It was four weeks to her wedding in September when Mohaddeseh Gol Alizadeh, a 26-year-old nurse, realized her mother’s colon cancer had returned. The news was devastating, but what followed turned into a nightmare for the family.
Her mother required an emergency PET scan -- a diagnostic test used for many diseases, including cancer -- within 24 hours. However, she couldn't get tested until at least 20 days from her initial diagnosis because of a shortage of medication and resources in Iran.
"They were the worst days of my life. My mom couldn’t sleep. She was very sad and stressful, which is the worst thing for a patient with cancer," Gol Alizadeh told ABC News.
By the time Gol Alizadeh received her mother’s test results, cancer had already spread, making treatment more complicated.
Limited access to medicine has frustrated Iranian patients and their families, especially after President Donald Trump withdrew from the Iranian nuclear deal in 2018. The deal signed in 2015 between Iran and six world powers (Germany, France, UK, Russia, China and the U.S.) eased sanctions on Iran in return for Tehran scaling back its nuclear stockpiles and manufacturing activities.
The U.S. withdrawal led to the return of economic, trade and financial sanctions against the Islamic Republic.
The direct impact of sanctions on medicine
While humanitarian goods are exempt from sanctions, medication manufacturers in Iran face many challenges because of other sanctions, including banking and transaction restrictions. Restrictions on payment for medications or equipment, in addition to problems shipping goods to and from Iran, have made it more difficult to get quick and widespread access to medicine.
Nuclear medicine, essential for PET scan diagnosis testing, is especially at risk since it is linked with Iran’s atomic energy industry.
Iranian nuclear medication manufacturer Pars Isotope Company was one of the companies added to the U.S. Department of the Treasury's sanction list after the U.S.'s unilateral withdrawal from the nuclear deal.
"We were all shocked when we heard the news. Our activities are purely for medical purposes. About 800,000 Iranians use our products annually," Mohammad Reza Davarpanah, head of Pars Isotope Company, said in an interview with ABC News.
According to the official website of the U.S. Department of the Treasury, Pars Isotope Company is designated as being "linked to the Atomic Energy Organization of Iran."
Davarpanah said that to produce radioisotopes, the company needs to use Tehran’s research reactor, which belongs to the AEOI and was built by the United States before the Islamic revolution in 1979. He said that all connections to the AEOI are merely for medical purposes.
Complicating matters is the delay in delivering raw materials used to make nuclear medicine, since sanctions were restored. Those materials typically have a very short half-lifetime, making fast shipment critical.
“Raw materials of radiopharmaceuticals are like ice. They melt away and decay if they are not delivered on time,” explained Dr. Davoud Beigi, nuclear pharmacist and professor of Tehran University of Medical Sciences, about the importance of the logistics and access in nuclear medicine production.
"When delivery of the raw materials are interrupted because of restricted access to aviation services, not only what we receive is less than what we really need, it makes us postpone our patients’ diagnosis test appointments and they can’t get any treatment until their diagnosis is completed," Beigi explained.
Airlines including Emirates, Qatar Airways and Turkish Airlines used to work with Pars Isotope, but no longer provide service to the company after it was sanctioned.
"We are left with just one Russian airline to import the raw materials and Iranian airliners to distribute the products," Davarpanah said.
Neither the U.S. Department of the Treasury, nor Emirates, Qatar Airways or Turkish Airlines responded to ABC News' inquiries about the sanction on Pars Isotope Company.
Sanctions beyond borders
Iranian medical facilities also provide services to patients from other countries like Iraq, who come in search for more affordable treatment options than may be offered in their own countries.
Some hospitals, including those in Iraq, India, Syria and Egypt, also import radiopharmaceuticals from Iran, Davarpanah said.
"Sanctions are not just damaging to Iranian patients with critical illnesses. Some of our customers face the same logistic problems as we do," said Davarpanah.
"Indian nuclear medicine society [and] many big government hospital and private hospitals [have been] using Pars Isotope products for the last five years," said Pratik Chitalia, managing director of India’s Vishat Diagnostics Pvt. Ltd., a distributor in the field of specialty diagnostics.
"After sanctions, we face a big difficulty and our poor cancer patients suffer a lot," Chitalia added.
While tensions between Iran and the U.S. over Iran’s nuclear and ballistic missile programs remain unresolved, there are attempts to ease the heavy burden of sanctions on Iranian people.
“Switzerland has reactivated a trade channel which used to work in the previous edition of the U.S. sanctions on Iran. The channel would be for the exchange of humanitarian goods such as food and medicine as licensed by the Office of Foreign Assets Control (OFAC) at the U.S. Department of Treasury," said Ferial Mustofi, chairwoman of money and capital market commission at Tehran’s Chamber of Commerce, to ABC News.
However, the channel’s service would not apply to the radioisotope access, as the manufacturer company is directly under the OFAC sanctions.
“For the Pars Isotope case, a direct OFAC exemption is needed,” Mustofi added.
Calls for change from within
The nuclear medicine crisis comes amid other unrest in Iran. In November, Iranians took to the streets to protest a sudden spike in gas prices. The decision had been made by top authorities to compensate the budget deficit the country faces due to the crippling U.S. sanctions.
Protests led to a crackdown by the Iranian government, which, according to Amnesty International reports, left nearly 300 killed. As a further control measure, the government cut off internet access for a week.
"The impact of the sanctions left people hopeless of their country," Sanam Vakil, senior research fellow and project director at Chatham House, Royal Institute of International Affairs, told ABC News.
In a comment about the latest unrest in Iran, Secretary of State Mike Pompeo said on Fox that the protests were "a direct result of economic collapse" that the United States accelerated through sanctions.
"The [U.S.] strategy is to put Iranian people under pressure so people redirect the pressure on their government. It is a low-cost policy for the U.S., which, in fact, imposes the cost on Iranians who are already suffering from various domestic, social and political pressures,” Vakil said.
Talking about the political and international affairs affecting the medicine market and people’s daily lives, Gol Alizadeh said she "cannot stop being angry."
"We are lucky my mom survived and is under treatment. But she probably wouldn’t go through so much stress and pain and wouldn’t have metastasis if she could get her PET scan on time," she said.
"When my mother has to take the PET scan, all officials from all parties have to find a way, so we, normal people, can have access to our basic rights," she added.