The human cost of economic sanctions and strategies for building health system resilience: A scoping review of studies in Iran

Abstract

Objectives

This review aimed to analyse the impacts of international economic sanctions on the overall health status of Iranians and the health system performance of Iran, in addition to identifying effective strategies for making the health system resilient to sanctions.

Study design

A scoping review.

Methods

Three databases and grey literature were reviewed, and additional papers were identified in the lists of references. Two authors reviewed papers to check duplications and screen through inclusion/exclusion criteria. Furthermore, a narrative approach was employed to synthesise the findings.

Results

Given overall health impacts, economic sanctions are believed to have adverse effects on Iranian's health and cause significant financial hardships in accessing healthcare services. These hardships mostly affect those in marginalised and vulnerable groups. Economic sanctions degrade Iran's health system by negatively impacting health services' availability. The detrimental effects of sanctions on economic and social circumstances were also documented. Economic sanctions could also adversely affect health research and education. Most strategies identified for health system resilience to sanctions are related to the health system governance.

Conclusions

Even if essential medicines and supplies are exempted from the sanction regime, the impact of economic sanctions on public health is unavoidable. The quantification of the effect economic sanctions on different health‐related areas needs by further research. The measures identified for dealing with sanction can be considered in other countries but more work is needed to explore how health of people can be resilient against negative consequences of sanctions.

Highlights

Our recent review of the effects of international economic sanctions on Iran led to worthwhile findings:

• There are no intelligent sanctions. The economic sanctions will inevitably affect public health even if essential medicines and supplies are exempted from the sanction regime.

• It is difficult to measure the effects of economic sanctions on health and their consequences. A rigorous research methodology is needed to analyse the specific effects of economic sanctions on various health outcomes.

• There is a shortage of solid evidence regarding effective and feasible measures to make the health system resilient against economic sanctions. The effectiveness and extent of these measures need to be evaluated—most of the measures found in the literature focus on strengthening the health system governance.