Exposed: The Massmurder by US and EU Sanctions | Prof. Reza Majdzadeh

## Introduction and guest Sanctions are often presented as a surgical instrument of foreign policy: targeted, reversible, and designed to pressure governments while sparing civilians. The conversation recorded with Professor Reza Majdzadeh dismantles that comforting fiction. Drawing on decades of public‑health work in Iran and with international bodies, the discussion brings into focus a body of emerging evidence showing that sanctions are not a side tool of diplomacy but a major driver of avoidable mortality and systemic health decline. Far from being a purely abstract policy debate, the exchange reframes sanctions as a public‑health intervention—one that, on aggregate, kills more people each year than many conventional wars and that imposes long‑term damage on health systems and societies. The academic literature referenced in the exchange has moved the topic from anecdote to quantifiable harm. Large cross‑national studies and systematic reviews demonstrate consistent relationships between sanctions and poorer health outcomes: reduced life expectancy, rising maternal and child mortality in sanctioned contexts, and broad declines in healthcare access. The weight of this research challenges policymakers and lawyers to reconsider not only the ethics but the mechanics of sanctioning regimes. If a policy instrument predictably and substantially harms civilians, it must be treated within the same frameworks of proportionality and protection that govern wartime conduct. This is the central contention that emerges from the recorded discussion. Professor Majdzadeh’s voice anchors the analysis. He brings the twin vantage points of epidemiologist and health‑system manager—someone who has tracked universal health coverage efforts while confronting the pragmatic consequences of financial isolation. His accounts bridge macro‑level statistical findings and micro‑level human tragedies, making the argument both empirically robust and morally urgent. The rest of this article unpacks the core themes from the conversation: the scale of mortality linked to sanctions, the pathways by which sanctions damage health systems, the adaptive strategies countries deploy, the difficulties of monitoring health under restriction, and the ethical appeal that closes the exchange. ## Death toll and personal loss One of the most jarring claims raised in the discussion is that sanctions have been associated with more than half a million deaths per year across the period studied. That magnitude transforms sanctions from a policy lever into a public‑health crisis. Several independent research teams contribute to this assessment: longitudinal analyses linking sanctions to declines in life expectancy, specific studies on maternal and child health under aid restrictions, and cross‑national estimates that place sanction‑related mortality on par with—or exceeding—combat fatalities. Taken together, these studies form a consistent picture: sanctions exert a chronic, distributed, and often invisible toll. Numbers, however, can anesthetize the moral shock they intend to convey. The conversation deliberately restores the human face of statistical findings. Professor Majdzadeh recounts a personal tragedy: a family member’s death in an Iranian hospital following a hospital‑acquired infection for which appropriate antibiotics could not be sourced. That anecdote is not an outlier but rather emblematic of the clinical realities that underlie the broad figures. When essential drugs, sterile disposables, and basic diagnostics trickle away, complications that would be manageable in well‑resourced settings become fatal. Each mortality statistic thus encodes stories of preventable, proximate suffering—fractured families, lost livelihoods, and the long shadow of grief. Beyond individual cases, the conversation underscores how sanctions amplify inequity and destitution. As national revenue streams shrink under export bans and trade constraints, governments lose fiscal capacity to subsidize healthcare or cushion households against price shocks. The poorest segments of society bear the brunt: children who miss immunizations, pregnant women who forego prenatal care, and chronic patients who ration life‑sustaining medicines. The cumulative effect is a displacement of the burden of statecraft onto the bodies of the most vulnerable. ## Resilience and local production Faced with these structural pressures, nations under sanction do not passively accept degradation. The recorded dialogue lays out a taxonomy of domestic responses divided across short, medium, and long time horizons. Short‑term tactics aim at immediate procurement alternatives: pivoting to non‑Western suppliers, rerouting shipments through neighboring markets, and exploring informal financial channels. Such measures can temporarily blunt acute shortages but are vulnerable to secondary pressures as multinational firms and banks withdraw to avoid legal and reputational risk. Medium‑term strategies emphasize efficiency and prioritization. Health ministries triage scarce resources, ration essential drugs, and focus programmatic funds on services with the highest population impact. Prioritization can preserve life‑saving interventions for a time, but it is inherently distributive—choices about which conditions to deprioritize become ethical flashpoints and can entrench preventable morbidity. Longer‑term pathways gravitate toward self‑sufficiency: bolstering domestic pharmaceutical manufacturing, developing local supply chains for consumables, and investing in training to reduce dependence on imported specialist equipment. The conversation cites vaccine development efforts as an illustrative case: when procurement uncertainties threatened access, countries mobilized to create indigenous production capacity. Self‑reliance can reduce vulnerability, but it is not a panacea. Local production requires capital, technological know‑how, and raw inputs that may themselves be subject to trade restrictions. Moreover, substituting homegrown solutions often imposes higher costs and longer timelines, with quality and scalability challenges. Professor Majdzadeh’s key insight is to resist binary thinking. Domestic resilience matters—and it can and should be supported—but it cannot shoulder the entire burden of protecting health. Resilience is necessary but insufficient; it must be complemented by external legal, diplomatic, and financial safeguards that preserve humanitarian supply lines even while sanctions pursue political ends. ## Monitoring health during sanctions A recurrent theme in the exchange is the challenge of measuring harm in contexts of political and infrastructural fragility. Reliable surveillance systems, routine vital statistics, and administrative health data are the foundations of modern epidemiology. Yet those very systems can be the first casualties of economic isolation. Reduced capacity for data collection, gaps in reporting, and the conflation of conflict and sanction effects complicate causal inference. Researchers thus face a dual problem: identifying robust indicators of harm while contending with incomplete or biased data. Despite these obstacles, recent studies have employed innovative designs to disentangle sanctions’ effects. Cross‑national comparisons over long periods, the use of natural experiments, and triangulation across multiple datasets have all yielded convergent findings. The recorded conversation emphasizes that we no longer need to rely solely on anecdotes; methodologically sound research is capable of quantifying mortality and morbidity attributable to sanctions with worrying consistency. Monitoring is not merely an academic exercise. Early detection systems could serve as an ethical and operational brake: if sanctions provoke measurable deterioration in health indicators, international law and policy could require a review or immediate mitigation measures. To that end, Professor Majdzadeh advocates for legal fra

Exposed: The Meassmurder by US and EU Sanctions | Prof. Reza Majdzadeh A recent study in the academic Lancet journal shows that between 1971 and 2021, more than half a million people diedPER YEAR due to US and EU sanctions. This meassmurder is something we need to talk about. Reza Majdzadeh has been involved in sanctions research from a public health perspective for decades. He is a Professor at the University of Essex and a public health expert with experience in Iran and at the WHO. Links: Article: https://www.thelancet.com/journals/langlo/article /PIIS2214-109X(25)00278-5/fulltext The article that outlines 500k dead per year: https://www. thelancet.com/journals/langlo/article/PIIS2214-109X(25)00278-5/fulltext Neutrality Studies substack: https://pascallottaz.substack.com (Opt in for Academic Section from your profile settings: https://pascallottaz.substack.com/s/academic) Merch & Donations: https://neutralitystudies-shop. fourthwall.co Timestamps: 00:00:00 Introduction and guest 00:01:20 Lancet findings on sanctions 00:07:30 Death toll and personal loss 00:10:45 Banking and supply chain breakdown 00:20:13 Resilience and local production 00:28:12 The myth of smart sanctions 00:30:57 Monitoring health during sanctions 00:38:39 Early warning before deaths 00:42:12 Final appeal and closing #Pascal Welcome back, everybody, to Neutrality Studies. My name is Pascal Lottaz. I'm an associate professor at Kyoto University, and today I'm joined by Dr. Reza Maizadeh, a professor of public health in the School of Health and Social Care at the University of Essex. Professor Maizadeh worked for decades in the public health sector in his native Iran and later also for the World Health Organization and other international institutions, publishing over 380 peer-reviewed articles. Together with his colleagues, he recently published very important studies in the Lancet journals— one of the most important academic health journals—on the issue of “Beyond National Resilience: Liability for Sanctions Impact,” in which he details what the impact actually is of U.S. and EU sanctions. Or, let me put it this way: he and his colleagues, who have been researching this issue for a long time, detail the impact of sanctions on individual countries. So, Professor Maizadeh, welcome. #Reza Majdzadeh Thank you so much. Thank you. #Reza Majdzadeh I really appreciate that. #Reza Majdzadeh -- 1 of 14 -- Thank you for having me. #Reza Majdzadeh Thank you for having me. #Reza Majdzadeh to attack exchange rates and the audiences. Over to you. #Pascal You're one of the experts who’s been researching sanctions for years. Maybe you could first lay out a little bit what that Lancet journal issue I just mentioned establishes, and what the effects of economic sanctions are. Some people think they’re just there to punish evil regimes, but the findings of you and your colleagues are very different. #Reza Majdzadeh Okay, let me start by adding a bit to the introduction, just so we know where we are and how I can contribute to this discussion. I’m an epidemiologist, and I was the head of Iran’s National Institute of Health Research. At that time, we started the health sector reform with the goal of achieving universal health coverage. That institution became responsible for monitoring universal health coverage and the health sector reform—how it could align with the global commitment, one of the SDGs, which is very important: reducing the financial burden and improving equity across the country and the world. At that time, I faced the problem that, under sanctions, we couldn’t reach that level. Therefore, I started working on different dimensions of sanctions in Iran in particular, because that was the area I was involved in. Later on, we thought, okay, this is the reality of sanctions—how can we mitigate their effects on health? That’s why many of my publications are related to health system resilience and how we can reduce the impact of sanctions on health. Later, we began thinking not only about making health systems more resilient, but also about what international human rights measures we could use to achieve that goal. And the piece you mentioned, which is a comment in *The Lancet Global Health*, comes from that angle. Later on, in *The Lancet*, we published another piece where we highlighted very concrete ideas about how to implement measures to reduce the harsh effects of sanctions. Therefore, my area of work is assessing the effects of sanctions, looking at the health system, and proposing mitigation measures to reduce those harsh effects. I wanted to put this in a meaningful way to connect it to what I’m doing. So, initially, I should say that sanctions affect systems before they affect people. When they start, patients are directly affected—but even before that, there’s the problem of access -- 2 of 14 -- to medicines and medical equipment. It’s a matter of logistics, of service delivery, of human resources. Through these health system building blocks, we can see how difficult sanctions make things. Let me start by saying that, right now, we have evidence on the effects of sanctions on health. You mentioned a publication by Rodriguez and colleagues in *The Lancet*, which shows that sanctions can have a huge impact on mortality—more than 550,000 deaths annually are expected from sanctions, which is almost at the level of, or even exceeds, that of war. We’ve also seen another paper by Ruth Gibson and colleagues, where they looked at the effect of ODA sanctions on maternal and child health, and they found a similar pattern. Another very important observation comes from a cross-national study by Jörg Gutmann and colleagues on life expectancy, which found that sanctions can reduce life expectancy by about 1.2 to 1.4 years. #Reza Majdzadeh 1.4 for the United Nations sanctions and 1.2 for the U.S. sanctions. It’s very interesting. The United Nations—the body founded for peace and the safeguarding of human life—is implementing a measure that can actually reduce people’s life expectancy. I find that quite shocking. #Pascal Hey, very brief intermission because I was recently banned from YouTube. And although I’m back, this could happen again at any time. So please consider subscribing not only here but also to my mailing list on Substack—that’s pascallottaz.substack.com. The link’s going to be in the description below. And now, back to the video. It is a shock. It’s just that, you know, in this paper you mentioned at the beginning, it analyzes data from 1971 to 2021—a 50-year span—and comes to the conclusion that every year, half a million people die, directly or indirectly, because of U.S. and EU sanctions. Again, the paper actually shows that this number is significantly higher than the number of people who die directly from military actions each year. So economic sanctions aren’t something that, as it’s sometimes assumed in the West, just punish regimes and make rich people a bit poorer so we can feel like we’ve done something, right? I mean, we did it. No—they kill half a million people every year. How long did it take you to realize just how impactful sanctions are on the individual level? I mean, Iran has been under heavy sanctions for many decades. Did you see the effects of sanctions— like the health effects—firsthand? #Reza Majdzadeh -- 3 of 14 -- Initially, I mentioned to you that before seeing the effects of sanctions on people, you can see their effects on the health system. What I’m saying is that it’s actually very upsetting to see that people don’t have proper access to medicines. That’s the first thing. I want to give you one example that’s very personal. #Pascal My mother was living in the United States. #Reza Majdzadeh She came to visit my younger brother in Tehran. She got an infection and was hospitalized there. During that hospitalization, she contracted a hospital-acquired infection—what’s called a nosocomial infection in medical terms. We couldn’t find the right antibiotic, and she passed away two years ago. #Pascal I'm so sorry to hear that. #Reza Majdzadeh What I’m saying is that this is something that’s affecting people. Do you understand me? That’s one case. But when you’re talking about more than 550,000 deaths, each single case is a tragedy. #Pascal Yes. #Reza Majdzadeh It’s destroying families. It’s the livelihood of the people. It’s not just a number. What I’m saying is that we don’t need to wait to see that mortality number—we can already see it when people don’t have access to medicine, medical equipment, tests, and so on. #Pascal What are the other areas where these sanctions make it impossible for the system to take care of people? I mean, I guess that’s just one example—the medicine. #Reza Majdzadeh -- 4 of 14 -- We go through that and explain to you about the mechanisms. What is the mechanism? Because initially, I should say that, you know, under the regime of sanctions, we have humanitarian exemptions. Within those exemptions, essential medicines and medical equipment that do not have dual purposes—meaning military purposes at the same time—are exempted from the sanctions regime. But what I’m saying is that these exemptions often do not function in practice. Let me explain why. First, we have blockages that are very clear for dual-purpose medicines or medical equipment. There’s a blockage of import and export, which is very reasonable, and I don’t want to go into that. But there are two other mechanisms that are happening. One is that there is no banking transfer between the sanctioning countries and the sanctioned country. Therefore, there’s no way to send money when you’re buying something. You don’t have a SWIFT code. If you don’t have a SWIFT code, how are you supposed to buy anything? So, it’s impossible. The second mechanism, which is very frustrating, is overcompliance and the chilling effect. I can come back to that and explain what it means. And the third one is the indirect effect of sanctions through reducing the country’s revenue and its capacity to pay for people. So, we have three mechanisms that affect access to medicines and equipment, and I can explain to you the other effects of these sanctions on the different building blocks of the health system. #Pascal Please explain that to me, and also let me know for how long—how many years—we’ve known in academia and elsewhere just how deadly these sanctions are. Is this a new insight, that they kill so many people, or have these numbers been understood before as well? #Reza Majdzadeh Initially, I think we should know that, many years ago—in particular, I want to highlight the published literature on the effects of sanctions on Iraq, which goes back to the early 2000s—there’s already a lot of evidence on this. But at the same time, look at which countries we’re working with. We’re working with countries that do not have robust data systems. We don’t have strong, reliable data. Therefore, we didn’t have much evidence to show. And I can explain what the problem is when you try to look at evidence and quantify it. Because, you know, when you look at the case of Syria, it wasn’t just sanctioned—it was also involved in a war at the same time. So how would you separate, let’s say, the effect of sanctions from the effect of war? Therefore, the methodology is not very straightforward, and we don’t really have that data. But what I’m saying—what I argue—is that there is potential. Right now, these three pieces of work I mentioned—by Rodríguez and colleagues, Ruth Gibson, and Jörg Bultmann—show strong evidence of the effects of sanctions, not only on mortality and morbidity, but also more broadly. There’s a good publication in *BMJ Global Health* from 2020, which Matthew Pinto published with colleagues. That paper shows the effects of sanctions, and there’s also a systematic review that my colleagues -- 5 of 14 -- in Iran and I conducted, looking at the impact of sanctions from different angles of health. What I’m saying