Iranian healthcare workers are straining to meet the demand in intensive care wards, and dream of leaving the country behind even as the collapsing system needs them more each day.

Iran’s healthcare system has recently seen its deadliest days since the spread of the coronavirus. 

But as the peak of the fifth pandemic wave gradually subsides, the vulnerability of the country’s worn-out healthcare infrastructure becomes all the more visible.

After several intense weeks of the virus surging through the country, brought about mainly by the highly contagious delta variant spread among Iran’s largely unvaccinated population, numbers of new cases and deaths are now showing a drop.

Yet, healthcare workers’ battle with trauma, exhaustion and disappointment continues. 

Thousands of Iranian doctors and nurses are now somewhere in the process of immigration.  

An overwhelming workload in understaffed health centres coupled with unprecedented economic hardship has left many healthcare workers on the brink of mental and physical exhaustion.

“Almost all types of medical workers—doctors, nurses, surgery room technicians, anesthesiology technicians—they all want to leave. Some have done the preparations, and others either have made a decision or don’t see the circumstances right,” Saeed Behagh, a fourth-year anesthesiology resident, tells TRT World. “I would immigrate if I were able to.”

He has been working in several hospitals in Tehran since the beginning of the pandemic. 

Amid a shortage of senior physicians, hospitals across the country have also been calling him, asking for his presence “even for a few days.” But, unfortunately, he says, he has to reject those calls as it would not be economically possible for him to go to hospitals in remote places. 

“Payments are close to minimum wage, and the workload is too heavy in the pandemic,” he says. “Our off days are constantly being cancelled. Many get Covid and have to leave. Many colleagues fail to go on. Some have left this job, and others have become determined to leave the country just in the past couple of months.”

“Hot topic”

The Medical Council of the Islamic Republic of Iran recently said that at least 3,000 doctors have requested from the council documents required for immigration during the past year.

Plagued by recurrent waves of soaring Covid-19 patients, nurses, too, have become determined to pursue their careers abroad.

“Among nurses, going abroad is a hot topic,” Javad Abbasi, an ICU nurse at Baharloo Hospital in Tehran, told TRT World.

“My friends have gone to Germany, Canada, Britain, Sweden. Many nurses are now studying a foreign language. Many are in line to get a visa. If I can sort the conditions, I will go too.”

Armin Zareian, head of the board at Nursing Organization Iran, was quoted as saying in April that, every month, the organization receives 500 requests for immigration documents.

Nasrin Kazemi, a head nurse at Emam Zaman Hospital in the southern outskirts of Tehran, says many nurses at her hospital are also intent on leaving the country.

“Here they don’t appreciate your work,” she tells TRT World.

Poor infrastructures  

Iran is the worst-hit country from Covid-19 in the Middle East.

The country has seen more than 5.6 million infections and almost 121 thousand deaths. However, daily deaths have dropped from a record high of 709 in early August to 238 on October 4. 

Over the past few weeks, emergency rooms and ICUs have been flooded by patients whose relatives would have to source overpriced medicines in the black market. 

Expensive equipment such as oxygen tanks and simple ones like serum stands became scarce as shortages of personnel at health centres proved a serious issue. 

“In recent weeks, we have faced shortages of medicines whose scarcity is unprecedented. Important medicines for anaesthesia, for instance, are in short supply. This has practically made us paralyzed,” Behagh, the chief resident, says.

“Residents run state hospitals. If they stop working for 3-4 hours, the system will fail. So it’s rapidly moving toward frustration. There have been deaths and suicides among residents, which is evidence of this.”

As of March, eight young residents working in Covid-19 emergency rooms have suffered sudden death, according to official reports.

The personal lives of health care workers are deeply affected by a heavy workload. There is added disappointment caused by the grimness of the economic future that awaits them.

Mental health crisis

Alireza Sedaghat, head of the ICU at Mashhad Hospital, was recently quoted as saying by Iranian news agencies that health workers face a “horrible wave of mental health diseases” with suicidal tendencies on the rise and life expectancy declining significantly. 

“After each patient’s death, I feel depressed for days, thinking whether I could have saved the patient had I done something different for him,” Behagh says. “These are traumas that pile up in your soul.”

Shortages of personnel have been posing a tremendous mental health challenge for nurses too. 

Kazemi, the head nurse working in Tehran’s outskirts, says her workplace struggled with staff shortages for months before the hospital transferred obstetricians and assistive personnel to the Covid section. 

“There were two nurses for 26 patients. They would run all night and still fail to meet the patients’ needs. They would often faint and give themselves serum injections to be able to get up and work,” she said.

“In these conditions, medication might be missed; a follow-up could be skipped; anything could happen, and we would have a difficult time forgiving ourselves,” Abbasi, the ICU nurse, says.

Health authorities say the fifth wave of the pandemic is now under control. But they warn that another wave could strike in November if a rapid and effective vaccination program does not create mass immunity.

The government has recently sped up vaccinations by using imported doses, showing a shift in policy from prioritizing the development of domestic vaccine production. 

The health ministry says 13 million out of a population of 83 million have been fully inoculated. 

Kazemi, the head nurse, says they still struggle with an overcrowded hospital despite a drop in the number of cases.

“All of our beds are still occupied. Therefore, patients need to register in advance to be able to use beds in the Covid unit.”

Source: TRT World