Abstract
Economic sanctions are a punishment mechanism to ensure that governments respect human rights. However, sanctions affect nations, and pose challenges social workers in health care practice. The present note discusses the connection between health care and economic sanctions, and the challenges that health care social workers face due to the sanctions.
Introduction
One of the positive outcomes of globalization is the development of human rights (Khan, 2004). However, some decisions inside international organizations must be evaluated and challenged. For example, the United Nations Security Council has established several sanctions regimes, like on Iran, to safeguard nations whose governments violate human rights (Jones, 2020). These sanctions have implications for these countries due to restrictions on access to medical items and treatments (Akbarialiabad et al., 2021). Therefore, health care social workers have faced numerous problems intervening and saving human lives in these countries (Yadav and Yadav, 2022). This paper examines the challenges created by sanctions in health care interventions by focusing on Iran as one of the nations with a significant health care casualties due to sanctions and discusses the implications for social workers in similar situations.
How globalization, economic sanctions, and health care are connected
Globalization is the process that leads to an increased collective economic, social, and cultural environment for citizens and communities (Jones, 2020). Global standards also give national governments regulations to foster the growth of societies and decrease inequities. In this regard, member states of the United Nations recognized the value of international collaboration in 1945 for resolving social, economic, and cultural problems as well as violations of human rights. So, the United Nations Security Council tried to take action to maintain international peace under Chapter VII of the United Nations Charter in 1966 by establishing 30 economic sanctions regimes such as Cuba, Haiti, Yugoslavia, Iraq, Syria, and Iran (Akbarialiabad et al., 2021; Yadav and Yadav, 2022).
These sanctions were only economic. However, they can have a deadly effect on people’s lives and health (Akbarialiabad et al., 2021; Jones, 2020). For example, in the 1990s, the United Nations economic sanctions caused the deaths of more than half a million children in Iraq (Aloosh et al., 2019; Court, 1995).
Sanctions also cause an extra burden for health care in countries under sanction (Khammarnia and Setoodezadeh, 2021). A study in Iran using the spatial panel method shows sanctions impact health care directly through a lack of equipment and medicine, and indirectly through unemployment and economic pressures (Abhari and Aghajani, 2020). For example, in 2012, due to the sanctions the availability of lyophilized coagulation factor VIII concentrate for haemophiliac patients in Iran fell from 96 percent to about 3 percent. This led to significant joint bleeding, disability, and the death of roughly 100 patients (Aloosh et al., 2019). So, sanctions negatively impact primary health care and the treatment of diseases such as cancer (Aslan et al., 2020; Gorji, 2014).
Impacts of sanctions on social work practice in Iran
Iran is an Islamic Republic located in western Asia with a population of almost 80 million. After the Islamic Revolution in 1979, several socio-cultural changes affected the social work profession. Most organizations, charities, and non-governmental organizations were either closed down or replaced by new revolutionary foundations such as the Emam-Khomeini Foundation. Social work as a university discipline also disappeared for a couple of years. Meanwhile, the Iran–Iraq war in 1980–1988 caused new social issues that escalated the number of poor in the country. Hence, new non-governmental organizations and charities were established to expand the services (Ghasemian, 2005).
In the 1990s, social work again became an academic major at universities. However, social work in health care began in 1961 in Rouzbeh Hospital, and after the revolution, a more academic focus was granted to the Ministry of Health (Sabzi Khoshnami et al., 2021).
While the US and European Commission argue that vital medications and medical products are excluded from sanctions, their harsh penalties on Iran’s financial sector make trading of these items impossible (Akbarialiabad et al., 2021). Hence, several Iranian citizens are facing death due to a lack of access to several medical products, and providing comprehensive medical care for such a large population is impossible without international aid (Gorji, 2014). Therefore, health care practitioners, including social workers, confront several problems when providing services in sanctioned nations.
Only a few pharmaceutical businesses collaborate with Iran. So, preparing medicine for particular patients with rare disorders is complicated since foreign drugs are expensive and raw ingredients for making medicines are hard to get into the country (Gorji, 2014).
Medical providers and physicians face numerous obstacles including increased medical errors owing to equipment failures, impairments, and higher mortality. On a macro level, these weaknesses will affect the entire population and the country’s health care system (Massoumi and Koduri, 2015).
Vulnerable groups, including the poor, have to use the black market to access medicine, pay extra costs, or travel abroad (Dehghani et al., 2021). Turning to the black market not only puts their lives in danger but also prevents social workers from documenting and providing services. Due to the difficulty of gaining evidence from an illegal market the procedure of recording activities and resources proves an arduous task (Bastani et al., 2022).
Public access to preventive services is another challenge. For example, during the COVID-19 pandemic, the lack of vaccines in Iran caused numerous deaths. Long peaks were experienced in the country, which resulted in public dissatisfaction and distrust of the international community. Moreover, Iranian health care faced problems in prevention, diagnosis, and treatment. Although the World Health Organization and other international humanitarian organizations sent medical supplies, the destructive effects of sanctions reduced access to medicines and health equipment (Dolatabadi and Kamrava, 2021).
Sanctions against Iran have had a crucial impact on the social determinants of health such as nutrition, employment, social happiness, life expectancy, and personal coping skills (Aloosh et al., 2019).
Sanctions have resulted in a lack of pharmaceutical and medical supplies. As a result, social workers face ethical dilemmas concerning professional evaluation and resource distribution among patients (Jones, 2020). Thus, social workers experience stressful moments regarding risk management and ethical issues due to sanctions. It leads to another significant problem, such as burnout.
Conclusion and social work implications
The international definition of social work indicates that the principles of social justice and human rights are central to social work, and social workers are responsible for monitoring the realization of human rights (Järkestig Berggren et al., 2020). Thus, social workers must reflect on decisions about human rights within international organizations.
Following comprehensive approaches such as psycho-social interventions in healthcare practice has assisted Iranian social workers, particularly in cancer treatment, to develop more effective strategies to help their clients (Sabzi Khoshnami et al., 2021). However, they should follow a holistic and international approach to ensure the achievement of human rights for all. It means they should consider that individuals, governments, and societies are intertwined (Harms-Smith et al., 2019; Weiss-Gal et al., 2014). In this sense, the punishment of governments also impacts their nations. Social workers must assess the consequences of sanctions, attempt to take early actions to moderate mechanisms, represent the nations’ demands, and call for alternative punishments if they notice that they are not leading to desired results.
The majority of Iranian social workers in health care work in non-governmental organizations and charities. This demonstrates that this sector has great potential for social workers. It creates capacity by utilizing existing social capital in non-governmental organizations. They can assess the needs by using this potential and report gaps in the health care system to international decision-makers and policymakers through inter-organizational and cross-border interactions, such as Red Crescent volunteer teams and the International Federation of Social Workers. Professional regulation for Iranian social workers is also necessary to support them through policies, laws, and supervision. Such legislation helps them to be more transparent in difficult situations and solve their professional challenges. The mentioned initiatives will give Iranian social workers the chance and voice to act early to moderate punishment mechanisms and their harmful effects.
Social workers should also seek to reduce or remove the causes of oppression and violation of human rights by governments (Harms-Smith et al., 2019). The active role of social workers in monitoring human rights in these countries will prevent the punishment mechanisms imposed by the United Nations (UN Centre for Human Rights, 1994). In this regard, they need to play a more active role through international partnerships, anti-oppression demands, and information and communications technology (Harms-Smith et al., 2019).
Finally, guilty governments occasionally use sanctions to cover up their crimes (Dyson and Cetorelli, 2017). In this regard, to emphasize the appropriate causes and identify the most effective solutions, social workers can benefit from engaging in evidence-based practice and relevant research. However, there is a lack of studies on the impacts of sanctions on health care and social work practice. Hence, social workers in health care should begin to reflect on the barriers they face and the consequences of sanctions on their clients’ lives in similar situations to provide an academic voice for a better advocacy process.
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
