A/HRC/43/20 97 per cent of the medicines used therein, 100 it relies on the import of raw materials for their production. European pharmaceutical exports to the Islamic Republic of Iran have plummeted due to sanctions. From 2017 to 2018, Swiss and French pharmaceutical exports to the country dropped by 30 and 25 per cent, respectively. 101 Of the 433 imported types of drug, between March and November 2018,102 before the imposition of sanctions, 240 were on the Model List of Essential Medicines of the World Health Organization (WHO). 103 Between September 2018 and June 2019, imports of medical supplies fell by 60 per cent. 104 According to the country’s Food and Drug Administration, the pharmaceutical items in shortage had been reduced to 20 as at July 2019.105 However, the absence of stable import flows disrupts supply chains,106 hindering domestic production of pharmaceutical items 107 and threatening health sector employment, potentially affecting over 125,000 individuals. 108 52. On 12 October 2019, the Minister of Health expressed concerns 109 about the consequences on patients of importers being compelled to purchase alternative pharmaceuticals and equipment of lower quality.110 According to reports received by OHCHR, the expiration dates of medical items are often extended by medical staff111 and quota units of medicines reduced against medical advice for patients with less severe conditions.112 Insurance companies are increasingly refusing to cover the growing cost of foreign medicines.113 Public insurance is unable to absorb the increasing cost of cancerrelated treatment, which often relies on high-tech equipment and technology.114 According to the president of the Mahak Pediatric Cancer Treatment and Research Centre, 115 a nonprofit charitable organization which has treated over 30,000 children with cancer since 1991, cancer medicines are among the imported drugs that have become scarce and expensive.116 The Centre experienced critical shortages of chemotherapy medication, including asparaginase and mercaptopurine, both on the WHO Model List of Essential Medicines for Children117 as required for the treatment of leukaemia, the leading childhood cancer in the Islamic Republic of Iran. The president of the Centre underscored that the situation would inevitably lead to a decrease in the survival rate of children with cancer. 118 2. Humanitarian aid 53. On 3 October 2018, the International Court of Justice issued an order on provisional measures in the case concerning Alleged Violations of the 1955 Treaty of Amity, Economic Relations, and Consular Rights (Islamic Republic of Iran v. United States of America). The case stems from the decision of the United States of 8 May 2018 to reinstate restrictive measures and sanctions against Iranian companies. 119 The Court determined that disregard of certain Iranian rights under the Treaty might entail irreparable consequences, 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 14 See https://ifpnews.com/iran-producing-97-of-medicines-it-needs-domestically. See https://foreignpolicy.com/2019/08/14/u-s-sanctions-are-killing-cancer-patients-in-iran/. See www.hrw.org/report/2019/10/29/maximum-pressure/us-economic-sanctions-harm-iranians-righthealth. See www.who.int/medicines/publications/essentialmedicines/en/. See www.bbc.com/news/world-middle-east-49051782. See www.isna.ir/news/98050703466/ (in Farsi). See www.tehrantimes.com/news/439394/IRCS-Sanctions-hindering-pharma-raw-materials-import. See https://foreignpolicy.com/2019/08/14/u-s-sanctions-are-killing-cancer-patients-in-iran/. Ibid. See http://behdasht.gov.ir/?siteid=1&pageid=1508&newsview=195932 (in Farsi). See www.hrw.org/report/2019/10/29/maximum-pressure/us-economic-sanctions-harm-iranians-righthealth. Ibid. See www.ilna.news/fa/tiny/news-803879 (in Farsi). Ibid. See www.ncbi.nlm.nih.gov/pmc/articles/PMC6110432/. See https://mahak-charity.org/main/index.php/en/. See https://farsi.euronews.com/2019/07/30/iran-struggles-with-medicines-crisis (in Farsi). See https://apps.who.int/iris/bitstream/handle/10665/325772/WHO-MVP-EMP-IAU-2019.07eng.pdf?ua=1. See www.sciencedirect.com/science/article/pii/S1470204518307514?via%3Dihub. See www.icj-cij.org/files/case-related/175/175-20181003-PRE-01-00-EN.pdf.