Last month, the U.S. Department of State released a video addressed to the people of Iran. In the video, Trump administration official Brian Hook claims that it is a “myth� that sanctions target Iran’s access to medicine. For more than a decade, my fellow Iranian medical professionals and I have been struggling to protect patients from the fallout of U.S. sanctions. We have studied sanctions impacts on Iran’s health care sector and advocated for better responses from our own government. Our findings make clear that the harms being inflicted on Iranian patients are not mythology.

Today’s integrated and interconnected world depends on banking systems and trade networks that are dominated by the United States. Consequently, the U.S. government is able to use economic sanctions to cause harm to economic, political, and even social relations in target countries with relative ease.

Although U.S. sanctions are engineered in a way that may appear not to target humanitarian access to food and medicine, in practice U.S. sanctions function as a tool of economic war.Officials in Washington continue to insistthat they maintain “exemptions� to their sanctions to protect humanitarian trade, even after the International Court of Justice has ruled that these exemptions are insufficient, leaving “little prospect of improvement� in the “serious detrimental impact on the health and lives� of Iranians individuals. At the end of the day, it is incumbent on the United States to heed this humanitarian warning.

Although U.S. sanctions are engineered in a way that may appear not to target humanitarian access to food and medicine, in practice U.S. sanctions function as a tool of economic war.

Although U.S. sanctions are engineered in a way that may appear not to target humanitarian access to food and medicine, in practice U.S. sanctions function as a tool of economic war.

Under U.S. President Donald Trump, the situation has gotten worse. Census Bureau data shows that the United States exported an average of $26 million of pharmaceutical products to Iran annually during the Barack Obama-era sanctions. Exports have averaged just $8.6 million a year in the last two years under the more draconian sanctions policies of Trump.

The Trump administration has also made it more difficult for European countries to export medicine to Iran. Swiss pharmaceutical exports to Iran fell 30 percent from 235 million Swiss francs ($240 million) in 2017 to 163 million francs ($167 million) last year, according to Swiss customs data. Even though sanctions were only fully reimposed in November 2018, Swiss exports that year fell below the 173 million francs ($178 million) annual average observed from 2008 to 2015.

Similarly, French pharmaceutical exports to Iran fell 25 percent from 194 million euros ($218 million) to 146 million euros ($164 million) last year, slipping below the 2008 to 2015 average of 150 million euros ($168 million), according to data from Eurostat.

In response to such pressures, and as part of its post-revolution policies of self-sufficiency, Iran has made important strides in safeguarding its people’s access to medication. Iran is a world leader in the production of generic drugs, helping significantly lower the cost of health care. According to Akbar Barandegi, director general of Iran’s Food and Drug Administration, almost 97 percent of the country’s needed pharmaceutical doses are provided by about 100 local pharmaceutical companies, most of which belong to the private sector. Just 3 percent of demand is met with imports, purchased from many of the world’s largest pharmaceutical companies.

According to the Lancet, chemotherapy drugs such as asparaginase, the leukemia treatment mercaptopurine, and even the basic pain killer paracetamol have run out of stock, threatening the treatment of thousands of children.

These purchases may form only just a small proportion of total demand, but they relate to specific medications vital for the well-being of many patients, particularly those with advanced or chronic diseases.

Last year, several of my colleagues who work in the field of pediatric oncology published a note in the Lancet showing that chemotherapy drugs such as asparaginase, the leukemia treatment mercaptopurine, and even the basic pain killer paracetamol had run out of stock, threatening the treatment of thousands of children. Access to these medications is being significantly disrupted as a result of U.S. sanctions against Iran. This disruption takes three primary forms.

First, sanctions impact the availability of imports. While imports represent just 3 percent of Iran’s total demand by unit, they account for 39 percent of the country’s needs by value, reflecting the fact that imported medicines are typically five times more expensive than domestically-made equivalents and the fact that Iran tends to import specialized drugs, which are generally more expensive.