US fines crypto firm Exodus $3.1mn over Iran sanctions breaches

Across Tehran and other major cities, advertising websites, job boards and even the walls outside hospitals are plastered with notices offering such services.

The role is not filled by relatives. Instead, patient companions are hired—often informally—to care for hospitalized patients, helping with eating, hygiene and mobility.

According to the head of Iran’s Nursing Organization, the country faces a shortfall of at least 100,000 nurses. The deficit appears to have created a parallel, low-wage labor market with little oversight and frequent abuse.

A nurse working at a hospital in Tehran told Iran International that the tasks assigned to patient companions often go far beyond what their wages suggest.

“They do work that no one would normally accept for this pay,” she said, requesting anonymity. “They care for patients who cannot go to the toilet or bathe on their own.”

Exploited

A search for “patient companion” (hamrah-e bimār) on Iran’s largest classifieds website, Divar, produces dozens of listings from across the country. The companies share a familiar pitch: assurances of experience, professionalism and official registration.

One company advertises an eight-hour shift for a mobile patient who does not require personal hygiene care at 800,000 tomans (about $6 at December 16 exchange rates). Many others list prices as “negotiable.”

Alongside these firms, individuals also advertise their services directly. Many claim to have first-aid training or nursing experience and say they are willing to travel nationwide.

Yet trust remains a major barrier.

“People don’t feel comfortable hiring individuals directly,” said another nurse in Tehran, who also asked not to be named. “So they turn to companies, even though the companies take most of the money.”

According to this nurse, nursing service firms often keep close to two-thirds of what families pay, leaving companions with little compensation despite the physical and emotional demands of the work.

No better option

To avoid company fees, some companions eventually try to secure work through hospital staff. After being introduced repeatedly by agencies, they ask nurses or aides to connect them directly with families in need.

The practice is most common in public hospitals, where staff shortages are most acute.

A doctor at a Tehran hospital told Iran International that families struggling to pay medical bills sometimes plead with doctors or nurses to help a relative find work as a patient companion. “It becomes a way to cover treatment costs,” he said.

A male nurse in Tehran described hiring a companion through an agency several years ago to care for his grandmother, who had cancer.

“She was a nursing student, working to support herself while studying,” he said. “She told us the companies demand large promissory notes from workers and then take two-thirds of the family’s payment.”

For many companions, the job is a temporary lifeline rather than a chosen profession.

Home-care assignments can carry additional risks, especially for women. Reports of assault or sexual harassment are not rare, the nurse added, but few are willing to come forward, fearing that agencies may move to cash promissory notes at the first sign of dispute—effectively blacklisting workers from future employment.

That lack of regulation cuts both ways. Families often prefer companies, believing them to be safer. But, as nurses acknowledge, the skills of agency-provided companions are far from guaranteed.

“Most companions are women, many of them heads of household,” one nurse in Tehran said. “Few have formal training. Most learn on the job from hospital staff. They do this because they have no other option.”

Prominent creators have reported revenue drops of as much as 90% in December.

Previously, RPM (revenue per 1,000 views) for Iranian content creators averaged $3-11 but has now fallen to between 20 cents and $1 for many channels, Shargh Daily reported on Tuesday.

Gaming YouTuber Aria Keoxer reported earning just $400 from a video with 400,000 views, down from thousands previously, the report said.

The changes stem from improved detection of VPN-spoofed locations, treating most views as originating from Iran, whose market advertisers rarely seek out due to stiff Western sanctions.

Users in Iran also use VPNs to sidestep broad official censorship of the internet.

While not all channels are equally affected - some report only 20% declines - the shift threatens the viability of Iranian content production, pushing creators toward sponsorships or alternative platforms.

“The income of Persian YouTube channels has practically dropped to zero," one account said on X. "Since last week, YouTube in its new update doesn't even show ads to those who connect from inside Iran using a VPN, and this means that the previous method of making money through monetization no longer works.”

“The result is that Persian channels without sponsors have practically reached the end of the line, continuing has become very difficult for them, and for some of them, continuing activities are no longer worthwhile!" it added.

An official YouTube statement on the changes in December did not mention Iran.

The country's digital marketing sector has grown modestly despite sanctions. E-commerce revenue stood at $15-16 billion in 2025 and had grown up to 12% annually, analysis site Statista reported.

Social media advertising in Iran has hit about $430 million each year driven by local platforms like Instagram and Telegram as well as apps like retail hub Digikala and ride-hailing platform Snapp.

Iran's President Masoud Pezeshkian has repeatedly promised to lift government censorship over the internet, a key pledge of his 2024 presidential campaign, but has made little headway.

Public anger intensified after revelations of so-called white SIM cards providing unfettered access to privileged insiders, which critics say contradicts government rhetoric about digital equality.

The digital and e-commerce economy in Iran faced a huge blow during a 12-day war in June with Israel, when Tehran briefly shuttered the internet entirely in what authorities called an effort to foil Israeli espionage but dissidents said aimed at free expression.

Central bank spokesperson Mohammad Shirijian said the individuals, using around 6,000 bank accounts, recorded a combined turnover of about 2,100 trillion rials ($1.6 billion).

Shirijian said about 130 trillion rials, or around $100 million, of the total was linked to the bank accounts of a 24-year-old whom he accused of involvement in “disrupting the foreign exchange market.”

He added that the cases of 13 people suspected of "disrupting the banking system and the foreign exchange market" had been referred to the judiciary.

Separately, Revolutionary Guards-affiliated Tasnim News Agency, citing the central bank’s public relations director Mostafa Ghamari Vafa, reported that authorities had identified and blocked the accounts of three individuals, aged 24, 28 and 33, whose transactions totaled about 262 trillion rials ($201 million).

Tasnim said authorities had identified the trail of currency traders linked to the accounts and that the case remains under close surveillance.

Iran’s central bank issued a new directive in late September requiring banks to set annual transaction limits for customers based on their level of financial activity.

Under the directive, the annual transaction cap is set at 200 billion rials ($154,000) for salaried individuals, 50 billion rials ($38,400) for individuals without employment and five billion rials ($3,840) for inactive legal entities.

Shirijian's remarks come as Iran’s currency hit a fresh low on Monday of 1.312 million rials to the US dollar on the open market according to currency-tracking websites, reflecting deep economic woes in the country.

Tehran has sought to boost financial regulation and gain entry into anti-money laundering bodies in a bid to gain greater access to the global banking system as renewed international sanctions have dented its already creaky economy.

But in October the Financial Action Task Force (FATF) rejected Iran's accession, saying Tehran would remain on its list of high-risk countries for failing to fully accept the body's rules on terror financing.

The 2025 National Security Strategy reflects a narrowing of what Washington now defines as its core national interests, Taleblu said, with Iran mentioned just three times despite being labeled a central threat in Trump’s 2017 strategy.

“There’s a focus on the homeland, the Western Hemisphere, strategic competition with China and getting Europe to do more,” said Taleblu, an analyst for the Foundation for Defense of Democracies think tank in Washington DC, adding that Iran is absent from the list of top-tier threats outlined in the document.

The strategy released this month emphasizes reducing US involvement in the Middle East in favor of focusing on great power competition with China, threats in the Western Hemisphere and urging Europe to shoulder more security responsibility.

Iran appears to have slipped down Washington’s priority list following last year’s 12-day war between Israel and Iran, which the United States briefly joined.

“It seems like, at least for the Trump administration, they’re content to take that victory lap,” Taleblu said on Eye for Iran, saying the White House is attempting to declare success and move on following US strikes on Iran’s nuclear facilities.

The NSS suggests Washington is ready to “turn the page” on a region that has dominated US foreign policy for decades, he added, and it credits Trump’s energy policies, regional diplomacy and limited use of force for creating political space to step back from the Middle East.

US strikes on Iran included the use of 30,000-pound bunker-buster bombs carried by B-2 stealth bombers.

While President Trump has said Iran’s major nuclear sites were “obliterated,” US intelligence assessments indicate the program was set back but not completely destroyed, according to officials cited in US media reports.

Iran is believed to possess more than 400 kilograms of highly enriched uranium whose whereabouts remain unknown, and Iranian officials have said they rebuilt its missile capacity and would respond forcefully to any future attack.

“Iran may be weakened, but it is down and not out,” Taleblu added.

The strategy document implies that major regional crises — including the Gaza war, the Israel-Hezbollah conflict in Lebanon, Houthi attacks from Yemen and instability in post-Assad Syria — are either resolved or on track toward resolution.

The document does not appear to assess that Iran could strongly reverse recent setbacks to its nuclear program and its so-called Axis of Resistance coalition.

While Taleblu credited the Trump administration for reviving elements of its maximum pressure campaign of sanctions, he criticized what he called gaps. Iranian oil exports have reached record highs, and the administration has not issued a single new human rights designation related to Iran in 2025.

“While the regime is threatening the life of this very president and the first family, it is beyond me to be thinking about peace and prosperity without a clear strategy to contain Iran further,” Taleblu said, “There is a lot of room for improvement when I look at both this document and the administration’s track record this year.”

While authorities say medicines remain available for now, they acknowledge that delays in transferring allocated foreign exchange, growing arrears to suppliers and shrinking inventories have pushed the sector close to a breaking point, raising the risk of shortages in the final months of the year.

Mehdi Pirsalehi, head of Iran’s Food and Drug Administration, said on Tuesday that worsening currency constraints in recent months had left the industry in a sensitive position.

“There are significant foreign-currency debts to overseas suppliers, and resolving them requires serious cooperation from the government, parliament and other decision-making bodies,” he said, according to ISNA.

Pirsalehi apologized to the public for shortages of even “a single item” of medicine and said the agency considered itself accountable.

He added, however, that without adjusting drug and medical equipment prices in an inflationary environment, “it is not possible for manufacturers to sustain stable operations.”

He said that if prices had not been increased last year, “a significant part of the country’s pharmaceutical industry would have exited the production cycle by now.”

Officials argue that in an economy grappling with chronic inflation and currency volatility, holding drug prices steady shifts pressure onto manufacturers and ultimately threatens national drug security.

Price adjustments, they say, are an economic necessity to prevent factory shutdowns and protect domestic production, a move that could nonetheless increase pressure on patients unless insurers reimburse costs on time.

According to ILNA on Tuesday, a month-on-month rise in medicine prices, uneven insurance approvals and gaps in access to original drugs are pushing patients toward out-of-pocket purchases, leaving wealthier households able to buy on the open market while poorer patients increasingly walk away empty-handed.

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  Iran medical suppliers warn of worsening drug shortages

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  Iran drug stocks under two months, 800 medicines at risk as FX delays bite

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  Three in ten Iranians forego medication as prices soar

Debts, FX delays and thinning stocks

Alongside currency shortages, accumulated government and insurance arrears have emerged as one of the most serious challenges facing the market.

Ebrahim Hashemi, chairman of the board of the Association of Pharmaceutical Distribution Companies, said recently that debts to drug distributors had reached 1.57 quadrillion rials (about $1.2 billion at today’s rates) by November 2024, warning that failure to settle them could severely disrupt the production and import of essential medicines.

According to figures cited by industry representatives, distributors’ claims on medical universities alone exceed 31 trillion rials ($240 million), while total government liabilities – including those linked to social security and insurance funds – amount to about 47 trillion rials ($360 million).

“Which economic sector can survive more than a year without receiving its payments?” Hashemi asked, warning that the final three months of the year (ending on March 20) would be among the toughest for the drug sector.

Pharmacies, the frontline of access for patients, are also under acute liquidity pressure. Shahram Kalantari, head of Iran’s Pharmacists Association, has said insurers owe private pharmacies, and warned that each wave of currency volatility inflicts tens of trillions of rials in fresh losses, sharply reducing pharmacies’ ability to restock.

Kalantari said shelves and warehouses had grown “thinner” in recent months, with strategic reserves steadily eroding – a development he described as an early alarm for broader shortages.

Abdollah Abdollahi Asl, director general for medicines and controlled substances at the Food and Drug Administration, said inventories had fallen below critical thresholds: less than one month at factories, under two months at distribution companies and under three months at pharmacies, compared with a recommended minimum of three to four months.

He said around 800 of the roughly 3,000 medicines on Iran’s official list are in a shortage warning status, awaiting foreign exchange and liquidity. He added that 21 essential hospital medicines and 56 essential non-hospital drugs are already in short supply.

The warnings echo recent statements by industry figures who say Iran could face a sharp deterioration in drug supplies within months if current conditions persist.

Alireza Chizari, head of Tehran province’s association of medical and pharmaceutical equipment producers, said earlier this month that the crisis had not yet fully hit society because regulators were managing depleted warehouses, but warned the situation could become “disastrous within one or two months.”

Iran’s pharmaceutical sector has been squeezed by foreign exchange shortages, sanctions-related payment hurdles and rising costs. Drug prices, medical equipment and healthcare expenses have jumped by about 70% since the government removed a subsidized exchange rate for medicine imports earlier this year, while insurance coverage has lagged behind.

Medical specialists have cautioned that sudden switches from imported medicines to domestic alternatives can pose risks for some high-risk patients, even though local drugs are effective in most cases.