By Tamara Qiblawi, Frederik Pleitgen and Claudia Otto, CNN
Updated: Fri, 22 Feb 2019 12:14:03 GMT
Ali only had two hours to save his baby's life. He careened through traffic and sped along highways to an east Tehran government pharmacy. When he saw some 800 people queued outside the facility, he dropped to his knees. Like him, they were waiting to obtain state-funded medications.
"I cried and screamed, begging people to let me get through," Ali -- whom we have not fully identified for security reasons -- recalls.
Eventually, he skipped the line and returned with the medicine in time for his one-year-old daughter, Dory, to recover.
The incident happened just as Iran's landmark nuclear deal with six world powers led by the US was being signed in 2015. It was a moment when Iranian President Hassan Rouhani had promised Iranians an easier life, free of medicinal and food shortages, and where desperate scenes such as Ali's outside the pharmacy would become a thing of the past.
Iran was halting its nuclear program in exchange for international sanctions relief, appearing to turn the page on a 36-year history of diplomatic and economic isolation.
But dreams of a new reality for Iran screeched to a halt in May 2018 when President Donald Trump pulled the United States out of the nuclear deal. Despite repeated certifications that Iran was sticking to its end of the bargain, Trump unleashed several rounds of stinging sanctions on the country.
The US president said the penalties aimed to force Iran to end its military adventurism in the region, a demand that Iranian officials have repeatedly brushed off.
Officially, the sanctions exempt humanitarian goods, such as food, medicine and medicinal instruments. But in reality, shortages in essential goods have affected households across the country.
Ali now gets the medicines to treat his daughter's rare genetic disease, from friends living abroad. Her medical bill has more than doubled, forcing him to sell his car, work two jobs, and accumulate loans. He says that his entire salary from his day job as a waiter goes toward Dory's treatment.
"I am a wedding singer at night. I try to stay cheery and keep a smile on my face, but on the inside all I can think about is my daughter," says Ali.
Because of sanctions, Iran's health sector is struggling to keep up with soaring prices of medications and medical instruments, doctors tell CNN.
European banks, fearing secondary US penalties, are reluctant to do business with Iranian companies even those not blacklisted by the US. Medical companies have had to resort to paying intermediaries exorbitant sums to secure needed supplies, including imported medicines and medical instruments which have more than tripled in value during Iran's rapidly dropping currency, health professionals explain.
"Sanctions is the first problem in our country and in our system. We can't transfer the money and make the preparations for surgery. It's a big problem for us," says Dr. Mohammad Hassan Bani Asad, managing director of the Gandhi Hotel Hospital. "We have the procedures, but we don't have the instruments. It is very difficult for patients and maybe leads to death of some patients."
Though most of Iran's medicines are domestically manufactured, much of the primary materials, many of them imported, are in short supply. And while the state provides universal healthcare, some of the treatment needed for critical cases cannot be covered by state insurance.
A US State Department spokesperson has told CNN that US sanctions have exempted medical goods. "The United States maintains broad authorizations that allow for the sale of agricultural commodities, food, medicine, and medical devices by US persons or from the United States to Iran," the spokesperson said.
Budget over emotions
A middle-aged man suffering from lung cancer writhes and squirms on his hospital bed as Dr. Behrouz Emami checks on him. His eyes bulge as he gasps for air through an oxygen mask.
The cancer has metastasized to the man's brain, Emami explains. The doctor has recommended to the patient's family that he be sent to a private ward where he can spend his final days with his family.
But the family simply cannot afford it, says Emami. They must settle for daily visits of just one-hour a day at the government-funded ward.
"The decisions of families are not made by their emotions. They decide based on their budget," explains Emami.
Patients and their families are doubly affected by plummeting purchasing power across the country. It's a situation, Emami says, that has made a lot of treatable cases lethal.
"I have a patient upstairs ... I diagnosed him with brain cancer. The cost of biopsy, the chemotherapy and medication is very high. So, the family asked me if I could leave him be," says Emami. "Every day, we see this story here."
Even when families can afford medical equipment they often join long waiting lists. Cardiac pacemakers are in short supply in the country, and patients must abandon their regular lifestyles, and become admitted to hospitals where they are hooked up to a cardiac machine.
Emami tells CNN that some families are opting out of paying for feeding tubes for relatives with advanced Alzheimer's disease. Without the feeding tubes, the patients spend the rest of their days wired to machines in hospitals, instead of receiving home care.
Emami recalls a family meeting in which an elderly woman's children decided to go against his advice to discharge their mother with Alzheimer's disease: "(The children) told me the patient is yours. We don't have any money to spend on her."
"I explained to the children that when she stays here, it means that her life expectancy is reduced by 80% ... it means that she may have an infection and means the lady will die much sooner," says Emami.
'I'll do whatever it takes'
Accompanied by her mother, 5-year-old Dory visits Ali at work wearing a tutu skirt and a coat with leopard print. He carries her behind the bar where she plays with empty juice dispensers. Later she settles on his lap and plays games on his smartphone.
It's a break from her shuttling between home and the hospital, which she must visit at least once a week. Sometimes the doctors determine that she has to stay in her hospital bed for several weeks. It's a routine that will continue until she's 18-years-old, her father says.
But Ali says he's dedicated to helping her have a normal life: "It doesn't matter what Trump's sanctions do, I'll do whatever it takes to find her medication."
He puts a hand on his chest, puffing up his skinny frame. "I'll even fly myself to get them for her. Whatever it takes."