ISTANBUL — Iranian hospitals have begun rationing dialysis sessions, pediatric cancer infusions and basic surgical anesthetics as rolling blackouts, a fifth week of Israeli strikes on industrial sites and a sharply tightened sanctions perimeter push the civilian medical system toward what international aid groups on Friday described as a cascading failure.

In a joint statement issued from Geneva and Istanbul, the International Federation of Red Cross and Red Crescent Societies, Doctors Without Borders and the World Health Organization said they had documented sustained shortages of more than forty essential medicines across hospitals in Tehran, Isfahan, Tabriz, Shiraz and Mashhad over the past two weeks, and warned that without immediate humanitarian carve-outs the deficit would translate into preventable deaths “in days, not weeks.”

“This is no longer a question of inconvenience or delay. It is a question of mortality,” said Dr. Soheila Tavakoli, a Tehran-based pediatric oncologist who has been coordinating informally with diaspora physicians to reroute supplies. “I have children on protocols that cannot be interrupted. I have parents on dialysis who are being told to come every nine days instead of every three. We are making decisions no doctor should make in 2026.”

The crisis has accelerated since March 27, when Israeli strikes on the Mobarakeh steel complex outside Isfahan and on substations serving a cluster of dual-use industrial sites near Arak knocked out grid capacity that hospitals in surrounding provinces had relied on. Iranian Health Ministry spokesman Pedram Pakaeen said Friday that 38 hospitals across seven provinces had been operating on backup generators for at least part of each day during the past week, and that fuel reserves at 11 of those facilities would be exhausted within a fortnight at current burn rates.

Aid coordinators outside Iran described a more granular picture. According to a confidential WHO field assessment shared with MetaCurrents and verified by two officials with direct knowledge, imports of insulin had fallen by 62 percent compared with January, cardiac stents by 71 percent, infant formula by 48 percent, and a class of pediatric leukemia drugs known as L-asparaginase by more than 80 percent. The assessment attributed the shortfalls to a combination of expanded U.S. Treasury sanctions on shipping intermediaries, the closure of overland routes through Iraq during periods of active strikes, and a banking-channel freeze that has stalled even authorized humanitarian payments.

“The exemptions exist on paper. They do not exist on the ground,” said Dr. Karim Eftekhari, regional medical adviser for an international NGO operating in the Gulf, who asked that his organization not be named because of ongoing licensing discussions with U.S. and European authorities. “Three of our authorized shipments have been sitting in Dubai for nineteen days because no correspondent bank will move the payment leg. Two more are sitting in Mersin. The drugs do not expire less because there is a war.”

A U.S. Treasury spokesperson, asked Friday about the bottlenecks, said sanctions exemptions for humanitarian goods “remain fully in force” and pointed to authorized humanitarian channels established under existing general licenses. A senior U.S. official, speaking on condition of anonymity, acknowledged that private banks had become “more cautious than the regulations strictly require” and said outreach to clearing institutions in Europe and the Gulf was being intensified.

The blackouts have layered a second emergency on top of the supply shortfall. Residents in central Tehran described power cuts of six to nine hours per day in residential districts over the past week. Cold-chain interruptions have spoiled batches of vaccines in three district clinics, according to a Red Crescent official in Tehran who asked not to be named because he was not authorized to speak publicly. Lifts have stopped working in residential towers; elderly residents on upper floors have been carried down stairs by neighbors when ambulances arrived.

“My father is 84. He has heart failure. We cannot get him to the clinic when the elevator does not work and the gasoline lines are four hours long,” said Maryam Ghassemi, 41, a translator reached by phone in the Narmak neighborhood of east Tehran. “We are not at the front. We are not under bombs every night. But the country is closing around us.”

The humanitarian picture inside Iran has, until this week, received less attention than the displacement crises in Iraq, Lebanon and Yemen, where the United Nations on Monday issued a $1.4 billion supplemental appeal. The Iranian Health Ministry’s most recent public figure, released Wednesday, put the civilian death toll inside the country at 2,840, with more than 8,900 wounded.

In Geneva, the Swiss foreign ministry confirmed Friday that it was in advanced consultations with Iranian, U.S. and European officials about establishing a “humanitarian financial channel” modeled loosely on the Swiss Humanitarian Trade Arrangement that operated in 2020 and 2021. A Swiss diplomat, speaking on condition of anonymity, said the channel could move medicines, food and medical equipment through a vetted Swiss bank with end-use monitoring, and that talks had advanced “considerably” in the past 72 hours. The diplomat cautioned that no agreement had been reached and that U.S. concerns about diversion remained “real and unresolved.”

Layla Hassan, the Beirut-based regional analyst at the Levant Policy Forum, said the convergence of strikes, sanctions and grid collapse was producing a kind of suffering that defied the usual visual grammar of war coverage. “There are no camps. There are no border crossings. There are apartments with no power and pharmacies with empty shelves,” she said. “The political pressure to act on this is going to come late. It always does.”

Iranian state media on Friday evening accused Israel of “deliberately targeting the medical foundations of civilian life,” a charge Israeli officials rejected. An Israel Defense Forces spokesperson said all strikes were directed at “verified military and dual-use industrial targets” and that the agency could not comment on grid effects from strikes on connected industrial substations.

In Islamabad, where mediators from Pakistan, Saudi Arabia, Egypt and Qatar are continuing to test the ground for formal negotiations, a senior Pakistani official said the humanitarian file had become “a possible early deliverable” — a narrow technical agreement that could move ahead of the harder questions of military pause and political settlement. The official, speaking on condition of anonymity, said a draft annex on medical corridors and banking carve-outs was being circulated quietly among delegations.

Mercy Corps regional director Hala Mansour said the organization had been forced to pause shipments of two pediatric formula products bound for Iranian importers because of insurance complications and that contingency stocks in the region had been depleted by parallel demands in Lebanon and Iraq.

“The system that was supposed to surge for this war is running on the same supplies as the system that was supposed to surge for the last one,” Mansour said. “Something has to give. We would prefer it not be children.”

Officials in Geneva said additional details on the proposed Swiss channel would be announced in the coming days if consultations advanced as expected.