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Iran was one of the first countries outside China to have a rapid increase in the number of cases of coronavirus disease 2019 (COVID-19). The country’s capacity to respond to the virus is substantially impeded by unilateral economic sanctions re-imposed after the US Administration withdrew from the nuclear deal in May, 2018, and further US sanctions imposed as recently as March 18, 2020. 1 As of March 31, 2020, the recorded number of people infected from COVID-19 in Iran was 41 495, with 2757 deaths, 2 but these numbers are likely a substantial underestimation.

Even before COVID-19, Iran’s health system was feeling the effect of the sanctions. 3 Their impact is now severe because they restrict the government’s ability to raise funds or to import essential goods. Of the ten countries with the highest number of recorded cases of COVID-19 to date, Iran is the poorest. 2 In 2019, Iran had the lowest rate of economic growth (–9· 5%) and highest rate of inflation (35· 7%) recorded in the country for the past 20 years. This financial situation makes the funding of adequate prevention, diagnosis, and treatment of COVID-19 impossible, and the country cannot take the same measures adopted in other countries to strengthen responses, such as paying the full cost of obtaining treatment. 3 Essential medicines and medical equipment are technically exempt from sanctions, but their availability is restricted by the effect of sanctions on the commercial sector, reducing manufacturing and trade capacity, and on foreign exchange. Consequently, although approximately 184 000 hospital and primary health-care staff are working to fight COVID-19, their efforts are …