How Iran’s coronavirus outbreak could spark a Middle Eastern epidemic

By Christopher Tan (PZ ‘21)

Crippled by US sanctions, embroiled in political unrest and rattled by the death of its most important general; the last few months have tested Iran’s hardline leadership. Yet, through tight control of the media, vote-rigging and revolutionary zest; Tehran has quelled whatever threats these posed to its regime. As the country grapples with the coronavirus’ spread, Iran may find itself flat-footed. This could prove consequential, with an outbreak in Iran threatening to spread the virus across a region already gripped by poverty and war. 

The situation is evolving. Up until February 18th, as rumors surfaced about an outbreak in the religious city of Qom, leadership in Tehran had insisted that Iran had no cases. At the time of writing, health authorities reported up to 250 confirmed cases of the virus, with 26 confirmed deaths. It has only been a little more than a week. “It will be safer for people to stay at home,” a spokesman for the health ministry told state TV. “There were 34 new confirmed cases in the past 24 hours, including 16 people in Qom city.” 

The other day, an MP from Qom claimed that over 50 people had died in his city alone, before his statement was quickly denounced by Iraj Harichi, Iran’s deputy health minister. Harichi, who had broadcasted these statements to quell public fears, appeared feverish on television. Incredibly, one day later, Harichi announced that he had tested positive for the virus and was placing himself in quarantine. In a regime accustomed to projecting stability through powerful rhetoric, this was a comedic show of the government’s shortcomings. 

What is concerning is the virus’ high mortality rate in the Islamic Republic. While in China, the virus’ mortality rate stands at close to 2.3%, in Iran this number is much higher, with 10% of coronavirus patients in Iran succumbing to the disease. This points to three potential scenarios.

Firstly, given the Iranian regime’s tight grip on the media, authorities may be hiding the true scale of the outbreak. Doctors around Iran were already voicing concerns that it is likely that the disease’s spread is more serious than reported.  The rapid growth of the virus throughout the country and around the region point to this. Secondly, as health authorities around the world have found out, Tehran may not be aware of how extensive the outbreak may be. Coronavirus testing kits are reportedly in short supply, making it difficult to track the virus’ infiltration. The number of infections could be in the thousands, and increasing by day. Thirdly and most pressingly, Iran may not have the infrastructure or supplies needed to handle the crisis. US sanctions have devastated Iran’s economy and there are fears that it lacks the medical supplies needed to care for patients. It is likely that a brutal combination of these three scenarios is true, complicating efforts to contain it.

Tehran has used its levers to halt the spread. Pilgrimage roots have been shut. Schools and universities throughout the country have been closed. Public gatherings and events have been cancelled. This may not be enough. Experts around the world harbor grave concerns about whether countries with less effective healthcare systems like Iran have the resources to manage an outbreak. American sanctions, imposed by President Trump after his withdrawal from the nuclear deal, have crippled Iran’s ability to import medication and supplies. While China’s struggles with the virus have been well-documented, the country has benefited from a government able to fly in medical personnel and supplies into critical areas. Iran does not have the capacity to undertake a similar operation. A study done by Human Rights Watch last year found that Iran’s health care sector was deeply affected by the latest round of US sanctions, with patients unable to obtain access to vital medications.

Worse still, Iran has long been a focal point for migration in the Middle East. Pilgrims, soldiers and migrant workers have constantly moved through weakly enforced borders onto Iran and surrounding countries. Similarly, the Iranian diaspora has spread far and wide in the decades since its revolution. Upwards of 4 million Iranians are thought to be living abroad across North America, Europe, the Persian Gulf, Australia and around the Middle East. Many of these communities return to Iran on a consistent basis. If the virus’ spread across Iran has been extensive, members of the diaspora could have contracted the disease and brought it with them around the world.

Regional governments have reacted swiftly to developments. Turkey, Pakistan, Afghanistan, Armenia and Iraq have all announced the closure of their land borders with Iran. Scores of flights to and from Iran have also been cancelled, with countries like Turkey and Armenia also announcing plans to evacuate citizens from the Islamic Republic. Saudi Arabia, home to many important religious sites in Islam, banned foreign pilgrims from entering its borders. Yet, there are worries that these measures have already come too late. 

Already, virus cases in Iraq, Afghanistan, Kuwait, Oman, Lebanon, the United Arab Emirates and even Canada have been traced to Iran. This has only compounded fears that the region is on the cusp of catastrophe. While the Gulf states may have the resources to handle this, poorer countries like Syria, Afghanistan and Yemen do not. The constant cycle of wars and unrest over the past decade has devastated healthcare systems across the Middle East. Should the coronavirus spread from Iran to these countries; its governments do not have the capacity, medical expertise or public trust needed to prevent a humanitarian disaster. 

Even Lebanon, a country with a significant Shi’ite population and a healthcare system comparable to many developed countries, could struggle. Over the past year, the Mediterranean country has been engulfed in a financial crisis amidst mass protests against the country’s political elite. This has already hampered efforts to import vital medical supplies. Should an outbreak occur in Lebanon, massive amounts of foreign aid will likely be needed to provide for its deficit in medications. 

The legitimacy of various regimes around the region already lies on shaky ground. This is worrying. Public trust is a vital element in a government’s ability to mitigate crises. After officials in Tehran were forced to admit lying about their knowledge of the accidental downing of a passenger jet two months ago, many Iranians are already openly skeptical of any information from the government. The New York Times reported that Iranians were ignoring official directives to avoid hospitals for fear of spreading the disease, with citizens instead crowding into rooms to report symptoms and get themselves tested. Should many people be contagious, mass gatherings like these could aid the virus’ spread. 

Things are not looking rosy. Despite implementing some measures to control the spread, officials in Iran rejected calls to quarantine major cities and other affected areas. For the regime, projecting a mentality of ‘work as usual’ appears to be taking priority over suggestions of a national crisis. In Tehran, President Hassan Rouhani continued to tout a familiar narrative, with the leader blaming “enemy plots” for “spreading fear and closing down the country” while urging Iranians to “continue work and other activities.” Delusion is not the best remedy in these situations.

Tehran must take evasive action to prevent disaster. Similar mass-quarantine measures like efforts seen in China and Italy, should be embraced and not resisted. Leadership must also press the US to lift sanctions so that medical supplies can be imported. With Tehran already facing a crisis of legitimacy, it can seek to regain public trust if it acts decisively and effectively. Iranians are aware of their country’s shortcomings and can accept its limitations. What would be unacceptable is delusion and inaction. If the government continues down this path, the consequences would be unimaginable. Overwhelmed hospitals, infections running into the thousands, mass looting, widespread hunger and panic. 

The Middle East is too impoverished and ill-equipped to handle the kind of outbreak that has devastated China. It may already be too late. One paper published by Canadian researchers noted that up to 18,000 people in Iran may already be infected by the coronavirus. As such, it is likely that transmissions in neighboring countries are occurring.  If an epidemic were to occur, it would take a massive outpouring of foreign aid to assist in the region’s recovery. Unfortunately, Iran is not alone in its plight. With the virus continuing to spread across Asia, Europe and the United States, the developed world may be too occupied with protecting their own citizens to care. 

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