Effects of economic sanctions on cancer care for patients in Iran: a qualitative study

Abstract

Background

Due to political and security concerns, Iran has faced stringent sanctions in recent decades, significantly impacting vulnerable cancer patients. According to the latest statistics, the 5-year prevalent cases in Iran were 357,906 for both sexes combined. This study aimed to investigate the perspectives of cancer patients, their families, and non-governmental organizations (NGOs) regarding the ramifications of economic sanctions on cancer diagnosis and treatment.

Methods

This qualitative study was conducted by semi-structured interviews with 21 cancer patients and their family members, as well as representatives from relevant NGOs based in Tehran in 2020. The interviewees were selected using convenience sampling, and the data were classified and analyzed using qualitative content analysis in MAXQDA-2019 software.

Results

The effects of economic sanctions on cancer patients were categorized into four themes: medicines, medical equipment, human resources, and financial resources. Medicines were further categorized into medicine price changes, scarcity, the complexity of dispensing medication, profiteering of drug manufacturers and distributors, and prolonged medical treatment subthemes. Medical equipment included price changes and difficulties in procuring medical devices and their accessories. Human resources comprised inadequate access to specialists and distorted doctor-patient relationships. Finally, financial resources were delineated by the diminished purchasing power of individuals and insufficient support extended to NGOs catering to patients’ needs.

Conclusions

The findings underscore the urgency of addressing the multifaceted consequences of sanctions, which exacerbate vulnerabilities among cancer patients and hinder their access to timely and adequate care. Collaborative efforts between policymakers, healthcare providers, and NGOs are essential to mitigate these challenges and ensure equitable access to cancer treatment amidst ongoing sanctions. Furthermore, global health diplomacy could help reduce the effects of economic sanctions and facilitate the provision of medical equipment, medicines, and financial resources.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-025-12501-6.

Background

In contemporary times, sanctions serve as a pivotal instrument for advancing foreign policy objectives by isolating non-compliant nations and compelling adherence to desired behaviors [1]. While designed as punitive measures for transgressions, economic sanctions ostensibly seek to safeguard human rights [2]. Nonetheless, empirical data suggests that these sanctions disproportionately impact ordinary citizens rather than governmental leaders, precipitating conspicuous adverse ramifications across multiple sectors, notably in healthcare [1].

There are substantial concerns regarding the efficacy of sanctions in influencing the behavior of governments [3]. Given that healthcare services represent fundamental human entitlements; such sanctions may be construed as constituting violations of human rights. Indeed, the plight of individuals should not be leveraged as a means to accomplish political objectives [4]. Prolonged and robust sanctions yield enduring and formidable repercussions that are not easily or swiftly ameliorated [5].

Due to political and security considerations, Iran has become a focal point of sanctions imposed by the United States of America, the European Union (EU), and the United Nations (UN) in recent decades [6]. Numerous reports issued by the UN, academic institutions, non-governmental organizations (NGOs), and advocacy groups for patients underscore the adverse effects of these sanctions on the health of Iranian citizens and their access to health services [7, 8]. By targeting Iran’s national budget and depreciating its currency, these economic sanctions have escalated costs associated with diagnostic procedures and treatments [9].

Investigations have revealed their role in impeding the easy access of approximately 6 million Iranian patients to essential medications [10]. Furthermore, these sanctions have effectively paralyzed Iran’s pharmaceutical industry by restricting its access to essential raw materials [8, 11]. Sanctions have led to a surge in catastrophic health expenditures and an increase in the poverty index. Contextual factors such as employment status and supplementary insurance coverage significantly influence the magnitude of out-of-pocket expenses, catastrophic health expenditures, or impoverishment resulting from illness-related costs [12].

The negative effects of sanctions are expected to affect the most vulnerable communities disproportionately [13]. Cancer patients constitute one of the most vulnerable demographics within Iran’s healthcare framework due to insurance plans inadequately meeting their requirements for a wide array of new and essential diagnostic, surgical, and therapeutic services and equipment [8]. According to the Global Cancer Observatory 2022 report, Iran had 137,198 new cancer cases (76,441 in males and 60,757 in females), with a five-year prevalence of 357,906 cases. The most common cancers for males were stomach, prostate, and lung, while females predominantly faced breast, stomach, and colorectal cancers. There were 87,247 cancer deaths overall, highlighting the significant cancer burden in the country [14].

Based on a recent study, economic sanctions have severely disrupted cancer care in Iran, causing medication shortages, outdated equipment, and overwhelming financial burdens on patients—leading to delayed diagnoses and less effective treatments [15]. This is because the impact of economic sanctions has curtailed the reimbursement capacity of the public insurance system [16], exacerbating challenges for cancer patients in obtaining necessary medications [17]. Additionally, fluctuations in currency rates and constraints on international trade have further limited access to vital equipment, leading to delays or interruptions in the treatment of these patients. Consequently, this not only diminishes the efficacy of therapeutic interventions but also poses a substantial threat to the lives of affected individuals [18].

Previous research has underscored the substantial and detrimental impact of sanctions on the overall health of targeted nations, contingent upon the level of economic development [19]. Countries like Iraq, Syria, and Cuba share analogous experiences concerning the repercussions of economic sanctions on their healthcare systems [20, 21]. A specific investigation into the influence of sanctions on public health in Syria revealed that the depreciation of the national currency escalated the expenses associated with healthcare services, particularly medications, thus adversely affecting patients, particularly those seeking treatments for non-communicable diseases [21].

Iran’s strategy to mitigate the impact of sanctions on people’s access includes bolstering domestic production and implementing support and compensation packages for vulnerable groups [22]. The existing evidence indicates that imposing sanctions inevitably results in detrimental effects on public health. Moreover, the occurrence of sanctions with events such as the COVID-19 epidemic and air pollution has further lowered the threshold for the potential collapse of the health system [23, 24]. Despite overwhelming obstacles due to sanctions, NGOs in Iran play a crucial role in bridging the gap between citizens and the government in the healthcare system. They engage in activities like social work, facilitating hospital development and equipment, launching informational campaigns, conducting educational research projects, publishing studies, and providing accommodation for patients’ companions [25–27]. However, these organizations face significant challenges, including funding limitations and operational constraints imposed by the sanctions themselves.

Several studies have approached the effects of sanctions on a country’s health system from the perspective of experts. Nonetheless, scant attention has been directed towards examining both the direct and indirect implications of economic sanctions from the viewpoint of patients. Therefore, the primary objective of this study was to examine the perspectives of cancer patients, their families, and representatives from NGOs concerning the impact of economic sanctions on the diagnosis and treatment of cancer.

Methods

This qualitative study encompassed 21 participants in scope, comprising individuals affected by various forms of cancer (such as stomach, pancreatic, intestinal, lung, breast, cervix, ovarian, and prostate cancers) alongside their family members (including children or spouses), and representatives affiliated with NGOs in Tehran. The interviews were conducted between October 2020 and March 2021 to gather insights from this diverse group of participants. The analysis of interviews was conducted concurrently with the interviewing process and continued until data saturation was achieved, as indicated by no new information emerging in the final few interviews.

Out of the total participants (Table 1), ten individuals (47.6%) represented patients, six (28.6%) were family members, and five (23.8%) were representatives from non-governmental organizations (NGOs) for cancer. Among these participants, there were 12 men (57.1%) and nine women (42.9%), with an average age of approximately 56 years (ranging from 43 to 86 years). The selection of interviewees was carried out using convenience sampling methods. Given the logistical challenges and the critical need for timely and relevant insights, convenience sampling was deemed the most practical and effective method to engage a diverse group of participants. Data collection occurred through either telephone interviews or semi-structured face-to-face interviews, contingent upon the occupational engagements and living circumstances of the participants. On average, each interview lasted for approximately 20 min. The study’s inclusion criteria encompassed individuals directly impacted by cancer during the period of economic sanctions, including patients, supporters, or caregivers who willingly expressed their interest in participating in the study. To comply with scientific principles and obtain informed consent from all participants, at the beginning of the interviews, the interviewees were briefed on the research title and the necessity of carrying it out; their permission was secured for recording the interviews with an emphasis on confidentiality, they were informed that they could withdraw from the research at any stage of it, and would be sent the results of the study if they wished.

Table 1.

Demographics of the participants

Variable			Frequency		Percentage
Group	Patient	Breast cancer	2	10	47.62
		Ovarian cancer	1
		Cervical cancer	2
		Prostate cancer	1
		Gastric cancer	1
		Pancreatic cancer	1
		Colorectal cancer	1
		Lung cancer	1
	Family member	Spouse	3	6	28.57
		A parent	2
		A sibling	1
	NGO representatives	Board member	2	5	23.81
		Staff member	3
Gender	Male			12	57.14
	Female			9	42.86
Total				21	100

The interview questions were to examine the repercussions of economic sanctions on the availability, accessibility, and utilization of cancer diagnostic and treatment services. The interview guide was developed through a thorough process involving a literature review, the research team’s subject matter expertise, and feedback from experts, including input from two experts affiliated with the Department of Management, Policy and Health Economics at the School of Public Health, Tehran University of Medical Sciences. This approach ensured that the questions were both relevant and comprehensive, incorporating pilot interviews to test their effectiveness. Specifically, we delved into inquiries regarding the obstacles encountered by patients in accessing crucial healthcare resources, encompassing medications, diagnostic tests, specialized treatments, and the overall quality of cancer care. Furthermore, we aimed to investigate the strategies and methodologies adopted by both individuals and non-governmental organizations (NGOs) to navigate the challenges posed by constrained resources and disrupted healthcare systems resulting from the sanctions. The interviews were conducted by proficient health experts and seasoned researchers in qualitative research. All interviewers underwent extensive training, including theoretical principles, ethical considerations, and practical exercises like mock interviews. Continuous support and supervision were provided to ensure the quality and consistency of the data collected. The interview guide is provided in Appendix 1.

The data underwent analysis utilizing qualitative content analysis employing an inductive approach. To facilitate this process, meticulous transcriptions of the interviews were created, and the identification of semantic units (codes) within the dialogue was systematically performed. The coding process involved multiple stages: initial open coding, where line-by-line analysis was conducted to identify and label semantic units; axial coding, which involved grouping related codes into subthemes; and selective coding, which further organized these subthemes into overarching themes. These extracted codes were subsequently organized into subthemes and overarching themes [28] within the MAXQDA-2019 software. Each transcript was independently coded by two researchers to enhance reliability, with discrepancies resolved through discussion and consensus. The rigor of the gathered information was evaluated in alignment with the four criteria outlined by Streubert and Carpenter, specifically focusing on credibility, dependability, confirmability, and transferability [29]. To fortify the confirmability of the findings, the researchers diligently endeavored to prevent their perceptions and values from unduly influencing the analysis and interpretation of the data. Furthermore, the coding process was supported by regular coding meetings where researchers reviewed and discussed the codes and themes, ensuring consistency and accuracy. Furthermore, ensuring the credibility, dependability, and transferability of the findings were achieved through a process of rigorous peer review. This meticulous review process served to enhance the overall robustness and trustworthiness of the study’s outcomes.

Results

The impact of economic sanctions on cancer patients resulted in four primary consequences, which were categorized as follows: medicines, medical equipment, human resources, and financial resources (Table 2). Each is described below. Additionally, most codes were related to the theme of medicines, particularly their prices, which have been constantly rising.

Table 2.

Themes and subthemes extracted from interviews

Theme	Subtheme	Code
Medicines	Price changes	Elevated prices of medications
		Erratic prices of medications
	Scarcity	Scarcity of medicines
		Alterations in prescribed medications
		A surge in seeking medications from the illegal market despite concerns regarding their questionable quality
	Complexity of dispensing medication	Confusion of patients and lack of guidance from medical personnel in obtaining prescribed medications
		Rationing of medicines and some unconventional practices at pharmacies
		Extended waiting times (spanning hours) to fill prescriptions
		Visiting multiple pharmacies across various locations to fill prescriptions
		Challenging prescription approval procedures at some pharmacies and insurance organizations in accessing prescribed medications
	Profiteering of medicine producers and distributors	Exploiting economic sanctions by some medicine producers and distributors to raise the prices of medicines
		Exploiting economic sanctions by some medicine producers and distributors to stockpile medicines
	Prolonged medical treatment	Slowing down the course of treatment or discontinuation of treatment due to inaccessibility of prescribed medications
Medical equipment	Price changes	Escalated prices of medical equipment
	Difficulties in procuring medical devices and their accompanying accessories	Rendering inoperable some medical equipment due to the unavailability of specific parts or accessories
		Inadequate availability of certain medical devices in cities beyond Tehran
		Constrained importation of needed medical equipment
Human resources	Inadequate access to specialists	Growing concentration of specialists in Tehran
		Emigration of specialists abroad
	Distorted doctor-patient relationships	Distorted trust between healthcare providers and recipients due to unmet expectations regarding medications and care
Financial resources	Diminished purchasing power of individuals	Diminished purchasing power due to imbalance between income and expenses of individuals
	Insufficient support extended to NGOs catering to patients’ needs	Limited financial capacity of donors and NGOs to support patients
		Insufficient allocated budget to NGOs

Medicines

The first theme, that is, ‘medicines’1, included price changes, scarcity, the complexity of dispensing medication, profiteering of medicine producers and distributors, and prolonged medical treatment. This theme captured the multifaceted impact of economic sanctions on the availability and affordability of essential medications, highlighting the struggles faced by patients and their families.

Certain interviewees expressed a belief that the elevated and erratic prices of medications were attributed to the effects of economic sanctions:

‘The medicine was very expensive. It was impossible for us to pay for it’ (Patient 1).

‘I was forced to pay 35 million Tomans (703 USD 2 ) for medicine on Monday that the Iranian Red Crescent Society had priced at 30 million Tomans (602 USD) on Saturday’ (Family member 1).

The interviewees further highlighted that the economic sanctions had also resulted in a scarcity of medicines. This scarcity not only limited the availability of essential medications but also created significant barriers to accessing proper treatment, led to the rationing of medicines and occasionally fostered unconventional practices at pharmacies:

‘I think distribution is not based on need. Some pharmacies stockpile medicines to sell them on the illegal market, and patients gain access to these reserves through their connections’ (Family member 5).

‘Pharmacies fail to provide us with the prescribed medicines. On one occasion, the doctor prescribed three medicines, but the pharmacy provided me with only one. They said that the prescriptions had to be confirmed every week’ (Patient 3).

All patients expressed dissatisfaction regarding the confusion and lack of guidance from medical personnel in obtaining their prescribed medications accurately. Additionally, some patients reported the need to visit multiple pharmacies across various locations in the city and endure extended wait times (spanning hours) to fill their prescriptions. This issue was further exacerbated for individuals travelling from other cities to Tehran to continue their treatment:

‘Someone should guide patients where they should go and what they should do. For example, I visited several pharmacies between the morning and evening to find a specific medicine, but I was told the same from numerous pharmacies that this medicine was unavailable’ (Patient 2).

‘I have to spend 2–3 hours to receive my medicines because the influx of individuals from various cities to Tehran seeking their prescribed medications contributes to this prolonged way’ (Patient 9).

Some interviewees highlighted the challenges encountered by patients in accessing prescribed medications. These challenges encompass confusion within the prescription approval procedures at pharmacies and insurance organizations, leading to a heightened frequency of visits required to procure medications:

‘Our insurance coverage is provided by a specific organization, through which we previously obtained costly chemotherapy drugs via the health and treatment department. Typically, for other necessities, we had to seek assistance from the Red Crescent. Regrettably, the Red Crescent would only facilitate the provision of general items if we also acquired expensive medicines through that particular organization’ (Family member 2).

Participants indicated that alterations in prescribed medications pose challenges for patients. Firstly, patients may have preferences or reservations regarding the source of their medication, which can complicate matters. Secondly, there exists the potential issue of receiving an alternate drug that might lack the same efficacy or combination as the initially prescribed medicine:

‘One of the problems is that pharmacies change the prescribed medicines at their discretion. For example, although my doctor prescribes a medication manufactured in France, the pharmacy may provide one manufactured in India without informing me, despite my potential preference against purchasing medication produced in India’ (Family member 6).

Interviewees highlighted that the heightened sanctions have led to a surge in patients seeking medications from the illegal market despite concerns regarding the questionable quality of medicines obtainable through these channels:

‘On one occasion, I was attempting to purchase Avastin, but I could not find it anywhere and was forced to look on the illegal market. I was asked to pay 6 million Tomans (120 USD). When I asked another pharmacy, they gave me a higher price. Since I was not sure about the quality of the medicine on the illegal market, I decided to buy it from that pharmacy at a higher price’ (Patient 1).

The interviewees pointed out that certain medicine producers and distributors were exploiting the economic sanctions by either raising the prices of medicines or stockpiling them:

‘We struggled to find the necessary medicines, as pharmacies frequently informed us that they were out of stock due to the economic sanctions’ (Patient 5).

‘At one pharmacy, I was told the price of the medicine manufactured in Iran was 900,000 Tomans (18 USD), and that of the foreign one was 2,560,000 Tomans (51 USD). I purchased the foreign option. The next time I visited the same pharmacy, I was told that foreign medicine was unavailable and the price of the Iranian option was over 3 million Tomans (60 USD). Drugs used to cost a lot before, now they cost an arm and a leg’ (Patient 3).

Some cancer patients or their family members expressed that the economic sanctions have resulted in a decelerated pace of treatment or forced some individuals to discontinue their treatment regimen:

‘The sanctions on pharmaceuticals have practically made many patients discontinue their treatment or slow down the treatment process’ (NGO representative 1).

Medical equipment

This theme encompasses the subthemes of price changes and difficulties in procuring medical devices and their accompanying accessories. Patients mentioned that the escalated prices of medical equipment amplified their financial burden in acquiring certain necessary medical devices:

‘We are facing a shortage of equipment, and the costs of maintaining and repairing them are constantly rising. Consequently, we are being charged higher and higher due to this shortage’ (Patient 8).

Other interviewees emphasized that certain medical devices were rendered inoperable due to the unavailability of specific parts or accessories. They also underscored the inadequate availability of certain medical devices in cities beyond Tehran, resulting in challenges for patients residing in those areas. Additionally, they mentioned constraints related to the importation of medical equipment:

‘We purchased a radioactive-based brachytherapy machine. The radioactive element required replacement every four months, allowing for operation for only three consecutive four-month periods’ (NGO representative 4).

‘We could not find this device in our city due to the sanctions. Therefore, we had to travel to Tehran and stay there for a month as we had one session of radiotherapy per week’ (Patient 7).

‘Some medical equipment must be imported from abroad. However, since the economic sanctions have caused many problems for Iran in currency exchange and banking transactions, it is very difficult to import them’ (NGO representative 2).

Human resources

This category outlining the impact of economic sanctions on cancer patients encompassed the inadequate access to specialists and distorted doctor-patient relationships. According to some interviewees, the growing concentration of specialists in Tehran, along with their emigration abroad, exacerbated the uneven distribution of specialized medical professionals across the country:

‘The economic difficulties in Iran have increasingly driven specialists and subspecialists to relocate to Tehran or emigrate abroad’ (Family member 3).

‘We have to endure remaining in long queues in public hospitals because they are more crowded’ (Patient 4).

The interviewees additionally highlighted that when patient expectations regarding the availability of necessary medications and care are not met, it can detrimentally affect the trust between service providers and recipients of healthcare:

‘Since I do not know anything about the medical profession, I am not sure that my doctor prescribes the right medicine for me’ (Patient 10).

Financial resources

This theme encompassed the diminished purchasing power of individuals and the insufficient support extended to NGOs catering to patients’ needs. The imbalance between income and expenses created hardships in sustaining livelihoods for people, burdening them with significant expenses:

‘The economic sanctions have significantly deteriorated our financial situation, further exacerbated by the escalating costs of my medical treatment. As I am now unable to work, I find myself not only battling illness but also grappling with the mounting healthcare expenses. To date, I have resorted to multiple loans and am struggling with their repayment’ (Patient 6).

The interviewed patients also mentioned that the economic challenges, including inflation and decreased donations due to sanctions, impacted the financial capacity of donors and NGOs, thereby affecting their ability to provide adequate support to patients:

‘Charitable institutions depend on financial resources provided by donors to support patients. However, due to the economic sanctions and the economic problems, the donors can help the charities less than they could before; or their help is not sufficient to meet the needs of the patients because of the inflation caused by the economic sanctions. As a result, the process of supporting the patients is facing difficulties’ (NGO representative 5).

One manager believed that the budget allocated to NGOs was insufficient to support the patients adequately. As a result, their capacity to provide proper support to patients has been compromised:

‘The budget of some institutions, especially those based in cities other than Tehran, has decreased, and so has their ability to support the patients properly (NGO representative 3).

Discussion

This study explored the impact of economic sanctions on the cancer diagnosis and treatment process, examining the perspectives of cancer patients, their families, and representatives from NGOs. The findings indicated that key challenges stemming from health system constraints encompassed shortages in medications, medical equipment, human resources, and financial support.

Medicines

In the context of medications, feedback from cancer patients and their families highlighted primary issues associated with changing prices, medication scarcity, complexities in medication dispensing, exploitation by medicine producers and distributors, and prolonged medical treatment. The insights shared by participants in this study emphasize the critical need for interventions aimed at overcoming obstacles hindering access to crucial medicines. Equitable pricing and fairer distribution practices are imperative in light of these experiences. Consistent with this observation, a separate study highlighted the disruption of individuals’ access to healthcare services as an adverse and undesired consequence of economic sanctions [30].

Earlier research has also delved into the real-life experiences of cancer patients affected by the negative impacts of economic sanctions on medications. These repercussions include resorting to self-medication, seeking medical care overseas, and heartrending decisions compelled by financial limitations. The ensuing sections delineate the specifics of the findings from these investigations. Kheirandish et al. highlighted that the main effects of economic sanctions in this domain included diminished access to or shortages of medicines, decreased importation of raw materials necessary for domestic medicine production, and reduced dosages of medicines taken by patients [31]. In a qualitative investigation, Bastani et al. identified key issues afflicting Iran’s pharmaceutical industry due to economic sanctions. These issues comprised medicine hoarding, scarcity of raw materials essential for domestic medicine production, challenges in updating scientific knowledge, and exploitation by beneficiaries and dealers [30]. Another issue highlighted in one of the studies was the increased smuggling of counterfeit and low-quality medicines from neighboring countries into Iran [32]. Since no official report on the effects and dimensions of economic sanctions has been made available to the general public, it appears that our study’s target population lacked a comprehensive understanding of some aspects of the issue.

Sahraian et al.’s study involving patients with multiple sclerosis (MS) revealed that over 80% of participants expressed concerns regarding the unavailability of specific medications, challenges in accessing foreign medicines, and the efficacy of Iranian medications in comparison to those from abroad. Furthermore, over 70% of respondents indicated that financial difficulties led them to contemplate switching from their regular medication to more affordable alternatives, while 40% expressed reluctance to persist with the treatment regimen due to the substantial economic burden associated with managing this disease [33]. Several studies have highlighted an increasing inclination among Iranians to self-administer medication in response to the ramifications of sanctions. Furthermore, a minority of financially privileged patients choose to pursue healthcare options abroad. Simultaneously, individuals, particularly those grappling with incurable illnesses, encounter the challenging predicament of having to cease medical services owing to financial limitations [34].

Medical equipment

The study findings underscored that the primary impacts of economic sanctions on medical equipment included price changes and challenges in procuring medical devices and their associated accessories. Despite exemptions for medications and essential medical equipment from these sanctions, their direct and indirect repercussions have constrained Iran’s banking system, resulting in wide-ranging limitations on trade, manufacturing, insurance, and business ventures [35]. Consistent with these findings, Hassani concluded that diminished radiotherapy facilities, reduced purchasing power for crucial medical equipment and specialized medications, limited access to advanced surgical technologies, and foreign companies’ reluctance to engage in collaborations with Iran due to fears of U.S. sanctions constituted key effects of economic sanctions on the country [36]. Barzegar et al. highlighted key issues resulting from economic sanctions, including challenges in accessing new equipment, potential decreases in patient visits, and shortages of radiation therapy centers alongside functional equipment [18]. Azami et al. conducted a review delineating the primary challenges concerning medical equipment due to economic sanctions, categorizing them into two general groups: difficulties in acquiring capital equipment and issues related to repairs and post-sales services [37]. In another study, the reuse and re-sterilization of many disposable medical devices were cited as consequences of the impossibility of financial transactions and transportation of materials [38]. Furthermore, an additional issue in this domain pertains to the procurement of items with dual applications for both medical and military purposes [39].

Notably, the quality of equipment and technologies employed in Iran for cancer treatment has consistently fallen below international standards. Nevertheless, endeavors have been undertaken to manufacture certain radiopharmaceuticals, assemble radioactive generators, and export them to several countries, including Iraq, India, Pakistan, Syria, Egypt, and Georgia, as well as various Asian and European nations [30, 31]. Consistent with the findings of this study, prior research has shown that sanctions have restricted access to critical medical products in Russia, including imaging equipment and surgical instruments. The lack of original spare parts and restrictions on importing replacements have led to significant challenges in maintaining medical equipment. Consequently, the Russian healthcare market has become saturated with low-quality Chinese alternatives, resulting in a surge of complaints [40].

Human resources

The study’s findings highlighted the main effects of economic sanctions on cancer patients concerning human resources, as perceived by the interviewees. These effects notably involved the inadequate access to specialists and the distortion of doctor-patient relationships. Shahabi et al.’s research delved into the effects of economic sanctions on rehabilitation services within Iran, identifying the high unemployment rate and the inadequate employment status of doctors as primary challenges in this sphere [41]. These issues may serve as additional incentives for doctors and specialists to relocate from smaller cities to Tehran, placing greater emphasis on personal financial gains over other considerations. Consequently, the imposition of economic sanctions could potentially widen the healthcare gap within the country [42].

Residents in cities and towns outside Tehran face no option but to endure the inconvenience of travelling to the capital city and navigating its vastness while also shouldering expenses for accommodation and meals to access adequate medical services. Consequently, the international community’s indifference to the violation of fundamental rights among cancer patients in Iran is deemed unacceptable [18]. Consistent with this finding, Ogbonna examined the impact of sanctions on Zimbabwe, highlighting the primary consequence as the significant turnover rate of nurses and doctors within the country’s healthcare system due to economic hardships and governance issues [43]. Another study focusing on the effects of sanctions on health providers revealed a reduction in the income of treatment teams and the migration of physicians from Iran. Additionally, experts noted feelings of anxiety and reduced motivation, which in some cases could lead to suicide [15]. The differences between the findings of this study and ours can be attributed to variations in the target groups of the studies. Prioritizing the motivation, well-being, and professional needs of healthcare workers stands as a recommended strategy to bolster the health system’s resilience against the effects of sanctions [5].

Financial resources

As per the insights provided by the interviewees, a significant effect of economic sanctions on financial resources was the diminished purchasing power among the population. Sen et al.’s study on the adverse impacts of economic sanctions on Syria highlighted that these sanctions detrimentally affected people’s accessibility to medicines, medical services, essential goods, and infrastructure [21]. Asgerdoun et al. asserted that economic sanctions have the potential to curtail individuals’ purchasing power, subsequently limiting their access to and utilization of medical services [44]. Hassani also contended that one of the principal repercussions of economic sanctions for cancer patients involved restricted access to medical services among individuals from middle and lower economic classes [35]. Additionally, according to a systematic review, reduced funding for healthcare is one of the serious impacts of economic sanctions. This reduction leads to several consequences, including the government’s decreased ability to support the health sector, reduced investment in pharmaceutical markets and medical infrastructure, and increased out-of-pocket expenses for patients [23].

Owing to resource scarcity, patients encounter numerous obstacles in accessing essential medical services. Additionally, the imposition of economic sanctions has led to a reduction in the allocated budget for cancer prevention and health promotion programs [45]. Cancer, as a disease, impacts not only the patients themselves but also exposes their circles to psychological and financial challenges. Financial constraints may compel families supporting cancer patients to seek loans from relatives or resort to high-interest bank loans. In such circumstances, the establishment of collaborative financial funds and pooling resources from various organizations stands out as an effective and recommended strategy [46].

Another consequence of economic sanctions on financial resources was the diminished support offered to patients by NGOs, which was attributed to reduced budgets and decreased donations from the public. Dastafkan et al. underscored the pivotal role of NGOs in soliciting governmental and public contributions to foster peace and aid Iran’s healthcare system [47]. Notably, these sanctions have compounded existing challenges faced by NGOs. Shariatrad and Marifvand highlighted that economic sanctions posed significant challenges for relevant NGOs, including shortages in medical equipment, limited patient access to medical services, financial constraints, and shifts in the national and regional pharmaceutical markets [48]. Despite these obstacles, these NGOs strive to assist patients by distributing donated medications, providing psychological support, and disseminating vital information. Despite the mentioned limitations, Iran’s non-governmental organizations have demonstrated their capacity to bolster the health system during crises and challenging circumstances [49].

Limitations

This study faced limitations as it was conducted amid the COVID-19 pandemic, which resulted in some individuals within the study population being unwilling to participate in face-to-face interviews. Consequently, the research team utilized online and remote communication tools for data collection. We were unable to interview hospitalized patients as we did not have access to them due to social distancing and quarantine measures. Due to the pain and suffering experienced by participants, the number of questions were limited, and interviews had to be conducted with great care to avoid causing further distress. Moreover, the study primarily included participants from urban areas, limiting the representation of rural and low-income populations, which should be addressed in future research. Beyond these challenges, economic sanctions are less commonly imposed on developed countries, leading to a scarcity of similar studies available for comparison. This scarcity constrained the scope for interpreting the study findings within a broader context.

Conclusions

The study’s findings suggested that the main effects of economic sanctions on cancer patients encompassed price changes, medication shortages, and exploitation within the health system, particularly concerning medications. These findings underscore the urgency of addressing the multifaceted consequences of sanctions, which exacerbate vulnerabilities among cancer patients and hinder their access to timely and adequate care.

While Iran’s healthcare system encountered challenges and deficiencies in managing cancer even before the imposition of economic sanctions, it becomes imperative to prioritize the requirements of this patient demographic within medical programs and services amidst these conditions. Intelligent budget management is vital to ensuring efficient resource allocation and optimal support for patients during these challenging times. Any corrective action in this context should consider the participatory role of NGOs and charities as executing arms of the government.

Leveraging global health diplomacy could help mitigate the impacts of economic sanctions and facilitate the provision of essential medical equipment, medications, and financial resources. Moreover, the establishment of a comprehensive patient and medication registration system holds the potential to enhance monitoring, inform better decision-making, and enable more efficient resource management. This initiative also lays the groundwork for a fairer distribution and improved accessibility to medicines and healthcare services. Educating patients, particularly regarding accessible financial aid and healthcare services, is needed to empower them. To address systemic gaps, reforms should prioritize expanding basic and complementary insurance coverage for cancer treatments and medications, alongside establishing a dedicated national fund to financially support patients. Equitable distribution of healthcare human resources across the country, coupled with revised payment structures, is critical to retaining skilled professionals. Furthermore, integrating psychological counseling services and support groups for patients and families into healthcare programs could alleviate mental health burdens exacerbated by sanctions. Additionally, it is advisable to regularly evaluate governmental policies and measures supporting cancer patients to ensure their efficacy in meeting evolving needs.

We advocate for a subsequent study encompassing a broader assessment of the sanctions’ impact, with specific emphasis on the human cost and resultant suffering. Future research should replicate this study on a larger scale, with enhanced focus on rural and low-income populations to improve generalizability. Such an approach would offer a more comprehensive understanding of this complex issue, providing valuable insights for future research endeavors.

Authors’ contributions

MN, LH, HR, KZ, NB, and ASh contributed to the design of the work. AL and LM contributed to data gathering. MN and NB contributed to the analysis and interpretation of data. MN and NB drafted the manuscript. All authors read and approved the final manuscript.

Funding

This research project was supported by the Cancer Research Center of Tehran University of Medical Sciences.

Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Imam Khomeini Hospital Complex, affiliated with the Tehran University of Medical Sciences (IR.TUMS.IKHC.REC.1399.013). Informed consent was obtained from all participants after they were briefed on the study’s purpose and assured of confidentiality. They were also informed of their right to withdraw at any time and their option to receive the study results. This study was conducted in accordance with the principles of the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.