Prescriptions for War Crimes: How U.S. and Israeli Strikes Dismantled Iran’s Medical Supply Chain

In the course of attacks carried out by the United States and Israel, as reported by Iran’s official news agencies and the Iranian Pharmacists Association, approximately twenty-five pharmaceutical units and companies within the country have been subjected to direct and indirect strikes. These attacks involved the destruction of pharmaceutical manufacturing plants, damage to raw material warehouses, and the disruption of distribution infrastructure. Following these events, the Director-General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, described the damage to Iran’s health infrastructure as “substantial” and emphasized the critical necessity of protecting health facilities during armed conflicts.

Among these incidents, four specific cases have been reported that have had profound impacts on public health and the national supply of medicines:

1. On March 13, an attack was directed at a pharmaceutical warehouse serving as a storage and distribution center for medications for patients with Multiple Sclerosis (MS) and other chronic conditions, as well as infant formula. As a result of enemy missile strikes, the facility was completely engulfed in flames, and its entire inventory was destroyed. This warehouse played a vital role in meeting the pharmaceutical needs of a significant portion of the civilian population.
2. On March 31, an attack was reported against Tofigh Daru Pharmaceutical Company, a major producer of biotechnological drugs and medicines used in the treatment of diseases such as cancer, MS, and hemophilia. This company accounts for a significant portion of the domestic production capacity for complex and high-cost medications. Damage to its production lines or specialized equipment leads to the cessation or prolonged disruption of drug manufacturing—medicines that, in the absence of domestic production, would typically have to be imported at very high costs from international companies, an endeavor fraught with severe difficulties under current sanctions and naval blockades.
3. One day later, on April 1, an attack was reported on Saha Darou Pharmaceutical Company. Affiliated with the Iranian Red Crescent Society, this company plays a critical role in the production and supply of essential medicines for emergency conditions, including saline solutions, antibiotics, and vital hospital supplies. The company’s position within the relief and crisis-response network means that damage to its facilities impacts not only pharmaceutical production capacity but also the broader ability of the health system to respond to emergency and wartime conditions.
4. Continuing this series of attacks, on April 2, reports emerged of damage to the Pasteur Institute of Iran. An institution with over a century of history in public health, it plays a fundamental role in monitoring infectious diseases, vaccine production and quality control, and the development of diagnostic kits. Operating as a WHO Collaborating Center, it is key to disease surveillance and strengthening national biosecurity; damage to its infrastructure could have consequences extending far beyond the national level.

These attacks, which have directly targeted the civilian population, exemplify a war against the most vulnerable segments of society. The systematic deprivation of civilians’ access to medicine and infant formula constitutes a clear violation of the International Covenant on Economic, Social and Cultural Rights (ICESCR) and represents “inhumane acts” as defined under Article 7 of the Rome Statute.

Attacks targeting pharmaceutical and medical infrastructure, while inflicting the most direct harm on civilians, specifically target the “right to health” and the “right to life” of infants and those suffering from illness. These actions not only violate the rules of International Humanitarian Law (IHL) but also leave lasting consequences by creating double suffering and direct economic and psychological pressure on ordinary people.

From the perspective of International Humanitarian Law, pharmaceutical manufacturing facilities, public health infrastructure, and relief-related institutions are fundamentally classified as civilian objects. According to the Principle of Distinction enshrined in Article 48 of Additional Protocol I to the Geneva Conventions, parties to a conflict must at all times distinguish between military objectives and civilian objects. Furthermore, Article 52 of the same Protocol prohibits any attack on civilian objects.

Moreover, Article 54 of Additional Protocol I prohibits attacks on objects indispensable to the survival of the civilian population. Given that pharmaceutical production and distribution infrastructure play a vital role in ensuring the population’s access to treatment, widespread damage to such facilities can have significant impacts on public health.

The International Committee of the Red Cross (ICRC) in its 2005 “Study on Customary International Humanitarian Law” emphasizes that the principle of distinction (Rules 1, 7, 10), the prohibition of disproportionate attacks (Rule 14), the prohibition of starvation of civilians (Rule 53), and the prohibition of attacking objects indispensable to the survival of the civilian population (Rule 54) govern all states as binding customary rules.

The International Court of Justice (ICJ), in its 1996 Advisory Opinion (Legality of the Threat or Use of Nuclear Weapons, ICJ Rep 1996, para. 79), stated that the fundamental rules of humanitarian law, including the principle of distinction, constitute “intransgressible principles of international customary law” and are binding upon all states, regardless of whether they have ratified the relevant treaties.

Within the framework of International Criminal Law, intentional attacks against civilian objects are identified as war crimes under Article 8 of the Rome Statute of the International Criminal Court (ICC). Attacks directly targeting pharmaceutical facilities, public health infrastructure, and relief institutions are assessed in light of these specific legal rules.

Furthermore, no evidence, technical report, or military assessment has been provided to date by the two attacking states to demonstrate that these pharmaceutical facilities, medical warehouses, or vaccine production centers possessed “dual-use” functions or played a direct role in military operations—a prerequisite for justifying any attack under International Humanitarian Law. The absence of any documented claim in this regard maintains the status of these facilities as “protected civilian objects.”

In conclusion, the reports regarding damage to approximately twenty-five pharmaceutical units—including facilities with vital roles in drug production, medical relief, and infectious disease surveillance—demonstrate that the consequences of these attacks are not limited to material losses; they significantly impact public health and patients’ access to life-saving treatments. Therefore, thorough investigation, international reporting, and condemnation of these events are necessary to prevent the recurrence of such attacks and the resulting harm to civilians.