https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01387-X/fulltext
A rapidly evolving and uncertain situation has unfolded in the WHO Eastern Mediterranean region following Israel’s cross-border military strikes on Iran on June 13, 2025, and Iran’s retaliatory strikes.1 On June 22, the US Administration opted to join the conflict just days after announcing a two-week window for diplomacy.2 Following US strikes on key nuclear-related sites in Iran and Iran’s subsequent retaliatory attack on a US military base in the region, an unsteady ceasefire is now in effect after the mediation by the Qatari Government and the US President.3 The underlying causes and political rationale behind these developments are beyond the scope of this Correspondence. Here, we focus on the implications of the current crisis from a health perspective.
Robust data show sharp increases in the burden of diseases and injuries in Iraq following the US invasion in 2003, in Libya after the international intervention and the fall of Muammar Gaddafi in 2011, and in Syria amid the prolonged conflict that followed the 2011 unrest. 4–6 These increases are not limited to the direct effects of war, such as injuries, but also reflect the broader consequences of conflict on the economy, health-system infrastructure, employment, and service delivery. The figure illustrates the trends in disability-adjusted life-years from all causes before and after the starting point of these wars or internal conflicts. The health effects of such crises are long-lasting—even after countries begin to stabilise, they often remain behind previously expected trajectories of health improvement. Vulnerable populations, including children, pregnant women, older adults, and other marginalised groups bear the greatest burden, further exacerbating health disparities.
For more than four decades, Iran has endured a revolution (1979), an 8-year war (1980–88), and extensive multilateral and unilateral sanctions.7 These factors, along with institutional inefficiencies, as reflected in the World Bank’s Worldwide Governance Indicators,8,9 have had a devastating effect on the country’s economy and development.10,11 Iran has undertaken several health-system reforms to improve performance and equity.12–14 Previous Global Burden of Disease analyses did not capture substantial improvements in population health following the major reforms of 2004 (introduction of rural health insurance) and 2014 (implementation of Health Transformation Plan); instead, international sanctions—another structural determinant—were linked to higher mortality rates from non-communicable diseases.15 Now, the looming threat of war has further heightened the risks to the population’s health, elevating them to an even more perilous level.
In recent years, global efforts to de-escalate tensions and reduce fatalities, hunger, and human suffering among civilian populations in the Eastern Mediterranean region have been insufficient and largely ineffective. Several powerful nations have either directly fuelled the conflict or passively enabled it by failing to condemn or prevent acts of aggression. With a population of approximately 90 million—larger than the combined populations of Iraq, Libya, and Syria—Iran’s richly diverse society faces unprecedented health-system risks. A scenario involving internal conflict, like what has previously emerged in these countries during and after foreign interventions, poses a severe threat to individuals’ health not only within Iran, but across the entire region. Iran also hosts millions of Afghan immigrants,16 either documented or undocumented, who have been affected by the recent military strikes. As one of the first developments after the Twelve-Day War, a substantial number of Afghan immigrants in Iran are now either being pressured or opting to leave the country. This trend is driven by a combination of insecurity, the escalation of forced deportations (which had already been intensifying over the past year), and worsening economic conditions in Iran. These developments are compounding Afghanistan’s already fragile humanitarian situation, particularly for women and children. Forced returns on this scale risk further destabilising Afghanistan and increasing displacement pressures across the region.17,18
The potential consequences for regional and global security, economic stability, and social cohesion are profound and unpredictable. Although recent diplomatic gestures could offer a path towards de-escalation, the overall situation remains fragile. Ensuring the health, dignity, and wellbeing of Iran’s population demands not only an end to violence but a lasting investment in peaceful solutions and resilience against future conflict.
This is where the authors and researchers’ article in the Lancet journal ends.
The authors approach the subject from the perspective of human health and refer to similar examples such as the masses of Iraq, Syria and Libya to illustrate the upcoming scenario, which is quite appropriate in the main topic, and we have also addressed the above examples in numerous articles on war and environmental destruction, as well as the Vietnam War, the war of the Islamic Republic and the Saddam regime, the Gulf War, etc. The topic that the researchers of the above article propose briefly examines the living conditions and health of the working masses under the threat of war, during the war and after it. But one point should not be forgotten here, and that is the living conditions, health and environment of the working masses in all the mentioned countries before all these scenarios, which was the precursor to the war between the beasts of capital in these countries.
An important part of providing health care to the working masses and their families is the responsibility of the health system of the society. We will discuss this issue in various places in this article. First, we will start with the workforce in the field of health care. Part of the workers in this field are nurses. Nursing is one of the jobs in which women are in the majority based on the gender division of labor. The World Health Organization speaks of a 75% share of women, and in Iran, a 90% share of women in the nursing job. The presence of such a majority of women in a job in a society where the capitalist mode of production with the characteristic and goal of maximum profit and at the same time patriarchy prevails, has turned this job into one of the jobs with a high rate of exploitation. The bed and patient standard is the number of nurses, which is measured according to the patient’s need for optimal care and the nurse’s ability to work in a job that is one of the difficult and harmful jobs. This standard is two and a half worldwide, including 7/10 of the nurse’s assistant and one nurse for each bed per day. But this standard is less than eight tenths, considering 140,000 beds and 110,000 nurses. This is the average number of nurses, but in reality this does not exist either. These are the difficult conditions of workers in the medical field. Workers in this sector are one of the few sectors that publicly declare their demands and have been fighting for their rights for many years. In these struggles, they have tried various ways until they have concluded that fundamental and lasting changes cannot be achieved by fighting in a hospital and clinic. But they have not yet reached the fundamental stage where they can establish specific and concrete contact with other workers in the capital’s fields and a force on the scale of the working class to confront the capitalists and their government in order to force them to respond to their demands. This is not all that capital does to human health. There is no particular need to use a war scenario to portray the living conditions and medicine and treatment of the working masses. A look back a few years ago at the situation of the cursed masses in the onslaught of the Corona pandemic illustrates the entire catastrophe that capital has prepared for humanity. The devastating storm of the capitalist crisis, the deadly Covid-19 epidemic born of the ugliness, corruption and desolation of capital, the lack of access of workers to minimal medical and protective facilities to combat the onslaught of this deadly disease, the death toll of at least 20 million and the infection of several hundred million people, along with the world of poverty, misery, displacement, unsanitary conditions and misery resulting from the domination of capitalism, all of which devastated the lives of the entire working masses of the world. Meanwhile, the situation of the working masses of Iran was and is more terrifying, catastrophic and crushing than in most regions of the world. Here, every breath of protest by the workers has been the target of a bloodbath by Islamic fascism, and there were and are no facilities available to the workers to protect their lives from the danger of the disease. All workers, from young children to the grave, were forced to work hard and risk death in any situation to earn a daily living, to cover the cost of treatment and medicine, and to survive.
A worker may ask himself that the living conditions of workers’ health in the Western democratic camp were not and are not like this. Capitalism has no good or bad, and the bourgeoisie is a canvas everywhere in the world. Man, humanity, human existence, and basic human needs are nothing, capital, profit, accumulation, and the gigantic self-aggrandizement of capital are everything. This is the first and last word of the capitalist production method throughout the world and in the entire history of this system. What the Islamic fascism of the bourgeoisie in Iran has brought upon the 65 million working people in relation to the Covid-19 pandemic needs no description. Everyone knows this. What is less often mentioned is the scenario of defending human life! In the famous peaks and chaotic cities of prosperity!! Civil society and human rights are a system of wage slavery. Sweden is the leader of these societies. In Sweden, the number of infected people was increasing hour by hour, with great speed, all regions and cities from the Baltic to the North Pole were the battlefield of Corona. Fear and panic have engulfed everyone, but the bourgeois government, the capitalist class and above all the social security and welfare organization are saying with indescribable insistence, firmly and resolutely that everyone must be present at work. The Swedish bourgeoisie, the government and the top brass of the country’s healthcare system do not see any of the necessary measures to confront the widespread spread and pandemic of the Corona! They are not looking for a solution to the challenge of Covid-19 in any of these processes, campaigns or plans to avoid contracting the virus, they have other very impressive and astonishing plans for the campaign against Corona and Covid. Allocating 500 billion kronor in credit for immediate, emergency and vital aid to medium and small companies, to capitalists who own industrial and commercial enterprises with the aim of completely preventing and remedying any reduction in the profits of these companies, free and unreserved reduction of employer tax or any tax related to capital and capitalists, with the aim of comprehensive and adequate compensation for any possible damage to companies in the event of the infection of thousands and thousands of workers exploited by them. This must be done so that not a single dinar is lost from the profits of any capitalist. Bank interest rates for capital owners must be further reduced so that the huge industrial and financial giants can freely engage in ever-increasing and more galactic accumulation.
Let us return to the subject and scenario of war. War is, at its core, the competition of capital with other means. The savage war of capital over the redistribution of the fruits of labour and the exploitation of the working masses of the world is the war of the ugly hyenas of the capitalists and the rulers of capitalism to increase their share in the share of the sovereignty of capital and the ownership of the capital and the profits created by us, the workers. The rulers of capital and its statesmen compete in their official assemblies and parliaments to bargain over the share of the public profit produced by the workers. The same process between the social capitals of each country and region is ongoing daily in international forums, in conferences with other countries. The capitalists and the capitalist states are advancing this process of competition with the mass murder of the masses more than ever before and with ever more terrible means of war and competition.
Surely the scenario of war, especially the current wars that global capital is simultaneously engaged in on all continents of the burning hell, sends shivers down every conscious human conscience. The most horrific example of that war is the one that has subjected the frail bodies of the working masses of Gaza to the most brutal attacks for two whole years. Since the beginning of the Israeli regime’s murderous war against the masses of Gaza, we have witnessed the intensity, albeit limited, of discussions among Iranian workers or parts of them, about the dimensions of the atrocities and crimes of the Israeli government and its allies, the “paradise of democracy.” It is a humane, pure, and praiseworthy feeling to witness the mountains of bombs falling on the heads of millions of workers, children trembling from the terror of the bombings and burning in groups in the fire of the bombs, fathers and mothers who, with the emaciated bodies of infants wrapped in blankets and cloth, seek shelter and become prey to the fire of bombers while searching, and the elderly and the old who leave their ruined nests so that perhaps the deceitful persuasion of this or that government can change their disastrous situation. Cities that are destroyed, mountains that are the result of the work of successive generations of working masses that are reduced to ashes, yes, seeing each of these, every cell of every human being, provided that this existence is not human capital, the capital of a conscious thinker, is definitely terrifying, this feeling, the tears that are shed, the sadness that weighs on hearts, are certainly worthy of appreciation and praise, but is it really so? These heartbreaking and burning sighs originate from the depths of the spontaneous humanity of the workers! The passion of Taftan is a meaningful human solidarity and connection that seeks a way to revolt?! Is the thread and fabric of these protesting whispers formed by the spontaneous existence of anti-exploitation and unjust flight of the workers!? Certainly, none of these are about to happen and have not even come close to them. We live in an upside-down world. A world in which buying and selling the working person like a commodity and throwing it away after its expiration date is considered a natural thing!! Housekeeping, which is a drain on women’s bodies and destroys their minds, is declared a sacred duty!! The overbearing and parasitic institution of the state is considered a necessity of social life!! This world is capitalism and, as it is inhuman and anti-human, it must be destroyed. The gravedigger of this system is our class, the working class. Now that in the hell of Iranian capitalism, the struggles of our class are boiling and seething, let us clearly express our historical demands and declare that we want the abolition of wages, the elimination of housework and the decline of the state, we want as much of what we produce as possible for our own lives and those of our families, we want an end to war and the slaughter of the masses, and before these demands are fully realized, we want:
The product of our work and social production, tens of trillions of Tomans (hundreds of billions of dollars), should be spent on the prosperous livelihood of all members of society, whether employed, unemployed, or retired. Medicine, treatment, education from kindergarten to university, transportation, the best form of care for children, the elderly, the disabled, water, electricity, gas, food and clothing, housing, household goods, telephones, the Internet, everything should be completely removed from the control of buying and selling and made free.
All information and statistics on the production and distribution process, data related to natural resources, environmental issues, planning, domestic and foreign trade, and diplomatic relations should be made available to everyone.
Every hour of housework should be considered an hour of employment time and the average share of each person in the social product should be allocated to it.
Government interference in the privacy of human life should be completely stopped.
All economic and military activities that are destructive to nature and harmful to human health should be shut down.
Hassan Abbasi