UN Rapporteur says greatly affected by impact of sanctions on Iranian patients

September 12, 2022 - 21:25

TEHRAN - The UN Human Rights Council’s Special Rapporteur has said she has been greatly affected by the impact of sanctions on Iranian citizens suffering from “genetic diseases” or “cancer”.

“What made a lasting impression on me was the impact of the sanctions on the health care system,” Professor Alena Douhan said in an interview with the website of Iran’s High Council for Human Rights published on Saturday.

Douhan, an international law professor, also said sanctions is the cause of death among certain people afflicted with serious diseases.

“It has usually been maintained that unilateral sanctions are imposed by ‘good guys on bad guys’ for some ‘supreme purpose’ and with good intentions, but unfortunately in reality that is the people of the country who are affected enormously,” she notes.

The Special Rapporteur also says though Iran is under severe economic sanctions it is has been providing services to millions of refugees from Afghanistan.

“Iran gives refugees free access to primary health care and schooling, regardless of whether they are documented or non-documented,” Douhan notes who visited Iran from May 7 to 18, 2022.

Following is the text of interview:

How do you assess the sanctions regimes?

As a professor of international law, I assess it from two sides. There must be a legal analysis, because countries, including the EU, never really even consider the legal basis. You cannot react to the behavior of other countries by illegal means. And from the other side – it is very important to assess humanitarian impact of unilaterally applied measures.

You visited Iran in May. What kind of impression did you get during your visit?

It was my fourth country visit. Before going to Iran, I visited Venezuela, Qatar, and Zimbabwe. I must say, each country has its own way of being affected by sanctions and coping with them. Iran is a country that suffers from very serious sanctions imposed by the U.S. and by some other states. What is special about Iran's situation is that it was under UN Security Council sanctions for 10 years until August 2020, which no longer exist today. But there is a number of states that are still following these non-existing Security Council sanctions and additionally impose other unilateral sanctions referring to human rights violations, ...  That makes it complicated for me to assess the impact of these different sanctions separately. When people ask me how I assess the impact of the European Union sanctions, I can't answer the questions precisely, but I look at the comprehensive impact of all sanctions imposed by different countries. Meanwhile, the humanitarian impact is even greater—due to over-compliance of states, banks, businesses and private individuals.

How have you been able to get a picture of the situation in Iran?

The purpose of my visit was limited by the scope of my mandate – to assess humanitarian impact of unilateral coercive measures on the enjoyment of human rights. For this purpose, I talked to all affected groups, both governmental and non-governmental, and got the strong impression that the sanctions have a massive impact on people's lives. I met officials in hospitals, visited hospitals and universities, and business enterprises. I spoke with all 17 UN missions in Iran, as well as with embassy officials from both countries that support the sanctions and those that oppose them. I also visited Isfahan and talked to associations representing the Afghan community. There, I spoke directly with people affected by the sanctions.

What was your main impression?

What made a lasting impression on me was the impact of the sanctions on the health care system. I spoke with emergency patients, those suffering from genetic diseases, and some who were suffering from cancer. I also spoke with members of patient organizations that cared for people with serious diseases, such as various types of skin diseases, gynecological diseases, as well as blood diseases, severe forms of diabetes, etc. All of these people suffer from these diseases and even the appropriate medicines are not available.

Is the lack of medication a result of the sanctions?

The impact of the sanctions is not always clear but sometimes it is rather obvious. In the cases where health is at stake, it is very clear. Let me give you an example. For a while, Iran produces around 95 per cent of medicine domestically. After sanctions have been imposed Iran largely lost access to the raw materials or faces impediments in delivery of proper quality raw materials.

Where do the medicines come from?

The availability of medicines is another issue. After sanctions were imposed in 2010 and reimposed in 2018, Iran made great efforts to continue production of much-needed medicines. As reports indicated, Iran was producing 90-95% of its own medicines. The problem was that although it would have been possible to produce the drugs in the country, this would require raw materials.

Was it still possible to manufacture drugs?

The procurement of individual components to manufacture the medicines is a special issue. This is because the countries that had previously supplied Iran with the relevant substances refused to do so due to the renewed sanctions. This was the reason why Iran had to look for alternatives, running the risk of obtaining basic substances for the production of medicines that were of the low quality. They were not certified, and even if Iran could produce drugs with the basic substances it received, their quality is affected.

Could all the needed medicines be produced through this route?

Despite all efforts, only 90-95% of the drugs could be produced domestically. The missing 5-10% had to be imported from abroad. It refers on the first hand medicines for people suffering from rare or severe deceases. Today unfortunately drug companies are refusing to send medicines to Iran, despite formal announcement in the sanctioning regulations of the humanitarian exception.

Humanitarian exemptions however, do not work for a number of reasons. To activate humanitarian exemptions, it is necessary to get a license from OFAC (Office of Foreign Assets Control) first of all. This is very problematic; the process is lengthy and expensive. However, when you get a license, it is usually valid for one month only.

What does that mean?

I spoke with UN institutions like UNICEF and UNFPA [United Nations Population Fund], and they confirmed that it is a big problem, even for individual UN institutions, to get a license from OFAC to guarantee the procurement of drugs.

Even if the license is there, the pharmaceutical companies usually say no. They are afraid that if they trade with Iran, they will then also fall under the secondary sanctions as the wording of sanctions’ provisions is very unclear and confusing.

Can a company decide to supply the drugs? Is that possible in principle?

If companies are willing to work with Iran, there are two problems still. The first one is the transfer of money. Even UNICEF, which operates in Iran and works with a Swedish pharmaceutical company, cannot guarantee payment from Iran to Sweden as Iran is cut off from SWIFT and banks decide not to risk. Thus, the payment had to be made in alternative ways via third countries.

If everything has still worked up to this point, then there is the problem of delivery. All transport companies in Iran are under sanctions. Anyone who delivers goods to Iran can be penalized by secondary sanctions. Any transportation insurance company is under sanctions against Iran.

I have talked to some of humanitarian associations. We have seen the documents that clearly show that they do not want to sell the drugs to Iran. I have talked to the Swedish and Swiss governments and to the pharmaceutical companies, because we have clear indications that there is a connection with the sanctions. Because of the lack of medicine, we have an increasing deterioration in the health of the population in Iran, especially among people suffering from rare and severe deceases. You can see the increasing death rate not only in intensive care patients like diabetics, cancer patients and many others, but also in less dangerous diseases. Deaths have tripled.

Are there any specific examples here of how you see the problem?

I'll give you an example. For the disease thalassemia, there was an average of 25-30 deaths per year. The average life expectancy for these people is 45 to 50 years, if the medicine they need is available. When sanctions were reinstated in 2018, deaths increased to 130-170 in the last three years, and the average life expectancy is now less than 20 years. There are several organizations that look at the problems and come up with the same numbers.

Are all people affected by what is happening in the healthcare system?

The so-called middle class in Iran is accustomed to using private medical care and they were able to pay more. But that has now changed; it can no longer pay for private services that puts an additional burden over the public system.

What does it mean for Iran to be cut off from international payments?

For example, it is not able to make any payments to international organizations. If it is unable to make the appropriate contributions, it loses its right to participate in international bodies. This excludes Iran from all the ability to participate in talks, to vote and thus to take part in decision-making. I have spoken with to some UN agencies that are assisting Iran in developing solutions to the payment problems, but so far there is no avenue available. Iran also cannot pay its dues to the UN like it does to WHO or UNICEF.

What does that mean for interaction at the diplomatic level?

It is very limited. In addition, Iranian embassies in each of the countries that have adopted the sanctions are not able to pay wages to their embassy staff because Iran cannot open accounts. Iran is excluded from SWIFT, and therefore you can't pay with a credit card in the country itself.

What does this mean for trade?

All countries that want to maintain international cooperation with Iran, not only on the diplomatic level, are highly restricted. There are also restrictions on freedom of action at the individual level. Because of the exclusion from SWIFT, no one is able to book a trip to Iran, a hotel, or a flight. Iranians are not able to book flights and hotels abroad as well. Cooperation in the field of science, art and sports is also not possible. There is no possibility to pay membership fees in international professional associations/bodies and therefore cooperation with foreign professional groups is limited. Iranians also face problems in using online platforms for international interaction and teaching. Iranian athletes are limited in their ability to participate in international competitions because they cannot book a trip or stay in a hotel room. Scholars and students are prevented from subscribing at the international databases, their publications are often not accepted for editing process due to precaution of publishing houses.

Are these sanctions compatible with human rights?

There is clear evidence that a broad scope of human rights are violated by the sanctions; for example, unrestricted trade or the possibility of scientific exchange in all fields. I have talked to many students, and for them it is incomprehensible why they are excluded from international cooperation. It is an absurdity to prohibit scientific cooperation, because that is a basic element for the economic and social development of a country. These are essential elements of economic and cultural rights. Iran is a clear example where these rights are being violated.

What about the right to food?

The situation in Iran is not so bad, because the country can produce a lot of things domestically. The situation is much better in Iran than in Venezuela.

Have you also been able to talk to citizens?

Yes, I was able to experience how ordinary people are directly affected by the sanctions. One Iranian told me that he and his wife decided to forgo having another child because, due to the inflation in the country, it would be too much of a financial burden. The country has hardly any income coming from outside, because the flow of tourists has depleted. In addition to the limited supply of goods and low income, people suffer from extreme inflation. The state and companies cannot raise wages at the same rate and have to try to cut costs, so people are getting poorer and poorer.

Besides the sanctions, doesn't Iran have a large number of refugees to take care of?

Yes, Iran has 5.5 million refugees from Afghanistan and since August 2021, 5 to 10 thousand refugees are coming daily. All other countries neighboring Afghanistan have closed their borders. All statistics can be found on the UNHCR web page. An additional problem for Iran is the fact that most of the refugees (90 percent) do not have papers or a valid visa. Before my trip to Iran, the UN High Commissioner for Refugees, Filippo Grandi, was in Iran. He was very appreciative of Iran's efforts.

How is Iran coping with this huge burden?

For example, Iran gives refugees free access to primary health care and schooling, regardless of whether they are documented or non-documented. This is all paid for by the state and is an extreme burden. If five to ten thousand people come into the country every day, that means a new school and a new hospital would have to be built daily. The Special Rapporteur for Afghanistan has confirmed—and this is also my impression—that more than half of the refugees are young people, because as a rule a family has five children. In addition to the shortage of medicines, the increase in patients who can no longer finance private care, and the large number of refugees, the health care system is under enormous strain.

How can Iran finance this?

This is a huge problem. Because of the shortfall in revenues, due to the sanctions, the state can hardly provide any support. Also, the number of social cases that rely on government support money is growing. Almost two months ago, just when I visited Iran, there were big protests there against the change of the state support system. Basic foodstuffs have very low prices. That has changed now. The state has raised prices. But the very poorest still get financial support so they can afford the goods. Other people who used to get that were left out. The consequences have been protests all over the country.

When you talk to the states that imposed the sanctions and tell them what you saw with your own eyes, what kind of reactions do you get?

One of the most common responses from the states that imposed sanctions is that they didn't think the situation in the country was that bad. They would not have heard from other sources that the impact was so severe. When I visited Venezuela, I saw how disastrous these sanctions are for the people, because Venezuela has very low domestic food production.

I try to be very specific and look at every fact to be able to show specific impacts on health, nutrition, access to water, sanitation, electricity, education, and development. My intention is to remind all states that every human being around the world enjoys basic human rights and all actions can only be taken in accordance with international law.

What sources do you rely on?

To gather information, I talk to various stakeholders during country visits: governments, hospitals, university professors, non-governmental organizations, international and national humanitarian organizations, UN agencies, local associations, embassies, victims of human rights violations. One month before visiting the country, I publicly call for contributions. All information is collected and verified.

Unfortunately, some interlocutors have no intention of sharing information relevant to the work of the mandate, but instead launch defamation campaigns and distribute fake news.

Who is doing such defamation?

UN Watch and other NGOs outside Iran called "Human Rights in Iran" called me a puppet of China or Iran. When I came back from Iran, the slurs were so strong that I informed the office of the High Commissioner Michelle Bachelet and the Coordination Committee of the Special Procedures about the case. The fact that I come from Belarus became the reason to question my integrity. I am a professor of international law and have never belonged to any party. I do research in countries as an independent expert according to academic criteria and have no political agenda.

Were the attacks related to your report?

No, I guess that none of those who attacked me read the report. The goal was to shift the focus away from my findings and to make a scandal. This is something that is done all the time. People politicize the discussion instead of dealing with the specific content. I keep trying to point out that we should be dealing with the legality and humanity rather than politics. It's about international law and humanitarian issues. If there is any problem, you have to take legal means. It is about using legal means, not about punishing one country for not complying with another.

After all the things you have told, the question I have is whether these sanctions and their devastating consequences on the economy, on politics, and therefore on the civilian population are compatible with human rights.

That is an important question, and I hope I can answer it in brief. Unfortunately, this area is so highly politicized. It has usually been maintained that unilateral sanctions are imposed by "good guys on bad guys" for some “supreme purpose” and with good intentions —but unfortunately in reality that is the people of the country who are affected enormously.

Toward the end of the 1990s, the Security Council was very active in issuing sanctions, for example, against Sierra Leone or Iraq, and legality of these sanctions have not been disputed. In this context, the Security Council decided to examine the humanitarian impact of sanctions. The effect appeared to be so huge that the UN Security Council changed its policy and stopped to use comprehensive sanctions. The UN Security Council also never threatened the public. Numerous threats however have become a part of the unilateral sanctions’ strategy, as we have recently seen as regards sanctions on Cuba, Iran or Russia. That is the reason why I think you should start to comply with the legal aspects.

It is hardly known that sanctions have a devastating impact on the respective populations. What is the reason for that?

The media hardly reports on it. They suppress the information, but people don't want to hear it either. It is something very unpleasant. But it is a reality for those affected. Sanctions are the cause of people dying. That is the reason why I am very concerned about the concept of planned prevention of disinformation. The EU has decided to launch a law against "disinformation," which is a violation of the International Covenant on Civil, Political and Cultural Rights, as well as calling into question the right to freedom of expression. I see this as a great danger to freedom of expression and freedom of the press.

Wouldn't it be more appropriate to pass a law prohibiting sanctions that drive people into poverty?

Yes, there is no mechanism for evaluating unilateral coercive measures. In March of this year, I organized an expert consultation with nongovernmental organizations and another with academics, at which they argued that there should be a monitoring mechanism to assess humanitarian impact of unilateral coercive measures. We need to establish a uniform transparent methodology verify the impact of sanctions. Also, there are no avenues of redress against unilateral coercive measures. Iran has launched a case in the International Court of Justice, and Venezuela – in the International Criminal Court. But it is nearly impossible to refer a case of unilateral coercive measures to a UN treaty body as it is very complicated for individuals under sanctions and especially for those affected by over-compliance – to bring a case to the national court, such as in the United States, as that is too far away and extremely expensive. I am working on how to set up a mechanism that would allow legal action against unilateral coercive measures within the framework of the UN and help the victims to get their rights.

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