The hidden toll of Iran crackdown: disability, chronic pain, opioid dependence

Much of the attention since Iran’s bloody crackdown has rightly focused on those who were killed. Far less has been paid to those who lived.

They went into the streets hoping this time would be different. For many, it was, but not in the way they had hoped.

They survived being shot with metal pellets, beaten and, in some cases, slashed with machete-like weapons. Now doctors warn that some could spend the rest of their lives with permanent disabilities, chronic pain and dependent on opioids simply to manage it.

“You’re creating a generation of people in chronic pain and potentially creating a generation of opiate dependence,” Dr. Sarah Raza, a trauma and vascular interventional radiologist in Los Angeles, told Iran International’s English-language podcast Eye for Iran.

Raza is accustomed to catastrophic injuries. She works across multiple Level I trauma centers, treating adults and children with gunshot wounds, severe bleeding and injuries from vehicle crashes. But she says nothing in her medical career prepared her for the scale of what she has seen among those wounded in Iran.

“I have never seen this scale,” she said.

Working with Physicians for Human Rights, Raza has remotely assessed hundreds of injured Iranians, often through secure communications because patients fear seeking treatment inside the country. She says every patient she assessed spoke to medical teams from a home, a neighbor’s home or a relative’s home rather than a medical facility.

What she found was a pattern of injuries that could follow survivors for decades.

Hundreds of tiny metal pellets can remain embedded in a single person, lodged in skin, tendons and joints and near major nerves and blood vessels. Raza says more than 95 percent cannot safely be removed because surgery itself could damage arteries, nerves and other surrounding structures.

For some survivors, even ordinary movement may become a source of pain.

“Every time you bend your finger, you’re going to feel that pellet and it’s going to cause pain,” Raza said. “You’re going to have chronic inflammation. You’re going to need to be on steroids to manage the chronic inflammation. You’re going to need to be on opioids.”

The consequences, she warns, can include blindness, nerve damage, chronic inflammation, disfigurement and permanent disability, with some survivors unable to work or even walk.

“These will cause chronic disability, chronic nerve issues, chronic pain to the point of disfigurement, to the point of people being unable to work, walk,” Raza said.

Among the patients she described was a six-year-old boy.

Metal pellets struck his face during the protests and remain embedded in his skull, face and near his eye socket. Because of the concentration of nerves and blood vessels in the area, Raza says they cannot safely be removed.

“He’s going to live his whole life with pellets embedded in his skull, in his face, near his orbit,” she said.

He was six years old when he was wounded. The crackdown could remain physically inside his body for the rest of his life.

For Raza, his injuries represented something even more disturbing.

“This is their way of inflicting lifelong torture,” she said. “This is making someone’s body a prison.”

She described another patient, a 16-year-old construction worker whose mother had died and whose father, in his 70s, has cancer. The teenager was the family’s sole breadwinner.

In addition to pellet wounds, Raza said he suffered a deep laceration across his hand after people entered the crowds striking protesters with what she described as “machete-like objects.” The wound cut down to his tendons.

But his greatest concern was not his own pain.

“How am I going to feed my family?” Raza recalled him asking.

He wanted to know whether he could return to work so he could continue supporting his father and buying his chemotherapy medication.

“What can I do so I can go back to work? I need to feed my father. I need to buy him medicine, chemotherapy medicine,” Raza recalled him saying.

For Raza, his case shows how permanent injury to one protester can ripple through an entire family.

“This is the multi-generational physical, psychological trauma that they have inflicted,” she said.

Raza also believes the location and pattern of the pellet injuries are significant. She says she repeatedly saw pellets concentrated around areas rich in nerves and blood vessels, including the eyes, neck, torso and genitalia.

“This is not crowd control,” she said. “This is an intentional use of this weapon to inflict maximum pain, not only in the moment, but for years on.”

She makes an even more explicit assessment of the injuries she documented.

“This pattern is not coincidental,” Raza said. “It is intentionally inflicted to cause maximum amount of pain, injury throughout your life.”

There is another consequence.

The pellets that injure protesters may also identify them.

Because the fragments are metal and often cannot be removed, Raza says they can remain visible on X-rays and potentially detectable years later. Patients told her they feared their injuries could effectively mark them as people who had participated in the protests.

“Their wounds, their injuries have now become identifying markers for attack and targeted persecution later,” she said.

For survivors, then, the injury can become both punishment and evidence: a source of chronic pain that may never leave their bodies, and a physical record of what happened to them.

The dead can be counted.

The lifetime carried by those who survived is much harder to measure.