Iran International
People in Iran have described deteriorating hospital services, rising treatment costs, shortages of medical staff and equipment, and long waits for care, as healthcare workers struggle with low wages and growing workloads, according to accounts shared with Iran International.
The complaints come as health officials report a growing shift from private to public hospitals because of financial hardship, with the country's nursing workforce at roughly half the national standard.
Rising costs and pressure on public hospitals
Four hospitals refused to admit a patient because they lacked specialist doctors, forcing the patient to seek private treatment at a cost of 200 million rials (about $76) in a single night, according to an account sent to Iran International.
The US dollar is trading at around 2.62 million rials in Iran, reflecting the sharp decline in the national currency's purchasing power.
Iran's minimum monthly base wage stands at around 166 million rials ($63), meaning the patient's single-night medical bill exceeded a full month's minimum wage, even before other living expenses.
Another patient said an emergency department at a public hospital charged around 100 million rials (about $38), provided no invoice and said emergency expenses were not covered by insurance.
A resident of Shiraz described worsening conditions at hospitals, where shortages of doctors and nurses have disrupted patient care.
Economic hardship and higher medical tariffs have shifted 30 to 40 percent of patient visits from private facilities to public hospitals this year, Yaser Foroughi, deputy for treatment at Iran University of Medical Sciences, said.
Other patients described overwhelmed medical staff struggling to meet growing demand despite efforts to provide adequate care.
Patients face steep bills and demands for unofficial payments
Several citizens described doctors requesting cash or gold coins outside formal hospital payment procedures before performing surgery.
One patient said a doctor at Tehran's Atieh Hospital quoted 4 billion rials for leg surgery alone, with at least two weeks of hospitalization due to an infection and accommodation for a companion expected to cost another 15 billion rials.
Others complained about rising out-of-pocket expenses and insurance coverage that failed to meet their medical needs.
Equipment shortages and long treatment delays
Patients said hospitals were running short of basic supplies, forcing them to purchase items including bedsheets, syringes and gloves themselves.
Healthcare workers and patients had previously told Iran International in September that syringes, sterile gauze, intravenous cannulas and latex gloves were either scarce or subject to rationing.
Another patient said MRI machines at public hospitals were frequently broken or required waits of up to three months for appointments.
Some private hospitals were also refusing supplementary health insurance, according to accounts submitted to Iran International.
One person said emergency services refused to dispatch an ambulance for their 73-year-old mother, who has cancer, after she fell, because two hours had passed since the fall.
Several patients also complained about declining patience among hospital staff when dealing with patients and their families.
Nurses say they are doing the work of two people
Iran's nursing workforce stands at roughly half the national standard, forcing individual nurses to carry the workload of two people, Ahmad Nejatian, head of Iran's Nursing Organization, said on October 17.
Nurses work an average of 80 hours of overtime each month, Nejatian said.
Healthcare workers linked deteriorating services to severe staffing shortages, exhaustion and inadequate pay.
One nurse said better salaries and living conditions, comparable to those in Persian Gulf countries, Europe and the United States, would improve healthcare workers' ability to care for patients.
A patient hospitalized for 12 days, however, described nurses continuing to treat patients respectfully and work diligently despite severe staff shortages and demanding conditions.
Low wages deepen pressure on healthcare workers
One healthcare worker said medical staff were expected to provide specialized care, particularly in intensive care units, on monthly salaries of just 250 million to 300 million rials ($95–$115), with a housing allowance of 10 million rials (about $4).
Another citizen blamed the government's economic policies for making it increasingly difficult for healthcare workers to concentrate on their duties.
Some nurses have gone months without receiving their salaries, leaving them with little motivation to train new staff, a medical trainee told Iran International in September.
The accounts point to mounting pressure on Iran's healthcare system, with rising treatment costs pushing more patients toward overstretched public hospitals as staff shortages, low wages and equipment shortages constrain the care available to them.
Retirees staged protests in several Iranian cities on Sunday over soaring living costs, inadequate pensions and healthcare problems, with some demonstrators also chanting against government corruption, repression and executions.
Social Security and steel industry retirees gathered in Tehran, Rasht, Kermanshah, Isfahan, Shush and Ahvaz, demanding higher pensions, payment of overdue benefits and improved access to healthcare.
Videos obtained by Iran International showed protesters chanting slogans including "Our enemy is right here, they lie when they say it's America" and "Cut back on one case of embezzlement and solve our problems."
In Tehran, retirees gathered outside the headquarters of the Social Security Organization, Iran's state pension and social insurance body, chanting "High prices, embezzlement — this is your economy," according to Pezhvak-e Kar Iran, a labor news outlet affiliated with the Iran Labor Confederation Abroad.
In the northern city of Rasht, demonstrators also condemned executions, chanting "We swear by the blood of our comrades, we will stand until the death sentences are overturned."
More than 70 political prisoners have been executed since December 2025, while at least 20 others face execution on politically motivated charges.
The US-based Human Rights Activists in Iran group said in an October 9 report that at least 2,003 people had been executed over the preceding year, a 29% increase from the previous 12-month period.
In the western city of Kermanshah, retirees protested the declining purchasing power of their pensions, chanting "Where are the oil dollars? We bear the inflation" and "War and sanctions are excuses; our lives are the evidence."
Protesters also demanded the release of imprisoned workers, teachers and protesters, including labor activist Nahid Khodajoo, who was arrested at her home by security forces about two weeks ago. Her whereabouts remain unknown.
In the central city of Isfahan, retired steelworkers marched to the provincial governor's office, demanding free and continuous healthcare, payment of overdue benefits and pensions equivalent to 90% of the salaries of comparable active workers.
Iran's semi-official ILNA news agency reported that repeated promises by officials to address the steelworkers' grievances had not been fulfilled.
In the southwestern city of Shush, retired workers from the Haft Tappeh sugarcane complex protested low pensions, inflation, unemployment, housing shortages and the suppression of independent labor organizations, according to the Haft Tappeh Sugarcane Workers' Syndicate.
"We will fight, we will die, we will win our rights," protesters chanted.
In nearby Ahvaz, retirees gathered outside the provincial Social Security headquarters, demanding overdue pension increases and protesting rising prices.
"Our expenses are in dollars, but our salaries are in rials," demonstrators chanted, according to the Iranian Retirees Council. Other slogans included "No to executions" and "Unity against poverty and corruption."
Retirees told ILNA that pensions below the poverty line had made it increasingly difficult to afford basic necessities, including food, medicine and medical care.
Iran's base monthly minimum wage stands at approximately 166.3 million rials ($63 at the October 18 free-market exchange rate), excluding additional allowances.
Years of inflation and the declining value of the rial have eroded purchasing power, fueling recurring demonstrations by retirees and workers demanding higher wages, improved healthcare and payment of outstanding benefits.
Iran's parliament speaker said a "Persian Gulf Data Authority" was coming and urged regional governments and investors to withhold resources from AI companies involved in military operations, amid Tehran threats against digital infrastructure across the region.
"The Persian Gulf Data Authority is coming," Mohammad Bagher Ghalibaf wrote on X Sunday.
"To governments, funds, and firms in the region: you are kindly advised to give no resources to any AI or data company aiding invasions or killing children. No finance, equity, land and energy."
Ghalibaf did not explain how the proposed authority would operate, what powers it would have or how Iran could enforce restrictions on companies operating elsewhere in the region.
The name echoes the Persian Gulf Strait Authority (PGSA), which Iran established to administer shipping permissions and tolls for vessels passing through the Strait of Hormuz in coordination with the Revolutionary Guards.
Ghalibaf did not say whether the proposed data authority would be linked to that body or follow a similar model for asserting control over regional digital infrastructure.
His remarks followed a series of warnings by senior Iranian officials and hardliners about targeting digital infrastructure across the Persian Gulf.
Hardliners threaten regional digital infrastructure
Last week, Mohsen Rezaei, secretary of Iran's Supreme National Security Council, warned that undersea communications cables, data centers and artificial intelligence facilities could become targets if war with the United States and Israel resumed.
"If war breaks out, many cables, data centers and artificial intelligence facilities, valued at $2 trillion, will be within range," Rezaei said, according to Iranian state media.
He said American technology assets in the United Arab Emirates and around the Strait of Hormuz had not yet been included among Iran's targets but could be struck in a renewed conflict.
The following day, Hossein Shariatmadari, editor-in-chief of the hardline Kayhan newspaper and the supreme leader's representative at the publication, endorsed Rezaei's warning.
In an article titled "Well Done, Brother Mohsen!", Shariatmadari called for using undersea fiber-optic cables running through the Persian Gulf and the Strait of Hormuz to pressure Washington and its allies.
He claimed that damaging the cables could disrupt more than 80 percent of commercial, banking, military and AI-related communications, an estimate that has not been independently verified.
The IRGC-affiliated Tasnim News Agency also backed threats against AI infrastructure, arguing in an article titled "Why Is Artificial Intelligence on the Target List?" that attacks on AI centers could undermine US technological competition with China, deter investment and put pressure on American stock markets.
Shariatmadari had previously urged Iran's military and Islamic Revolutionary Guards on September 3 to disrupt or sever international fiber-optic cables beneath the Persian Gulf and the Strait of Hormuz.
In May, Tasnim proposed imposing licensing and annual renewal fees on foreign operators of undersea internet cables passing through the strait.
It also called for major technology companies, including Meta, Amazon and Microsoft, to operate under Iranian law and proposed granting Iranian companies exclusive control over cable maintenance and repairs.
Previous threats against technology companies
Iran's Revolutionary Guards had already threatened major American technology companies operating in the Middle East during the war earlier this year.
On March 31, the IRGC published a list of 18 companies, including Microsoft, Google, Meta, Apple, Oracle, Nvidia and the UAE-based artificial intelligence company G42, warning that their regional operations could be targeted.
The Guards accused American technology and AI companies of assisting US military operations against Iran and warned employees to leave their workplaces.
The threats followed Iranian drone attacks in early March that damaged Amazon Web Services data centers in the United Arab Emirates and Bahrain.
Amazon said two facilities in the UAE were directly struck, while a nearby drone strike caused physical damage to its infrastructure in Bahrain.
The company reported structural damage, power disruptions and cloud service outages affecting customers across the region.
The Persian Gulf has become an important hub for American technology companies expanding their cloud computing and artificial intelligence operations, with the UAE among the countries hosting major investments in data centers.
Undersea fiber-optic cables are also critical to the region's digital infrastructure, carrying international internet traffic and supporting financial transactions, cloud computing and government communications.
US President Donald Trump on Sunday warned Washington could “soon finish the job” against Iran unless Tehran changed course, as Israeli Prime Minister Benjamin Netanyahu said Israel was prepared to strike Iran without US support and vowed to bring down Tehran’s government.
“Unless they change their ways, rapidly, we will soon finish the job,” Trump wrote in a post on Truth Social, after saying Iran had been “systematically destroyed, both Militarily and Financially.”
Addressing the people of Israel directly, Trump pointed to Tehran’s long-standing slogans of “Death to Israel, Death to America,” saying it had only been a matter of time before Iran sought to act on such threats.
He endorsed Netanyahu for re-election in Israel’s October 27 parliamentary vote, calling him a “Great Warrior Prime Minister” and an “even greater Partner for Peace in combatting the Islamic Republic of Iran.”
He said that if Israel were led by “anyone other than Bibi,” the United States would have to take on the work against Iran itself, adding that he was “not inclined to do so.”
Trump gave Netanyahu his “Complete and Total Endorsement” for re-election and praised him as “Strong, Brave, and Brilliant.”
Netanyahu thanked Trump on X, saying: “Together we will complete the mission!”
Israelis will vote on October 27 in the country’s first national election since the Hamas-led October 7, 2023 attack. The prime minister is not directly elected but emerges through coalition-building in the 120-seat Knesset.
Trump did not say what further action against Iran he had in mind. Earlier this month, he said the United States would not attack Iran before the November 3 US midterm elections and said Washington and Tehran were having “productive discussions.”
His latest comments come after he and Netanyahu discussed the possibility of a new military operation against Iran, according to Axios, which reported last week that the Israeli leader raised concerns about intelligence suggesting Tehran was trying to rebuild its nuclear program.
Netanyahu says Israel can strike Iran without US support
Separately on Sunday, Netanyahu said Israel was prepared to launch a preemptive strike against Iran without US support and that his objectives regarding Tehran did not depend on Washington’s approval.
“The objectives I set do not depend on American approval,” Netanyahu said as he presented an updated national security doctrine, according to Israel Hayom. “To the extent necessary, we will also act independently. We have done so before, and if necessary, we will do so again.”
Netanyahu described confronting Iran as his “life’s mission” and identified a nuclear-armed Iran as Israel’s greatest security threat. “We are prepared to take the initiative,” he said. “We must prevent the enemy from delivering the first blow.”
He said “90% of the job is done,” pointing to Iran’s economic crisis, recent protests and what he described as the government’s weakened position.
“We must bring this regime down once and for all,” Netanyahu said. “That is the directive I have given to all the security agencies.”
Iranian officials raised the possibility of a shift in nuclear policy and threatened retaliation against further US-Israeli attacks, while Tehran outlined its conditions for reopening the Strait of Hormuz on Sunday.
The developments came after Iran's parliament approved a new defense minister with longstanding ties to the Revolutionary Guards' missile program, and Israeli Prime Minister Benjamin Netanyahu called for eliminating what he described as the Iranian threat.
Nuclear doctrine comes under scrutiny
Iran's new supreme leader, Mojtaba Khamenei, may take a different position on nuclear weapons from his late father, Ali Khamenei, whose religious ruling opposed their development, Iranian lawmaker Ahmad Naderi said.
“From Mojtaba Khamenei's conduct, my understanding is that his fatwa will be different,” Naderi told.
Naderi separately expressed his own support for acquiring an atomic bomb, saying he had advocated the move for more than a decade and believed Iran should pursue what he called ultimate military deterrence.
Calls for nuclear deterrence have become more prominent among Friday prayer leaders and representatives of the supreme leader, Naderi added.
The remarks came after US Vice President JD Vance said Washington had achieved a decisive military advantage over Iran but could not consider the conflict finished without a firm commitment that Tehran would not rebuild its nuclear program.
Vance also linked US involvement to energy security, warning that Iranian control over shipping through the Strait of Hormuz could increase gasoline prices.
Hormuz proposal remains unresolved
Iran's seven-day proposal for reopening the Strait of Hormuz remains under consideration, with Tehran reviewing Washington's comments, Foreign Minister Abbas Araghchi said.
“Our conditions are completely clear and were presented to the United States in the form of a seven-day plan,” Araghchi said.
Under the proposal, the strait would reopen on the sixth day if Washington met Iran's conditions, with negotiations resuming on the seventh, Araghchi added.
The conditions were fair and had previously been accepted by the United States, he said.
New defense minister threatens retaliation
Iran's parliament approved Mehrdad Akhlaghi Ketabchi for the post of defense minister with 237 votes in favor and 15 against.
Akhlaghi, a sanctioned veteran of Iran's missile industry, replaces Aziz Nasirzadeh, who was killed during the opening day of US-Israeli strikes in February.
The new minister warned that any further American attack would bring casualties among US personnel stationed in the region.
“If he drops one bomb, he should see how many of his people he will have to carry out horizontally (dead),” Akhlaghi said, referring to President Donald Trump.
Iran's armed forces have also prepared a new operational plan for any renewed attack, Supreme National Security Council Secretary Mohsen Rezaei said.
The plan would be more destructive than those used during the previous wars and would not follow familiar patterns, Rezaei added.
Army commander-in-chief Amir Hatami separately urged the new defense minister to accelerate military modernization, citing the impact of recent wars and international sanctions.
Israel presses for further action
The complete elimination of what Israel considers the Iranian threat remains a central objective for the remainder of Trump's presidency, Netanyahu said in an interview with Life, Liberty & Levin.
Netanyahu argued that military and economic pressure should continue and called for the eventual removal of Iran's current political leadership.
The Israeli prime minister also said Tehran is pursuing intercontinental ballistic missiles capable of reaching the United States and seeking nuclear warheads for them.
Separately, Iran's hardline Kayhan newspaper urged strikes against Israeli nuclear facilities if Washington attacked the underground Pickaxe Mountain complex near Natanz.
The warning followed Trump's suggestion that US forces could target the fortified site.
The statements underscored the competing priorities shaping the confrontation: Washington's demand for guarantees against renewed Iranian nuclear activity, Tehran's conditions for restoring maritime access, and continuing threats of military escalation from both sides.
Investment in trade routes linking Asia and Europe through Central Asia and the Caucasus is putting pressure on Iran’s ambitions to become a major transit hub, with neighboring countries developing transport and digital networks that bypass Iranian territory.
Among them is the Middle Corridor, a network of rail, road and sea links connecting China to Europe through Central Asia and the Caucasus while bypassing Iran.
The corridor is intended not only to connect Chinese and European markets. Countries along the route are also expanding trade among themselves, and the broader connectivity push extends beyond cargo to energy, information technology and data.
On October 15, the presidents of Azerbaijan and Kazakhstan inaugurated a 380-kilometer fiber-optic link across the Caspian seabed with a capacity of more than 400 terabits per second. Part of the Digital Silk Way initiative, the cable complements the Middle Corridor.
Beyond carrying data along the East-West axis, its backers say it will help attract investment in AI data centers, cloud services and high-tech industries.
In its latest report, the World Bank projects that, if the planned investments materialize, freight volumes across the Caspian could rise from 8.8 million tons in 2023 to 32.1 million tons in 2040.
The report also finds that developing the corridor could, in the long term, increase the combined GDP of host countries by about 3.3 percent, equivalent to approximately $58 billion at current levels of economic activity, and raise employment by 2.9 percent.
These gains depend on policy and operational reforms alongside construction. The World Bank identifies at least $25 billion in infrastructure investment needs through 2040, plus an estimated $30 billion for connecting infrastructure, logistics facilities and equipment.
One of the most contentious proposed links is the route through southern Armenia that would connect mainland Azerbaijan to its Nakhchivan exclave, known in Azerbaijan as the Zangezur corridor.
Under agreements reached since August 2025, the US-backed project is being developed as the Trump Route for International Peace and Prosperity, or TRIPP, with Armenia retaining sovereignty and jurisdiction over its territory.
Azerbaijan projects that the route could carry 15 million tons of freight annually. The section through Armenia is roughly 42 to 43 kilometers long.
After several years of fierce opposition to the proposed Zangezur corridor, Iran appears to be taking a more pragmatic approach to Armenia’s inclusion in East-West transport networks, although concerns over American involvement remain.
Iran’s ambassador in Yerevan expressed concern in September about an American presence near the border and proposed a mechanism to address Tehran’s concerns. On October 16, Armenian Foreign Minister Ararat Mirzoyan said Iran had asked about the possible deployment of US military forces on Armenian territory and that Yerevan had assured Tehran this would not happen. He said he believed the Iranian side was satisfied with Armenia’s answers.
The World Bank estimates that developing the Middle Corridor could increase Armenia’s GDP by 3.4 percent, equivalent to $873 million, and raise employment by 3.9 percent in the long term. Armenia, however, is not yet a transit country on the route; the report assumes a direct rail link through the country becomes operational in the early 2030s.
Iran’s transit ambitions face growing competition
Azerbaijan and Iran have also pursued an alternative connection between mainland Azerbaijan and Nakhchivan through Iranian territory, known as the Aras corridor.
That route could preserve a role for Iran in regional transit, but participation in one connecting segment would fall short of Tehran’s broader ambition to become a central hub for trade between Asia and Europe. Western sanctions also complicate efforts to attract European businesses to routes through Iran.
A comparison with Turkey, a key link between the Middle Corridor and European markets, is telling. The World Bank estimates that corridor development could increase Turkey’s GDP by more than $47 billion and employment by about 4.4 percent in the long term.
Iran also faces competition from other regional transport plans. Iraq, with participation from Qatar, the UAE and Turkey, is advancing the Development Road, intended to link the Grand Faw port to the Turkish border at an estimated cost of about $17 billion. Iraqi officials have projected annual revenues of roughly $4 billion, although the project’s returns depend on financing, completion and demand.
The proposed India-Middle East-Europe Economic Corridor and Syria’s Four Seas initiative, linking the Mediterranean, Persian Gulf, Black Sea and Caspian region, likewise reflect efforts to develop alternative networks. These projects remain at different stages of development, and their commercial success is not assured.
More than two decades after Iran, India and Russia agreed to establish the International North-South Transport Corridor, Tehran’s ambition to become a transit hub linking India with Russia and European markets remains only partly realized. Shipments have moved through Iran, but the existence of traffic alone does not demonstrate that the route has fulfilled its wider commercial promise.
Iran’s weak logistics performance adds to the challenge. In the World Bank’s 2023 Logistics Performance Index, it ranked 123rd with a score of 2.3 out of five. Geography gives Iran potential advantages, but converting them into sustained transit business requires reliable infrastructure, efficient border procedures and commercially viable international connections.
