Iran International
An increasing number of Iranian doctors and nurses are leaving the profession or emigrating, mainly due to very low wages, raising concerns about a serious shortage of healthcare workers.
Iranian medical and government officials have repeatedly warned in the past few years about the inevitable deterioration of the healthcare system and its possible collapse if the same trends continue.
Mohammad Raiszadeh, the head of the Medical Council of the Islamic Republic of Iran (IRIMC), the non-governmental licensing and regulatory body for the medical profession, said at a conference Thursday that forty percent of general practitioners have left the profession.
IRIMC is a non-governmental licensing and regulatory body and a recognized trade union for Iranian medical doctors with nearly 300,000 registered members.
Raiszadeh said young physicians no longer show interest in continuing their education to specialize and many are emigrating.
Only 100 have applied for the 385 available residency positions, he said, adding that there is no interest in some residency positions, such as anesthetics, for which no one applied. He warned that there is already a highly critical shortage of anesthesiologists.
A parliamentary report last year said the number of general practitioners in Iran has dropped to 13 per 10,000. This puts Iran behind most regional countries including Saudi Arabia, Azerbaijan, the United Arab Emirates, Turkey, Turkmenistan, and Oman but ahead of others including Iraq, Pakistan, Bahrain, and Afghanistan.
The head of the Medical Council also pointed out at the conference that teaching at medical universities has also lost its attraction and 850 faculty members left their academic positions in the Iranian calendar year that ended in March 2024.
Iranian media and medical officials have also repeatedly warned about the exodus of medical professionals and healthcare workers in the past few years and said the country may be forced to import doctors soon.
Government officials refuse to acknowledge the problem and have never offered concrete figures on the number of doctors, midwives, and nurses who have left the country for better jobs in neighboring countries including the United Arab Emirates and Oman, as well as elsewhere in the world.
Raiszadeh attributed the declining appeal of the medical profession to the slow pace of increases in doctors' fees. He noted that, compared to the salaries of civil servants and wages of workers, doctors' incomes have seen minimal growth in recent years. Meanwhile, because of a persistent high rate of inflation, surpassing 40%, nominal incomes have lost most of their purchasing power since 2019.
Many, however, believe medical professionals choose to leave not only in search of better income but also want to escape instability and the social and political restrictions that affect them like other Iranians.
The Iranian government highly regulates medical fees and annually announces chargeable rates for private general practitioners, specialists, and dentists.
In early April, for instance, general practitioners’ and specialists’ fees were set at 1.26 ($20) and 1.89 million rials ($30) for the next twelve months.
The purchasing power of the fees may drop even further due to the recent state of conflict with Israel and the possibility of tougher sanctions by the incoming US administration before an increase is allowed again in April.
Since August, nurses in dozens of cities across Iran have been staging ongoing protests against harsh working conditions and the government’s failure to pay wages consistently.
Ahmad Nejatian, head of the Nurses Council of the Islamic Republic—a non-governmental body overseeing nursing regulation and licensing—stated Thursday that Iran’s healthcare system faces a severe crisis with a shortage of 100,000 nurses. He urged the government to raise nurses' wages to retain talent and reduce emigration.
Nejatian reported that 1,900 nurses have recently applied to the Council for certificates required by other countries to validate their professional credentials.
“We don’t have exact numbers on nurse emigration, but we know that it has increased significantly,” he added.
Immediately after Donald Trump’s election, Iranian officials and media sought to downplay its significance, while markets in Iran reacted negatively, anticipating a tougher US policy than under the Biden administration. However, this public stance now appears to be shifting.
The most notable call for efforts to lift sanctions came from former parliament speaker Ali Larijani in an interview with Khabar Online on Saturday. The seasoned Islamic Republic politician voiced serious concern over next year’s budget deficit, projected to exceed 30 percent and amounting to over $30 billion.
Larijani expressed dismay at the large budget deficit and emphasized that the only solution is a significant improvement in the economy. Although Iran always had deficits, but this year’s picture is worse than ever, he stressed. The only solution is to lift sanctions, he emphasized.
"These sanctions have become a barrier to our development. I’m not saying that removing them will solve everything, but it’s like a large stone has fallen into a stream. You need to remove that stone to allow the economy to flow smoothly. So, I believe we must make an effort to resolve this issue,” the former Speaker said.
So far, after six years of economic crisis, a year of conflict between Israel and Iran’s regional proxies, and Donald Trump’s return to the presidency, Supreme Leader Ali Khamenei has remained silent, giving no indication of whether he is open to major concessions. During Trump’s first term, he demanded that Iran halt its nuclear program, scale back missile development, and cease support for militant groups like Hezbollah and Hamas.
The new president has yet to clarify his policy toward the Islamic Republic, but most observers agree he is likely to adopt a tough stance once again. Meanwhile, ordinary Iranians, struggling with over 40% annual inflation, are increasingly eager for the government to show flexibility.
University professor Mehdi Motaharnia told a conservative website on Saturday that Donald Trump has returned to power stronger than ever, now supported by a Republican-majority Congress. While Trump emphasized his aversion to further conflicts during his campaign, Motaharnia noted that he is expected to take a tough stance on Iran.
"Regarding Iran, we will see an increase in tensions and sanctions. Trump will apply maximum pressure on Iran in an effort to push Tehran towards a new agreement. Trump believes in direct negotiations with Iran; he is even willing to personally engage with certain individuals in Iran,” Motaharnia argued. He added that while Trump is generally open to negotiations, the conditions he will set for Iran are likely to be stringent.
Mahmoud Jamsaz, a prominent academic and economist, emphasized that US political developments affect not only Iran but the entire world. Jamsaz, who has frequently spoken openly about the government’s misguided policies, argued that Iran is currently facing too many economic challenges to afford indifference to Trump’s election.
"In May 2018, when Mr. Trump withdrew from the JCPOA, the country’s inflation sharply increased and has continued to rise ever since. Such conditions have had severely damaging effects on Iran’s economy,” Jamsaz said.
Within Iran’s restricted space of public discourse, the economist tried his best to sound a warning. "Trump has said he doesn’t have much interest in dealing with Iran, stating only that he will not allow Iran to acquire nuclear weapons. This is where the issue depends on Iran’s policies. If Iran shows some flexibility and, for example, the JCPOA is somehow revived, we would see a positive economic impact. But if we move in a direction other than flexibility, conditions will naturally become more difficult."
As winter nears, Iran faces an escalating energy crisis that has forced the government into tough decisions. After enduring summer blackouts from surging electricity demand, Iran now faces a natural gas shortage that could disrupt winter power supplies. With dwindling options, the administration has outlined a controversial plan to either impose blackouts or turn to mazut, a high-pollution fuel source that risks further air pollution.
The government issued a directive on November 3 to halt mazut burning at major plants in Arak, Karaj, and Isfahan, hoping to reduce health hazards in densely populated areas. Yet, with mazut still being used in other parts of the country, concerns persist about air quality and its impact on public health.
Economic pressures on Iran’s industry
The energy shortages have placed Iran’s industrial sector under strain, as frequent blackouts disrupt production and increase costs. In August, the government diverted electricity from industrial clients to meet household needs, causing substantial losses in sectors such as automotive and cement manufacturing. According to Saber Parnian, head of the Industry, Mining, and Trade Organization in West Azarbaijan, frequent power cuts have doubled production costs for cement, while MP Mansour Alimardani described the blackouts as devastating for job stability and business operations.
With cold weather driving up household energy demands, Iranian industries are again feeling the pinch. Gas restrictions this year began earlier than usual, leaving sectors like cement production struggling to maintain output as costs rise.
Environmental and health costs of mazut use
Reliance on mazut has raised alarm among environmental and health experts, given its high levels of sulfur, which are well above global standards for fuel oils. Environmental expert Masoud Tajrishi highlighted the risks in an interview with Rouydad24 website, adding that “Mazut retains hazardous elements from crude oil. When burned, it increases particulate matter, leading to respiratory problems and severe health risks.”
Although Iran’s ministry of energy has expressed concerns over mazut’s environmental effects, it faces limited options as gas supplies continue to fall short of demand.
Reliance on Turkmen gas imports
Iran’s reliance on natural gas imports from Turkmenistan to support its northern regions has exacerbated the crisis. An unresolved debt dispute has blocked Turkmenistan from resuming gas exports, leading to fears that residents in northern provinces could be left without sufficient heating this winter.
During a recent cabinet meeting, President Pezeshkian acknowledged the financial hurdles in negotiating with Turkmenistan, noting that payment issues have hampered gas imports in previous winters as well.
Systemic failures and calls for reform
Energy analysts argue that Iran’s crisis stems from years of underinvestment and resource mismanagement. Energy expert Narsi Ghorban estimates that Iran’s infrastructure requires a $250 billion overhaul to meet its energy needs.
“Yet no progress has been made on this front,” Ghorban added, indicating little confidence in swift reforms.
Hashem Oraei, a university professor, in an interview with Aftab News warned that the energy sector’s challenges could leave Iran facing blackouts reminiscent of those in Cuba if solutions are not found.
"Nationwide blackouts like in Cuba and a return to the era of waiting in line for oil and burning wood are not just predictions but something inevitable," he said.
Tajrishi also stressed the need for systemic reforms, citing the Clean Air Act, which requires upgrades to energy systems to reduce consumption, particularly in regions at the end of the gas network. “Reducing household energy use by even 15% could stabilize supplies and lessen the need for mazut,” he said.
With planned blackouts set to begin, Iran’s energy crisis highlights a need for reform. Pezeshkian’s administration now faces mounting pressure to balance energy access with health and environmental concerns as winter approaches.
DeFFI, a non-profit organization dedicated to protecting media freedoms, noted that the government’s restrictions on information access have intensified during the Pezeshkian administration.
“In the first 100 days of Masoud Pezeshkian’s presidency, not only was there no significant change in the indicators of press freedom in Iran, but organized disruptions to free information continued, patterns of suppressing freedom of expression were expanded, and 78 media outlets and journalists experienced judicial and security confrontations by the Islamic Republic,” wrote DeFFI on Friday.
Established amid the Women, Life, Freedom protests in 2022, DeFFI was formed by journalists, lawyers, and human rights advocates to document media suppression and advocate for free expression.
The protests, which called for greater social freedoms and led to widespread unrest, triggered unprecedented levels of state repression targeting journalists and media outlets. This latest report suggests that despite the change in presidential administration, there has been little to no improvement in press freedom.
DeFFI’s report highlights that Pezeshkian’s term has seen a continuation of repressive tactics, with the number of imprisoned journalists increasing from eight to ten during the administration’s first 100 days. Temporary detentions were also prevalent, affecting journalists such as Fatemeh Gholipour, Fardin Mostafaei, Ajdar Piri, and Reza Valizadeh between July and November.
According to DeFFI, Pezeshkian’s administration has presided over a sharp escalation in legal actions against the press. From late July through early November, political and press courts issued criminal charges in 32 documented cases, resulting in prison sentences, corporal punishment, and fines. Seven journalists, including Niloufar Hamedi and Elahe Mohammadi, received a cumulative sentence totaling over 13 years in prison, 70 lashes, and substantial fines.
Hamedi and Mohammadi are recognized for their reporting on the death of Mahsa Amini in September 2022. Their work brought international attention to the incident, leading to widespread protests in Iran. In September 2022, shortly after their coverage of Amini's death, both journalists were arrested. They faced charges including "collaborating with the hostile US government," "acting against national security," and "propaganda against the system." In October 2023, the Tehran Revolutionary Court sentenced Hamedi to seven years and Mohammadi to six years in prison.
The DeFFI data reflects that September was a particularly fraught month for press freedoms, with judicial and security confrontations against journalists increasing by 30% from August. In September, DeFFI documented that at least 24 journalists and media entities faced government confrontations in 28 separate cases, underscoring a pattern of intensified pressure on those reporting critically on state matters.
DeFFI’s findings also reveal a rise in legal complaints against media professionals since Pezeshkian took office. During this period, at least 38 new complaints were filed, with government entities accounting for more than half. Prominent complainants included the Tehran Prosecutor’s Office, Cyber Police, and several high-profile ministries, including those of Oil, Culture, and Economy. While Pezeshkian previously committed to withdrawing government-led complaints against journalists, the report notes that officials not only failed to retract cases but filed numerous new complaints.
In addition to increased judicial actions, the report describes ongoing violations of journalists’ rights during investigations. Between July and November, there were 74 documented instances of rights violations, with unauthorized or non-transparent trials occurring in 46 cases. DeFFI reported other violations, including interference in journalistic activities, arbitrary detentions, denial of legal representation, and seizure of personal property. Physical assaults on journalists were also reported, with two instances of documented physical abuse by security forces.
Since its establishment, the Islamic Republic has consistently suppressed independent media through arrests, torture, and imprisonment.
While Pezeshkian’s government initially suggested it would support freer expression, DeFFI’s findings suggest otherwise, pointing to an entrenched pattern of media suppression.
Then there are those, a significant number it seems, who are indifferent. They have lost hope of any change for the better.
“It makes no difference to me who’s in the White House, cause I see the problem here at home,” says Mahmoud, a well-educated pensioner who has “seen it all”.
“We are where we are, barely living, because of our rulers’ incompetence and bigotry. They don’t care if sanctions have broken our backs. They can end this if they want to. They could back down and reach an agreement with either Harris or Trump,” Mahmoud added.
US presidential elections are normally followed by many in Iran. But this time there was not so much appetite, perhaps because people are struggling more than ever, but also because many have come to believe that things go only downhill in Iran, whoever sits in the Oval Office.
The markets were less indifferent though. Iran’s currency dropped further as soon as Trump was declared winner, breaking its record low of the week prior.
“Trump will definitely impose more sanctions on Iran and back Israel in any attack against us,” says Hossein, 45, working in advertisement. “All we had has been wiped off by skyrocketing inflation, partly due to sanctions and partly due to corruption and incompetence at home. How much more we can take, how far lower we can go, I’m not sure.”
Recent official data suggests 30 percent of Iran’s population live below the poverty line. This is double the figure from two decades ago. The impact of sanctions is impossible to deny. But on the streets and at family gatherings, most appear to blame the Islamic Republic for it, not the United States.
Expletives are common when people talk about Iran’s foreign policy and support for armed groups across the region. The government announced last month that the military budget would be almost tripled in the upcoming Iranian calendar year. ‘Why spend so much elsewhere when so many are in need at home,’ is something you hear every day.
Hessam, a 29-year old photographer, is keen to see the back of this “wasteful policy” that he believes is at the heart of Iranians’ misery. “I hope Trump’s arrival ends the Islamic Republic’s game,” he says, “I don’t expect the regime to fall, and I fear war, but I think a Harris victory would have encouraged the regime to continue with its policies. Now they have to think twice.”
Some media reports suggest that president Masoud Pezeshkian was hoping for another Democratic administration. Hardliners have warned him against any talks with Trump, who has “blood on his hand”, that of IRGC top general, Qasem Soleimani.
The reactions to Trump’s win are not just political. Many of those who aspire to move to the US are disheartened. The memory of the 2017 travel ban is still fresh.
Samin, a computer science graduate, is one of many thousands who are at various stages of a long process to make a home in Europe or North America. “I was hoping to move to the US. I have submitted several applications and am waiting,” Samin says. “But with Trump’s return and the immigration policy that we all know well, I’m not so sure. I don’t know what future awaits me.”
It’s not clear if a Trump administration would make Samin’s move any harder. But that’s the general perception. So is the idea—rightly or wrongly—that the president-elect can play a significant role in determining the fate of the Islamic Republic one way or another.