The war against the coronavirus pandemic is literally a life and death fight for nations. But Iran is waging it with an economy badly crippled by United States sanctions that have Tehran bereft of financial resources to mount an effective public health response.
Mahsa is a 28-year-old nurse in Mazandaran, a northern province in Iran that has been hard hit by the virus.
"Ventilators are very crucial for treatment of COVID-19 patients, but officials tell us that because of the sanctions, they have not been able to order enough of them from abroad," she told Al Jazeera. "Medical goods are supposed to increase in accordance with the number of admitted patients, but these goods are very hard to find these days."
More than 3,000 people in Iran have lost their lives to COVID-19, and the number of confirmed cases in the country has surpassed 47,500, according to Johns Hopkins University.
Mahsa, who asked Al Jazeera to withhold her surname, described the harrowing conditions facing front-line health workers.
"There have been times that we had to order masks or gowns from Tehran ourselves. Our staff at the labs who are conducting the tests are supposed to be working with N95 masks, but they are working with the simple three-layer masks instead. There have been shifts in which I had to be exposed to infected patients without having the protective gown. This is exactly why a number of our colleagues have died in recent weeks," she said.
Dozens of health workers across Iran have lost their lives to COVID-19, according to the country's health ministry. And it pins the blame on Washington.
"Everyone knows that the United States, through its abusive and unilateral acts against humanity and inhumane measures against the people of Iran [sanctions], has led to these events," said health ministry spokesman Kianush Jahanpur, IRNA news agency reported.
But many also fault Iran's leadership for acting too slowly to contain the virus.
US Secretary of State Mike Pompeo has been a particularly vocal critic, tweeting last month: "The Iranian regime ignored repeated warnings from its own health officials," adding that throughout February, Iran's Mahan Air "continued to fly at least 55 times between Tehran and China".
On Sunday, Iranian President Hassan Rouhani described such charges as "political war", and said that he had to weigh efforts to contain COVID-19 against the blow it would deliver to the country's already ravaged economy.
Ventilators are very crucial for treatment of COVID-19 patients, but officials tell us that because of the sanctions they have not been able to order enough of them from abroad.
MAHSA, FRONT-LINE HEALTH WORKER, IRAN
Turning to the IMF
Since the administration of US President Donald Trump unilaterally withdrew from the Iran nuclear deal with world powers in 2018, Iran has been relentlessly punished with successive rounds of US economic sanctions that have starved the country of its main source of revenue - oil sales - and isolated it from the global financial system.
Though humanitarian goods such as medicines are technically exempt from US sanctions - a caveat often reiterated by Trump administration officials - a report by Human Rights Watch in October found that "broad restrictions on financial transactions, coupled with aggressive rhetoric from US officials, have drastically constrained the ability of Iranian entities to finance humanitarian imports, including vital medicines and medical equipment".
On Tuesday, the German foreign ministry confirmedthat Iran had received medical supplies in the first transaction under the Instrument in Support of Trade Exchanges (INSTEX) special-purpose vehicle set up by nuclear-deal signatories the United Kingdom, France and Germany to bypass US sanctions.
Qatar, Kuwait, Japan, China and the European Union have also either sent medical supplies to Iran or pledged to do so.
The dire conditions facing Iran were underscored last month, when the government took the unusual step of requesting $5bn in emergency funding from the International Monetary Fund (IMF) to help combat the pandemic. The request marked the first time since 1960 that Tehran has sought assistance from the international lender.
"While the amount is too small to completely address the needs of the country right now, it reflects Iran's openness at this critical time to international aid from one of the leading US-backed international financial institutions," Sina Toossi, a senior research analyst at the National Iranian American Council in Washington, DC told Al Jazeera.
While the EU has said it will support Iran's request for help from the IMF, the US is the Fund's largest shareholder, which effectively gives Washington veto power over any lending decisions.
"My understanding is that the US is obliged to vote against it because Iran is on the State Department's list of terrorism sponsors and US legislation requires that the US oppose lending from international bodies to such states," Barbara Slavin, director of the Future of Iran Initiative at the Atlantic Council in Washington, told Al Jazeera.
But there could be a loophole, says Slavin.
"If the other important members of the IMF board such as China vote in favour [of lending to Iran], the US might not be able to block the loan," she said. "This would be an important confidence-building measure and obviously very helpful to Iran in these difficult circumstances."
If the other important members of the IMF board such as China vote in favor [of lending to Iran], the US might not be able to block the loan.
BARBARA SLAVIN, DIRECTOR, FUTURE OF IRAN INITIATIVE, ATLANTIC COUNCIL
International outcry to ease sanctions
Last week, the United Nations High Commissioner for Human Rights, Michelle Bachelet, urged countries to ease sanctions against nations such as Iran to enable medical systems to fight the pandemic and curb its spread.
"At this crucial time, both for global public health reasons, and to support the rights and lives of millions of people in these countries, sectoral sanctions should be eased or suspended," she said.
Beyond the difficulties of paying for medical supplies, analysts say Iran's fragile economy also undermines containment efforts because the financially-strapped population cannot afford not to work.
"Enforcing needed quarantine measures necessitates shutting down large parts of the economy, denying an already struggling population sources of income," said Toossi. "In this case, as we see unfolding in other countries, the government will have to distribute aid and direct cash payments to meet the subsistence needs of the people."
Washington has faced withering criticism for continuing to target Iran's economy with sanctions even after Tehran confirmed the first two cases of coronavirus in the country on February 19.
But on Tuesday, Pompeo appeared to soften that hard line. When asked if the US might reevaluate its position on easing sanctions on Iran, Pompeo told reporters, "We evaluate all of our policies constantly, so the answer is - would we ever rethink? - Of course."
But Slavin does not see a policy change in the cards. "Secretary of State Pompeo continues to insist that the US is willing to provide humanitarian assistance to Iran, although he has yet to provide details," she noted. "It is hard for me to envision a change in the US position, no matter how counterproductive it has turned out to be."
For front-line health worker Mahsa, who puts her own life at risk to save the lives of her fellow citizens, the memory of the human toll of the crisis, and Washington's intransigence, will linger long after the crisis has passed.
"We will get over these hard days in the end, but we won't forget how US officials imposed a direct war against ordinary people by their sanctions," she said.