Iran’s health system ‘beyond disastrous’ from COVID surge

Hospital medics in Iran are triaging patients on the floors of emergency rooms and in cars parked on the roadside. Lines stretch for blocks outside pharmacies. Taxis double as hearses, transporting corpses from hospitals to cemeteries. In at least one city, labourers are digging mass graves.

Iran is under assault from the most cataclysmic wave yet of the coronavirus, according to interviews with physicians and health workers, social media postings from angry citizens, and even some unusually frank reporting in state media. The aggressive delta variant has led to record numbers of deaths and infections, and appears to be overwhelming the health system of a country that has been reeling from COVID-19 since the scourge began.

The latest phase of the crisis has intensified the challenges facing Iran’s new hard-line president, Ebrahim Raisi, testing his abilities just days after he took office.

“The situation we are facing is beyond disastrous,” said Dr Mahdiar Saeedian, a 39-year-old physician in Mashhad, Iran’s second-largest city. “The health care system is on the verge of collapse.”

Even during the 1980-88 war with Iraq, said Saeedian, who was born during that conflict, “it was not like this.”

The official virus death toll is 500 to 600 people a day, but even these record-high figures are disputed as low by some government media. Iran’s state television has said that one Iranian dies every two minutes — at least 720 a day.

Frontline doctors in Tehran, Isfahan, Khuzestan and Mashhad told The New York Times that the real death toll was closer to 1,000 a day.

Doctors also say that the true rate of infections is likely much higher than the official rate of about 40,000 a day because of insufficient testing and lack of access to care.

Medical personnel who were once afraid to speak out are now openly chastising what many Iranians see as gross misjudgment, incompetence and negligence in the nation’s leadership, from Supreme Leader Ayatollah Ali Khamenei on down.

They are especially furious over a dearth of vaccines, which Iran’s leaders refused to purchase in time or in sufficient quantities, instead holding out for domestically developed alternatives that may be too late. They banned vaccines made in the United States and Britain, even rejecting donations, because Khamenei said they had been designed by the West to “contaminate other nations.”

Less than 3% of Iran’s 85 million people have been fully vaccinated.

Nurses from COVID-19 wards are shown crying on state television. Doctors are posting videos on social media begging officials to act immediately before the crisis gets even worse: lock down the country and buy more foreign-made vaccines, they plead.

“Whatever budget you have, whatever steps you can take, get help from the world, do it to save people,” Dr Nafiseh Saghi, a renowned physician and professor of medicine in Mashhad, begged Iran’s leaders in a voice message posted on social media. “History will judge you.”

Iran’s leaders have repeatedly sought to blame the United States and its prolonged economic isolation of the country for a range of domestic crises, including the COVID-19 contagion.

Critics say the leadership has mismanaged the pandemic from the start: concealing accurate data, refusing to order quarantines, criminalising transparency by medical staff, prioritising development of insufficient homegrown vaccines and misleading the public by overpromising mass inoculations.

“Whoever is at fault must be held accountable,” said Dr Muhammad Reza Fallahian, a physician and professor of medicine in Tehran, the capital. “Our vaccinations are very, very late. What else can we doctors do that we are not doing? We are at the breaking point in Iran.”

In revelations that have shaken many Iranians, Dr Alireza Zali, the head of Tehran’s coronavirus committee, told Iranian news media on Wednesday that officials had not allowed the purchase of foreign vaccines because of the expense.

When experts from the World Health Organisation visited to assess Iran’s needs and offer help, Zali said, his superiors ordered medical personnel to portray the country as self-sufficient.

“They told us to praise Iran’s health care system,” he said. “We covered up real death tolls from the WHO and turned around international aid at the airport.”

In his first week in office, Raisi, the new president, is under fire, even from supporters, for refusing to lock down the country for two weeks at the request of the Health Ministry and for the vaccine shortage.

He acknowledged Wednesday that “not that many” doses of domestic vaccine had been produced yet and that he planned to import at least 40 million doses before winter.

A spokesman for Iran’s Food and Drug Administration, Kianoush Jahanpour, promised that an improbably high 120 million doses of vaccine would be imported within three months, including Pfizer and Moderna brands — as long as they were not produced in the United States or Britain.

Khamenei, who is responsible for Raisi’s ascendance and is believed to consider him a possible successor, said in a televised speech on Wednesday that the pandemic was the country’s top issue. He also said that efforts to vaccinate Iranians must be accelerated, opening the door to more purchases from producers in China, Russia and India.

But Khamenei also overruled Health Ministry warnings to cancel Shiite mourning rituals now underway for the holy month of Muharram, when thousands of faithful converge on shrines, tightly packed and often unmasked — ripe incubators for superspreading the virus.

The government’s refusal to impose such restrictions has invited some unusually blunt expressions of anger, even from supporters who risk retribution or at least accusations of disloyalty.

“If I say, ‘Raisi, by not quarantining Tehran when there are no hospital beds you are responsible for the rising deaths,’ am I considered counterrevolutionary?” Mehdi Sasani, a Tehran resident who voted for Raisi, asked in a Twitter posting.

Sasani related his family’s ordeal in battling the virus, from being unable to find a hospital bed to wandering for hours from pharmacy to pharmacy in search of prescribed medication. He said people lining up for health care and medication were cursing Khamenei.

“We are officially facing a situation of having no government,” Hamidreza Salehi, a computer programmer, said in a Twitter posting. “They have lost control of everything.”

Despite the ravages of the most recent virus wave, pictures and videos from Iran mostly show business as usual on the streets. Offices, shops and restaurants are open at full capacity. No restrictions have been enforced on masking, travel or social distancing. Many people, exhausted from pressures of the poor economy, the pandemic and distrust of government, are not following recommended protocols.

The deputy health minister, Iraj Harirchi, said last week that Iran’s death toll would rise for six weeks, according to estimates by international agencies. Nearly all of Iran’s 31 provinces are labelled “red,” the highest risk level under Iran’s alert system.

In what appeared to be a concession to medical critics, Iran's Revolutionary Guard, the powerful paramilitary force that reports directly to Khamenei, said Thursday that its regional commanders would take steps to help prevent unfettered movement of people around the country. Details on how such restrictions would work remained unclear.

A mother in Tehran with a 13-year-old son who contracted COVID-19 said that when his respiratory symptoms worsened she could not find a hospital bed and that doctors who made house visits for hefty prices told her they had no openings for days. To obtain the prescribed antiviral medications, she said, she waited from midnight to 3 a.m. outside a 24/7 pharmacy.

Ehsan Badeghi, a journalist for the government newspaper Iran, said in an interview that his next-door neighbour, a 43-year-old mother of two young children, had died a few days earlier waiting for an ambulance. He said the woman had been unable to find a hospital bed and could not afford home care services.

“Vaccination or quarantine both need money and planning and neither is happening here,” he said. “So the pandemic rages and will continue to get worse. We are dying and nobody cares.”

Critical medical therapies such as intravenous fluids, oxygen tanks and antiviral medications are in short supply at hospitals and pharmacies and are sold in the black market at exorbitant prices, according to interviews with doctors from four cities.

Medical staff are also physically exhausted and emotionally drained as they work double shifts in hospitals without a break, said Dr Ali Nikjoo, a 43-year-old psychiatrist in Tehran. He said he has received many calls from colleagues battling depression, anxiety and grief.

“The medical staff is walking through a minefield every day,” Zakani said. “There is an overwhelming feeling of abandonment among not just doctors and nurses but ordinary people. We are floating and drowning.”

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