Wars are, without doubt, public health emergencies. They have lasting implications on the physical and psychological wellbeing of those affected. The extensive health harms from conflicts are notably exacerbated when essential infrastructure is (either intentionally or unintentionally) destroyed during conflict, risking civilian access to healthcare, energy, food supplies and more.¹

As such, the Iran war has been the latest to attract condemnation from health scholars, health leaders, activists and politicians who have urged for peace in the Middle East and a cessation of the war since USA-Israel launched their attack.^2,3,4,5 

But the violence and human rights suffering that Iranian people experience will not end when the war ends. This is because the main source of violence towards Iranian people comes not from the war, but from their own government. The Islamic Republic, the theocratic totalitarian regime which governs Iran routinely uses violence to assert dominance over its citizens, viewing the Iranian people themselves as “a primary threat to its [own] survival”.⁶ Consequently, Iranian people have suffered imprisonment, torture and murder under this regime for decades, culminating in the January 2026 massacre of tens of thousands of Iranian protestors who risked their lives to rally against the regime.⁷ The regime’s response to these protests was characteristically callous including the targeting, imprisonment and in some cases execution of health workers for the mere act of providing care to wounded protestors.⁸ This included two Iranian nurses who were imprisoned for aiding protestors; both of whom have now been left with long-term health consequences as a result of the sexual violence inflicted upon them by the regime’s security forces, as punishment for merely acting in line with their ethical duties.⁹

This is not new. The Islamic Republic’s willingness to inflict violence upon its own people has been demonstrated time and again over the past 47 years. The Islamic Revolutionary Guard Corps has the highest national execution rate per capita globally and its security and intelligence forces routinely use sexual violence to crush uprisings of its citizens; men, women and children alike.^10,11 These are deemed by the regime as appropriate punishments following arbitrary arrests of citizens who dare to challenge decades of oppression and gender-based discrimination under this regime.

In times of war, most governments support their citizens; with bomb shelters, public health warnings, and information on how to keep themselves safe. The Islamic Republic does the opposite. It cuts its citizens off from communication, enforcing deliberate internet blackouts to mask its own violence, thereby protecting itself from global scrutiny.¹²

Under both the darkness of war and internet blackout, there are reports from human rights officials that the regime is planning its ‘next war’ with the enemy this time being its own people.¹³ This is amidst the external conflict civilians already face. Hundreds of arrests have taken place since the war began, including three young men who participated in the January protests having already been executed, which signals an alarming warning for what may be to come.¹⁴ Having been weakened by the war and facing existential threat, the regime seems more determined than ever before to extinguish any dissent or challenge to its rule. This includes retaliatory violence against lawyers that defend political prisoners, healthcare professionals that treat wounded protestors and ordinary citizens who offer any criticism of the state. Thus, many Iranians fear the violence of the regime far more than they fear the violence of war.

In turn, it is crucial that the international medical community continue to condemn the ongoing violations against humanity that the regime imposes upon its citizens. We must refuse to allow this regime to harm or kill people under the shadow of war. Condemning only the war without, in the same breath, condemning the regime risks erasing the lived experience and trauma of Iranian people who have battled and indeed, died, for years under this regime. If being anti-war is about being anti-violence, then that principle must be applied consistently, and health voices must speak up urgently about both harms. A demand for ‘peace’ in Iran without also demanding liberation has little value to Iranians on the ground.

Health voices can support Iranian people by spotlighting the plight of Iranian citizens (whilst being sure to avoid platforming regime spokespeople, sympathisers or affiliated groups). They can also ensure any calls for de-escalation of the war from health bodies also explicitly call for holding the regime accountable for its own violence as well. The moral inconsistency of failing to name both the war and the regime as violent provides a whitewash for the regime’s ongoing aggression; giving the impression that one doesn’t care about who is being killed and only cares about who is doing the killing.

Iranian people deserve better. They deserve to be humanised. They deserve the dignity of a truthful acknowledgement of their existence and a full recognition of their trauma, from all parties. The global health community can help be the voice of a people who are being silenced and harmed from multiple sides. 

References

1. Kapasi Z. War is a global health crisis: community based action can confront it BMJ 2025; 390 :r1820 doi:10.1136/bmj.r1820
2. WHO. Health impact of the escalation of conflict in the Middle East. 5 March 2026. Available at: https://www.who.int/news-room/feature-stories/detail/health-impact-of-the-escalation-of-conflict-in-the-middle-east (Accessed 27 March 2026)
3. BMA. BMA ‘alarmed’ by escalating conflict in the Middle East. 6 March 2026. Available at: https://www.bma.org.uk/bma-media-centre/bma-alarmed-by-escalating-conflict-in-the-middle-east (Accessed 27 March 2026)
4. Mahase E. Iran war: 43 attacks on healthcare facilities in Iran and Lebanon, WHO says, as thousands killed BMJ 2026; 392 :s484 doi:10.1136/bmj.s484
5. Medact. Medact statement on US and Israel’s attack on Iran. 2 March 2026. Available at: https://www.medact.org/2026/statements/statement-on-us-and-israels-attacks-on-iran-feb26/ (Accessed 26 March 2026)
6. Iran Human Rights. IHRNGO warns of mass arrests amid war in Iran. 24 March 2026. Available at: https://www.iranhr.net/en/articles/8657/ (Accessed 26 March 2026)
7. International Center for Human Rights. Latest human rights report: 43 000 killed in the crackdown on protests in Iran. 20 Jan 2026. https://humanrightsintl.com/2026/01/20/latest-human-rights-report-43000-killed-in-the-crackdown-on-protests-in-iran-for-immediate-release/
8. Jafari M, Alaei K, Abdi H, Kooschi A, Saidi R F. Iran: Attacking injured protestors and healthcare workers violates medical neutrality BMJ 2026; 392 :s243 doi:10.1136/bmj.s243
9. Iran International. Iran’s security agents gang rape two nurses detained for aiding protestors. 15 March 2026. Available at: https://www.iranintl.com/en/202603102323 (Accessed 21 March 2026)
10. Iran Human Rights. At least 63 executions in fortnight, IHRNGO calls for international community reaction. 2 May 2024. Available at: https://iranhr.net/en/articles/6682/ (Accessed 27 March 2026)
11. Amnesty International. Iran: security forces used rape and other sexual violence to crush ‘Women Life Freedom’ uprising with impunity. 6 December 2023. Available at: https://www.amnesty.org/en/latest/news/2023/12/iran-security-forces-used-rape-and-other-sexual-violence-to-crush-woman-life-freedom-uprising-with-impunity/ (Accessed 26 March 2026)
12. Human Rights Research Center. Iranian information blackout could continue indefinitely, cutting the country off from the world. 21 January 2026. Available at: https://www.humanrightsresearch.org/post/iranian-information-blackout-could-continue-indefinitely-cutting-the-country-off-from-the-world. (Accessed 17 March 2026) 
13. Kramer K, A Esfandiar. Iran is already ramping up its next war. Guess who the ‘enemy’ is. The Washington Post. 25 March 2026. Available at: https://www.washingtonpost.com/opinions/2026/03/25/iran-islamic-republic-protests-executions/ Accessed 26 March 2026
14. Center for Human Rights in Iran. Three protesters publicly hanged in Iran; Dozens more at imminent risk of execution. 19 March 2026. Available at: https://iranhumanrights.org/2026/03/three-protesters-publicly-hanged-in-iran-dozens-more-at-imminent-risk-of-execution/ Accessed 26 March 2026

Author
Dr Rammina Yassaie

Rammina is a medical doctor, medical ethicist and Senior Lecturer in Leadership for Health and Social Care at Sheffield Hallam University. She is deeply proud of her Iranian roots and cannot wait to visit when, one day, Iran is free. 

Declarations of Interest
I have read the competing interest policy and have none to disclose. There has been no use of AI in the writing of this piece.