Iran's regional diplomatic efforts fall short in rallying support

Speaking to the semi-official ILNA news agency, the head of the Ministry’s Tuberculosis and Leprosy Division, Mahshid Nasehi, noted that other provinces with significant case numbers included Gilan, Khuzestan, Khorasan Razavi, Qom, and Yazd.

Nasehi also stated that there is no province without reported tuberculosis cases and added that, in Tehran province, the incidence rate of tuberculosis relative to the population is higher than the national average.

The official noted that among the 7,261 identified cases, 44% were women, and 25% were non-Iranians. Pulmonary tuberculosis, primarily affecting the lungs, was the most common form, accounting for over 80% of all cases.

At Zabol University of Medical Sciences in Sistan-Baluchistan, the program head reported in August that dust storms in the Sistan region are contributing to an increase in serious diseases, including tuberculosis.

Higher tuberculosis rates, like those in Sistan-Baluchistan and Golestan, are usually driven by a combination of factors. Proximity to high-tuberculosis countries increases exposure through cross-border movement, while limited healthcare access delays diagnosis and treatment. Environmental challenges, such as frequent dust storms, weaken respiratory health, making people more vulnerable. Socioeconomic factors, including poverty and overcrowded living conditions, further facilitate its spread.

Nasehi emphasized Iran’s overall relative success in managing the disease but cautioned that the high rates in neighboring countries pose a risk that could potentially compromise these achievements.

According to World Health Organization estimates, Iran’s annual tuberculosis incidence stands at 11 cases per 100,000 people, equating to roughly 10,000 new cases each year.

In comparison, Pakistan reports 258 cases per 100,000 people (around 600,000 cases annually), while Afghanistan reports 185 cases per 100,000 (approximately 76,000 cases per year).

Tuberculosis, a contagious infectious disease, can affect many parts of the body, including the bones, joints, brain, kidneys, and skin. However, it most commonly targets the lungs due to the bacterium's high need for oxygen. It primarily spreads through the air, making it possible for anyone to contract the disease simply by inhaling airborne particles.

In Western countries, tuberculosis rates are significantly lower than in many parts of Asia and Africa. The highest incidence in the West is generally seen in countries with higher rates of immigration from tuberculosis-endemic regions or where certain vulnerable populations – those with HIV or in close living quarters like homeless shelters and prisons) have higher exposure risks.

Treating drug-resistant tuberculosis, Nasehi said, is far more challenging and costly than treating drug-sensitive tuberculosis.

Drug-sensitive tuberculosis treatment costs around 1 million tomans with a high recovery rate (over 95%) and lasts about six months. In contrast, drug-resistant tuberculosis treatment is significantly more expensive at approximately 500 million tomans, has a lower recovery rate (around 60%), and requires 18 to 24 months of treatment.

She emphasized that incomplete or irregular treatment can lead to drug resistance, a risk that’s heightened by the lengthy treatment period, which makes adherence more difficult. The Ministry of Health says it provides tuberculosis medications free of charge through Iran’s national healthcare system.

In Iran, October 15 is designated as National Tuberculosis Awareness Day.

Iranian Foreign Minister Abbas Araghchi made the statement during a visit to Oman, which had previously facilitated indirect talks with the US.

"We do not see a basis for these talks until the current crisis is resolved. Afterward, we will decide whether to resume negotiations and in what form they should continue," Araghchi said.

Iran’s latest declaration comes as the state and country brace for an anticipated counter-retaliation from Israel following a missile barrage earlier this month.

Tehran launched over 180 ballistic missiles at Israel, in response to an Israeli air strike in the southern suburbs of Beirut that killed Hezbollah leader Hassan Nasrallah and Brig-Gen Abbas Nilforoushan, the operations commander of the Islamic Revolutionary Guards’ (IRGC) overseas arm, the Quds Force. The Israel Defense Forces (IDF) says the majority of missiles were "intercepted by Israel and a defensive coalition led by the United States".

Despite that escalation, Tehran has since – including the Iranian Foreign Minister's visit to Oman – appeared to signal its effort to avoid an all-out war with Israel.

“We are not seeking war, although we are fully prepared for it. We believe that diplomacy must work to prevent a major crisis in the region,” Araghchi said.

Meanwhile, reports suggest that Israel has narrowed down what it will target in their response to Iran’s attack early this month. Some officials have described the targets as Iranian military and energy infrastructure.

It remains uncertain whether Kharg Island, Iran’s primary oil export terminal in the Persian Gulf, is among Israel's potential targets. However, recent data obtained by Iran International indicates that Iran's oil loadings have plummeted by nearly 70% in early October.

Reports suggest that after Iran’s large-scale missile attack on Israel on October 1st, Tehran immediately withdrew its tankers from the Kharg Island to prevent them from being targeted by Israeli retaliatory strikes. Since then, Iran's oil loadings have significantly dropped.

The Pentagon announced on Sunday that the US is deploying the advanced Terminal High Altitude Area Defense (THAAD) missile defense system to Israel, accompanied by approximately 100 American troops to operate it.

This marks the first deployment of US forces to Israel since the Hamas-led attacks on October 7, 2023. The move comes amid escalating tensions, following Iran's launch of around 200 missiles at Israel on October 1, as the situation in the Middle East continues to deteriorate.

While Israel currently shows no signs of targeting nuclear facilities or conducting assassinations, US officials have emphasized that Israel has not made a final decision on its course of action, and no assurances have been given that it won't strike Iran's nuclear sites.

The index, which combines inflation and unemployment rates, is widely used to assess economic distress.

In Kermanshah, the Misery Index reached around 51%, while in Isfahan, it exceeded 49%, according to the report.

The high Misery Index figures show that Kermanshah and Isfahan had the highest combined rates during the summer, with inflation and unemployment more severe there than in other provinces. Isfahan’s situation is puzzling, given its status as an industrial hub.

While the exact reasons behind its high index ranking remain unclear, experts point to summer power shortages and an escalating water crisis as potential factors. These issues may have contributed to job losses in industrial and agricultural sectors, worsening the overall economic situation.

Reza Gheibi, an economic journalist, told Iran International that the economic hardship in Isfahan, an industrial hub, "rings an alarm for the entire Iranian economy".

He said: "The lack of foreign investment has led to decreased production and higher unemployment in the province."

U.S. sanctions imposed since 2018 have not only slashed Iran's oil export revenues and foreign trade but also undermined confidence needed for foreign investment.

The economic struggles are also evident in the inadequate minimum wage for the current year, which is set at around 109 million rials (over $170). This amount covers only 29.62% of the estimated cost of living for a typical household, calculated recently at about 368 million rials ($584) based on the official data.

The rising costs of essentials such as food, housing, healthcare, and education have made it increasingly difficult for workers to make ends meet.

Labor sociologist Pedram Ebadi describes the situation as a shift from poverty to absolute poverty for many workers. In his interview with Taadol website, he highlighted that most workers now live below the absolute poverty line, facing not only economic hardship but also job and income insecurity.

Ebadi argues that the government has failed to take meaningful action to address the growing poverty and has instead continued policies that do little to alleviate workers' struggles.

“Neglecting workers' livelihoods can lead to many other crises in society, including higher divorce rates, an increase in petty crimes, loss of work motivation—which could inflict irreparable damage on the country's growth and development—and countless other issues that cannot all be listed here,” he added.

Sanctions have played a significant role in elevating Iran's Misery Index. International sanctions, particularly targeting the oil sector, banking, and trade, have restricted Iran's access to global markets. It has resulted in reduced revenues and foreign currency shortages, sparking a weakening of the national currency, skyrocketing prices for essential goods, and increased inflation.

The sanctions, approved during a meeting of EU foreign ministers in Luxembourg on Monday, target seven individuals and seven entities involved in the transfer of military technology to Russia.

“Today’s designation includes individuals and entities responsible for the development and transfer of unmanned aerial vehicles (UAVs), missiles and related technology to Russia in support of its war of aggression against Ukraine, and to armed groups and entities undermining peace and security in the Middle East and the Red Sea region,” reads a statement by the European Council.

The EU's decision follows earlier warnings in March 2024, when the European Council indicated that any transfer of ballistic missiles by Iran to Russia would be met with punitive actions. The latest sanctions impose asset freezes, travel bans, and restrictions on financial transactions involving the designated individuals and entities.

The sanctioned parties include high-ranking officials and major organizations in Iran's defense sector, such as the Deputy Defense Minister Seyed Hamzeh Ghalandari and commanders from the Islamic Revolutionary Guard Corps (IRGC). Additionally, three Iranian airlines—Saha Airlines, Mahan Air, and Iran Air—were listed for transporting military supplies through transnational networks. Companies involved in the production of rocket propellants and other missile components were also targeted.

The EU has accused Iran of playing a destabilizing role beyond Ukraine, pointing to Tehran’s military support for armed groups in the Middle East. In May 2024, the EU had already expanded its sanctions framework to cover Iran’s missile and drone programs, targeting support for regional armed groups as well as Russia.

On September 13, 2024, the EU issued a strong condemnation of Iran's recent transfer of ballistic missiles to Russia. The states labeled it a direct threat to European security and an escalation beyond the earlier provision of Iranian UAVs and ammunition used in Russia's aggression against Ukraine.

The High Representative announced that the EU would act promptly and in collaboration with international partners, implementing new and substantial restrictive measures against Iran.

The UK also on Monday announced new sanctions targeting senior Iranian military leaders and organizations linked to destabilizing activities in the Middle East, following Iran's missile attack on Israel earlier this month.

The sanctions include asset freezes and travel bans on high-ranking figures from the Iranian Army, Air Force, and the IRGC Intelligence Organization, as well as restrictions on entities such as the Farzanegan Propulsion Systems Design Bureau and the Iranian Space Agency, both involved in missile-related technology.

Foreign Secretary David Lammy emphasized, "Despite repeated warnings, the dangerous actions of Iran and its proxies are driving further escalation in the Middle East. Following its ballistic missile attack on Israel, we are holding Iran to account and exposing those who facilitated these acts."

The new measures are part of a broader effort to isolate Iran economically and diplomatically. Last month, the United States, backed by intelligence shared with its allies, said that Russia received ballistic missiles from Iran for its ongoing conflict in Ukraine. In response, Washington imposed sanctions on the ships and companies implicated in the weapons transfers.

In light of the US accusations, Iranian President Masoud Pezeshkian asserted that his government has not transferred any weapons to Russia since taking office in August. However, a high-ranking EU official revealed that Iranian Foreign Minister Abbas Araqchi informed Borrell that Iran had supplied "short-range rockets" to Russia, capable of traveling up to 250 kilometers.

The Iranian minister clarified that the rockets were not classified as ballistic and did not specify when the transfer occurred, according to the EU official, who spoke on the condition of anonymity.

Meanwhile, discussions among EU nations are ongoing regarding the potential designation of Iran's Revolutionary Guards as a terrorist organization. A recent decision by a German court has provided a legal basis for such a classification, but EU members are still weighing whether it would be politically prudent to proceed with this designation.

Iran is also sanctioned by the EU in addition to nations globally for its nuclear program and human rights abuses at home, heightened after the Women, Life, Freedom protests in 2022.

According to Israeli intelligence analyst, Ronen Solomon, of the Intellitimes blog, the fire “consumed two metal factories that were engaged in the production of chips for parts of centrifuges and valves that can be used by Iran's nuclear industry”.

It is cited as Block D, the fires across two manufacturing plants for valve parts, compressors and pipes used in the gas industry, but which can also support uranium conversion and enrichment plants, Solomon assessed.

Iran's government-controlled media extensively reported the incident, but made no reference to any sensitive work being done in the "iron market" district.

The analysis came from satellite imagery and details on the companies operating in the complex.

Solomon cited the companies that operated in the complex as “Claniz”, a company that provides engineering design and engraving services for the production of centrifugal compressors and valves, and the "Easy Pipe" company for the production of valves and pipes for the gas industry.

Jason Brodsky, head of policy at United Against Nuclear Iran, said “there is a history of sabotage operations against AEOI workshops in the Shadabad area”.

Andrea Stricker, deputy director and research fellow at the Foundation for the Defense of Democracy’s Nonproliferation & Biodefense Program, noted that it comes amid the growing fears that Israel will attack Iran’s nuclear facilities.

US President Joe Biden has said he will not support such an attack, even in retaliation for the 181 ballistic missiles rained down on Israel earlier this month, but the latest findings suggest the Jewish state may have found a way round the issue.

"Israel reportedly not targeting Iranian nuclear sites in [an] upcoming counter-strike may simply mean no aerial bombing. Supply chain facilities mysteriously catching fire, exploding, sudden unexplained damage, might be a different story,” she wrote on X.

Stricker pointed to a powerful explosion that destroyed an advanced centrifuge assembly plant in Iran in July 2020, an event which was believed to be the result of Israeli sabotage.

“An attack by Jerusalem on one of Tehran’s key nuclear assets could foreshadow a covert action campaign designed to set back Iran’s nuclear program. The timing for such a campaign is opportune, since Tehran may hesitate to respond with force, lest it provoke the final collapse of the 2015 nuclear deal,” she wrote at the time.

The July 2020 attack destroyed the Iran Centrifuge Assembly Center (ICAC), located within the Natanz nuclear complex. The ICAC produces advanced centrifuges capable of enriching uranium at much faster rates than Iran’s older centrifuge design models. Today, this is being produced in increasing numbers, against the limits established by the 2015 nuclear deal, formally known as the Joint Comprehensive Plan of Action (JCPOA).

In 2021, according to a report by London’s The Jewish Chronicle, Israel used an Iranian network of agents to conduct sabotage operations against Iran’s nuclear facilities.

A large explosion in April that year inflicted major damage to the Natanz uranium enrichment site and was conducted by recruiting several Iranian scientists working in the complex, the report said. They had smuggled explosives into the highly secure facility and at the chosen moment the explosion was triggered remotely.

According to the report, 90 percent of the centrifuge machines enriching uranium were destroyed and the facility was put out of action for nine months.

In September that year, a weekly publication in Iran reported another fire incident in a military research center, calling it an “attack” by Israel to exert pressure on Iran.

The little-known Sobh Sadegh publication of the Islamic Revolutionary Guard Corps (IRGC) mentioned that a “self-reliance research center” west of Tehran was targeted by Israel in an operation similar to other attacks since July 2020, including the two explosions in the Natanz uranium enrichment facility.

The IRGC reported that a fire damaged one of its research facilities and three personnel were injured. Hours later, the announcement was deleted from its website and another version appeared saying that the fire was in the depot of the facility. Later, the IRGC said that two of its personnel died in the incident.

Israel has a history of totally destroying enemy nuclear capabilities, succeeding in both Iraq and Syria. But now, the Iran issue remains elusive in the face of a reluctant US battling to calm a hawkish Israel.