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The first wave of US sanctions against Iran was imminent when doctors told Aram Rawanshad the bad news.
In early June, she learned that she was suffering from endometriosis, a painful disease that occurs when tissues grow outside the uterus. It was too late for surgery and the doctors advised him to act quickly before the disease spreads.
Rawanshad, a 42-year-old writer from Karaj, Iran, received a prescription and was urged to stock up before the stocks ran out.
"I told the pharmacist that if I bought more than a month, other patients would be deprived of care," she said.
Although it was a nice gesture, it had a cost. The following month, on his return to the pharmacy, the drug was exhausted.
Soaring inflation, scarcity of raw materials and declining imports have made Iranian medicines both rare and expensive.
Although humanitarian goods, such as drugs and food, are exempt from US sanctions, the severe restrictions imposed on Iran's financial institutions have forced the outside world to reconsider its trade relations with the Islamic Republic.
Experts fear that the latest sanctions will make the situation even worse.
A month after the US Treasury imposed sanctions on 20 Iranian financial institutions, the Trump government again imposed sanctions on the Iranian energy, banking and shipping sectors.
While previous administrations that had imposed sanctions on Iran had been keen to encourage companies to continue their humanitarian exchanges, the Trump administration did not do so.
"Companies looking for potential customers will feel it is very difficult to sell to Iran," said Elizabeth Rosenberg, Research Fellow at the Center for New American Security and former Senior Advisor for Sanctions at US Treasury.
Although the Iranian Ministry of Health provided domestic manufacturers with foreign exchange at subsidized prices, the high costs of raw materials such as cardboard, aluminum and lactose, used to soften the pills, resulted in the price of domestic drugs increased by nearly 50%, according to Siavash Saadat, 65, a pharmaceutical company manager in Tehran.
Iranian analysts and pharmaceutical companies fear that patients with cancer and other serious illnesses, such as Rawanshad, are the most exposed.
After searching for drugs in Tehran, Rawanshad finally found a pharmacy that had it in stock. She bought three months of supply, but plans to turn to the black market in the future.
"Merchants and intermediaries buy (medicines) and store them. It also raises prices, "she said. "People are at the mercy of black market sellers who take advantage of the scarcity of imported medicines."
The Iranian authorities, anxious to reassure the frustrated citizens, denounced the American sanctions, qualified as illegal and promised to survive the economic crisis.
Secretary of State Michael R. Pompeo said the US sanctions were intended to force the Iranian government to "abandon its destructive activities," adding that the sanctions would target the government, not the people of Iran.
But the reality is much more complex.
After years of fiscal mismanagement and corruption, global banks have been reluctant to do business with Iran's financial institutions. Even when the Obama administration lifted sanctions against two dozen Iranian banks as part of the historic nuclear deal, this has hardly changed.
Parsian Bank, a well-known private sector bank, was a vital means for European companies to conduct humanitarian exchanges with Iran. But she too has been swept away by the new set of sanctions.
The US Treasury said the sanctions imposed on Parsian Bank were not based on illegal activities, but on a company that had used its investments from the Bank of Paris to provide money to the Revolutionary Guards Corps. .
Richard Nephew, research professor at the Center for World Energy Policies at Columbia University, said the restrictions on the Parsian Bank would be a warning to sever trade with Iran.
"The Trump administration is attacking everyone at all levels of the food chain. It will scare people you may not want to scare like humanitarian businessmen, "Nephew said.
Brian Hook, US Special Representative for Iran, said it was Tehran's responsibility to ensure that other countries and foreign institutions feel comfortable to deal with the Republic. Islamic.
"The United States is not required to identify safe channels. It is the responsibility of the Iranian regime to create a financial system that complies with international banking standards to facilitate the sale and provision of humanitarian goods and assistance, "Hook said.
At the same time, some of the poorest and most vulnerable in Iran are preparing for the future.
The price of most commodities in Iran – not just drugs – has risen after years of economic mismanagement, blistering inflation and the collapse of the Iranian currency, which has lost more than half of its value since early 2018, according to Steve Hanke, professor of applied economics at Johns Hopkins University.
Hanke estimates that Iran's annual inflation rate is about 270%, up from 13% in January, before President Donald Trump withdrew from the nuclear deal and starts hitting Iran's severe penalties.
(EDITORS: HISTORY CAN END HERE)
Sepideh Saadat, a pharmacist in Tehran, is in charge of buying medicine for her grandmother, who has Parkinson's and Alzheimer's.
In the coming months, she anticipates that she will have no choice but to buy it on the black market.
"Black market traders are anticipating a further devaluation of the rial. So they buy medicines from Turkey and sometimes sell them 10 times more, "she said. "Those who can not afford it are doomed to die painfully."
Experts say that in the next six months, the Iranian authorities will be able to withstand the latest sanctions.
"Will Iran be able to avoid sanctions and will the Trump government impose new ones?" Said Nephew. "These are the things we do not have an answer for."
(Mostaghim is a special correspondent for the Los Angeles Times.)
PHOTO (for help with images, contact 312-222-4194): IRAN-SANCTIONS-MEDICINE
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