Formal humanitarian exemptions technically allow the shipment of medicines and medical devices to Iran. However, these legal carve-outs often fail in practice due to the collateral effects of secondary sanctions on the aviation industry. When international carriers fear losing access to the US financial system or their license to fly into major hubs, they simply stop servicing Iranian routes. This creates a logistical vacuum. Even if a shipment of insulin or oncology drugs is fully compliant with OFAC regulations, finding a reliable way to transport it becomes a nightmare.
Many logistics firms view the risk of 'over-compliance' as higher than the potential profit from humanitarian shipments. They often decline to move any goods involving Iranian entities to avoid accidental violations. Consequently, the physical infrastructure needed for medical transport—such as specialized cold-chain logistics and cargo flight capacity—withers. Even when medical goods are legally cleared, the inability to secure air freight means these supplies sit in warehouses or arrive too late. The legal permission exists on paper, but the physical mechanism for delivery often breaks under the weight of financial uncertainty.
