The most recent news out of Vienna is that the P5+1 and Iran are 95% of the way to an elusive nuclear deal. With less than 40 days to the November 24th deadline, both sides still need to resolve issues around the number of centrifuges Iran will be allowed to maintain, how long the deal will last, how quickly Iran will see sanctions relief, and the possible military dimension to Iran’s pre-2003 nuclear activities. These outstanding points of contention will need to be addressed, and concessions will need to be made, leading some to question Iran’s will to stay at the negotiating table.

The United States, the European Union and the United Nations implemented sanctions in 2010 that by 2012 had hit Iran’s economy incredibly hard.  Inflation rose to 45% in 2012-2013, oil export proceeds dropped, and the rial, Iran’s currency, lost 60% of its value. Nevertheless the Islamic Republic has adjusted to new sanctions and its economy is predicted to grow moderately in 2015. Iran’s GDP is expected to rise 2 percent  in 2014 and 2015, at roughly the same pace as the U.S. economy.

The present not-so-bad economic reality may suggest that Iran can afford to throw in the towel on nuclear negotiations, but it doesn’t take into account the whole picture.

As much as the Iranian regime likes to paint the U.S. as the big bad wolf, Western sanctions are not exclusively responsible for the estimated 31% of Iranians living below the poverty line. The current destitute condition of the everyday Iranian is the result of  widespread corruption and mismanagement from the Ahmadinejad era compounded by an influx of sanctions since 2010. Although sanctions may have played a role in bringing Iran to the table, they wouldn’t have been necessary if hardliner conservatives in Iran and the U.S. hadn’t let relations deteriorate so dramatically post-2003.

Sanctions have worked to destabilize domestic politics and isolate Iran from the global economy, yes, but what about the average Iranian citizen?

SANCTIONS HURT GRANDMA AND NEW BABY, TOO

Although specific sanctions are not placed directly on Iran’s medical industry, backlash from financial isolation has directly affected access to medicine and medical devices.

Sanctions against Iran are supposed to include legal loopholes to facilitate the flow of humanitarian aid.  Even so, the import of lifesaving medicine from the West is nearly impossible. According to a 2013 study carried out by the Wilson Center, “Iranian patients find it increasingly difficult and expensive, if not impossible, to obtain some of the medicines they need. When they do fill a prescription, they risk amplified side effects and reduced effectiveness because Iran is forced to import more and more medicines, or their chemical building blocks, from India and China, thereby replacing the higher quality products from Western manufacturers.”

I spoke with an Iranian citizen whose grandmother needed back surgery. The doctor was to replace one of her vertebrae with an artificial vertebra. The high quality artificial bone, which before the latest bout of sanctions was easy to obtain in Iran, was impossible to find. Instead the doctor had to use a version made in China. Even the doctor was skeptical of the safety of the device.

In another example, new parents are having trouble obtaining Neocate, a baby formula for infants with milk allergies. Parents in Iran have to wait in long lines and pay exorbitant prices for the only brand of formula their children are safe to consume.

Iran has had to increase imports of lower quality drugs and medical devices from China and India.  Furthermore, U.S. and European pharmaceutical companies often patent their drugs. Meaning the West is the only place certain drugs are manufactured thus Iran can’t look to the East for alternatives.  

In accordance with the Joint Plan of Action, the U.S. and EU have rolled back sanctions on petrochemicals, gold, and precious metal exports. The U.S. has also suspended sanctions on Iran’s automotive industry and associated services and “Establish[ed] a financial channel to facilitate humanitarian trade for Iran’s domestic needs using Iranian oil revenue held abroad.” While the recent sanctions rollbacks have helped stimulate the economy, the benefits have not yet reached Iran’s pharmaceutical and medical industry.

The sanctions relief that would result from a nuclear deal this year would allow the average Iranian access to the high quality Western medical goods they need. But ultimately, the only person Rouhani needs to persuade to nail down a deal is Supreme Leader Ayatollah Ali Khamenei, who has thus far maintained hardliner resistance to cooperating with the West. That said, the Iranian political apparatus isn’t impervious to influence from below, despite the regime’s undemocratic nature. Pressure from the Iranian people on the regime should not be underestimated as motive for Khamenei to make compromises on a deal. Keep in mind that the 1979 Iranian Revolution was spearheaded by student groups and the urban middle class.

Because of this pressure from below, Iran should have a vested interest in resolving the nuclear issue with diplomacy and with haste. Although the timeline of sanctions relief is still being debated in negotiations, it will be a key feature of any nuclear deal. The sooner the P5+1 and Iran come to an agreement, the faster the average Iranian will see tangible relief from the consequences of sanctions.