The first wave of U.S. sanctions against Iran was looming when doctors gave Aram Rawanshad the bad news.
It was early June when she learned she was suffering from endometriosis, a painful disease that occurs when tissue grows outside the uterus. It was too late for surgery, and doctors warned her to act fast before the disease spread.
Rawanshad, a 42-year-old writer from Karaj, Iran, was given a prescription and urged to stock up before supplies ran out.
She refused.
"I told the pharmacist that if I buy more than one month's supply, other patients would be deprived," she said.
Though it was a kind gesture, it came at a cost. The following month, when she returned to the pharmacy, the medicine was sold out.
Skyrocketing inflation, a shortage of raw materials and fewer imports have made medications in Iran both scarce and costly.
Although humanitarian goods, such as medicine and food, are exempt from U.S. sanctions, severe restrictions on Iran's financial institutions have forced the outside world to reconsider doing business with the Islamic Republic.
Experts fear the latest round of sanctions will make the situation even worse.
A month after the U.S. Treasury leveled sanctions against 20 Iranian financial institutions, the Trump administration reimposed sanctions against Iran's energy, banking and shipping industries.
Whereas previous administrations that slapped sanctions on Iran made it a point to encourage companies to continue humanitarian trade, President Donald Trump's administration has not.
"Companies that are looking at potential customers will feel like it's a huge headache to sell to Iran," said Elizabeth Rosenberg, a senior fellow at the Center for New American Security.
Although Iran's Health Ministry provided domestic manufacturers with foreign currency at subsidized rates, the soaring costs of raw materials have increased the price of domestic medicine by nearly 50 percent, according to Siavash Saadat, a 65-year-old manager of a pharmaceutical company in Tehran.
Analysts and Iranian pharmaceutical companies worry that patients with cancer and other serious diseases, such as Rawanshad, are most at risk.
After searching Tehran for medicine, Rawanshad finally found a pharmacy that had it in stock. She bought three months' supply, but anticipates she'll have to turn to the black market in the future.
"Dealers and middle men are buying [medicines] and hoarding them. This also increases the prices," she said.
Secretary of State Mike Pompeo said U.S. sanctions are meant to force the Iranian government to "abandon its destructive activities," adding that the sanctions target the government, not Iranian people.
But the reality is far more complex.
After years of fiscal mismanagement and corruption, global banks have been hesitant to do business with Iran's financial institutions. Even when former President Barack Obama's administration lifted the sanctions against two dozen Iranian banks as part of the landmark nuclear accord, it made little difference.
One of the bright spots had been Parsian Bank -- a reputable private-sector bank that has been a vital conduit for European companies to conduct humanitarian trade with Iran. But it too was swept up in the new round of sanctions.
The U.S. Treasury said it hit Parsian Bank with the sanctions because of a firm that used its investments from Parsian Bank to provide money to Iran's Revolutionary Guard Corps.
A Section on 11/12/2018