Aged 49, Iranian diabetic Parviz Sadeghi appears closer to 70 with deep wrinkles surrounding his clear blue eyes and sunken cheeks testifying to shortages at a time of intensifying medical crisis. After a six-hour wait, he is relieved but exhausted as he emerges from a pharmacy in the capital Tehran with insulin — an increasingly scarce necessity, as US sanctions bite. “I’ve been a diabetic for nearly 10 years,” the out-of-work labourer said, adding that he lives in Karaj, about an hour west of the capital. “Before… you’d go to any pharmacy and they’d give it to you, but now you have to go to 1,000 places,” he lamented, after spending a week trudging from one dispensary to another. Iranians had been hit by low medicine supplies even before the new coronavirus broke out in the central city of Qom and spread, claiming several lives and fostering panic amid a lack of face masks. The medical shortages kicked in after the US pulled out of a landmark nuclear deal and reimposed crippling sanctions on Iran in 2018. Washington had exempted humanitarian goods, especially medicines and medical equipment from its punitive measures. But international purchases of such supplies are forestalled by banks being wary of conducting any business with Iran, for fear of falling foul of sanctions themselves. This in turn has worsened the acute shortage of medicines and led to skyrocketing prices, against the backdrop of an increasingly devalued rial. “I used to get insulin about three years ago for 17,000 tomans ($1.10, one euro), now it’s 50,500 tomans,” said Sadeghi. “And it’s getting even more expensive. “Insurance does cover this. That’s why I’ve been to 1,000 places since last Saturday to get them to approve this. They did accept eventually, but it took a long time, and you have to go to a lot of places,” he said. Sadeghi “borrows” life-saving insulin from other patients during lean periods just to survive. He struggles to find pharmacies that provide needles with the syringes. “Recently, they’ve started forcing us to pay for the needle.” Overburdened pharmacies Health ministry spokesman Kianoush Jahanpour told AFP that Iran was “today capable of producing more than 97 percent of its needed medicine. “We only import about three percent of the drugs we use, which is obviously just about new and hi-tech drugs — medicine which is used in limited amounts and would not be feasible to produce inside the country,” he said. But he admitted that the country had been struggling to import “medicines for rare and special diseases” for around a year now. Located right in the heart of Tehran, the “13 Aban” state-run pharmacy is a hive of activity, drawing hordes of patients daily who queue patiently for hours as it stocks and subsidises medicines for rare diseases. It and a handful of other pharmacies in Tehran work with the government-run insurer. Mohammad Aminian, 73, who needs insulin for his diabetic wife, blamed the sanctions for his woes in procuring a supply. “The government tries to make things work, even though it creates some problems of its own… We would have preferred if they did negotiate” with the United States, he said. Diabetic Sadeghi meanwhile squarely blames the government. “It’s definitely the government. They don’t have the ability to manage things. Some people who don’t have insurance, they have to buy” at the inflated prices. “They have to either die or… pay.” Mohammad Rezaei, the deputy director of pharmacies attached to the Tehran University of Medical Sciences, said: “Insulin is one of the main medicines affected… and our stocks of it along with other medicines are reducing with time.” Alongside diabetics, cancer patients and people suffering from thalassaemia, a genetic blood disease common in the country, have been hit hard. A young woman with a serious disease called epidermolysis bullosa — a group of rare genetic conditions that result in easy blistering of the skin and mucous membranes — died recently due to a lack of specialised bandages. Smuggling Shahrzad Shahbani, the owner of a private pharmacy in the capital, points to another grave problem — medicines for people with psychiatric problems. “A patient with a prescription for say, 200 pills, can only come and get 100, or even 20 … and this is getting even more frequent,” she said. Another medicine in short supply is Depakine, a drug manufactured by French company Sanofi and used by epilepsy patients. Mohammed, an Iran-Iraq war veteran in his 50s, is one of them. He also has post-traumatic stress disorder. He uses a locally made medicine for PTSD, saying “it sometimes causes stomach problems, burning. And it doesn’t even calm you down enough. If I get nervous, it might work half as (well as) the other one.” Pharmacy owner Shahbani backed him. “The quality is really a problem unfortunately. It’s not something you can talk about officially,” she said. “There’s even a difference (of quality) from company to company, because the formulations are different.” Shahbani said people with Parkinson’s disease sometimes even smuggled in foreign medication through Turkey, in order to get a better quality supply. A new financial channel set up by Switzerland to facilitate humanitarian trade with Iran appears to have made little difference. Meanwhile, some pharmacies continue to charge exorbitant black market rates to Iranians already reeling under recession and the plunging currency.