TEHRAN – In an exclusive interview with Tehran Times, Ruth Gibson, a scholar at Stanford University’s Center for Innovation in Global Health and the Center for International Security and Cooperation, examines how international sanctions have systematically weakened Iran’s public health system under the guise of political pressure.

Gibson analyzes how U.S.-led unilateral sanctions and UN-mandated measures under Resolution 2231, despite formal humanitarian exemptions, have disrupted Iran’s access to essential medicines and medical equipment. She argues that legal ambiguity and over-compliance by banks and suppliers have translated into shortages, rising costs, and declining healthcare delivery.

She discusses the impact of the post-2018 “maximum pressure” campaign on women, children, and patients with chronic illnesses, warning that sanctions increasingly function as economic warfare against civilians rather than targeted policy tools.

The following is the full text of the interview:

Can you describe the main ways in which sanctions, even with humanitarian exemptions for essential goods like medicine and medical equipment, translate into real-world disruptions in a country's health system?

When the UN Security Council Resolution 2231 was reimposed, it essentially meant that multilateral sanctions mandated by the United Nations applied to all member states. While there are humanitarian exemptions for medicines and medical equipment, these exemptions are not clearly defined at a level where companies can confidently continue to sell. Companies face significant risks if they supply medicines or medical equipment to Iran, and ultimately, it is each company's independent decision whether to engage in trade. This uncertainty is a major problem for health and the right to health in Iran.

Based on Resolution 2231, how should we understand the differences between unilateral sanctions and UN-mandated sanctions in terms of their humanitarian impacts?

Unilateral sanctions occur when a single nation imposes restrictions independently, outside the UN framework. For example, the United States has imposed more unilateral sanctions against Iran than any other country, primarily related to the nuclear program and human rights concerns.

UN-mandated multilateral sanctions, by contrast, require all UN member states to comply. Some of the most severe examples of human suffering have resulted from multilateral sanctions because so many countries participate, affecting GDP, the ability to trade internationally, access to goods, and international banking. Multilateral sanctions are becoming less common because it is increasingly recognized that ordinary populations often bear the brunt of these measures, despite the original intent.

In what ways has the U.S. maximum pressure campaign since 2018 acted as economic warfare, and what historical parallels emerge from decades of global sanctions research?

The U.S. maximum pressure campaign targets nuclear proliferation and arms control, particularly Iran’s adherence to IAEA mandates. My focus, however, is on the impact on the population, particularly women and children, and human health.

Sanctions affect the prices and availability of infant formula, dialysis equipment, renal replacement therapy, oxygen machines, and other essential medical supplies. These impacts were clearly documented in the 2022 report of the UN Special Rapporteur on Unilateral Coercive Measures on Iran, which highlighted how sanctions and financial restrictions contributed to hospitals struggling to procure masks, protective gowns, and other critical medical items. While sanctions aim to pressure nuclear programs, in reality, they drive up the cost of essential goods and create scarcity, which is where human suffering emerges.

You frequently refer to over-compliance by banks and suppliers as a major driver of humanitarian harm. Could you explain how this operates in Iran and why it is difficult to correct?

Companies that do not comply with UN-mandated or U.S. sanctions risk severe fines, often in the millions. This creates a chilling effect: even when exemptions exist for essential medicines and equipment, companies choose not to trade with Iran.

I believe solutions exist through clear communication and policy guidance from both the UN and the U.S. government to clarify exemptions, reduce risk for companies, and prevent unintended consequences for local populations. Currently, breakdowns occur because businesses make independent decisions under legal uncertainty, which limits the flow of critical goods.

Do you think that Western policymakers genuinely assess the humanitarian cost of these sanctions, or are these effects treated as acceptable collateral damage?

There is increasing awareness that sanctions, particularly broader economic and financial tools, cause severe human suffering. Targeted sanctions attempt to minimize this, but gaps remain. The challenge lies in the interplay between policy decisions and how businesses respond. More needs to be done to ensure that exemptions for essential goods are effectively communicated and applied, so populations do not bear unnecessary harm.

Based on your research and data, what long-term health consequences have sanctions had on Iran's public health system, particularly for chronic illnesses, women, and children?

Sanctions have direct implications for Iran’s healthcare system. Following the U.S. withdrawal from the JCPOA in 2018, Iran’s GDP dropped significantly, inflation rose, and access to food and medicine became more difficult.

Healthcare delivery suffers due to the inability to secure equipment and medicines. Agricultural production is also affected, impacting the right to food. Research consistently shows that the most vulnerable populations—women, children, and the elderly—experience the greatest suffering, including elevated mortality rates.

Do you believe the international community will retain sanctions as a default foreign policy tool, or is the human cost still politically invisible?

Sanctions are a powerful tool for exerting pressure short of military action and are often used alongside military measures. Over the last decade, awareness of their humanitarian impact has grown, but policymakers still face challenges in implementing safeguards. The key is improving communication and design so that populations are not unduly harmed.

Do you think the current international sanctions architecture is capable of reform, or does it require a fundamentally different approach to protect civilians?

The UN’s creation of the 2022 report of the UN Special Rapporteur on Unilateral Coercive Measures on Iran highlights the importance of evaluating sanctions’ impact on human rights, including the right to health and food. Reform is possible if policies are crafted pragmatically, informed by historical patterns, and include clear mechanisms to prevent humanitarian suffering. Policies can achieve their intended aims while minimizing harm to civilian populations.