Systematic health destruction in Iran by Operation Epic Fury.

# Systematic health destruction in Iran by Operation Epic Fury *The Lancet 2026* Correspondence Systematic health purposes.8,9 Yet, verified reports2–7 an agreement between the Pasteur destruction in Iran by indicate US–Israeli attacks on health Institute in Paris and the Iranian facilities and the killing of at least Government—became the target of a Operation Epic Fury eight health-care workers, doctors, strike on April 2, 2026.6 nurses, and emergency first responders Under IHL, the principle of The military campaign initiated on in Iran.6 These actions disregard precaution requires parties to Feb 28, 2026, by the USA and Israel the principles of distinction and minimise civilian suffering. Launching against Iran has rapidly evolved into a proportionality, failing to meet the a high-intensity war against a regional conflagration with catastrophic legal thresholds for lawful self-defence. nation of 86 million people—already health consequences for Iran as well The responsibility of the belligerents is weakened by decades of sanctions, as for the region. The sheer ferocity heightened by the lack of preparation mismanagement, corruption, and duration of the strikes of this so- for the predictable secondary and and repression—without viable called preventive action to dismantle tertiary effects of such an extensive mechanisms to protect the health of nuclear and missile capabilities, conflict.10 The consequences the population is a violation of the intentionally or not, has led to violation extend beyond direct kinetic duty of care. The pattern of attacks on of International Humanitarian Law damage. In Tehran alone, 26 926 health infrastructure and personnel (IHL) and the foreseeable collapse of civilian units have been destroyed, follows the systematic large-scale civilian life-sustaining systems for contributing to a national total of destruction of health facilities as a Iranian citizens, including those who over 87 000 damaged residential weapon of war that was observed in have suffered gravely under Islamic and commercial structures.5,6,11 Power the civil war in Syria and continued in Republic oppressive rules and brutal outages and infrastructure collapse Ukraine, Gaza, and Lebanon, among crackdown. Although the immediate have compromised the cold chain for others.12,13 The initiators of the war human toll is staggering—at least 3636 vaccines, raising the imminent risk must be held accountable for the quiet people, including around 1700 civilians, of outbreaks of preventable diseases death imposed on civilians through had been killed as of April 7, 20261— such as measles and polio. Over the deliberate or negligent destruction the systematic degradation of the 4000 women and 1600 minors have of the very systems required for Iranian health-care system, which was been injured, and the deaths of over human survival.12 already compromised under medical 237 women and over 200 children We, as physicians, think the medical and economic sanctions, represents a or teenagers (<18 years) have been profession should raise their voice profound violation of IHL and a long- reported.5,6 Up to March 24, 2026, against the widespread increase of term threat to population health.2–4 eight medicine production factories these destructive attacks against As of March 27, 2026, data compiled have been destroyed, primarily in health facilities and personnel.13 from WHO, the Iranian Red Crescent, Karaj City, where attacks intensified Peace remains the only viable and national health agencies reveal recently.5,6 In Hamadan, a medicine solution for a region now entering a targeted erosion of medical stock was attacked, and in Tehran, its most dangerous era. We call on all neutrality.5,6 A total of 292 medical the KimiDaroo factory was targeted.5 involved parties for an immediate and relief centres, including hospitals, Destruction of the Tofigh Daru cessation of attacks on health-care pharmacies, and primary health clinics, industrial complex due to a missile facilities and the establishment of have been damaged or destroyed.6 This strike occurred at 0630 h on independent monitoring mechanisms destruction has forced 13 hospitals March 31, 2026.6 Although this specific to ensure accountability for these completely out of service, while another factory did not produce finished drugs, grave violations of international law. seven have been fully evacuated under it manufactured raw materials for We declare no competing interests. MS retired in duress because of proximity to danger hospital medications and various anti- February, 2012. zones.5–7 The emergency response cancer drugs, playing a vital role in the *Iradj Sobhani, Ali Keshavarzian, capacity has been further crippled by national supply chain. The temporary Asghar Rastegar, the destruction of 48 ambulances and suspension of WHO’s logistics hub Mohsen Shahmanesh rescue vehicles, as well as an emergency in Dubai, United Arab Emirates, has iradj.sobhani@aphp.fr medical helicopter.5–7 interrupted the flow of emergency kits, Gastroenterology Department, Henri Mondor The assault on health care is not medicines, and laboratory materials Hospital, Assistance Public Hopitaux de Paris, Créteil merely incidental but systemic. to over 25 countries.5 The Pasteur 94000, France (IS); Université Paris est Creteil Under the Geneva Conventions and Institute of Iran—one of the oldest (UPEC), Créteil, France (IS); Department of Anatomy Submissions should be and Cell Biology, Rush University, Chicago, IL, USA the UN Charter, medical personnel and most prestigious research and made via our electronic (AK); Department of Medicine, Yale School of submission system at and facilities must be protected at public health centres in the Middle Medicine, New Haven, CT, USA (AR); Queen http://ees.elsevier.com/ all times unless used for military East, founded in 1920 following Elizabeth University Hospital, Birmingham, UK (MS) thelancet/ Correspondence Unusual measles 1 Abdallah N, Alaaeldin M. How many people Gavi, the Vaccine Alliance warned of have been killed in the Iran war? April 10, mortality in Bangladesh major gaps among children living in 2026. https://www.reuters.com/world/ Published Online middle-east/how-many-people-have-been- urban slum settlements and other signals an immunisation April 20, 2026 killed-us-israel-war-iran-2026-04-07/ underserved settings.4 Given normal https://doi.org/10.1016/ (accessed April 17, 2026). emergency levels of two-dose coverage and S0140-6736(26)00687-2 2 Horton R. Offline: the human consequences of Epic Fury. Lancet 2026; 407: 1040. catch-up systems, measles outbreaks 3 Mahase E. Iran war: 43 attacks on healthcare Bangladesh is experiencing a measles are predictable, as herd protection facilities in Iran and Lebanon, WHO says, as resurgence with unprecedented requires very high levels of population thousands killed. BMJ 2026; 392: s484. 4 Blanchet K, Barakat S, Kumar B, Spiegel P. numbers of severe paediatric cases. immunity.5 Iran’s humanitarian crisis: war, legality, and the As of March 30, 2026, nationwide For Bangladesh, therefore, it is not erosion of population health. Lancet Reg Health Europe 2026; 63: 101656. deaths increased to at least 38 children, enough to have a reactive campaign. We 5 Golshiri G, Imbert L. En Iran, les infrastructures including 32 deaths in March alone.1 recommend a measles severity-control civiles de plus en plus touchées par les frappes The clinical pressure on hospitals is roadmap: (1) use every paediatric Américano-Israéliennes. Le Monde, April 5, 2026. https://www.lemonde.fr/ phenomenal: the Infectious Diseases measles admission as a trigger for 72-h international/article/2026/04/04/en-iran-les- Hospital in Mohakhali (Dhaka, household tracing and neighbourhood infrastructures-civiles-de-plus-en-plus- touchees_6676648_3210.html (accessed Bangladesh) admitted 560 suspected catch-up vaccination; (2) publish weekly April 8, 2026). measles cases in the first 3 months district dashboards linking admissions, 6 Centre for Human Rights in Iran. Attacks on of 2026 compared with 69 suspected intensive care unit occupancy, deaths, essential infrastructure will have catastrophic consequences for millions of civilians across cases for the entire year before; March and vaccination gaps; (3) create an the region. Center for Human Rights in Iran. alone accounted for 448 of those enabling environment between April 6, 2026. https://iranhumanrights. org/2026/04/attacks-on-essential- admissions.1 At the Infectious Diseases outbreak management and nutrition infrastructure-will-have-catastrophic- Hospital, 22 admitted children died in screening with treatment of vitamin consequences-for-millions-of-civilians-across- 2026, including 21 children in March.1 A deficiency; and (4) implement zero- the-region/ (accessed April 8, 2026). 7 WHO Regional Office for the Eastern This means a crude in-hospital mortality dose mapping in urban slums as well as Mediterranean Region. Conflict deepens rate of 3·9% overall and 4·7% for March migrant settlements and other clusters health crisis across Middle East, WHO says. March 11, 2026. https://www.emro.who.int/ admissions specifically at this sentinel of missed populations.4,5 This outbreak media/news/conflict-deepens-health-crisis- facility—an alarming statistic for a serves as a timely reminder that routine across-middle-east-who-says.html (accessed vaccine-preventable disease.1 coverage data alone are inadequate. April 8, 2026) 8 International Committee of the Red Cross The strain on hospitals extends Severity-linked measles surveillance is Humanitarian Law Databases. Convention (I) beyond Dhaka. Rajshahi Medical College now required in Bangladesh to avert for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Hospital reported that it had taken in preventable deaths. Field. Geneva, Aug 12, 1949. https://ihl- 280 patients displaying symptoms We declare no competing interests. databases.icrc.org/en/ihl-treaties/gci-1949 of measles since January, 2026, while (accessed April 8, 2026). *Safayet Jamil, Uzma Asif, 9 UN. Charter of the United Nations and Statute Mymensingh Medical College Hospital Masoud Mohammadnezhad of the International Court of Justice. San said it had admitted 106 children over Francisco, CA, USA: United Nations, 1945. safayet.ph@diu.edu.bd the course of 13 days.2,3 Another facility 10 Arbour L. The responsibility to protect as a duty of care in international law and practice. in Dhaka, the DNCC Covid-19 Dedicated Department of Public Health, Daffodil International Rev Int Stud 2008; 34: 445–58. Hospital, was treating 85 patients with University, Dhaka 1216, Bangladesh (SJ); Faculty of 11 Reuters. Tehran hospital evacuated after Health, Education and Life Sciences, Birmingham explosions nearby, WHO says. Thomson measles or who were suspected of City University, Birmingham, UK (SJ, MM); Reuters, March 2, 2026. https://www.reuters. having measles—including 17 patients Department of Biochemistry, Batterjee Medical com/world/middle-east/tehran-hospital- College, Jeddah, Saudi Arabia (UA) in intensive care.3 These numbers imply evacuated-after-explosions-nearby-who- 1 Adhikary TS. At least 38 children dead in says-2026-03-02/ (accessed April 8, 2026). that the current outbreak is not just an measles outbreak. The Daily Star, 12 Barnes-Dacey J, Geranmayeh E, Bianca C, et al. upswing in case counts, it is a severity March 30, 2026. https://www.thedailystar.net/ A war with no winners: the costs of US–Israeli crisis, with hospitals taking on a rare news/bangladesh/news/least-38-children- aggression on Iran. European Council on dead-measles-outbreak-4138831 (accessed Foreign Relations. March 2, 2026. https://ecfr. burden of hypoxic, malnourished, and March 30, 2026). eu/article/a-war-with-no-winners-the- acutely ill children. 2 The Business Standard. 280 hospitalised with costs-of-us-israeli-aggression-on-iran/ measles symptoms at Rajshahi Medical College (accessed April 8, 2026). The culprit driving the disease is Hospital as cases continue to rise. The Business 13 Stahl-Timmins W, Mahase E, Hutcheson M, probably not measles biology, but Standard, March 30, 2026. https://www. Looi MK. How attacking healthcare has tbsnews.net/bangladesh/health/280- become a strategy of war. BMJ 2025; immunity failure. Almost 5 million hospitalised-measles-symptoms-rajshahi- 391: r2153. children in Bangladesh were not medical-cases-continue-rise-1397861 fully immunised in 2025, including (accessed March 30, 2026). 3 Jashim SU. Vaccine gaps and malnutrition fuel 70 000 children with zero doses and child deaths in measles outbreak. Jago News more than 400 000 children who were 24, March 30, 2026. https://www.jagonews24. com/en/national/news/91285 (accessed underimmunised.4 UNICEF, WHO, and March 30, 2026). 1596 --- [PDF原文](https://sci-net.xyz/storage/7932541/c081f50d3c0c8a64618554ce7f35d96ffb769d892607c1c0db84a0697470d808/Systematic-health-destruction-in-Iran-by-Operation-Epic-Fury.pdf) DOI: 10.1016/S0140-6736(26)00689-6