US President Donald Trump unilaterally withdrew from the 2015 Iran nuclear deal last year and re-imposed punitive sanctions as part of a stated campaign of "maximum pressure" against the Islamic Republic.
Officially, the sanction regime makes exceptions for food, medicine and other humanitarian goods, but most companies are unwilling to do any trade with Iran for fear of repercussions in the world's largest economy.
Trump "administration officials claim they stand with the Iranian people, but the overbroad and burdensome US sanctions regime is harming Iranian's right to health, including access to live-saving medicines", said Sarah Leah Whitson, Middle East director at HRW.
"The comprehensive web of US sanctions has led banks and companies to pull back from humanitarian trade with Iran, leaving Iranians who have rare or complicated diseases unable to get the medicine and treatment they require," she added.
The sanctions add previously suspended nuclear-related embargoes including those on Iran's oil exports and financial transactions, to new ones.
In a 47-page report, HRW documents how the US-built exemptions for humanitarian imports into its sanctions regime have failed to offset the strong reluctance of US and European companies and banks to finance humanitarian goods.
Over the past year, the US Treasury Department has added a large number of institutions, including Iranian government and private banks, to the Specially Designated Nationals and Blocked Persons List for the sanctions.
US and non-US companies and financial institutions that engage in transactions with these entities can be prosecuted in the United States. The serious regulatory and due diligence requirements placed on international firms trading with Iran have left only a small number of companies and banks with the capacity to finance trade with Iran and a willingness to accept the increased financial and legal risks.
Excessive caution or “over compliance” by banks and pharmaceutical companies is a significant factor for this, Human Rights Watch said. Human Rights Watch found, for instance, that a European company refused to sell the special bandages needed by patients with EB despite the humanitarian exemption. Human Rights Watch reviewed correspondence with two other banks in which they refused to authorize humanitarian transactions with Iran.
Iranian patients have struggled with a foreign medicine shortage and price hikes for over a year both due to re-imposed US trade sanctions.
Medicine importers get subsidized currency rates from the government, yet foreign drugs and medical equipment cannot always be found in state-owned pharmacies.
Iran produces 96 percent of the drugs it uses but imports more than half the raw materials to make them, according to the Syndicate of Iranian Pharmaceutical Industries.
It also has to import special medicine which patients with rare diseases require.
Human Rights Watch said it found that US economic sanctions on Iran, despite the humanitarian exemptions, are causing unnecessary suffering to Iranian citizens afflicted with a range of diseases and medical conditions. Some of the worst affected are Iranians who have rare diseases and/or conditions that require specialized treatment and are unable to acquire previously available medicines or supplies. This includes patients with leukemia, epidermolysis bullosa (EB, a type of disease that causes fragile, blistering skin), epilepsy, and chronic eye injuries from exposure to chemical weapons during the Iran-Iraq war.
Viable financial channel
The recent US Treasury and State Department announcement of a “new humanitarian mechanism” for trade with Iran is a rare implicit acknowledgement that broad US sanctions on Iran have restricted the flow of humanitarian goods into the country,” Whitson said.
“The US government should get serious about addressing the harm resulting from its cruel sanctions regime by creating a viable financial channel with reasonable requirements for companies, banks, and groups to provide humanitarian goods for people in Iran instead of requiring more burdensome hurdles.”
The US government should work to establish viable financial channels for humanitarian trade with Iran and take immediate steps to ensure that humanitarian exemptions are effective in facilitating Iranians’ access to medicine and medical equipment, Human Rights Watch said.
“Ordinary Iranians are bearing the brunt of America’s sanctions policy, and their hearts and minds will be keeping tabs on the parties that are causing them harm,” Whitson said.
AFP and hrw.org contributed to this story.