurdish, and Azerbaijani music. He is an unlikely convert to online performances. “I’ve never been into social media and giving online concerts. It was never my thing,” he said.
“Following the outbreak, I was feeling down. Then a friend reached out to me and asked me totally out of the blue, ‘Why aren’t you giving concerts on Instagram? It would be really nice and you’d enjoy it.’”
After mulling it over for a few days, Mollaeian decided to give it a shot.
Now, regularly gives live performances for his followers on Instrgram. “I received messages telling me that my music instills a sense of calmness and rekindles hope. I didn’t expect that,” he said.
Mollaeian believes that the uncertainty introduced by the pandemic has taken a toll on people, who are increasingly anxious about the future. “My music is a reflection of my personal struggles. I think coming across works of art, people see what they long for. And these days what people need is peace of mind and hope.”
In a time of crisis, a deeper sense of community has emerged. “People are working hard to rekindle long lost friendships. They are more willing to go the extra mile to get in touch with strangers, to forge new fellowships, to go beyond boundaries,” Mollaeian explained.
Bridging the Gap
Two weeks ago, Mollaeian reached out to Aida Shahghasemi with a simple invitation: to perform a duet.
Shahghasemi is an Iranian-born singer and kamancheh player living in Minneapolis, Minnesota. She and Mollaeian have never met in person—they got to know one another through social media.
“We have known each other for years. We had discussed doing a joint project but had never managed to do so,” Mollaeian said.
The pandemic provided the two artists with a chance to bridge the 10,000-kilometer gap between Iran and the United States.
Shahghasemi is a music teacher who has also had to adapt as the coronavirus outbreak in the United States worsened. “My husband and I, along with our dog, have been self-isolating since March 13. Following the outbreak, I had to switch to giving online classes,” she said.
She has seen a surge in demand for classes over the past few weeks as people search for new hobbies to pass the time. But Shahghasemi thinks that for most of her new students, learning music, like the lockdown, will be temporary. “I think many of them might not have enough time to continue taking lessons after the pandemic is over,” she noted, wryly.
After agreeing to play a duet, Mollaeian and Shahghasemi did a trial run to test their Internet connection. But otherwise, they decided improvise their performance. On April 3, they performed a few pieces live on Instagram.
For Shahghasemi, the online performance lacked the ritual and the connection with the other musicians that make concerts special. “With these online performances, artists go online, people pop in, listen to half a song, get distracted by notification on their phones and drop out. It certainly wasn’t as fulfilling as performing in front of an audience,” she admitted.
Shahghasemi is hesitant to give it another try. “Maybe I’m holding myself back but I’m open to collaborating with my fellow artists and friends.”
But for Mollaeian the concert still felt meaningful, perhaps because of the lack of context. “While playing the duet it felt as if she was sitting next to me. So far, yet so close. We are practicing social distancing, but are we really distancing from each other? To me, it doesn’t seem that way. The crisis is bringing people together. New connections are being made.
“Iranian, American. In the face of this pandemic, these differences are immaterial,” Mollaeian said, referring to the longstanding animosity between the governments of the United States and Iran.
“Humans have been divided by borders and boundaries for ages. Technology has afforded us the opportunity to cross such boundaries—and with our music we have.”
Photo: Amir Jadidi
Iranian Civil Society, Businesses Step-Up in Virus Fight
Faced with the gravity of the COVID-19 outbreak, members of Iranian civil society and private sector business leaders have joined the fight against the virus, seeking to address gaps in the government’s response.
It may be springtime, but the nights are still chilly in Shiraz. It is 2:30 am. The streets of Iran’s fifth largest city are deserted and Ali Mousavi and his team of volunteers are walking along the boulevards and back-alleys with their disinfection equipment.
Shiraz has been an epicenter for cases of COVID-19 in Iran. Less than two weeks ago the city council wrote a letter to Iran’s president, Hassan Rouhani, expressing grave concerns over the soaring number of the new cases and calling for the government to take more serious action.
But many Shirazis were not content to wait for government interventions that tend to arrive slowly and often fail to provide adequate support. Mousavi, who is a lecturer at a local university, decided to take matters into his own hand by launching a volunteer effort, as they had last year in response to the deadly flash floods that hit Shiraz.
Mousavi and his team began disinfecting neighborhoods just a few days after Iran officially disclosed its first cases of COVID-19. Starting with two groups of 20 volunteers, there are now over 300 people contributing their time. Mousavi reports on the group’s efforts on Twitter.
The volunteers have also helped with the production of protective face masks and hand sanitizer. “A local factory was understaffed and we could contribute manpower,” Mousavi explained. “With the coordination of Shiraz University of Medical Sciences, our team started working at the facility in three shifts producing 20,000 disposable surgical masks daily to meet the new demand.”
Grassroots Efforts Across Iran
COVID-19 has killed over 3,603 in Iran and the country has registered more than 58,000 cases of the illness, with 2,483 new cases announced just yesterday.
The government’s slow response to the virus allowed it to spread unhindered for several weeks before serious action was taken.
As the toll from the outbreak continues to mount, already diminished stockpiles of critical medical equipment are nearly depleted. To make matters worse, the Iranian government faces a significant budget deficit as a result of a collapse in the global oil price, a fall in regional trade, the pressure of U.S. sanctions, and fiscal mismanagement.
Faced with the gravity of the situation, members of Iranian civil society and private sector business leaders have joined the fight against COVID-19, seeking to address gaps in the government’s response.
Groups of concerned citizens have organized in dozens of cities across Iran, mobilizing to support sanitation efforts, to increase production of critical supplies, and to deliver groceries and medication to the homes of those most vulnerable to infection, including the elderly and those living in underprivileged communities.
A group of young seminary students in Mashhad were lauded after they volunteered to wash the bodies of coronavirus victims before burial, in keeping with Islamic custom—a risky job that few people were willing to do.
Volunteers are working selflessly, putting themselves at risk to help people in need, explained Mousavi, describing it as the “right spirit.” When asked whether any of his volunteers had been infected, Mousavi responded “no one so far, thank God.”
Mousavi and his team, like many similar groups around the country, are funded by donations. “Many people think we receive financial help from the government or military institutions, but in reality we receive limited support from those bodies.” He presents a receipt for a purchase of 400 pairs of industrial gloves for his disinfection teams, paid for by donations.
So far, Mousavi has collected around USD 20,000 in donations to purchase food and basic supplies for vulnerable households, especially those families that have lost their breadwinners to COVID-19.
Major Companies Join the Effort
Perhaps the largest philanthropic campaign under way in Iran is the Nafas Campaign (nafas means “breath” in Persian, but it is also the base of the Persian idiom for “trust in oneself”). Launched in late February, over 200 companies from Iran’s private sector have joined the campaign, coordinated by chambers of commerce and the philanthropic arms of several of Iran’s largest firms. Together, the members have donated over USD 1,000,000, medical equipment, in-kind services, and cash assistance to help fight COVID-19.
The Nafas Campaign has managed to supply ventilators to hospitals across the country. Last week, the campaign donated 55 ventilators, valued at around USD 350,000, to hospitals in Golestan, a province facing one of the most severe outbreaks of COVID-19 in the country.
Hospitals are also facing unprecedented demand for medical oxygen cylinders—and the Tehran Compressed Gas Association has stepped-up. Mahrad Ebad, vice chairman of the association, described a market under strain. "Unfortunately, in recent months, oxygen cylinders have been in short supply in Iran for variety of reasons, including high demand, sanctions pressures, and the depreciating rial. Prices have skyrocketed and we are seeing cylinders sold at prices as high as 2 to 3 million toman (USD 125 to USD 185).”
“Within the framework of our support to the Nafas Campaign, we have procured and donated over 1800 oxygen cylinders for use at hospitals across the country.” Ebad added.
Medical systems around the world are scrambling to procure N95 masks used by healthcare workers to protect themselves from the risk of infection. Tapping into the supplier relationships of its member companies, the Nafas Campaign has imported over 500,000 N95 masks from China, with another 120,000 masks slated to arrive in the coming days.
The Nafas Campaign’s flagship project was the construction of the Nafas Clinic, a center where patients can be tested for COVID-19 and other acute respiratory disease. Built in just eight days, the clinic, located in Tehran’s Sadeqieh square and adjacent to Ebnesina Hospital, has the capacity to test 300 patients daily and is open 24 hours, seven days a week.
Despite these successes, campaign members continue to be disappointed by the bureaucratic hurdles and lengthy custom clearance procedures that have delayed delivery of critically needed items to hospitals. “It is unacceptable that such key supplies are held for days merely for certain bureaucratic processes while our medical centers are facing shortage of protective gears,” said Farzin Fardis, communications director for the campaign. The campaign has called on the government to reduce the red tape.
Fadis believes the campaign is pioneering a new model of civic action, and the private sector nature of the initiative has enabled donations to be solicited from Iranians abroad. “The fact that so many businesses have come together to cooperate in civic activities as part of this campaign, sets an important precedent in Iran and we hope that when the coronavirus crisis is over, this campaign will be considered a successful model for such efforts.”
Photo: IRNA
Under Lockdown, Iranians Rediscover the Joys of Baking Bread
Iranians are staying at home, doing their part to “flatten the curve” as the country confronts COVID-19. Adjusting to confinement at a stressful and uncertain time, many Iranians have found a new and creative pastime—baking bread.
Iranians are staying at home, doing their part to “flatten the curve” as the country confronts COVID-19. Adjusting to confinement in a stressful and uncertain period, many have found a new pastime—baking bread.
The bustling streets of Iran’s cities are now deserted, although the country’s lockdown measures are not as strict as those in Italy or France. The government has instructed bakeries to keep normal working hours and bakers continue to be well-supplied with flour, which is heavily subsidized in Iran.
Some customers continue to line up—keeping a safe distance from one another—and many bakeries have stopped accepting cash to avoid bakers handling spare change. But many Iranians have opted to stop visiting bakeries, if only to limit their time outside.
Unable to get fresh bread each day, Iranians have turned to store-bought brands. Others have bought bread to freeze, hoping it would last them during the lockdown.
On March 13, armed forces chief of staff Mohammad Bagheri, announced that security forces would begin enforcing restrictions on intercity travel, a move many interpreted to mean that a full lockdown was imminent. Iranians rushed to stock up on essentials.
Hearing the news, Ahmad, who declined to share his last name, headed to the nearest bakery. Married and with two children, he bought stacks of bread that could sustain his family for at least a week. “At the time I thought if the government imposed a lockdown, at least we’d have bread to eat.”
Although Iranian cuisine is often associated with rice, bread is the true staple. Iranian per capita bread consumption is 160 kilograms each year—by some accounts the second highest level in the world. It should be no surprise then that the global “bread-baking boom” would reach Iran.
Nasim Moghaddam is a manager at an Iranian startup. She is immune-compromised and has been self-isolating since early March. Four weeks into her quarantine, with ample time to take on a new project, she tried her hand at baking Lavash and Barbari, two of the most popular Iranian flatbreads.
“I have always been into cooking and baking. I had even tried baking bread once or twice before. Bread-baking takes time and effort, but time is something I’ve got in abundance these days,” she said.
Moghaddam explained that baking helps her wind down during these stressful days. “Baking takes your mind off all the tensions. You need to concentrate on what you are doing or you will simply ruin what you are making.”
Maryam Keshtparvar, a psychologist, believes many Iranians are seeking ways to cope with the profound psychological effects of the pandemic. “The first priority for everyone has become the urge for survival and people feel that that they have been deprived of the many securities of modern life. This can trigger fear and anxiety,” she said.
Keshtparvar notes that as people settle into a new routine at home while they wait out outbreak, new pastimes are gaining popularity. “Some of these activities may be considered throwbacks to an earlier age. People have started growing vegetables and baking bread at home. They find themselves experimenting with soil, plants, and flour. This newfound familiarity with the elements rekindles calm in people.”
Artist Pooya Shahsiah and her husband Ehsan started baking bread a few months before COVID-19 outbreak. But they have taken their baking to new heights since beginning self-isolation. The pair have come to see baking bread as a “creative experience that has a prevailing presence during your daily life.”
Pooya recalled the origin of their hobby in an Instagram post, writing, “One day I woke up and found Ehsan trying to bake bread. A new hobby, I thought to myself, which he’d give up on soon. But he didn’t. This still comes as a surprise to me, but we have not bought bread even once over the past six months.” In the same post, she explains the basics of baking sourdough bread.
Their loaves have won fans. “We have been receiving calls from friends asking us to bake them a loaf or two,” she said, laughing boisterously. “We might even start selling bread.” The couple is currently going through as much as 8 kilograms of flour a week.
Speaking by phone, the couple explained that for them, baking has an emotional significance. “For years, Ehsan longed for the taste of bread his late aunt baked. Sourdough was the answer,” Shahsiah explained. “Some even name their sourdough starters as if they were newborn babies. We don’t, but we certainly pamper our starter.”
Posting about their baking exploits on social media, the couple was asked by friends to share their starter, which helps speed the fermentation process. “We did, just to give them a head start in the process. But I was worried that they wouldn’t take proper care of it. You need to pay attention to minuscule details. The smallest details can change the outcome.”
The pair learned how to bake by watching YouTube tutorials, accessed by VPN.
Over the past few weeks, as the coronavirus outbreak grew worse, similar tutorials have been uploaded to Aparat, Iran’s leading video-sharing platform. Even IRNA, a state news agency, has published an article entitled “How to Make Taftoon Bread at Home: An Enjoyable Pastime.”
Those who have tried it tend to agree.
Photo: Nasim Moghaddam
As Coronavirus Spreads, Iranian Doctors Fear the Worst
The combination of Iran’s physical interconnectivity and its relative political and economic isolation pose unprecedented challenges for international public health, particularly as U.S. sanctions constrain the supply of raw materials and imported medical supplies.
By Esfandyar Batmanghelidj and Abbas Kebriaeezadeh
Iran is often described as an isolated country, but the spread of the coronavirus has made clear that the Islamic Republic is less isolated than often assumed. Iran’s significant trade links with China, where COVID-19 originated, left the country vulnerable to the spread of the virus.
The outbreak in Iran is one of the world’s largest, with more than 2,300 confirmed cases and 77 declared deaths. Many of the first cases registered in other places—including Iraq, Lebanon, Georgia, Qatar, New Zealand, and even New York—are attributable to individuals who had traveled from Iran. Clearly, notwithstanding the attempts of U.S. President Donald Trump’s administration to isolate Iran politically and economically, Iran remains connected to the world. It follows that Iran’s success or failure to manage its coronavirus outbreak will directly impact the threat of a pandemic.
The combination of Iran’s physical interconnectivity and its relative political and economic isolation pose unprecedented challenges for international public health. The first two weeks of Iran’s coronavirus outbreak have been similar to those in other countries. Authorities were slow to take measures such as closing of schools and universities and canceling of public gatherings, including briefings and government meetings that contributed to the infection of numerous officials.
As the severity of the crisis became clearer, members of the public became anxious, adding to the strain on Iran’s health care system. People rushed to pharmacies and stores to purchase supplies. They rushed to hospital emergency rooms worried that a persistent cough could be COVID-19.
These are understandable reactions and are always preferable to indifference—any successful public-health campaign requires individual members of the public to take responsibility and proactive action. But as the number of confirmed cases mounted, so too did demand for respiratory masks and contamination suits, symptom relief medication, and immunity-boosting vitamins, as well as disinfectants, detergents, and related hygiene equipment.
Given its sophisticated manufacturing base, Iran produces many of these products domestically, limiting the initial impact of sanctions on the availability of medicine and equipment. However, inventories in pharmacies and shops are running low. Importers are struggling to get their hands on new inventory and factories are struggling to ramp up local production to keep up with the rising demand. U.S. sanctions are largely to blame for these disruptions.
The Iranian companies producing medicine, disinfectants, and protective clothing also have a supply-chain problem; they are dependent on imported ingredients and materials. For example, even though antiviral drugs are manufactured in Iran, the raw materials are almost entirely supplied from China and India. Should Iranian manufacturers run out of these raw materials, it will be very difficult, if not impossible, to effectively contain and treat COVID-19 in Iran. U.S. sanctions are constraining the supply of raw materials and imported goods in two ways.
First, there is the issue of transport links. Even before the outbreak of the virus, the Trump administration’s reimposition of secondary sanctions on Iran in November 2018 saw many airlines and international shipping companies end their presence in the Iranian market. As a result, for a country of its size, Iran is unusually reliant on regional hubs for both air travel and freight forwarding.
As neighbors impose travel restrictions, Iran is facing difficulties in sustaining imports, particularly for time-sensitive deliveries by air. The World Health Organization recently faced delays in supplying Iran with coronavirus testing kits “due to flight restrictions” that prevented their dispatch from the United Arab Emirates.
The kits were eventually delivered via a commercial flight from Baghdad, but that route may also be closed as Iraq as now announced its first confirmed cases of the virus. A subsequent delivery of equipment did arrive in Tehran from Dubai—but only after the Emirati government arranged a military transport at the request of the World Health Organization.
Second, even if a viable means of delivery can be found, it has been well documented how U.S. secondary sanctions have restricted humanitarian trade with Iran by scaring off most banks from facilitating the necessary payments.
The imports that do take place—from major suppliers such as Germany, Switzerland, and China—reflect long-standing business relationships in which the foreign exporter and Iranian importer have put the facilitating bank (usually a small merchant bank) at ease by preparing extensive compliance documentation.
The fact that humanitarian trade is currently conducted in this manner—a slow, inflexible process—makes it inherently difficult for Iranian entities, particularly governmental entities such as the Ministry of Health and Medical Education, to quickly identify new suppliers and purchase the required goods during a public health crisis. Moreover, sanctions have both weakened Iran’s currency and made it difficult for Iran to access its foreign exchange reserves, further adding to the time and cost of any emergency purchases.
Medical professionals in Iran are seeing the early signs of shortages. They are calling the Iranian vendors of respiratory masks, surgical gowns, and ventilators only to hear that the goods are out of stock. They are struggling to get antiviral medication even to those patients exhibiting the most acute symptoms.
While much of the global attention towards Iran’s response to coronavirus has focused on the question of whether or not the Iranian government has adequately managed the outbreak, there is a far more urgent concern among Iran’s doctors. If Iranian pharmaceutical companies and medical equipment manufacturers are unable to establish speedy and reliable means to import raw materials, the country could soon face a humanitarian catastrophe.
The Trump administration has made an offer of humanitarian assistance to Iran—but has provided no detail. To address the impact of sanctions on Iran’s ability to import and manufacture key items, it would be straightforward for the administration to provide greater legal clarity to exporters and the banks on which they rely—for example by expanding the definition of “humanitarian” goods so as to include items needed to fight COVID-19, such as respiratory masks and disinfection equipment, as well as raw materials, within the scope of existing general licenses.
Given that it is unlikely that the United States will take any such steps, it is commendable that the governments of France, Germany, and the United Kingdom have dispatched “equipment for laboratory tests as well as… protective body suits and gloves” to Iran. They will also be providing “urgent additional financial support close to €5 million to fight the COVID-19 epidemic affecting Iran, through the WHO or other UN agencies.” But these are stopgap measures.
To address the vulnerabilities of Iran’s domestic medical and medical equipment manufacturers, European governments could utilize the Instrument in Support of Trade Exchanges (Instex) trade mechanism, which was established to ease humanitarian trade between Europe and Iran by creating a standard compliance protocol and by eliminating the need for European banks to receive payments directly from Iranian banks.
The company, which boasts nine European states among its shareholders, has yet to make its first transaction. Nonetheless, policymakers are adamant that the company is nearly operational. Aiding Iran in its fight against coronavirus could provide INSTEX a renewed sense of purpose.
Of course, Western governments are increasingly preoccupied with their own coronavirus outbreaks, and further assistance may be difficult to coordinate. The Iranian health care system and the companies that supply the nation’s hospitals will continue to fight coronavirus without all the resources they need—a situation that has drawn parallels to the country’s experience during the Iran-Iraq War.
Nevertheless, Iran’s experience with COVID-19 offers a cautionary tale about the intersection of sanctions policy and international public health. The economic vulnerabilities that sanctioning countries seek to create in target countries never exist in true isolation. Just as a virus will attack the most vulnerable members of any given population, the coronavirus is now attacking the global health system at its most vulnerable points—before spreading everywhere else.
Esfandyar Batmanghelidj is the founder of Bourse & Bazaar. Follow him at @yarbatman.
Abbas Kebriaeezadeh is a professor of pharmacology at the Tehran University of Medical Sciences He is vice chairman of the Iranian Pharmaceutical Industries Syndicate and chairman of Baran Chemical and Pharmaceutical Company.
Photo: IRNA
The Coronavirus Crisis Is a Diplomatic Opportunity for the United States and Iran
Washington and Tehran could use the COVID-19 public health emergency to show goodwill, dial down tensions while saving face, and avoid a dangerous confrontation.
By Robert Malley and Ali Vaez
If Iran’s leaders thought things couldn’t get worse, they were wrong. The country faces three simultaneous crises: a public health emergency that is worsening by the hour, tensions with the United States that have once again grown in the past few days, and an economic picture that could go from troubled to dire in a matter of months.
The confluence of a coronavirus pandemic, security threats, and financial troubles has deepened the political system’s legitimacy crisis in the wake of last month’s parliamentary elections that saw the lowest turnout in the Islamic Republic’s history. Washington might view this as a validation of its so-called maximum pressure strategy against Tehran, but if it fails to capitalize on this moment to de-escalate tensions and lay the groundwork for a mutually beneficial diplomatic settlement, the leadership in Tehran is likely to become more aggressive in the region, increasing the risk of a conflict that neither side appears to want.
Since the dramatic escalations of late 2019 and early 2020, which culminated in the killing of the Islamic Revolutionary Guard Corps commander Qassem Suleimani and Iranian missile strikes on Iraqi bases hosting U.S. forces, both Iran and the United States appeared content to return to their respective corners.
But there has been a steady stream of incidents in Iraq, with at least seven attacks near U.S. diplomatic facilities inside Baghdad’s Green Zone and U.S. military installations in Iraq throughout January and February. These attacks spiked on March 11 following a barrage of rockets that killed three members of the U.S.-led coalition, including two Americans, and injured more than a dozen others at an Iraqi army base, Camp Taji, north of Baghdad.
U.S. Secretary of Defense Mark Esper subsequently assessed that “Iranian-backed Shiite militia groups” were responsible. Secretary of State Mike Pompeo warned that “those responsible must be held accountable.” A day later, the United States retaliated against an Iranian-backed Iraqi militia in Iraq, which in turn fired more rockets into Camp Taji on March 14 and again on March 17.
This latest moment of peril is playing out against the backdrop of a dramatic COVID-19 outbreak in Iran, which has the third-highest number of confirmed cases and fatalities anywhere in the world. The Iranian government was slow in responding to the outbreak; and when it finally realized its scale and scope, Tehran was hampered by shortages caused by sanctions. Moreover, the government has kept a worryingly tight grip on the information flow to save face, prompting fears that the death toll—currently listed as 988—is probably much higher than the official figures suggest.
With Tehran’s initial response being dismissive of the risks of the virus’s spread and slow to mobilize against it, the government is now pleading for international assistance. Having already scored several calamitous own goals in recent months—raising fuel prices with little warning in November 2019, then violently suppressing subsequent protests, and in January downing a Ukrainian civilian airliner in the apparent belief it was an incoming U.S. missile—the government’s response to the coronavirus crisis could increase the population’s sense that its leadership is incompetent.
Meanwhile, the impact of the rapidly spreading disease and collapse in oil prices will likely present almost unprecedented challenges to an economy that is already beset by government mismanagement and under siege from U.S. sanctions.
One Iranian official calculated a drop of 18 percent in trade as a result of the pandemic—and that was before Iraq, a key regional trade partner, announced a full closure of the two countries’ common land borders and the price of crude tumbled below $30 per barrel. (While Iran’s exports have been blocked by the United States since April 2019, it has continued to make sales to China, albeit at sharply reduced levels.) The combination of reduced regional trade, evaporation of remaining oil revenue, and COVID-19’s impact on domestic business could prove catastrophic.
But that doesn’t mean that Tehran will bow to U.S. pressure and back down. Indeed, since May 2019, when the Iranian government chose to counter U.S. maximum pressure with a blend of nuclear and regional provocations, the system’s hard-liners have contended that high-risk brinkmanship yields greater dividends than restraint.
The coronavirus outbreak has now put more pressure on the leadership’s calculus. Feeling besieged and with no obvious diplomatic exit ramp, Iran might conclude that only a confrontation with the United States might change a trajectory that’s heading in a very dangerous direction.
This is also the view of Gen. Kenneth McKenzie, the head of U.S. Central Command, who told Congress on March 10 that the outbreak “probably makes them, in terms of decision-making, more dangerous rather than less dangerous.”
With U.S. President Donald Trump focused on the domestic economic and electoral effects of the coronavirus and the Iranian leadership highly reluctant to display any weakness to the United States, neither side is likely in the mood to engage the other.
That would be a missed opportunity. Indeed, both Washington and Tehran have floated ideas that, if acted upon, could break the current vicious cycle. Pompeo has urged the Iranian government—which furloughed tens of thousands of convicts due to fears of an epidemic in prisons—to free U.S. prisoners and other dual and foreign nationals on humanitarian grounds. The death of any of those inmates from COVID-19 would be a stain Iran might find hard to erase.
Conversely, Iran has asked the International Monetary Fund for emergency funding and a substantial list of essential equipment ranging from gloves and masks to portable respiration and X-ray machines. If the Trump administration stands in the way of such basic needs—by voting against an IMF loan to Iran—the United States would find it hard to overcome the impression that it had acted inhumanely.
The most logical and mutually beneficial outcome would be a two-phased humanitarian de-escalation. Iran would need to first agree to furlough all detained foreigners as the U.S. facilitates the transfer of medicine and medical equipment Iran needs to contain the outbreak and save lives without any sanctions-related delays.
In the second phase, the U.S. government could agree not to block the IMF loan to Iran while Tehran freezes its nuclear escalation and reins in its allied groups in Iraq, preventing any further attacks on U.S. forces and assets. This phase could also comprise another prisoner swap, either on par with the one-for-one exchange that happened back in December or, even better, a broader exchange of prisoners. This would be a win-win: putting tensions with Iran on ice, providing Trump with another success in his efforts to free Americans detained abroad, and providing Tehran with some economic reprieve and the means to save lives at home.
Since 2018, when the Trump administration pulled out of the nuclear deal with Iran, Washington and Tehran have been on a collision course pitting unrealistic U.S. demands against Iranian inflexibility. For either side to let a possible diplomatic off-ramp pass by would mean that a dangerous and deadly situation might again take a turn for the worse.
Robert Malley is president and CEO of the International Crisis Group. He served as a special assistant for the Middle East under President Barack Obama. Follow him at @Rob_Malley.
Ali Vaez is the director of Iran Project at the International Crisis Group and an adjunct professor at Georgetown University's School of Foreign Service. Follow him at @AliVaez
Photo: IRNA
New European Limits on Medical Gear Exports Put Iranians at Risk
The European Commission has announced a new regulation that will establish export controls for Personal Protective Equipment (PPE), a category of goods that includes the face shields, gloves, masks, and other protective gear. The new policy could make it more difficult for Iran to source the equipment necessary to protect doctors and nurses fighting COVID-19.
As the world grapples with shortages of the medical equipment needed to fight the COVID-19 pandemic, the European Commission has announced a new regulation that will establish export controls for Personal Protective Equipment (PPE), a category of goods that includes the face shields, gloves, masks, and other protective gear that help medical professionals limit their exposure to bacteria and viruses. The regulation will limit the sale of these PPE items to countries outside the European Union (EU)—exports of these items were valued at USD 12 billion last year.
Analysis by Chad Bown of the Peterson Institute for International Economics makes clear how the European Commission’s move could have significant consequences for non-European countries that largely supply their healthcare systems with protective equipment made by European firms. Bown argues that the new policy could prove “self-defeating,” both because it may serve to “disrupt supply chains” and also because the new act could “block EU exports of vital equipment to the world’s poorest victims of the pandemic.”
The European Union is home to many of the world’s largest producers of medicine and medical equipment. With the support of their governments, these firms have encouraged “developing countries to open up their markets to imports, facilitating a system in which these countries have come to rely on EU suppliers for their essential medical equipment.” Iran is one such country.
When looking at EU exports to Iran of the PPE items specifically covered under the new regulation, two things become clear. First, Iran was importing significantly more of these goods prior to the Trump administration’s reimposition of secondary sanctions beginning in May 2018. Total exports to Iran fell from EUR 39 million to just EUR 13 million last year, suggesting that Iran’s healthcare system was already grappling with limited inventories of face shields, gloves, and other protective equipment even before the COVID-19 outbreak.
Second, despite the fall in trade, it is clear that EU is a significant supplier of PPE items to the Iranian healthcare system—a fact that leaves Iranian doctors and nurses vulnerable as the bloc begins to enforce the newly announced export controls. This vulnerability is made more clear when looking to EU exports in proportion to exports from Iran’s other leading trade partner: China. In the category of face shields, which account for around half the total value of world PPE exports to Iran, 35 percent of exports were dispatched from the EU.
This figure is lower than the proportion identified by Bown for many countries that trade with Europe, reflecting how sanctions have deterred European suppliers from the Iranian market over the last decade, enabling Chinese suppliers to expand market share. Nonetheless, the EU accounts for about one-fifth of all PPE exports in value terms, meaning that Iran’s healthcare system will be hit as the new export controls are implemented. Already struggling to procure goods through existing supply chains, Iranian importers—and the hospitals that depend on them—may find the supply chains cut altogether.
Moreover, the administrative burden of complying not only with the new export control regime but also with new sanctions regulations will put Iranian buyers at the back of the line for any sales that are to be licensed. European manufacturers of personal protective equipment will want to get whatever limited inventory available for sale to third party countries to the buyers who can make payment and take delivery in the shortest amount of time—Iranian importers are not those buyers.
The new regulation does indicate that some accommodations will be made for the provision of European aid. The regulation states, “exports of certain quantities of specific products may be authorized under specific circumstances such as to ensure assistance provided to third countries.” Iran has already received aid from France, Germany, and the United Kingdom as well as assistance provided by the EU itself. But the regulation has the effect of cutting long-standing commercial relationships between European manufacturers and importers in countries like Iran, and replacing them with a highly political procurement channel. It is not clear how European policymakers will prioritize who receives aid including PPE items—will it be the countries currently facing the most acute outbreaks, such as Iran, or will it be the countries where Europe sees the most favorable political and economic relations, such as Norway.
In the face of such uncertainty, China has mobilized resources to increase aid shipments and commercial sales of medical equipment to countries around the world, including Iran. But Chinese suppliers cannot replace European suppliers in each and every country as the COVID-19 pandemic spreads. As Bown, concludes, “to ensure the hospital equipment to fight the pandemic arrives where and when it is needed the most, policymakers must coordinate and cooperate globally.” The European Union is the only global actor that could effectively marshall such an approach.
As a country with a large manufacturing base, Iran can be part of the solution. Iranian firms have already taken steps to increase production of face masks, disinfectants, hospital beds and other products and equipment for which there is growing global demand. Rather than seek to cut its supply chains with non-EU countries, European authorities could seek to increase imports of basic PPE items such as surgical masks or gowns from countries like Iran, leaving European firms to focus on ramping up production of more advanced equipment such as face shields, generating a surplus for export. In short, the same notions of comparative advantage that led to the creation of today’s complex supply chains should inform their retooling during the COVID-19 crisis. Abandoning economic interdependence will put everyone at greater risk.
Photo: IRNA
Shutters Come Down for Iran’s Cafés and Restaurants
While Iran’s economy has struggled over the last two years, the country has nonetheless seen a boom in new restaurant and café openings, especially in the bustling capital, Tehran. But the COVID-19 outbreak has brought the shutters down at establishments across the country, leaving the owners to wonder if they will ever open again.
While Iran’s economy has struggled over the last two years, the country experienced a boom in new restaurant and café openings, especially in the bustling capital, Tehran. Even in times of financial hardship, a foodie culture has seen Iranians of all walks of life enthusiastically patronize new restaurants, cafés, and fast-food joints.
But the COVID-19 outbreak, which has now led to the infection of more than 15,000 Iranians according to official figures, has brought the shutters down at establishments across the country, leaving the owners to wonder if they will ever open again.
“Many businesses will not be able to survive this crisis if it lasts for a month or two. Even if they survive, the crisis will lead to layoffs and a sharp surge in prices,” said Shahram Rajabi, owner of Sakura Sushi Restaurant, which is located in Ava Center, a mall in the upscale Aqdasiyeh neighborhood of Tehran.
Rajabi owns two other food businesses in Ava Center—a bakery and a café. In total, he employs 70 people—it is not clear how much longer he can afford to keep them on the payroll. “Only the bakery is still open. Sales have dropped 80 percent, but we have kept the doors open. The café and restaurant’s employees are all on paid leave.”
Nowruz—a two-week period during with Iranians celebrate the new year—is fast approaching. Before Iran found itself in the midst of a public health crisis, bakeries were already working around the clock to prepare the confections and treats that Iranians traditionally enjoy during the holiday. But this year there is little cause for celebration.
“With the fear of coronavirus hanging over everything, no one is in the mood to celebrate. People aren’t buying ready-made confectionaries. These businesses will be forced to dump what they had baked. All that money and effort will go to waste,” Rajabi said. “The pandemic is taking a harsh toll on businesses and is pushing many to the verge of bankruptcy. I don’t know how long we can survive,” he added.
Social Media Outreach
Behzad Mosayyebi is the owner of Café Hedayat in Shiraz, where he employs around 25 people. He too is struggling to keep his business afloat.
“A week after news broke about COVID-19 spreading in Iran, our sales plummeted by 70 percent. Initially, we tried to keep business going but a week into the outbreak, with sales nose-diving we were forced to shutter the café,” Mosayyebi said.
Currently, his employees are on paid leave. “Employees are the most valuable assets of any business. We have invested in training our staff. But if the situation does not improve in a month or so we’ll be forced to let our staff go.”
Mosayyebi acknowledged that even after the epidemic is over, the café might need to hike prices to cover its losses—but he hopes his customers will remain loyal even if they go weeks or months without visiting.
In order to keep his clientele engaged, Mosayyebi has launched a campaign on Instagram, which features his employees and social media influencers offering easy recipes and cooking tutorials for everything from dal to pasta.
Other restaurants have also launched similar campaigns. Vitrin Kitchen, a trendy eatery located in Tehran’s A.S.P Towers, recently closed in light of the spread of COVID-19. Vitrin’s chef, Armin Milani, has self-quarantined at home. But from his kitchen, he continues to keep the restaurant’s Instagram active by posting pictures of his latest creations, accompanied by short reflections on being in isolation. His posts reach over 60,000 followers.
Some restaurants, especially fast-food chains, have endeavored to remain open despite the outbreak. These establishments have turned to social media to reassure buyers that they are doing their best to keep their food “COVID-19 Free.” Popular burger joint Burgerator has posted a video on Instagram that shows the body temperature of its staff being checked and explains how “every surface is sanitized.” The video ends with a tag line, “We care for you.”
Famous fast-food chain Barooj is sending out text messages to customers announcing a new offer: “half-cooked” pizza. Customers are meant to finish cooking the pizza in their home oven. The text message explains that “high temperature kills coronavirus.” One of the oldest delivery pizza shops in Tehran, Dar-be-Dar, has likewise started selling par-baked pizza.
Perseverance
Just a few days after Iran announced its first confirmed case of COVID-19, employees at Yerma House café off Karimkhan Street in downtown Tehran, were geared-up with latex gloves and face masks.
Located in a chic pre-Islamic Revolution building, Yerma House is part gallery and part café. A large self-portrait by Frida Kahlo dominates the space and the aroma of freshly roasted coffee and spices usually waft through the air.
Startled by the staff’s appearance, a customer asked “what was the hassle for.” The cashier, her headscarf fashioned as a turban, replied, “We are just trying to keep you safe, love.” Later the same day, the manager decided to shutdown the café until further notice.
Yerma’s manager, Neda Hengami, is worried. “The COVID-19 outbreak hit us hard. Right now I am trying to help people get through the crisis and pass time while social distancing by conducting a writing contest.”
Hengami feels a responsibility to sustain the business and find a way to keep paying her employees as they face difficult times. She said that she is considering setting up a take-away-only service. “But I’m not certain whether it’d work. We can’t do much, can we?”
At the end of the interview she recalled a passage from Strait is the Gate, a novel written at the turn of the 20th century by André Gide. “I read the book ages ago,” she explained. “There is a section where Gide describes a Bible sermon.” Hengami proceeded to quote from memory: “Enter ye in at the strait gate: for wide is the gate and broad is the way that leadeth to destruction, and many there be which go in thereat. Because strait is the gate, and narrow is the way, which leadeth unto life, and few there be that find it.”
“The passage has stuck with me over the years. It has helped me through the hard times,” she said.
Photo: IRNA
As Economic Anxieties Deepen, This Clinic Helps Iranians Manage Debilitating Stress
These are stressful times in Iran and people are seeking relief. According to a recent study, 80 percent of Tehran residents experience at least one major stressful event per year and 45 percent report feeling stress due to the economic situation.
Whether facing a deadly eight-year war or seemingly unending economic crises, Iranians have been exposed to more than their fair share of stress in the past few decades. A significant 23 percent of Iranians—around 20 million people—struggle with mental health while 12 percent of men and 16 percent of women suffer from depression, according to figures from the Ministry of Health.
A recent study of children and adults in Tehran by the Iranian Pediatric Association found that 80 percent of residents experience at least one major stressful event per year and 45 percent report feeling stress due to the present economic situation. Association director Dr. Ahmad Ali Noorbala told an audience at the University of Tehran, "The results of this study show that the incidence of mental disorders in our country is increasing. We live in a country where people sometimes experience unpleasant events and face a lot of stress daily. If they cannot control the stress, they may face psychological problems, which can manifest physical illnesses." Nonetheless, traditional mentalities and lackluster education mean that a cultural stigma persists around the issue of mental health.
In the absence of adequate government attention to the increasing risks to mental health, a private clinic in Tehran is employing an integrative method of therapy—never before offered in Iran—to help individuals better cope with stress. Having begun general studies in 2011 and having recently completed three years of clinical research, the Aramesh Multidisciplinary Pain Clinic publicly launched its neuropsychotherapy services on August 15.
Their treatment method is a meta-framework which takes into account the dynamic interplay between the mind, body, society, and environment. This framework formulates a holistic therapeutic practice informed by neuroscientific research. Outside of Iran, such treatments were first pioneered around a decade ago.
“In countries like Iran where stress is very acute, using knowledge that can teach us how to manage this stress can prove immensely influential on our daily performance,” Masoud Nosratabadi, a professor of clinical psychology at the University of Social Welfare & Rehabilitation Sciences and a supervisor of the clinic’s neuropsychotherapy department told Bourse & Bazaar.
In recent months, Nostrabadi and his colleagues have seen an increase in patients complaining about stress related to rising economic anxieties. Due to returning US sanctions, promised to be “the strongest in history,” Iran’s currency has collapsed and inflation has risen. Most experts foresee inflation to return to 20 percent, pushing up the price of many common goods. With their livelihoods threatened, some Iranians are considering emigration. But most will not be able to escape the pressures of life under sanctions in this way.
Stress caused by economic conditions has public health consequences. As Nostrabadi points out, the common denominator of many serious ailments, from heart disease and cancer to strokes and respiratory sicknesses, is stress and related emotional disorders. Evidence suggests that stress either acts as the generator of disorders and diseases or it exacerbates sickness and inhibits recovery.
Nostrabati and his team cannot control how much stress is imposed on their patients, but they aim to arm them with the tools to better manage stress. Unfortunately, many individuals are debilitated by stress and find themselves frozen in a state of inaction. “‘Freezing’ is the worst response and in my experience many Iranians go down this path when facing major stress,” Nosratabadi said.
The experts at Aramesh Clinic turned to neuropsychotherapy because previous methods failed to use comprehensive evaluations of patients and lacked integrative solutions rooted in the brain, behavior, and cognition. Old methods also ignored the uniqueness of each patient by offering general treatment guidelines.
When patients first arrive at Aramesh, they undergo a full evaluation consisting of four dimensions: mental health and stress control, cognitive performance, brain biomarkers, and personality traits. The clinicians employ brain performance improvement technology including but not limited to neurofeedback and biofeedback therapy.
In such a treatment protocol, the clinicians at Aramesh Clinic display measure brain activity using electroencephalography (EEG) monitors attached to the scalp. Heart rate monitors are also used. With brain activity and heart rate displayed to the patient on a computer screen, they are then asked to try to regulate the mind and body in order to play a simple game or to play a film. For example, reducing ones heart rate to a target level will unfreeze a game of Pacman. Through repeated practice, training is intended to give the individual a degree of control over their mental and physical state encouraging them to apply the same techniques for stress management in their daily life.
In addition, the clinic offers psychotherapy with a focus on devising therapeutic processes that are unique to each person based on the integrative profile of the patient. Nosratabadi adds, “Our process doesn’t include medication, but we’re not against patients taking medication because some of the patients really need it.”
Neuropsychotherapy services offered at the clinic pursue two general goals. They have the potential to improve the personal and professional performance of people with a wide variety of vocations from students to executives to athletes. They can also help reduce the severity of ailments like chronic anxiety, chronic migraines, irritable bowel syndrome and sleep problems rooted in stress.
The clinic also focuses on improving corporate performance by offering evaluation services that seek to find ignored talent in corporations and incentivize workers. According to Nosratabadi, they have already consulted for many private organizations and individuals, but have yet to work with the government sector.
By neglecting mental health, Iran's government is also ignoring a major issue that is hurting its already embattled economy. As Pouya Paknejad, head of neuropsychotherapy at Aramesh Clinic's explains, to encourage government action, many countries calculate the significant losses their economies suffer each year due to stress. But there are no such source of information in Iran. "This way of thinking hasn't yet been entrenched here in Iran where we would calculate a rial equivalent to measure the impact on the economy whenever we speak of mental health," he says.
As with all other issues, reforms to Iran's approach to stress management are arriving slowly and with great difficulty. The government must better cooperate with the private sector to tackle this challenge that so greatly impacts the economy and the everyday lives of Iranians around the country.
Photo Credit: Radiokafka, Aramesh Clinic
