companies, allowing them to deny coverage for those treatments. The government itself offers a limited amount of assistance for services such as gender-confirmation surgeries and hormone therapies. However, these funds are limited and government officials decide who qualifies for assistance on a case by case basis.19 The Vice President of Social Relations of the SWO stated that the organization helps patients with some of the costs of the surgery, but the financial assistance is not significant when compared to the costs of surgery. 20 Beyond the provision of insurance, sanctions and banking restrictions impact the state’s ability to provide a minimum level of healthcare benefits, especially with regard to the “production, availability and distribution of medicines, pharmaceutical equipment and supplies”. 21 “There is a documented, significant rise in the price of medicines and the depletion of available stocks, combined with the risk of corruption and smuggling” linked to imposition of sanctions by the United States in November of 2018.22 While most medicines are produced domestically, Iran relies on the import of raw materials for the production of medication. The lack of availability of stable imports has seriously hindered domestic production of medicines. By June 2019, imports of medical supplies had fallen by 60 per cent as compared to September 2018 before the sanctions had been implemented. The Minister of Health has expressed concern that importers and manufacturers may be compelled to purchase alternative or lower-quality products, which could pose health risks for patients.23 In May 2018, Ehsan Bodaghi, a journalist with Iran Newspaper, the government’s official news outlet, tweeted that his wife had experienced severe complications after a Caesarean section and was told by a family member who is a doctor that “the complications were likely caused by non-standard anesthesia being used because of sanctions and a lack of adequate medication.”24 Iran has made strides towards extending health insurance to a larger percentage of the population through its Health Reform Plan. However, a significant number of individuals, especially undocumented refugees, still lack health insurance. Even for those who are covered by insurance, that insurance does not provide the minimum essential level of benefits to all individuals and families. Recommendation Status: This recommendation has been PARTIALLY implemented. 19 https://qz.com/889548/everyone-treated-me-like-a-saint-in-iran-theres-only-one-way-to-survive-as-a-transgender-person/ https://www.en-hrana.org/iranian-medical-insurances-do-not-cover-the-charges-related-to-gender-reassignmentsurgery?hilite=%27insurance%27 21 https://www.hrw.org/report/2019/10/29/maximum-pressure/us-economic-sanctions-harm-iranians-right-health 22 https://www.ohchr.org/Documents/Countries/IR/Report_of_the_Special_Rapporteur_on_the_situation_of_human_rights_in_the _Islamic_Republic_of_IranA4361.pdf 23 Id. 24 https://www.hrw.org/report/2019/10/29/maximum-pressure/us-economic-sanctions-harm-iranians-right-health 20 4