ÂEconomic sanctions are, at their core, a war against public health.Â
ÂThe New England Journal of Medicine 
While campaigns are organized to deter the United States and Israel from acting on threats to launch an air war against Iran, both countries, in league with the European Union (winner of this yearÂs Nobel Peace Prize) carry on a low-intensity war against Iran that is likely to be causing more human suffering and death than strikes on IranÂs nuclear facilities would.
This is a war against public health, aimed at the most vulnerable: cancer patients, hemophiliacs, kidney dialysis patients, and those awaiting transplants. Its victims are unseen, dying anonymously in hospitals, not incinerated in spectacular explosions touched off by cruise missiles and bunker buster bombs.
But ordinary Iranians who canÂt get needed medications are every bit as much victims of war as those blown apart by bombs. And yet, we think, that as long as the bombs donÂt rain down, that peace has been preserved. Perhaps it has, in formal terms, but bleeding to death in the crater of a bomb, or bleeding to death because you canÂt get hemophilia drugs, is, in either case, death.
In Iran today there is an acute shortage of pharmaceuticals for kidney dialysis and transplants and for treating cancer, hemophilia, thalessemia, multiple sclerosis, and other disorders. Hospital equipment is breaking down for want of spare parts. And raw materials used by domestic pharmaceutical manufacturersÂblocked by Western sanctionsÂare in short supply.
It adds up to a healthcare crisis. The United States and European Union say their sanctions donÂt apply to drugs and medical equipment, but US and European banks are unwilling to handle financial transactions with Iran. If they do, the US Treasury Department will deny them access to the US banking system. Since isolation from the worldÂs largest economy would guarantee their demise, banks comply and shun Iran.
As a consequence, few goods from the West make their way into the country, the exemptions for drugs and medical equipment being nothing more than a public relations ruse to disguise the barbarity of the sanctions. Not that Washington is denying that its sanctions are hurting ordinary Iranians. ItÂs just that responsibility for their consequences is denied. US president Barak Obama Âhas said the Iranian people should blame their own leaders.Â  For whatÂfailing to knuckle under?
ÂIn contrast to warÂs easily observable casualties, the apparently nonviolent consequences of economic intervention seem like an acceptable alternative. HoweverÂ economic sanctions can seriously harm the health of persons who live in targeted nations.Â 
This has been well established and widely accepted in the cases of Iraq in the 1990s and the ongoing US blockade of Cuba. Political scientists John Mueller and Karl Mueller wrote an important paper in Foreign Affairs, in which they showed that economic sanctions Âmay have contributed to more deaths during the post-Cold War era than all weapons of mass destruction throughout history.Â 
ÂThe dangers posed today by such enfeebled, impoverished, and friendless states as Iraq and North Korea are minor indeedÂ, they wrote in 1999. It might be added that the dangers posed by Iran to the physical safety of US citizens are not only minor but infinitesimally small.
Notwithstanding the fevered fantasies of rightwing commentators, Iran has neither the means, nor the required death wish, to strike the United States. Nor Israel, which has the meansÂan arsenal of 200 nuclear weaponsÂto wipe Iran off the face of the earth. However, the danger the country poses to the idea of US domination Â and hence, to the banks, corporations, and major investors who dominate US policy-making Â are admittedly somewhat greater.
ÂSevere economic sanctionsÂ, the Muellers contend, ought to be Âdesignated by the older label of Âeconomic warfareÂÂ. ÂIn past wars economic embargoes caused huge numbers of deaths. Some 750,000 German civilians may have died because of the Allied naval blockade during World War I.Â 
ÂSo long as they can coordinate their efforts,Â the two political scientists continue, Âthe big countries have at their disposal a credible, inexpensive and potent weapon for use against small and medium-sized foes. The dominant powers have shown that they can inflict enormous pain at remarkably little cost to themselves or the global economy. Indeed, in a matter of months or years whole economies can be devastatedÂ
Â  And with devastated economies, come crumbling healthcare systems and failure to provide for the basic healthcare rights of the population.
We might ask, then, why the United States and European Union, practitioners of economic warfare against Iran, are bent on destroying IranÂs economy, along with its public health system. ÂSanctions,Â New York TimesÂ reporter Rick Gladstone writes, have subjected Âordinary IraniansÂ to Âincreased deprivationsÂ in order to Âpunish Iran for enriching uranium that the West suspects is a cover for developing the ability to make nuclear weapons.Â  In other words, Iran is suspected of having a secret nuclear weapons program, and so must be sanctioned to force it to abandon it.
Contrary to Gladstone, the West doesnÂt really believe that Tehran has a secret nuclear weapons program, yet even if we accept it does believe this, the position is indefensible. Why should Iranians be punished for developing a capability that the countries that have imposed sanctions already have?
The reason why, it will be said, is because Iranians are bent on developing nuclear weapons to destroy Israel. DidnÂt Iranian president Mahmoud Ahmadinejad threaten to Âwipe Israel off the mapÂ?
Regurgitated regularly by US hawks and Israeli politicians to mobilize support for the bombing of Iran, the claim is demagogic rubbish. Ahmadinejad predicted that Israel as a Zionist state would someday disappear much as South Africa as an apartheid state did. He didnÂt threaten the physical destruction of Israel and expressed only the wish that historic Palestine would become a multinational democratic state of Arabs and the Jews whose ancestors arrived in Palestine before Zionist settlers. 
No less damaging to the argument that Iranians aspire to take Israel out in a hail of nuclear missiles is the reality that it would take decades for Iran to match IsraelÂs already formidable nuclear arsenal, if indeed it aspires to. For the foreseeable future, Israel is in a far better position to wipe Iran off the map. And given IsraelÂs penchant for flexing its US-built military muscle, is far more likely to be the wiper than wipee. Already it has almost wiped an entire people from the map of historic Palestine.
But this is irrelevant, for the premise that the West suspects Iran of developing a nuclear weapons capability is false. To be sure, the mass media endlessly recycle the fiction that the West suspects IranÂs uranium enrichment program is a cover for a nuclear weapons program, but who in the West suspects this? Not high officials of the US state, for they have repeatedly said that thereÂs no evidence that Iran has a secret nuclear weapons program.
The consensus view of the United StatesÂ 16 intelligence agencies is that Iran abandoned its nuclear weapons program years ago. Director of US intelligence James Clapper Âsaid there was no evidence that (Iran) had made a decision on making a concerted push to build a weapon. David H. Petraeus, the C.I.A. director, concurred with that viewÂ
. Other senior United States officials, including Defense Secretary Leon E. Panetta and Gen. Martin E. Dempsey, the chairman of the Joint Chiefs of Staff, have made similar statements.Â 
Rather than weakening this conclusion, stepped up US espionage has buttressed it. IranÂs leaders Âhave opted for now againstÂ
designing a nuclear warhead,Â said one former intelligence official briefed on US intelligence findings. ÂIt isnÂt the absence of evidence, itÂs the evidence of an absence. Certain things are not being doneÂ  that would indicate that Iran is working on nuclear weapons. Even Mossad, IsraeliÂs intelligence agency Âdoes not disagree with the US on the weapons program,Â according to a former senior US intelligence official. 
So, contrary to the claim that the West ÂsuspectsÂ Iran of concealing a nuclear weapons program, no one in a position of authority in the US state believes this to be true. Neither does Israeli intelligence. Why, then, is the United States and its allies subjecting ordinary Iranians to increased deprivations through sanctions?
The answer, according to Henry Kissinger, is because US policy in the Middle East for the last half century has been aimed at Âpreventing any power in the region from emerging as a hegemon.Â This is another way of saying that the aim of US Middle East policy is to stop any Middle Eastern country from challenging its domination by the United States. Iran, Kissinger points out, has emerged as the principal challenger. 
Indeed, it did so as long ago as 1979, when the local extension of US power in Iran, the Shah, was overthrown, and the country set out on a path of independent economic and political development. For the revolutionariesÂ boldness in asserting their sovereignty, Washington pressed Saddam HusseinÂs Iraq into a war with Iran. This served the same purpose as todayÂs economic warfare, sabotage, threats of military intervention, and assassinations of IranÂs nuclear scientists: to weaken the country and stifle its development; to prevent it from thriving and thereby becoming an example to other countries of development possibilities outside US domination.
Uranium enrichment has emerged as point of conflict for two reasons.
First, a civilian nuclear power industry strengthens Iran economically and domestic uranium enrichment provides the country with an independent source of nuclear fuel. Were Iran to depend on the West for enriched uranium to power its reactors, it would be forever at the mercy of a hostile US state.
Likewise, concern over energy security being in the hands of an outside power has led Turkey, Saudi Arabia, Vietnam and South Korea to insist over US objections that they be allowed to produce nuclear fuel domestically, without sanction. With US nuclear reactor sales hanging in the balance, it appears that their wishes will be respected.  Iran will be uniquely denied.
Secondly, uranium enrichment provides Tehran with the capability of developing nuclear weapons quickly, if it should ever feel compelled to. Given WashingtonÂs longstanding hostility to an independent Iran, there are good reasons why the country may want to strengthen its means of self-defense.
The hypocrisy of the United States championing counter-proliferationÂand only selectively since no one is asking Israel to give up its nuclear weapons, and the United States hasnÂt the slightest intention of ever relinquishing its ownÂreveals the illegitimacy of the exercise.
The reason, then, for waging war on IranÂs public health, a war that intensifies the suffering of the sick and kills cancer, kidney dialysis and other patients, is not because their government has a secret nuclear weapons program Âwhich no one in the US intelligence community believes anywayÂbut because a developing Iran with independent energy, economic and foreign policies threatens WashingtonÂs preferred world political orderÂone in which the United States has unchallenged primacy.
Primacy is sought, not to satisfy ambitions for power for powerÂs sake, or to provide ordinary US citizens with economic opportunities at home, or to protect them from dangers that originate abroad, but to secure benefits for the plutocrats who dominate US public policy.
The benefits uniquely accrue to plutocrats: opportunities to squeeze more for themselves from our labor, our land, and our resources and from those of our brethren abroadÂthe 99% in other lands, with whom weÂre linked by a common economic position and interests.
If the plutocrats and their loyal political servants in Washington and Brussels have to kill numberless Iranians to secure these benefits, they will do so. And are doing so.
November 3, 2012
1. Eisenberg L, ÂThe sleep of reason produces monstersÂhuman costs of economic sanctions,Â New England Journal of Medicine, 1997; 336:1248-50.
2. Thomas Erdbrink, ÂIran sanctions take unexpected toll on medical importsÂ, The New York times, November 2, 2012; Najmeh Bozorgmehr, ÂIn Iran, sanctions take toll on the sickÂ, The Washington Post, September 4, 2012
3. Karine Morin and Steven H. Miles, ÂPosition paper: The health effects of economic sanctions and embargoes: The role of health professionalsÂ, Annals of Internal Medicine, Volume 132, Number 2, 18 January 2000.
4. John Mueller and Karl Mueller, ÂSanctions of mass destructionÂ, Foreign Affairs, Volume 78, Number 3, May/June 1999.
7. Rick Gladstone, ÂIranian President Says Oil Embargo WonÂt HurtÂ, The New York Times, April 10, 2012.
8. Glenn Kessler, ÂDid Ahmadinejad really say Israel should be Âwiped off the mapÂ?Â The Washington Post, October 6, 2011.
9. James Risen and Mark Mazzetti, ÂU.S. agencies see no move by Iran to build a bombÂ, The New York Times, February 24, 2012.
10. Joby Warrick and Greg Miller, ÂU.S. intelligence gains in Iran seen as boost to confidenceÂ, The Washington Post, April 7, 2012.
11. James Risen, ÂU.S. faces a tricky task in assessment of data on IranÂ, The New York Times, March 17, 2012.
12. Henry A. Kissinger, ÂA new doctrine of intervention?Â The Washington Post, March 30, 2012.
13. Carol E. Lee and Jay Solomon, ÂObama to discuss North Korea, IranÂ, The Wall Street Journal, March 21, 2012.