In international diplomacy, economic sanctions are often portrayed as a clean, humane alternative to war, a civilized way to pressure governments to comply with international law without shedding blood. But this reassuring story hides the devastating truth that sanctions can destroy the health and well-being of ordinary people. These are aimed at weakening regimes, but they often cripple the targeted countries’ ability to provide basic health care to the very people they purport to protect. Mechanisms intended to protect civilians and enable humanitarian assistance frequently break down, leaving the most vulnerable people to pay the highest price for political decisions taken outside their reach.
The result is a kind of economic warfare that kills people not with bombs and bullets, but with health systems, medicines, and the slow erosion of human dignity.
Our recent exchange in The Lancet examines this reality in the context of the United Nations Security Council’s September 28, 2025 decision to reimpose multilateral sanctions against Iran. In this article, we do not take a position on the Security Council’s decision to reimpose multilateral sanctions. Rather, we are focused squarely on the potential impact of this measure on the Iranian people, especially given the severe health effects seen under previous sanctions. Based on evidence from the pre-2015 sanctions period, our analysis published in The Lancet shows how these measures have shattered Iran’s health system and reveals serious structural flaws within the international sanctions regime designed to protect the fundamental right to health.
The findings of this study make it clear that sanctions are not just a diplomatic tool. These are public health interventions with deadly consequences.
Sanctions can literally shorten lives.
The impact of sanctions on public health is not theoretical. It can be measured in years of life lost. A comprehensive cross-border analysis shows that the imposition of UN sanctions is directly associated with significant declines in life expectancy. Life expectancy has been reduced by about 1.2 to 1.4 years in countries under these sanctions, with women particularly affected.
This is not collateral damage. This is evidence that sanctions are acting as a weapon against the health of the entire population. Poverty is slow and often invisible, hospitals run out of medicines, treatment is delayed, and patients die not from the disease itself but from policies that prevent access to care.
The illusion of humanitarian immunity
On paper, sanctions regimes almost always include “humanitarian exemptions” that allow the importation of essential goods such as food and medicine. In reality, these safeguards often exist only in name. As our Lancet report highlights, with previous UN sanctions against Iran, there was no dedicated UN mechanism to verify whether these exemptions were working in practice.
The results were dire. The sanctions disrupted drug imports, causing prices for some anti-epileptic drugs to soar by up to 300%. Counterfeit and expired medicines are flooding the market, putting countless lives at risk as millions of patients are forced to forgo reliable treatments. These were not unintended defects. These were the predictable results of a sanctions system designed without accountability or oversight.
Institutional blind spots
The United Nations agency responsible for overseeing sanctions against Iran also operated with a dangerously narrow focus. The Sanctions Committee and its Committee of Experts were primarily concerned with tracking compliance with nuclear regulations, such as monitoring uranium enrichment, but were unable to assess how these measures would affect people’s broader access to medicines, medical devices, and health care.
Their report did not include a systematic assessment of the humanitarian impact of sanctions, revealing persistent institutional blind spots. Technical compliance was monitored down to the last centrifuge, but the suffering of ordinary Iranians was not recorded. This oversight is not unique to Iran. This reflects a broader pattern in global sanctions policy, where political objectives are prioritized over human costs.
The hidden harms of overcompliance
The harm caused by sanctions extends beyond the public restrictions themselves. A more subtle but equally destructive process known as “overcompliance” often escalates humanitarian crises. This happens when companies and banks become overly cautious and refuse to participate in transactions involving pharmaceuticals and medical devices that are actually legally permissible, for fear of violating complex sanctions rules.
Our exchange in The Lancet highlights how this hyper-vigilance is deepening the suffering of ordinary people. Overcompliance by pharmaceutical and medical device companies and financial institutions unnecessarily drives up prices, fuels corruption, and opens the door to lower-quality or counterfeit substitutes. It also creates a shadow market of intermediaries who claim to know how to move medical supplies under sanctions, increasing both costs and risks. In some cases, legitimate distributors attempting to import approved medicines may inadvertently become involved in illegal activities.
The result will be further tightening of the lockdown on national health systems, even in countries where humanitarian exemptions are said to exist. Overcompliance has become one of the most insidious and most neglected aspects of modern sanctions regimes, allowing policymakers to deny responsibility while covertly cutting off access to life-saving solutions.
Calling for a health-conscious foreign policy
The evidence is clear. Without strong and actively monitored safeguards, sanctions become blunt instruments that inflict untold suffering on those least able to bear them. These are not unfortunate side effects, but the direct and foreseeable consequences of policies applied without consideration of the human cost.
The lesson from decades of similar experience in Iran and elsewhere is that economic sanctions should not be imposed without an independent system to protect the right to health. This means establishing effective humanitarian payment channels, monitoring the availability of essential medicines and medical supplies in real time, and assigning oversight to a technical committee that can fully assess the health impact of sanctions on civilians.
Sanctions are often justified in the name of human rights, but they can quietly destroy the very lives they claim to protect. The international community must recognize that the protection of health is not an optional consideration, but a fundamental obligation. If sanctions are to remain part of global diplomacy, they need to be reimagined with public health at the core, rather than being left to erode public health.
The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial policy.
