"Many life-saving drugs are no longer available," said an Iranian pharmacist who wished to remain anonymous, adding that the country's supply crisis has worsened dramatically in recent months.

Although the Iranian Food and Drug Administration produces more than 90% of the country's medicines on its own, it faces raw materials shortages because of import bans. Iran has also been unable to purchase special medicines — like those required by cancer patients — since snapback sanctions were triggered in September.

At the time, Mohammad Jamalian, a member of the Iranian parliament's health committee, told the Iranian news agency ILNA: "Many people stop treatment because they can't afford it. That is a big problem. Because serious health complications loom without medication."

The activation of the so-called snapback mechanism and the resulting reimposition of all previous UN sanctions was a move brought by France, Germany and the UK — signatories to the 2015 Joint Comprehensive Plan of Action (JCPOA) or Iran nuclear deal — to put pressure on authoritarians in Tehran to change course on their nuclear program.

In practice, however, sanctions tend to hurt the general population rather than political elites.

Applying pressure on the civilian population is integral to the concept of sanctions, as Jerg Gutmann, a professor of behavioral law and economics at Germany's University of Hamburg, told DW. "That pressure is supposed to force decision-makers to change policy. The impoverishment of the general population is seen as an acceptable side effect."

Still, Gutmann added, the aim of sanctions is never to keep people from getting life-saving medicine.

'Sanctions are not smart'

"There is often talk of 'smart' sanctions," said Reza Majdzadeh, a professor of health and social care at the University of Essex in the UK.

"From a health perspective, this argument doesn't hold. Sanctions, even if targeted, have ripple effects that reach far beyond their intended scope," he told DW.

Majdzadeh has spent years researching the impact of sanctions on the health care systems of countries like Afghanistan and Iran. "When it comes to data, we face major limitations — especially in countries like Afghanistan, where reliable health data are sparse due to weak research infrastructure. Still, the trend is clear: poverty increases and healthcare systems collapse."

Majdzadeh and Gutmann are co-authors of a study — published in the medical journal The Lancet in early November — on how reimposed UN sanctions are affecting health care in Iran.

The study shows that sanctions imposed to enforce international obligations have countless unintended consequences for public health in targeted countries — especially due to very limited access to important drugs and medical equipment. Previous experience shows that prices for important medication can rise by 300% in such situations.

Smugglers, drug gangs profiting

In Iran, it's the poorest who are being hit hardest, with the situation made all the worse by chronic mismanagement and high inflation. Those with means lean on friends and relatives abroad for help, but poorer families are forced to look for medication on the black market.

Organized smuggling rings and drug gangs are among the biggest profiteers, selling uninspected and at times expired pharmaceuticals to those in desperate need.

"There are lots of Telegram channels, each with thousands of members, where medicine is being sold," the Iranian pharmacist explained. "Many of those pharmaceuticals are expired."

Experts like Majdzadeh are calling for binding international rules that not only include humanitarian exemptions, but also effectively implement them — creating transparent and independent oversight mechanisms to identify supply gaps in sanctions situations early on, for instance by working more closely with international organizations like the World Health Organization. 

Sill, Gutmann said Iran has no short-term path past the current difficulties it faces as financial sanctions freeze it out of international markets. And, he added, sanctions will likely remain an instrument with which nations seek to enforce international law and assert their interests.

"Objectively, it is just as questionable to fundamentally dismiss sanctions as it is to blindly trust in their use like politicians do. It's about informing the public on the benefits and risks so that political decisions can be made responsibly," he said. 

This article was originally written in German and translated by Jon Shelton.