Editor’s Note: Maryam Shirinsokhan conducted an interview with Amin Afshar, Chairman of the Board of Directors of the Iranian Hemophilia Society, and offered for Iran Unfiltered to run the interview in full in order to shine further light on the impact of sanctions on public health in Iran. Below follows Shirinsokhan’s interview with Afshar:
While political decision-makers debate sanctions, negotiations, and geopolitical strategies, thousands of people in Iran are fighting for something far more fundamental: access to life-saving medication. For many patients with hemophilia or other severe bleeding disorders, it is not the disease itself that determines life or death, but whether the necessary treatment reaches them in time.
On July 29, Maryam Shirinsokhan conducted an in-depth interview with Amin Afshar, Chairman of the Board of Directors of the Iranian Hemophilia Society, about the consequences of international sanctions on medical care. He describes concrete examples of how supply chains collapse, international aid efforts fail, and families are forced to live with the constant fear that a bleeding episode affecting their child may no longer be treated in time.
This interview is not intended as a political statement, but rather as an insight into the humanitarian consequences of a healthcare crisis whose impact is felt primarily by the most vulnerable: children, women, and people who depend on life-saving medication.
Maryam Shirinsokhan: During the brief period when a sanctions exemption existed: Which medications were you able to import, and what impact did this have on the situation of hemophilia patients?
Amin Afshar: Since September 2025, with the reactivation of the so-called snapback mechanism, there has effectively been no meaningful exemption for the import of life-saving medications for hemophilia patients. Even during periods of political negotiations, temporary agreements, or short-lived ceasefires, there was, in practice, no improvement over the past more than twelve months in the supply of the three essential medications that these patients urgently require.
The shortage of these three medications directly affects around 4,000 patients in Iran. The majority are women, children, and people with severe von Willebrand disease and Factor XIII deficiency.
During this period, several patients have died. Others continue to fight for their lives in hospitals, while some have suffered irreversible brain, joint, and physical damage — injuries that cannot be reversed even if the medications become available again in the future.
MS: What happened specifically after the return of sanctions?
AA: The problem was by no means limited only to the sale of medications.
In reality, an entire chain of simultaneous obstacles emerged: from money transfers and cooperation with banks, to insurance coverage for shipments and transportation, as well as the issuing of export licenses and pharmaceutical companies’ concerns about so-called secondary sanctions.
In many cases, manufacturers were willing to provide the medications. However, the process of actually getting them to patients in Iran was effectively blocked.
In other words, Iranian patients are not victims of a single obstacle, but rather of an entire chain of restrictions.
MS: The United States repeatedly emphasizes that medicines are not affected by sanctions. What has been your practical experience?
AA: Our practical experience clearly contradicts this statement.
A particularly illustrative example concerns the World Federation of Hemophilia (WFH). After assessing the dramatic situation of Iranian patients, the organization decided to donate medication free of charge to people suffering from von Willebrand disease in Iran. The necessary coordination with the Iranian Red Crescent Society, the International Federation of Red Cross and Red Crescent Societies, and other relevant institutions had already been completed.
However, the shipment required the necessary official approvals. These approvals were ultimately not granted, meaning that the medication never reached Iran.
This was a purely humanitarian donation. There was no commercial transaction and no financial transfer involved.
From our perspective, the problem therefore cannot be reduced solely to financial transactions. In some cases, even patients’ access to donated medication was effectively prevented.
MS: How many patients are currently affected by medication shortages?
AA: In Iran, more than 16,000 people with hemophilia and other inherited bleeding disorders are receiving care through the Iranian Hemophilia Center.
In recent months, the most severe supply crisis has affected around 4,000 patients with Factor XIII deficiency as well as people with severe von Willebrand disease.
The consequences of this medication shortage include a growing number of hospital admissions, severe bleeding episodes, postponed surgeries, permanent mobility limitations, higher treatment costs, and, unfortunately, the deaths of several patients.
MS: What happens when a patient does not receive their clotting medication in time?
AA: For a person with hemophilia, a delay in receiving medication is not merely a postponement of treatment.
Every hour can determine whether a joint will suffer permanent damage, whether a brain hemorrhage will occur, or whether the patient will lose their life.
Bleeding into joints can lead to irreversible joint damage within a short period of time.
Brain, gastrointestinal, or internal bleeding represents an immediate threat to life.
This is especially critical for children, whose bodies are still growing. Every untreated bleeding episode can result in lifelong disability.
MS: Some argue that domestic mismanagement is the real problem - not sanctions. What is your response?
AA: In reality, both factors play a role.
Sanctions significantly restrict access to life-saving medications, lengthen procurement processes, and make them considerably more expensive.
At the same time, domestic issues such as bureaucratic procedures, delays in allocating foreign currency, problems within the insurance system, limited budgetary resources, and lengthy administrative processes further intensify the crisis.
If either of these two factors were removed, managing the healthcare crisis would become significantly easier.
Therefore, we believe that neither aspect can be ignored.
MS: Have there been cases in which foreign companies discontinued business relationships because of sanctions?
AA: Yes.
Over the past years, we have repeatedly witnessed international companies, intermediary banks, or transportation companies terminate their cooperation solely because of concerns about U.S. secondary sanctions.
In many cases, the problem was not a legal prohibition against selling medication, but rather fear of the possible consequences of doing business with Iran.
MS: What problems are patients’ families facing today?
AA: In addition to the financial burden of treatment, families live in a state of constant fear and uncertainty.
Mothers go to sleep every night worrying that, if their child suffers a bleeding episode, the urgently needed medication may not be available.
Some families have had to travel hundreds of kilometers in the hope of finding the necessary medication somewhere.
Others have been forced to postpone essential treatments.
This psychological burden, emotional exhaustion, and constant feeling of insecurity do not appear in any official statistics.
MS: Have you had to resort to alternative treatment methods?
AA: Unfortunately, yes.
In some cases, patients have been forced to use non-purified plasma-derived blood products, such as cryoprecipitate or fresh frozen plasma, instead of clotting factor concentrates.
This represents a return to treatment standards that were common approximately four decades ago.
This year, the World Health Assembly also classified the use of these treatments for hemophilia patients as medically undesirable and recommended their gradual elimination from healthcare systems.
The Iranian Hemophilia Center, as an official member of the World Federation of Hemophilia (WFH), also supported this resolution.
These blood products are significantly less effective, carry a higher risk of complications, and are insufficient to meet patients’ medical needs in cases of severe bleeding or major surgical procedures.
MS: To what extent have international organizations been able to provide assistance?
AA: We greatly appreciate the efforts of the World Federation of Hemophilia (WFH).
The organization has repeatedly attempted to find ways to support Iranian patients.
However, restrictions caused by sanctions have resulted in a significant portion of these efforts ultimately failing.
We have contacted numerous international organizations and conducted extensive correspondence with them.
Our impression is that many of these organizations also fear the possible consequences of U.S. sanctions and are therefore, in practice, unable to deliver life-saving medication to Iran.
MS: Have you submitted reports to the United Nations?
AA: Yes.
Over the past years, the Iranian Hemophilia Center has submitted numerous reports and documented evidence regarding the humanitarian consequences of medication shortages to international organizations, specialized institutions, and global networks.
From our perspective, however, the international response has not matched the scale of the crisis.
We remain convinced that the health of patients must never become a casualty of political conflicts.
MS: What would you say today to political decision-makers in the United States?
AA: I would not ask them for political concessions.
I would simply ask them to allow a child to access the life-saving medication they need.
No political decision should result in the death of a child who could have lived a normal life simply because they did not receive essential medication in time.
As a non-governmental organization, we are prepared to work together with the World Federation of Hemophilia (WFH), the International Federation of Red Cross and Red Crescent Societies, and other humanitarian organizations to establish a transparent, traceable, and verifiable mechanism for importing life-saving medications — even when these medications are purchased through regular channels rather than donated.
MS: What would you say to the authorities of the Islamic Republic of Iran?
AA: I would urge them to make access to life-saving medications for patients with rare and severe diseases their highest priority.
The allocation of foreign currency, expansion of domestic production, investment in plasma processing, establishment of strategic medication reserves, and removal of bureaucratic obstacles must be accelerated significantly.
Furthermore, we believe that patient organizations should be more actively involved in fundamental decisions concerning pharmaceutical policies. They are the first to witness the direct consequences of medication shortages among affected patients.
MS: Are children particularly affected by these consequences?
AA: Unfortunately, yes.
One of the most tragic events in recent times was the death of a three-year-old child with Factor XIII deficiency in the city of Khash.
In the months before his death, the child had been hospitalized several times due to the absence of the specific medication required for his condition and ultimately he passed away.
For us, this is not merely a number, but a symbol of the real and human consequences of medication shortages.
Currently, four additional children in different regions of Iran are receiving inpatient treatment due to a lack of medication and insufficient access to appropriate care. Their families hope and pray every day for their survival.
MS: Is it possible to design sanctions in a way that prevents harm to patients?
AA: From our perspective, any sanctions policy that restricts patients’ access to life-saving medication has failed from a humanitarian standpoint.
If sanctions are imposed, there must simultaneously be a practical, transparent, accountable, and verifiable mechanism ensuring that medicines, medical equipment, and other essential goods can reach the affected people without obstacles.
The right to health is a fundamental human right.
MS: You have repeatedly stated that medications are affected by sanctions. Can you provide evidence supporting this claim?
AA: For me, the most important evidence is the story of the medication donation by the World Federation of Hemophilia (WFH).
These medications were not intended to be sold, nor was any money supposed to be transferred for them. No one would have gained any economic benefit from this.
Despite extensive coordination with international organizations, this shipment never reached Iranian patients.
If even donated medications cannot reach patients, it becomes difficult to maintain that medicines are, in practice, completely exempt from the effects of sanctions.”
MS: If you only had two minutes to speak with a political decision-maker responsible for sanctions, what would you say?
AA: Today, I do not want to talk about politics. I want to talk about children whose only wish is to go to school, play, and have a normal future like other children their age.
They must not pay the price for political conflicts over which they have no control. Access to life-saving medication must never depend on political disputes. Humanity should begin where a child’s life is at stake.
Today, thanks to advances in modern medicine, hemophilia is a manageable condition — provided that the necessary medications are available. When access to these medications is interrupted, the consequences are predictable: bleeding, permanent disabilities, chronic pain, and, in some cases, death.
I appeal to all governments, international organizations, and political decision-makers to separate healthcare for patients from political conflicts.
No child, no woman, and no patient should ever be denied life-saving treatment simply because of their place of birth or the political situation of their country.
This is not a political demand; it is a humanitarian appeal. Today, I am not asking you to take sides for Iran or for the United States. I am asking you only to take the side of life.”