A correspondent writes for Tehran Bureau:
On Vali Asr Street, in a lower-income district of southwest Tehran, a 30-year-old man storms out of a pharmacy. Arash, a bachelor with long hair and a substantial mustache, lives with his father, for whose heart medicine he has been searching fruitlessly.
International sanctions, intended to compel Iran into reversing the development of its nuclear program, have brought not only straitened economic conditions for ordinary Iranians, they have made access to a host of vital pharmaceuticals difficult or impossible.
Arash says that his father had a heart attack a year ago. "His doctor prescribed Carnitine for him when he was released [from the hospital]. The doctor said that it is very beneficial for his heart muscles."
He says Italy produces the kind of heart medicine his father needs. "It comes as pills and in liquid form. But neither exist [here] these days." He says his father has tried domestically produced versions, "but they are not useful. They don't have the effect of imported drugs."
Arash believes sanctions are to blame for his inability to locate the Italian-produced drug. "Clearly, this is the result of the sanctions," he says. "When three or four months ago I could purchase this medicine easily, and since I can't buy them now, then what could be the reason? What happened during this period? We got sanctions imposed!"
He describes three different ways the government could make the medicine available. "First, develop the ability to produce effective drugs itself, or import the required expertise from the West, or third, import the medicine directly."
"Of these three things, none is about to happen," he concludes.
The European Union and the United States have both declared that they have not prohibited the export of medical goods to Iran in their sanctions protocols. Last month, when the E.U. ratified a new package of sanctions that effectively prohibits most financial transactions between Iranian and European banks, it explicitly excluded humanitarian assistance and medicine. Last month, the U.S. Treasury Department's Office of Foreign Assets Control altered its licensing regulations to ease the export of medicine and medical supplies to Iran. Even so, many Iranians say the ban on financial transactions and a prohibitive exchange rate keep the situation from improving for them.
Mahmoud, a pharmacologist in his 50s, works at a 24-hour pharmacy. He requests that neither his real name nor even the approximate location of his pharmacy be revealed.
"The shortage of medicine started slowly about a year ago," he says. "Imported drugs became rare, and then distributed in rations. Though not as abundant as before, they would show up, and if a person was patient, he would get some."
He adds, "But in the last few months the shortage has become a crisis." In July, he says, "medicine supplies diminished dramatically, and patients had to have medicine held aside for them through connections."
It is 11 in the evening and the pharmacy is quiet, though every once in a while Mahmoud has to tend to a client. I ask him if pharmacies are hoarding scarce medicines. "No, they don't hoard. They get three or four packages of each medicine, and they hold them for their regular customers. It is the distributors that offer limited quantities to pharmacies."
In Mashhad, the country's second-largest city, Elham, a 60-year-old physician who also works at a pharmacy, confirms her colleague's description. "By way of an example, a distributor allocates 400 packages of a medicine for the whole city of Mashhad and divides that between all the pharmacies," she explains. "We have between 20 and 30 distributors, who are all private."
I ask her about domestically made medicines.
"Domestic production, too, started to decline by early September. Usually there would be periodic shortages of one or two drugs. That had become normal since the economic crisis started three years back. It happened all the time. The supply of a few drugs, fewer than the number of fingers on a hand, would now and then decline. It wasn't like now, when all medicines have become rare."
She says that among the most important domestic medicines to become scarce are female contraceptives. But is the shortage related to Supreme Leader Ayatollah Ali Khamenei's statement this past summer that if the state's population control policy continues, Iran will face an increasingly aging and ultimately declining population?
"Of course many thought that the shortage was due to Khamenei's warning. But it wasn't related," Elham says. She says that the morning-after pill --- popularly known as Oorjancie, urgency -- has almost entirely disappeared from pharmacy shelves. "It's impossible to find any."
Elham mocks Marzieh Vahid Dastjerdi, President Mahmoud Ahmadinejad's health minister and the first female cabinet member since the 1979 Revolution.
"A few days ago, Mrs. Vahid Dastjerdi asked, 'Why do they baselessly claim that [contraceptive] medicine has been prohibited? Was Oorjancie prohibited? This is the pharmacies' ploy to create a black market.'" Elham states emphatically, "This, while those of us who work in pharmacies know that this medicine is in fact unavailable. Really, no medicine reaches any of the pharmacists for them to start a black market!"