Intended for healthcare professionals

Opinion

Iranian healthcare caught in political crossfire: a global call to action

BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1642 (Published 17 July 2023) Cite this as: BMJ 2023;382:p1642
  1. Anonymous
  1. US

Healthcare professionals in Iran are risking their lives to treat the wounded and maintain medical ethics, the global health community must back them

Medical impartiality is a well established principle but the impartial practice of medicine has brought clinicians into conflict with the authorities in Iran. The current crisis in Iranian healthcare and protests began in September 2022, following the killing of Mahsa “Jina” Amini by the “morality police” for improper hijab.1 The authorities tried to cover up the truth of her death, but 800 members of the Iranian Medical Council spoke up.1 Ten months after Iranians started protesting for their basic human rights, the morality police have resumed their patrols.2

There have been reports of security forces deliberately injuring protestors.1 When the wounded show up to hospitals to seek medical attention, they are often identified and detained by security agents.1 Authorities have also interrupted treatment of the wounded to transfer them to detention centres, against medical advice.4 Ambulances are used to transport these patients directly to prisons.1 On 25 October 2022, Iranian doctors held a peaceful rally outside the Tehran Medical Council to protest the militarisation of hospitals and ambulances and the prevention of medical care for the injured.1 Security forces opened fire on demonstrators and killed a surgeon.1 Aylar Haghi, a medical student at the University of Tabriz, was killed by gunshot at a protest in November.3 Many doctors have been harassed, kidnapped, arrested, and murdered for providing medical care for wounded protestors or attending protests.145 Upholding the Hippocratic oath and their ethical obligations under civil unrest has come at a high cost for doctors in Iran.

International humanitarian laws were established to prevent atrocities and to protect healthcare professionals and their services during armed conflict.67 According to these laws, governments, armed forces, and other authorities have an obligation to ensure that medical professionals and facilities are protected and can provide care to all in situations of violence.67 This obligation includes a responsibility to protect clinicians, healthcare facilities, and medical transport.89 Neither the wounded nor healthcare professionals should be attacked, mistreated, or persecuted.67 Intentional attacks against medical professionals in internal armed conflict is considered a war crime, punishable under international humanitarian and criminal law.7 Furthermore, medical professionals are obliged not to breach doctor-patient confidentiality or act contrary to the rules of medical ethics, which may mean refusing to obey orders that are illegal or unethical.7

According to the World Medical Association, medical ethics in times of conflict is the same as in peacetime.8 A clinician’s primary obligation is still to their patients and their primary goal is preserving health and saving lives.8 Medical professionals are bound by international humanitarian laws to treat all casualties impartially and confidentially, without discrimination based on factors such as a patient’s religion, political beliefs, or reason for injury.7 The injured are protected by the Geneva Conventions from denunciation to authorities who might harm them.6 If a law is unjust or violates ethical values, clinicians have a responsibility to attempt to change it.9

Doctors are expected to speak out against atrocities, do anything within their power to prevent retaliations against healthcare and the wounded, and encourage authorities to recognise their obligations under humanitarian law to protect medical professionals and infrastructure in situations of violence.67 These expectations are hard to meet in Iran when clinicians risk their lives for simply doing their job and even peaceful protests are met with force and risk of reprisal.

Iranian doctors have deployed various strategies to honour their obligation of ethical care for the wounded. Healthcare professionals in Iran and worldwide have been using social media platforms to provide medical recommendations to the wounded.1 There are brave doctors in Iran who continue to treat injured protestors in person, outside hospital settings, despite the great risk to themselves and their families.1

Access to healthcare should not be used as a tool of oppression. Iranian doctors have resisted becoming pawns in this systemic oppression and demonstrated bravery, ingenuity, and resilience in upholding their medical and ethical obligations. I would like to urge more clinicians and medical organisations to condemn the continued violation of human rights and war against Iranian medical professionals. The international community can provide support by being the voice of Iranians and healthcare professionals by raising awareness of the situation and healthcare crisis in Iran through various avenues, such as social media platforms, protests, and medical meetings. The medical community can contact their local governments and international organisations to verbally condemn crimes against humanity and attacks on Iranian healthcare. Meaningful action can be taken against the perpetrators of these crimes through international laws, not releasing Iranian frozen assets in international bank accounts, sanctions, and denouncing responsible individuals and organisations as terrorists.

Footnotes

  • The author wishes to remain anonymous.

  • This article is dedicated to freedom fighters in Iran and worldwide.

  • Competing interests: None.

References