From a Strategy of “Human Casualties” During COVID-19 to the Black Market in Medicines and the Silent Death of Sick Prisoners
1. Framework of the Report and Key Findings
Universal Health Coverage emphasizes access for all people, everywhere, to essential, quality health services without financial hardship. Extensive and well-documented evidence demonstrates that in Iran this principle has not only failed to materialize but has been systematically violated.
Based on official admissions by state authorities, reports published by regime-affiliated media, data collected by the NCRI, and international reactions, this report shows that the situation in Iran does not reflect an isolated crisis or administrative failure. Rather, it reveals a sustained pattern of decision-making and implementation in which public health and human life are subordinated to political, security, and economic considerations.
2. COVID-19; Lethal Policymaking and Systematic Concealment
Official Admission of 700,000 Deaths
On 20 September 2025, Mohsen Mansouri, Executive Deputy to President Ebrahim Raisi, stated that by the end of Hassan Rouhani’s administration, approximately 700,000 people had died from COVID-19 in Iran. This admission sharply contradicts the last official figure announced on 3 August 2022, which reported 142,000 deaths. The discrepancy exceeds 7.5 times the regime’s official statistics.
Resistance Data; More Than One Million Victims
The Secretariat of the National Council of Resistance of Iran reported that since March 2020 it had relied on daily field reports from the People’s Mojahedin Organization of Iran across all 31 provinces. Through more than 730 uninterrupted public briefings, it announced on 8 April 2022 that the real number of COVID-19 victims had exceeded 530,000, using what it described as extreme caution. Mansouri’s later admission indicates that the final death toll surpassed one million, confirming that even earlier estimates were conservative.
3. The Direct Role of Ali Khamenei; From Calling COVID-19 a “Blessing” to Banning Vaccines
On 3 March 2020, at the height of the pandemic, Supreme Leader Ali Khamenei declared:
“This calamity is not that significant… it can be an achievement… the calamity can turn into a blessing for us.”
These remarks were broadcast by state media and reflected the regime’s instrumental approach to mass death.
On 8 January 2021, Khamenei issued a direct order banning the import of American and British COVID-19 vaccines. This decision was taken while vaccination campaigns were underway globally and preventable deaths in Iran continued to rise.
4. The “Economic Blessing” of COVID-19; Profiteering From Ineffective Vaccines
On 2 September 2021, the state-run newspaper Javan revealed that Iran had purchased ineffective Chinese vaccines worth tens of trillions of rials without scientific evaluation and had compelled the population to use them despite knowing they were ineffective. The report cited official acknowledgments, including by senior health officials, that these vaccines lacked efficacy and caused adverse effects. It further noted cases in which patients who were not expected to die lost their lives after receiving these products.
On 14 September 2021, the newspaper Shargh disclosed that Barkat, a company affiliated with the Islamic Revolutionary Guard Corps, charged 200,000 tomans per vaccine dose, extracting more than one billion USD from public funds for an estimated 120 million doses.
5. Rising Drug Prices, the Naser Khosrow Black Market, and the Chain of Corruption
Medicines; From Essential Goods to Luxury Items
In January 2025, the state news agency Mehr reported official price increases for 955 pharmaceutical items. Some drugs experienced price hikes of 50 to 100 percent, including:
- A tablet rising from 20,000 to 50,000 tomans
- An ointment increasing from 12,600 to 37,000 tomans
- Dexamethasone rising from 7,700 to 19,000 tomans
- Blood glucose sensors doubling from approximately 4 million to over 8 million tomans, while becoming scarce
These figures reflect only the official market; real access for patients is often determined by the informal sector.
Naser Khosrow; The Core of Iran’s Pharmaceutical Black Market
Iranian media have long identified Naser Khosrow Street in Tehran as the central hub of the pharmaceutical black market. Reports confirm that medicines unavailable in licensed pharmacies are sold there at multiple times their official prices.
The compiled data indicates that life-saving medicines for cancer patients, dialysis, organ transplants, and rare diseases, many imported with subsidized foreign currency, are systematically diverted from the legal supply chain and sold on the black market for tens of millions of tomans.
Actors and Mechanisms
The continued operation of the Naser Khosrow market is impossible without structural protection. The area operates in the center of Tehran, under constant police and security surveillance, and in close proximity to state institutions.
Former Health Minister Saeed Namaki publicly referred to “organized corruption in the pharmaceutical and medical equipment sector” and questioned the fate of 1.3 billion USD. The data links parts of this network to companies affiliated with the IRGC, which profit directly from artificially created shortages.
Human Consequences
According to official statistics, even before the escalation of the drug crisis, workers and pensioners were spending approximately 1.4 million tomans per month on medical care, while average monthly incomes stood at around 6 million tomans. With the recent surge in drug prices, medical treatment has become effectively inaccessible for large segments of society, forcing patients to choose between poverty and death.
6. Iranian Prisons; Waiting Rooms of Death for Sick Prisoners
Reliable evidence from inside Iranian prisons demonstrates that denial of medical care to sick prisoners constitutes a deliberate policy.
Representative Cases
- Maryam Shahreki, 40, Fardis Prison (Karaj); suffered severe cardiac symptoms, was misdiagnosed with gastric pain, and died on 11 September 2025 before transfer to hospital.
- Jamileh Azizi, Qarchak Prison (Varamin); transferred to the prison clinic with heart attack symptoms on 18 September 2025, returned untreated, and died hours later.
- Somayeh Rashidi, 42, Qarchak Prison; an epilepsy patient whose repeated seizures between 15 and 19 September 2025 were dismissed as “feigning illness”, leading to critical deterioration.
- Seyed Abolhassan Montazermoqaddam, Qezel Hesar Prison; a death row prisoner with multiple serious illnesses requiring urgent surgery, denied proper treatment.
- Mir Yousef Younesi, 72, Fashafouyeh Prison; hospital transfer reportedly cancelled three times at the last moment.
- Ayoub Parkar, 69, Sheiban Prison (Ahvaz); suffering from multiple chronic illnesses after 17 years of imprisonment, denied adequate care.
Patterns of Medical Deprivation
These cases reveal consistent mechanisms, including deliberate delays in hospital transfers, security control over medical decisions, labeling complaints as “malingering”, humiliating conditions such as transfer in restraints, denial of essential medicines, and forcing prisoners to cover medical costs themselves.
7. International Condemnations and Reactions
International human rights bodies and UN special procedures have repeatedly expressed concern regarding access to health care in Iran, particularly in prisons.
Amnesty International, in its investigative report “Waiting Rooms of Death”, stated that Iranian authorities deliberately deny sick prisoners access to life-saving medical care, effectively turning prisons into places of slow death.
UN Special Rapporteurs on torture and on the right to health have also raised serious concerns in official communications, calling for the immediate and unconditional provision of medical care to all sick prisoners in Iran.
8. Conclusion
The cumulative evidence demonstrates a systematic violation of the right to health in Iran. From lethal COVID-19 policies and large-scale concealment of death figures, to profiteering in vaccines and medicines, the institutionalization of the Naser Khosrow black market, and the deliberate denial of medical care to sick prisoners, health has been subordinated to political, security, and economic priorities.
This report documents a coherent pattern in which preventable suffering and death have become normalized as instruments of governance.
