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PLOS BLOGS Speaking of Medicine and Health

Healthcare Under Fire in Iran

The names of the authors are being withheld by request.

The government of Iran is blocking healthcare access through violent tactics, forcing secretive patient treatment in the face of conflict, and suppressing the voices of Iranian healthcare providers. The UN Security Council and World Health Assembly have denounced attacks on healthcare facilities and personnel as war crimes which constitute violations of international law. Academics, clinicians, and policymakers globally should declare solidarity with the Iranian people and the healthcare workers aiding them.

Threats to Healthcare

Three days after Mahsa Amini was cited for improperly wearing her headscarf and detained by the Islamic Republic of Iran’s ‘morality police,’ the previously healthy 22-year-old woman died in custody. The resultant protests, largely led by women, have rocked every corner of the nation and sparked social movements of solidarity globally, posing one of the greatest threats to the theocratic government since the Islamic Revolution of 1979.

As protests increased in frequency, intensity and violence, Iranian police began co-opting ambulances for arrests and transporting paramilitary forces, and have been stationing at hospitals and clinics to arrest patients who presented with wounds consistent with the tactics used to quell demonstrations. Common injuries include bird-pellet shotgun wounds, traumas from paint guns shooting metal rounds, and second- or third-degree burns from electrical batons. To avoid the possibility of arrest, many wounded protesters are turning to veterinarians or social media to seek advice on at-home care. Doctors have been forced to lie about their patients’ injuries and treatments or have secretly provided care at their homes, and have been arrested if discovered.

In a recent interview, Dr. Kayvan Mirhadi, an Iranian-American doctor and Chief of Internal Medicine at the Clifton Springs Hospital in New York, shared his experience offering online medical advice to injured protesters. He receives between 300 and 500 Instagram messages per day from people sending photos of their wounds and seeking advice. Dr. Mirhadi feels that his Instagram page has become a primary source of medical information used by the citizens of Iran while coping with regime violence. A new Twitter account “Emdadgaran Enghelab,” meaning “Aid Workers of the Revolution,” also offers online support for at-home medical procedures in Farsi, quickly garnering over 37,000 followers (@emdadgarane401).

Dr. Mirhadi has developed a system of triaging his social media patients. If in-person medical care is needed, he directs patients either to a hospital with a coached story, or sends them to a team of trusted doctors in secrecy, using code words to ensure safety and confidentiality. Such precautions are necessary, but the conditions of covert medical care and minor operations are sub-optimal. Meanwhile, hospital supplies like medications, antibiotics, and tetanus boosters are becoming scarce at facilities and pharmacies alike, and individuals are forced to turn to home remedies and removing pellets with home-sterilized tweezers.

Doctors silenced

The political pressures on healthcare providers began immediately in the aftermath of Ms.  Amini’s death, when Dr. Hossein Karampour, the medical officer overseeing the proceedings, refused to confirm police claims that she had died of a heart attack. In an official letter to the Head of the Medical Council, Dr. Karampour noted a concussion and signs of internal bleeding consistent with blows to the head as the cause of death. Dr. Karampour’s letter was rebuked by the government-appointed head of the council, who swiftly denounced the claim as aligned with the “troublemaker and separatist” protesters. A letter from 800 members of the medical council was then released in support of Dr. Karampour, noting that the head of the Medical Council had abused his position and ignored the obligations of the medical field to the people.

A peaceful physician protest, held in front of the medical council of Iran on October 26th, 2022 for the right to treat wounded patients, was responded to with arrests, beatings, tear gas, and gun shots. Dr. Parisa Bahmani, a young general surgeon, was killed from police fire at the protest. In the weeks since, doctors and researchers have continued to be arrested for treating protesters or giving speeches at protests, but “the true number of doctors in custody is unknown.”

On December 12th, 2022, Dr. Aida Rostami vanished on her way home from treating a wounded protester, too fearful to visit a hospital, at their home in the Ekbatan neighborhood of Tehran. The next day, her family was contacted by forensic services and informed of her death, stating that she had died in a car accident. Her skull was crushed, her eye enucleated, and arms broken, with all evidence pointing towards homicide. Government news sources later proclaimed that she had been thrown off a bridge and died as a result of blunt force.

These violent incidents have led to intense fear among healthcare personnel, further heightened following the death sentence of Dr. Hamid Ghare-Hassanlou, a renowned physician and philanthropist. Dr. Ghare-Hassanlou and his wife Farzaneh were driving home on November 3rd, 2022, when they were inadvertently caught up in a crowd of protesters brutally beating a member of paramilitary force group of the Islamic Revolutionary Guard. While many witnesses attested to the couple having no role in the event, the couple were beaten in front of their 14-year-old daughter and arrested at their home later that night. Dr. Ghare-Hassanlou was charged with a death sentence and his wife sentenced to 25 years in prison, without proper legal representation. Though the death sentence was later repealed, the episode further terrorized doctors and curtailed their willingness to participate in protests.

Dr Ebrahim Rigi was arrested for treating wounded prisoners in Zahedan in October 2022, but subsequently released. Faced with a death sentence, he posted on his Instagram page with the following caption “My death, my execution, does not matter. I have died in this country a thousand times.” He was rearrested a week later and died as a result of wounds received during torture.

A Call to Action

The toll of the regime’s brutal and violent response has left hundreds beaten and seriously wounded – and has placed Iranian healthcare workers treating them in a dangerous position.

Dr. Mirhadi states, “I’m reaching out to the community outside of Iran for help. I do feel hopeless at some points because I cannot keep up with all these messages.” Dr. Kamiar Alaei, a physician and activist who served more than 2 years in prison following a conviction by the Iranian government for ‘working with an enemy government’ on his HIV/AIDS research, shares some optimism: “Iranian doctors are taking part in protests for the first time, which shows how widespread they are. I am optimistic now about Iran and we say to academics around the world, please support the Iranian people.”

Healthcare is a human right, and that right is under fire in Iran. We cannot turn a blind eye.

This article is dedicated to the healthcare providers of Iran. We see you, and we stand with you.

Woman, Life, Freedom

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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