Early in the 12-day exchange of missiles between Iran and Israel, Jalal, an ophthalmologist based in Ahvaz, Khuzestan province – some 650 kilometres southwest of Tehran – received unexpected orders. Like hundreds of others, he was summoned by the Islamic Revolutionary Guard Corps (IRGC) to reinforce the capital’s overstretched hospitals. Though the ceasefire was announced on 23 June, Jalal was still in Tehran days later, tending to war casualties.
“Iranians were fleeing Tehran because of the bombardment, while the Revolutionary Guard was recruiting hundreds of us from across the provinces to work in hospitals dedicated to the Guard, the army, and military bases,” the eye doctor said.
Ten of his colleagues, all surgery specialists, were transferred by force. “A representative from the Guard came to our hospital, requested the staff roster, and selected all surgeons, regardless of age. They were taken to Tehran immediately,” he recalled.
The Israeli strikes, which began on 13 June and focused heavily on the capital while also hitting strategic sites elsewhere, killed an estimated 600 people – security personnel and civilians – and injured thousands. The influx overwhelmed hospitals already strained by years of sanctions, staff shortages, and infrastructure decay.
Israel claims to have struck 900 sites and taken out 200 missile launchers inside the Islamic Republic. The International Atomic Energy Agency, the UN’s nuclear watchdog, also claims that centrifuges at the Fordow enrichment plant are "no longer operational" after US strikes on three of Iran’s nuclear facilities last weekend.
In retaliation for the US strikes, Iran fired missiles at a US military base in Qatar, while Tehran has moved to cease cooperation with the UN’s nuclear watchdog. According to the US-based Human Rights Activists News Agency, at least 705 people were also rounded up on security charges by Iranian authorities during the 12-day missile exchange.
A ceasefire has held since 24 June, but in addition to sparking an immediate crisis of displacement and anxiety among millions desperate to avoid being caught in the line of fire, the conflict has also brought longstanding Iranian vulnerabilities into sharp focus.
A fragile system pushed past its limits
Iran’s healthcare sector has long been under pressure. Years of international sanctions, especially those reimposed by US President Donald Trump in 2018 – during his first term – have curtailed access to medicines, medical devices, and essential supplies. While humanitarian goods are technically exempt, banking restrictions and sanctions on logistics and insurance have made procurement slow and costly.
Human Rights Watch warned back in 2019 that these constraints threaten Iranians’ right to health, particularly those needing lifesaving treatments.
Iran’s domestic pharmaceutical production, which once covered much of the population’s basic medical needs, now struggles with raw material shortages. According to local data, 4,500 health workers applied to emigrate in 2024, on top of 7,000 who left the previous year. The country is ranked among those with the highest rates of brain drain globally.
This exodus has left rural provinces chronically short of specialists, even in times of peace. The conflict further depleted local capacity, as doctors were reassigned to military hospitals in Tehran.
“Doctors used to move to Tehran for higher salaries,” Jalal said. “Now, everyone tries to get out – no one wants to risk being pulled into military bases.”
“A hospital, or a battlefield?”
At Imam Khomeini Hospital, located near Revolution Square in central Tehran, and at Jamaran Hospital in the city’s north, staff faced conditions more akin to combat zones than medical facilities.
Even after the shelling ceased, the two hospitals continued to receive a steady stream of casualties. Doctors described being unable to manage the overwhelming volume of wounded or the handling of bodies arriving each hour.
“We waited 20 minutes for an ambulance. When it came, they refused to take him to Imam Khomeini – it was full. They took us to Jamaran.”
Among them was Amina Ansari, a philosophy professor from Qom who had travelled to Tehran on 15 June to complete paperwork for her doctorate. She was accompanied by her 27-year-old son, Mohammad Ali, who was driving her. Their route took them to Taleghani street, where an Israeli missile struck. Mohammad Ali sustained multiple shrapnel injuries.
“We waited 20 minutes for an ambulance,” she said. “When it came, they refused to take him to Imam Khomeini – it was full. They took us to Jamaran.”
There, she found dozens of patients – many of them children – scattered through the corridors. Her son bled for over 30 minutes before a doctor could attend to him. He underwent two operations to remove shrapnel and repair his leg.
“It looked more like a chaotic marketplace than a hospital,” she said. “People were lying on stretchers in hallways and outside – anywhere there was space.”
Capacity stretched, staff deployed
Imam Khomeini Hospital, the largest in Iran, took the brunt of the emergency load due to its central location near targeted areas. Farham Arefi, one of the attending physicians, described a system buckling under pressure.
“We couldn’t keep up with the waves of dead and injured. The medical team was too small. The workforce was drained. It felt like a battlefield,” he said. “We had no choice but to discharge patients immediately after treatment to make room for the next round.”
As casualties mounted, hundreds of doctors were pulled from provinces such as Qazvin, Isfahan, Gilan, and Khuzestan to treat the wounded in military and Guard-run hospitals.
These redeployments were done quietly, bypassing official announcements and instead using direct orders sent to hospital administrators across the country.
But in poorer regions, this meant fewer staff at civilian hospitals already facing shortages. Elective surgeries were suspended. Basic services – maternal care, dialysis, cancer treatment – were delayed or denied. The consequences were felt most acutely in remote and underserved areas.
Conflicting narratives from the top
Despite the worsening conditions on the ground, government officials insisted the system was coping. In an interview with semi-official Tasnim News, Ali Asghar Bagherzadeh, a member of the Iranian parliament’s Health and Treatment Committee, denied the existence of any medicine or blood shortages. He claimed that healthcare workers were delivering services “without interruption”.
But multiple accounts from doctors, aid workers, and patients suggested otherwise.
In Qom, a Red Crescent aid worker, speaking anonymously, described how orders were given on the first day of bombardment to mobilise 50 doctors from various specialties. They were told they would only be treating IRGC and military casualties in the event of strikes on local installations.
He said a colleague from Gilan told him the IRGC threatened jail for doctors who refused to serve – and warned that even after hostilities ended, those who declined assignments would not be allowed to return to their former posts.
The same source confirmed that doctors were offered high salaries and the promise of permanent roles in Guard-affiliated medical centres in Tehran after the war.
Alongside staffing gaps, a second crisis quietly exploded: access to medicine.
Pharmacists and distributors reported that the IRGC began withdrawing large quantities of medicine from civilian stockpiles – without payment – early in the conflict. Those supplies were redirected to field hospitals and military care.
“During the Iran-Iraq War, doctors were drafted, medicines were seized, and the public suffered. What’s different now is how fragile the system already was before this war started.”
Reyhaneh Z., a pharmacist from Gilan province, described the fallout. “By the second day, we couldn’t fill prescriptions. The warehouses were empty, and our suppliers said they had been requisitioned by order of the Guard,” she said.
Iran’s pharmaceutical system, already under strain from sanctions, began to shut down. Many key drugs for chronic conditions became unobtainable. Companies were already struggling to source raw materials before the war as a result of the sanctions. After the war, pharmacies were forced to turn patients away.
According to a former health ministry official who served during former Iranian president Hassan Rouhani’s first administration from 2013-2016, the pattern mirrored past conflicts.
“During the Iran-Iraq War, doctors were drafted, medicines were seized, and the public suffered,” he said. “What’s different now is how fragile the system already was before this war started.”
He added that legal threats against doctors remain a powerful deterrent. “Refusal to comply with military orders can result in imprisonment,” he said. “It disrupts the whole healthcare system when people are pulled randomly, without planning, during a national emergency.”
This piece was published in collaboration with Egab. Edited by Ali M. Latifi.
