Sanctions are often called a “civilian” alternative to war — yet their human toll can rival war itself.
I’ve seen this up close.
In one sanctioned setting I worked on, “humanitarian exemptions” looked reassuring on paper, yet hospital orders still stalled: banks over-complied, payments froze, suppliers walked away. Neonatal units began rationing human milk fortifier and specialised enteral feeds; haematology clinics cancelled life-saving transfusions when shipments slipped.
Out in the community, retail infant-formula prices climbed more than tenfold within a year as supply chains buckled. It left me with a blunt lesson: exemptions on paper don’t save lives — deliveries do.
What are economic sanctions, and why do they matter for public health?
Economic sanctions use financial, trade and aid restrictions to pressure governments. Cross-country evidence links broad sanctions in low- and middle-income settings to around 500,000 excess deaths, a 1.2–1.4-year drop in life expectancy, disrupted supply chains and rises in maternal and child mortality.
Aid-related sanctions alone have been associated with average annual losses of $213m in official development assistance and $16m in direct health aid, wiping out up to 30% of gains in child mortality and 64% in maternal mortality over five years.
This does not stop at borders. COVID-19 proved that health is interdependent: when one country cannot maintain core outbreak control, its consequences ripple outward. If any country fails to sustain polio immunisation, global eradication remains out of reach.
And when health systems collapse, so too do the capacities needed for climate adaptation and emission control. Sanctions, in this sense, create cross-border externalities that undermine regional stability, global health security and collective progress on climate resilience.
What is your main research aim, and how does it build an interdisciplinary agenda?
Since the 2010s, my colleagues and I have mapped the pathways through which sanctions affect health systems — from medicine access and supply chains to workforce and governance. As the evidence consolidated, our focus shifted to practice: how to protect communities under sanctions.
That requires health-systems science (information, financing, governance, pharmaceuticals) working alongside law and human rights, so that populations with no responsibility for political decisions are shielded from avoidable harm.
The aim is to turn “health under sanctions” into an active agenda for justice and resilience.
What are the biggest challenges?
The field is highly politicised, complicating neutrality and scientific independence. Researchers face thin data, limited field access and blocked payments due to over-compliance and regulatory risk; local partners are often unable to contract or receive funds.
Funders may view the area as high-risk, and journals hesitate when data are incomplete.
Most critically, demonstrating impact is hard — crises overlap, access is constrained and confounding is real.
We therefore invest in rigorous ethics and compliance-by-design, low-risk financial pathways, trusted local networks and shared indicator frameworks, so evidence can travel the last mile into policy.
Given this context, what is happening now — and how can colleagues engage?
Two complementary streams are moving forward.
Firstly, under a project commissioned by the World Health Organisation's Regional Office for the Eastern Mediterranean (WHO EMRO), which contributed substantively to its design and review, we developed an evidence-based monitoring tool to identify health-system bottlenecks under sanctions.
This includes governance and decision-making; health financing and strategic purchasing; medicine/equipment supply chains; health information and real-time dashboards; workforce retention and rotation; continuity of essential services (particularly immunisation and maternal–child care); social protection and the social determinants of health; plus legal–banking interfaces to reduce over-compliance and reopen safe payment channels.
Second, globally, the UN Human Rights Council’s Special Rapporteur on unilateral coercive measures is advancing an online system to track humanitarian consequences. We align definitions, datasets and ethics to avoid duplication and accelerate data-to-decision pathways.
Open invitation
If you work in public health, health systems, law, economics, compliance/banking, supply chains or field operations — and want to turn evidence into measurable protection for people’s health — do get in touch.
This is intrinsically interdisciplinary, and progress depends on a community that matches scientific care with practical resolve.
My work
I have had several works published on economic sanctions in 2025, including in Health System Resilience, The Lancet, and a second Lancet piece on sanctions in Iran.
