Study Protocol for Investigating the Impact of Economic Sanctions on Public Health and Healthcare Systems in Iran: A National and Sub-national Analysis from 2000 to 2020

The economic sanctions imposed on Iran in recent decades have impacted the country s healthcare system and the health of its people. However, there has not been a thorough examination of the full scope and changes in these effects over time. Therefore, we designed a mixed-methods study, comprising a parallel quantitative analysis and qualitative study. The quantitative part assesses the effects of sanctions on public health and the healthcare system using 28 indicators, i.e., macroeconomic, healthcare resources, and health outcomes indicators at both national and sub-national levels from 2000 to 2020. The analyses will include descriptive analysis, change point regression analysis, and mediation analysis, performed using R software. The concurrent qualitative study aims to explore the pathways of the sanction effects by considering the perceptions of both patients and health policymakers. The perceptions and experiences of patients regarding living with and dealing with the long- and short-term health implications of sanctions, and the experiences of health policymakers regarding the effects of sanctions on the healthcare system will be analyzed. This study will provide comprehensive and evidence-informed recommendations for global health policymakers to support countries under economic sanctions to protect and promote the human right to health and well-being.