Table 2. Main Findings of the Review of Literature .

	Authors	Method	Relevant Findings/Message	Humanitarian Effects
				Healthcare	Medicine	Determinants of Health
1	Baradaran-Seyed and Majdzadeh39	Review of reports of Iranian Academy of Medical Sciences, Iranian Medical Council and UN Secretary General	Sanctions against Iran’s financial system made medicine inaccessible.		*
2	Butler40	Interview with health professionals	- Economic sanctions against Iran caused acute shortages of medicines, vaccines and key medical supplies. - Humanitarian exemptions on food and medicine did not work.	*	*	*
3	Cheraghali41	Observations from Iran’s pharmaceutical market	Sanctions in foreign trade, financial and banking services against Iran resulted in inaccessibility of life saving medicines and weakened national health sector and affected ordinary people.	*	*
4	Ghiasi et al42	Analysis of the collected data from a group of pharmacies	Imported and locally produced asthma medicines were not accessible in community pharmacies of Tehran during 2012-2013 in which sanctions against Iran were intensified.		*
5	Golzari et al43	Observations of pharmaceutical market	Economic sanctions against Iran had led to shortages of patented and generic cancer drugs while this country has the highest incidence of cancer in the Middle East.		*
6	Gorji44	Observations of pharmaceutical market	- Economic sanctions against Iran influenced all branches of Iranian economy and affected vulnerable patient. Unavailability of medicine and raw materials for domestic pharmaceutical companies and medical equipment for hospitals and unaffordability of medicines were big challenges of Iran during sanction’s period. - The weakened medical infrastructure decreased the ability of the health system to provide services even in medical emergencies. - Establishing uniform operational criteria and definitions for exemptions of medicine and medical products from sanctions in the future sanction regimes is necessary.	*	*
7	Hajizadeh and Nghiem45	Investigating health system of Iran from financial, utilization, and quality perspectives	Quality of hospital care is different among different provinces of Iran. Economic sanctions seem to have negative impact on Iran's healthcare delivery system.	*
8	Hosseini46	Observation of pharmaceutical market of Iran	- Because of sanctions on foreign trade, financial and banking services, Iran faced major difficulties for importing medicines and medical instruments. - Quality, accessibility and affordability of medicines decreased during sanction’s period. - In a public health prospective, ordinary people and patients paid the cost of economic sanctions. Appropriate measures should be taken by international community to facilitate access to medicine. To facilitate the process of medicine’s importation, defining a white list of Iranian pharmaceuticals companies and their foreign counterparts is necessary.		*
9	International Campaign for human rights in Iran31	Review of scholarly material and journalistic accounts and interviews with a cross-section of Iranians	Economic sanctions against Iran and the country’s policies resulted in a significant economic decline and deterioration of living standards of Iranians. Sanctions decreased affordability and accessibility of healthcare and medicine.	*	*	*
10	International Institute for Peace, Justice and Human Rights47	Interviews with health professionals, patients, health services managers and pharmacists	Sanctions on Iran have had destructive effects on healthcare system, Iranian’s lives and quality of life. Because of sanctions on banking system, import of medicines has become difficult. These are violations of the basic human rights.	*	*	*
11	Karimi and Haghpanah48	Examining the effects of sanctions on access to healthcare from patients’ point of view and related physicians	By adversely influencing accessibility of medicines, sanctions had considerable effects on public health and health of patients with thalassemia and hemophilia.		*
12	Kheirandish et al49	Media analysis	Negative effects of the sanctions on access to medicines in Iran after the sanctions of 2012 is proved.		*
13	Mohammadi50	Interview with clinicians	Economic sanctions against Iran affected the availability of essential and life-saving medicines and forced patients to seek their medicines from an unregulated black market.		*
14	Moret51	Analyses of semi-structured interviews, official discourse and case studies	Economic sanctions negatively impacted the health of ordinary citizens in Iran and Syria through factors such as difficulty in access to medicine and food.		*	*
15	Namazi32	In-depth interviews with Iranian importers, manufacturers, and distributors of pharmaceuticals and medical equipment as well as their Western counterparts	Economic sanctions against Iran have had severely affected the availability, accessibility and quality of medicines in Iran.		*
16	Roshan et al52	Review of literature on the situation of some health indicators before and during sanctions’ period	Economic sanctions have had negative effects on people's health particularly in the field of medicine and treatment, air pollution and the environmental health.	*	*
17	Setayesh and Mackey53	Review of key characteristics of the Iranian drug shortage	73 scare medicine were closely tracked with the disease burden of the country. 44% of these medicines were classified as essential medicines by WHO. A vast majority of these medicine were exempted theoretically from the sanctions.		*
18	Shahabi et al54	Literature review	Iran's NCCP has substantial deficits, including a serious shortage of medicines for cancer care. Sanctions exempted medicines and food, but lead to disruption of health services through complications in shipment or lack of foreign currencies.		*	*
19	Iranian Society of Atherosclerosis55	Observation of pharmaceutical market	There was an acute shortage of essential medicines for patients with cardiovascular disease in Iran in 2012.		*
20	Takian and Kazempour-Ardebili56	Review of Iranian National Action Plan for the Prevention and Control of NCDs and WHO framework	There are many obstacles hindering the achievement of the targets of the Iranian National Action Plan for the Prevention and Control of NCDs including lack of financial resources. Sanctions exacerbated the situation. Safeguarding peoples’ health and well-being in the post-sanctions era is necessary.	*	*
21	UN Economic and Social Council57	Review of reports and observations	The number of street and working children has increased from 2009-2013. They have limited access to healthcare and education.	*		*
22	UN General Assembly58	Review of reports obtained from local newspapers and institutions such as UNICEF and observations	Sanctions adversely affected standard of life of Iranian’s particularly of children and elderly people. Medicine for the treatment of diseases such as cancer, heart disease, thalassemia, HIV/AIDS, hemophilia and multiple sclerosis were not accessible from 2012-2013. Also, humanitarian exemptions for food, medicines and medical supplies could not meet their intended purpose.		*	*
23	UN Refugee Agency59	Review of reports and observations	The sanctions affected adversely the life of refugees in Iran, and operational and humanitarian assistance costs of UN.			*
24	UN Secretary-General60	Review of reports and observations	Unemployed women and female-headed families have been vulnerable to country’s economic decline of recent years in Iran. Since they are economically dependent to and more probable to face poverty.	*		*
25	UNICEF61	Review of reports and observations	Tightened unilateral sanctions against Iran have adversely affected the environment, public health and socio-economic determinants of health of ordinary people, especially children. In recent years, the number of working and street children has increased. These children have limited access to health services and education.	*		*
26	Zare et al62	Spline and quantile regression techniques	Income elasticity is lowest for the poorest Iranians in urban and rural areas Economic sanctions on Iran have the potential to disrupt government-subsidized healthcare services.	*
27	Kebriaeezadeh et al63	Systematic literature review	Iranian pharmaceutical market has undergone great growth till 2011. Before sanctions, Iran’s national pharmaceutical industry could provide essential medicines to patients.		*
28	Hashemi-Meshkini64	Literature review	Financial and trade sanction revealed the weaknesses of Iran’s domestic pharmaceutical industry in proving medicines and medical devices in political and international crisis.		*
29	Kheirandish et al65	Review of published reports and articles	Iran faced major challenges in the provision of adequate access to medicines during sanctions of 2010–2014. Economic crisis might lead to changes of national priorities for investment and expenditure and reduce government’s available resources, and thus may affect the health system and access to medicines.	*	*
30	Asadi-Pooya et al66	Retrospective chart review study of drug adherence of patients with epilepsy	Unavailability and unaffordability of medicines resulted in poor drug adherence. Shortage of medicines and increase of the price were directly associated with intensifying of economic sanctions against Iran. These sanctions brought a bout considerable socio-economic hardship for Iranians.	*	*
31	Duttagupta et al67	Examining healthcare financing and market access implications of pharmaceuticals in light of the introduction or removal of sanctions.	Lifting of economic sanctions on studied countries including Iran will have a positive impact on innovative pharmaceuticals, from perspectives of market access and technology transfer.	*	*
32	Deilamizade and Esmizade68	Interviews with drug users, questionnaires, participants’ observations, and statistical analysis of the existing data were used.	Because of economic sanctions, the price of goods and services including drugs has increased in Iran. Major changes in the drug use patterns and an increase in use-related harms of drug are expected in near future.			*
33	Massoumi and Koduri69	Interviews with physicians and review of literature	Sanctions caused limitations in the import of medicines (pharmaceutical ingredients and finished products) and access to patented ones. The quality of substituted medicines was not satisfactory while these scare medicines were not affordable for some groups of patients.		*
34	Ahmadi and Meskarpour Amiri70	Review of literature	Study of targeted countries by sanctions including Iran showed that through limiting access to minimum basic needs, economic sanctions can threaten public health especially health of the mothers and children of poor families. Reduction of target countries’ revenues can lead to reduction of government capacity to finance healthcare system and increase of the share of households in healthcare costs and adversely affect access to healthcare services.	*
35	Gordon71	Review of literature	Food security and access to healthcare and education were not supposed to be undermined by economic sanctions against Iran. The sanctions influenced every sector of Iran’s economy and public services which were necessary for well-being of the whole population specifically women who are most economically vulnerable. Female heads of households faced much stress trying to feed their families, obtain medicines, and buy necessary goods. In the sanctions period, unemployment and bankruptcies increased substantially.	*	*	*
36	Dizaji et al72	Comprehensive set of VAR models	Social impact of economic sanctions against Iran may extend beyond the sanction period because “the costs of imposing sanctions exceed the benefits of lifting sanctions.”			*
37	Farzanegan et al73	Examining the macroeconomic and household welfare consequences of oil sanctions in Iran by using social accounting matrix and developing a computable general equilibrium model	Iranian economy and households are affected enormously by economic sanctions. The welfare of all income groups of households in urban and rural areas has declined.			*
38	Kermani74	Analyzing the conceptual framework of political economy	Sanctions adversely affected people’s livelihood. It is ignoring basic human rights of Iranian’s particularly the rights to life, health, access to medicine and development. Promoting justice by discriminatory punishment of innocent people is impossible.	*	*	*
39	Chenoy75	Review of reports and papers	Smart sanctions against Iran has severely impacted on socio-economic pattern and the lives of ordinary people. Inflation and shortages have led to high costs of food prices. The decline in women's status, job security and opportunities coincide with sanction regime.			*
40	Rezapour et al76	Concentration Index on inequality	In recent years, out-of-pocket payments for health increased while the capacity of households to pay decreased. The poor spend a greater portion of their capacity-to-pay for healthcare, in comparison to the rich. Sanction-borne inflation in economic and health sectors has caused financial crisis. Supporting the poor and decrease of out-of-pocket must be considered.	*
41	Ebrahimi et al77	Literature review	Sanctions resulted in deprivation and restriction of Iranians in enjoyment of their rights to a standard of life, health, education and development.	*		*
42	Menezes78	Theoretical conceptual approach	Because of economic sanctions, health system of Iran faced difficulties in the import of medicines and medical equipment.		*
43	Neuenkirch and Neumeier79	Nearest neighbor matching approach	US sanctions have led to larger poverty gap in sanctioned countries including Iran compared to their nearest neighbors.			*
44	Palaniappa80	Comparative study using review literature	Iran’s health indicators used to be one of the best in the Middle East. The sanctions against Iran have had notable humanitarian implications, specifically on economic growth and health sector. The sanctions have decreased oil revenue and immensely destroyed economy of Iran. Unemployment rate, inflation, and commodity prices increased. It caused major shortages of medicine since the organizations with proper licenses were unable to find third-country banks for importing medicine and food. Due to the rise in food costs and general inflation, many lower and middle class families could not afford food.	*	*	*
45	Sha’bani et al81	Content analysis of library resources and Internet data	Socio-economic status of Iranians is influenced adversely by the sanctions in recent years. Iran is facing a great deal of different challenges such as unemployment, inflation and depression, immigration, and marriage problem, brain drain and economic downturn.			*
46	Asadi et al82	Content analysis and comparative study	Studying Iran showed that sanctions with a large economic effect on the target country can have severe public health consequences which are very much similar to the effects of major military conflict.‏ Using resistive economy might be helpful in this situation.	*
47	Bastani et al83	Content analysis with an inductive approach applying a 5-stage framework analysis (familiarization, identifying a thematic framework, indexing, mapping, and interpretation)	Sanctions can influence the final price of domestic medicines, production quality and the hidden prices of imported medicines. In order to improve access to medicine in Iran, affordability of medicines, effects of exchange rate fluctuations on the cost of pharmaceuticals, influence of sanction on the final prices of pharmaceuticals, efficiency and patient's ability to cooperate in payment should be taken into account.		*
48	Portela84	Analysis of the design of different categories of sanctions instruments	In Iran, sanctions affected the economy, healthcare and environment and caused a decline in the living standards of the population. It made acquisition and distribution of medical and pharmaceutical supplies difficult while legislation exempted the importation of humanitarian items from sanctions. No plan for monitoring of impacts of sanctions against this country was devised.	*	*	*
49	Dizaji85	Impulse response functions and variance decomposition analysis	The decreases in Iran’s revenues limited the government financial capability for financing health, education and social security and payment to its employees which damaged the Iranians’ standard of life.	*		*
50	Taghdisinejad and Allahmorad86	Interviews with the elite using Delphi	Sanctions have led to increase of inflation, decrease of government’s revenues, public investment, employment, Job Security and stability as well as households’ income and purchasing power and government’s abilities to support vulnerable groups.			*
51	Nematolahi et al87	General equilibrium pattern	Economic sanctions against Iran and change of Iran’s policy about subsidized food have increased food price and decreased purchasing power of households and food security.			*
52	Mostafavi et al88	Hsiao causality procedure	Economic sanctions influenced production models from clean production techniques to pollutant ones and led to more use of old technologies and air pollution.			*
53	Mousavi et al89	Content analysis of international human rights laws and review of reports and literature	- Sanctions against Iran influenced the livelihood of Iranians and resulted in more poverty and less welfare. - Because of economic downturn, inflation, decrease of households’ purchasing power, some groups of the population cannot access necessities of life such as food and shelter. - Particularly the sanctions resulted in violation of Iranian’s right to health by adversely effecting accessibility of medicine and medical devices, increasing healthcare costs, decreasing government’s financial ability for support of the poor and limiting import of quality gasoline.	*	*	*
54	Mashhadi and Rashdi90	Literature review	Iranians’ right to a healthy environment is violated by recent sanctions on import of gasoline and energy sector and prohibition of related knowledge and technology.			*
55	Marzban and Ostadzade91	Extension of a generalized growth pattern despite a random exchange rate boycott	Since the economy of Iran is dependent to oil revenues, the sanctions resulted in decrease of Iranians’ welfare.			*

Abbreviations: UN, United Nations; NCCP‏, National Cancer Control Program; WHO, World Health Organization; UNICEF, UN Children Found; VAR, vector autoregressive; NCD, non-communicable disease.