Iran’s healthcare workers face unpaid wages, arbitrary deductions, staff shortages, and endless shifts, alongside rising suicides and mental distress, while union-style organising is blocked and official “solutions” remain delayed on paper.
Emergency rooms are gasping for air and payslips arrive thin and late. Between arbitrary insurance deductions, accumulated debts, and controversial residency exams, medical staff in Iran are trading endless shifts for empty promises.
“One month I did 165 hours of overtime, several times working two shifts back-to-back,” says a staff member at a public hospital in Sistan and Baluchistan. “At the end of the month, only seven million tomans (70 USD) of overtime was recorded, and part of that was taken as tax.” This is not an isolated story; it is a snapshot of the pressure that has spread across the healthcare system.
In Kermanshah, “Nurses’ Day” did not pass with congratulations. On 5 Aban 1404 (27 October 2025), a group of nurses gathered in front of the University of Medical Sciences demanding the payment of more than a year’s worth of outstanding bonuses and overtime. They spoke of neglect of their livelihood and professional demands and warned that if payments were not made, protests would continue. Their placards denounced “wage injustice” and “structural discrimination.”
A few days later, on 17 Aban 1404 (8 November 2025), Yasuj saw another gathering: nurses and health workers lined up in front of the governor’s office in Kohgiluyeh and Boyer-Ahmad, once again calling for the “immediate payment of bonuses and arrears.”
From other cities, similar reports followed. ILNA, a labour-focused media outlet, reported on protests by nurses in Khuzestan, angry about low wages, unpaid arrears, and the pressure of compulsory overtime, chanting:
“We’re nurses, not slaves.”
The same report said discrimination in payments had intensified the protests. The next day, a similar story came from Mashhad: some nurses at Qaem Hospital staged a workplace protest, demanding higher pay, an end to unequal payments, and full implementation of laws on hazardous work.
Dissent is not only on the streets or at hospital gates. Within the formal structures too, voices are raised. ISNA, a semi-official state news agency, reported on a statement signed by the heads of more than 130 Nursing Council boards, calling for “serious pursuit of nurses’ demands” while distancing themselves from “divisive currents” among nurses. The official Nursing Council website carried almost the same line: “Support for serious pursuit of nurses’ demands and avoidance of damaging the organisation’s standing.”
Insurance Deductions, Cash Shortages, and Missing Overtime
From the hospital corridor to the accounting office, the second layer of crisis appears: money. The director of Loghman Hakim Hospital in Tehran says insurance organisations pay claims late, then cut them during document review; monthly insurance deductions there reach about seven billion tomans (70,000 USD). He adds that the lack of “direct contracts” between insurers and hospitals is one of the main obstacles to financing care centres.
A deputy health minister has announced that part of the government’s debt to Social Security has been settled and around 43 trillion tomans (430,000,000 USD) allocated to pay Social Security’s debts to medical universities—showing how hospital liquidity depends on insurance and inter-agency payments as much as its own income. Provincial Social Security officials also speak of settling arrears, but their emphasis on “settling claims from Farvardin to Khordad 1404 (21 March–21 June 2025)” makes clear how delays and deductions turn into late wages for health workers.
Field reports published by Pezhvak-e Kar-e Iran, the news outlet of the Confederation of Labour (Iran – Abroad), quote nurses in Sabzevar, Hormozgan, Shiraz, and Tehran describing “widespread and arbitrary deductions” from their salaries; in some payslips up to eight million tomans (80 USD) less was paid, and overtime simply did not appear. Other reports note that under intense workload and irregular payments, many nurses either leave the profession or choose emigration. Estimates speak of a deficit of about 165,000 nurses in Iran’s health system.
At the same time, residents (specialist trainees) and other medical staff are protesting. Tasnim News reported on residents objecting to the 1404 (2025–2026) board exam: according to them, around 400 residents were denied completion certificates and, after failing an exam they call “non-standard,” must remain in teaching hospitals until the next round—delaying the entry of specialists into the formal care system. Technical-medical groups such as radiology technicians in Kermanshah and Tabriz also protested on 19 Mordad 1404 (10 August 2025), citing “poor working conditions and lack of equipment.”
Across several provinces, stories of “underpayment, months-long delays, and forced overtime” keep repeating. In some cases, nurses say their official salary is 18 million tomans (180 USD) but only 10 million (100 USD) is actually deposited, with no explanation from accounting. The picture grows darker when the death of a nurse in Tabriz is reported in connection with “prolonged work pressure, dense scheduling, and staff shortages”—as one outcome of the chronic threat to nurses’ own health.
At the macro level, officials insist solutions are under way. ILNA, a labour-focused media outlet, quoted Health Ministry officials saying that of the Ministry’s claims on insurers, 12 trillion tomans (120,000,000 USD) in bonds are to be paid “urgently” so that “part of overdue payments to nurses and other staff” can be cleared and “the payment gap reduced to less than three months.” Yet hospital managers point to continued insurance deductions, the lack of direct contracts, and chains of delay that keep public hospitals in the red and push financial strain down onto suppliers and frontline staff.
This gap between official narrative and lived experience is visible in the courtyards of the same hospitals where morning meetings discuss “following up payments” and afternoon rosters record rotating shifts. Labour networks describe “repeated delays in wage payments” as “a clear violation of the occupational and human rights of healthcare workers,” noting that “the silence of medical universities” has pushed nurses into hospital-yard protests where the slogans are clear: “Nurse, raise your voice, shout out your rights,” and “The nurse is oppressed, deprived of fair tariffs.”
Mental Health of Healthcare Workers
Updated data from Iran is limited and opaque, but multiple signs point to an alarming mental health situation among healthcare workers. Research and media reports converge on the particular vulnerability of residents and young doctors.
In 2024, the journal Lancet Psychiatry reported that among roughly 14–15,000 “medical residents” (postgraduate trainees roughly equivalent to interns) in Iran, an average of 13 suicide deaths occur per year—around 90–100 per 100,000, several times the national rate. This ratio was also reflected in domestic media; Khabar Online cited a 3.1 to 5-fold increase in suicides in the “medical community” and repeated the figure of 13 deaths per year among residents. Some outlets, quoting officials from the Medical Council or the psychiatric association, have mentioned “16 cases in one year,” while noting that part of the data is treated as “confidential” at the Ministry of Health.
Among students, the deputy minister for culture and student affairs at the Health Ministry told Shafaqna that in 1403 (2024) “at least seven students” died by suicide and “84 attempts” were recorded, a statement later repeated in other reports. IRNA also warned that the publicization of resident suicides signals a situation that must be taken seriously. At the same time, officials sometimes claim the suicide rate among medical students is “lower than in the general population,” a line that itself highlights contradictions and the absence of a transparent data system.
In nursing, domestic studies over recent years have reported high rates of depression, anxiety, and suicidal ideation. In some samples, about a quarter of nurses show signs of depression and around a third show significant anxiety. These figures are not mortality rates, but they indicate elevated risk across the workforce.
Despite this, unlike for residents, there are almost no official, disaggregated statistics on suicides among nurses. The secretary-general of the “Nurses’ Home” told Tabnak that certain nursing statistics, including those on suicide and migration, have become “non-publishable”—a description that amounts to saying the data has been made secret. Added to this is the broader repression of activists and the blocking of independent organising, which leaves no legal space for collective defence of rights.
Repression and the Blocked Path to Independent Organising
The legal framework of labour in Iran leaves almost no room for independent unions. Under labour law and related regulations, workers may only organise in three types of bodies: Islamic Labour Councils, “guild associations,” or “workers’ representatives” in small workplaces. All are fundamentally state- or employer-linked structures, designed within the orbit of management and the state rather than as independent organisations.
In healthcare, bodies such as the Nursing Council and structures tied to the Ministry of Health play a professional–bureaucratic role rather than a union role; they regulate and implement policy but do not act as tools for independent collective bargaining. The main regulatory pillars for nursing sit under the Health Ministry, and the Nursing Council itself is defined under parliament, a model that severely limits professional autonomy.
On the ground, when nurses’ wage and livelihood demands reach the level of protest or strike, the response is consistently security-based: arrests, threats of administrative exile, wage cuts, disciplinary files. The Centre for Human Rights in Iran, reporting on the wave of strikes last year, noted that peaceful protests by nurses were met with arbitrary detentions and that the state is violating core International Labour Organization principles, including the right to independent association. Parallel media reports spoke of “widespread arrests” and threats of “forced transfers.”
In this landscape, a hospital is not just a building of wards and corridors; it is a network of accounts, bonds, insurance contracts, and distant decisions that stretch all the way to the emergency room. When “tariff-setting” remains on paper, it turns into “endless overtime hours” in the nurse’s logbook. When “debt settlements” come with deductions and delays, they show up on the payslip as obscure cuts.
Official narratives say the wheel of health financing is turning again. Staff on the ground say: if the wheel turns late, it makes little difference to someone standing in their third consecutive shift.
This report is only a snapshot in time—but in this snapshot, the language of nurses and the figures in accounting speak the same word: pressure.
