Medicine Costs Triple in Six Months as Iran’s Retirees Wait for Unpaid Pensions

A 39-year-old from Masjed Soleyman in southwestern Iran describes a healthcare system collapsing under inflation’s weight: the stomach medication he once bought for 700,000 tomans now costs 2.2 million tomans^[1]. He is not alone. Across Iranian cities, residents report that essential medicines have become unaffordable, surgical procedures now require bribes in the hundreds of millions of tomans, and the government has stopped paying retirees on time^[1].

The pattern emerging from accounts across Iran reveals how sanctions, currency depreciation, and state mismanagement have fractured the social contract. Social Security pensioners in multiple regions remain six months behind on wages^[1]. Workers at state enterprises report months of unpaid salaries. A cardiac surgeon demanded 100 million tomans in under-the-table payments for an emergency operation; another in Karaj asked for 150 million tomans^[1]. Families choosing between food and medication are now routine.

Inflation has become daily rather than monthly. A tire that cost 2.6 million tomans in 2023 now sells for 40 million tomans, a 15-fold increase in three years^[1]. Water bills have more than doubled in some regions. A person from Rasht reported paying 3.5 million tomans for four basic skin-care items^[1]. Government schools demand 20 million tomans in enrollment fees despite being nominally free^[1].

The regime’s response has been administrative rather than economic. Healthcare workers describe insurance coverage being cut for entire categories of treatment while premiums remain unchanged. One person paying 5 million tomans monthly for insurance found coverage terminated for specific medications and procedures^[1]. A resident of Bijnord underwent minor facial surgery, a CT scan, and ultrasound without insurance – the total came to 8 million tomans^[1].

Employment offers little shelter. Workers at Arin Pars Motor, a major Iranian automotive company, have gone five months without salary^[1]. Employees at Karaj’s sugar factory have not received wages or benefits in six months and fear retaliation if they protest^[1]. A Caspian shipping company employee reported five months of unemployment with no savings remaining^[1]. At one manufacturing firm in Jajrud, management distributes wages in installments while threatening dismissal for complaints; multiple workers have resigned^[1].

The collapse is particularly acute because Iran’s middle class – public employees, retirees, skilled workers – once anchored regime stability. These groups had reliable salaries, pensions, and access to subsidized healthcare. That foundation has eroded. A retiree borrowing a billion tomans for colon cancer treatment represents not merely personal hardship but the complete failure of the state’s welfare apparatus^[1].

What this tells us about the regime’s stability calculus: the government can tolerate street protests and external pressure, but it cannot indefinitely ignore the economic grievances of its own institutional base. When teachers cannot afford school supplies for their children, when pensioners go months without income, when a skilled worker must choose between food and medicine, the regime faces not ideological opposition but survival pressure from within its own constituency. The question is no longer whether Iranians are angry – anger is now universal. It is whether that anger remains diffuse and localized or coalesces into coordinated pressure the regime cannot manage through security force deployments alone.