Eleven days after the crackdown, Pezeshkian urged doctors to align with the official narrative and prioritize “calming” interventions—while hospital accounts describe systematic, targeted lethal violence.
Some documented accounts from medical staff reached media outlets despite the internet blackout. They describe hospitals in Tehran, Isfahan, and other protest centers during the turbulent nights of January 8–10, 2026, as catastrophic—scenes of blood, pain, and collapse under overload. One doctor, speaking anonymously to BBC Persian, described working with colleagues in blood-soaked clothing amid waves of patients suffering horrific injuries from live ammunition fired at close range.
From the night of January 8, these accounts suggest, the pattern of repression shifted: security forces moved from pellet rounds to targeted live fire aimed at vital areas such as the head, neck, and eyes—producing irreversible injuries and immediate deaths. In one ordinary hospital that might typically perform two emergency surgeries a day, doctors reportedly carried out 18 urgent operations for severe head trauma within a few nighttime hours, while unidentifiable bodies—faces shattered by close-range shotgun fire—were brought in one after another. The volume of wounded overwhelmed hospital capacity. Surgeons reportedly worked for up to 96 hours without rest.
Accounts of people dying on the way to hospitals, others allegedly abducted during treatment, morgues overflowing with bodies stacked on one another, and pressure on medical staff to remain silent about gunshot wounds together point to a broader pattern: violence on a scale large enough to require not only killing, but also management, concealment, and intimidation.
A directive to the medical profession
According to the government’s news agency, on January 21, 2026—just 11 days after one of the bloodiest crackdowns in the past half-century—Masoud Pezeshkian, the president of the Islamic Republic, addressed Iran’s medical community during a meeting officially titled “Monitoring and Evaluating the Implementation of the Family Physician Program and the Referral System.” His message was direct: physicians must be “convinced” of what he called the “facts” of the recent events.
Pezeshkian presented this effort as necessary for the health system itself. He argued that securing doctors’ alignment with the state’s account was essential to preserving professional cohesion and ensuring physicians could fulfill their “professional and ethical role” toward the injured and society—warning that without such alignment, medical duties would not be properly carried out. He also cautioned that the health system must not fall into “analyses favored by the enemies,” a familiar phrase in the Islamic Republic’s official language that signals interpretations outside the state’s framework are unacceptable. The stated goal was to prevent social crises from affecting the country’s healthcare system.
He then emphasized mental-health interventions, drawing a direct link between social crisis and the psychological state of society. Less than two weeks after the killings, he proposed foregrounding a “therapeutic and calming approach” in response to unrest. He highlighted the role of psychiatrists, psychologists, and mental-health specialists in reducing violence and social tensions, and called for scaling such interventions nationwide rather than keeping them in pilot form. Prevention, he argued, matters more than costly treatments like surgery and could reduce the burdens imposed on the healthcare system.
What Pezeshkian is asking of doctors
More than 300 hours into the nationwide internet blackout, the full scale of the killings—along with precise numbers of dead, wounded, and detained—remains unclear. Some estimates place the death toll at 12,000, even 20,000. Few groups, however, are as directly exposed to what unfolded on January 8–9 as medical workers.
Pezeshkian is urging the medical community—under the banner of prioritizing a “therapeutic role rather than a political role”—to accept and reinforce the state’s account of the “recent events.” In practical terms, this positions doctors as agents of social “calming,” while discouraging critical analysis or independent political readings that the state labels “desired by the enemies.” By reframing mass protest as a mental-health problem rather than a political crisis, the approach shifts responsibility away from structures of power and toward the healthcare sector—using physicians’ public credibility to lower tensions without structural change.
Pezeshkian speaks of “prevention,” but in this framing prevention means preventing renewed protest through psychological intervention, not addressing the economic and political roots of mass dissatisfaction. While he gestures to factors such as employment and deprivation, the proposed solution remains therapy and mental-health programming—not reform of unequal structures. His admission that, “from a certain point onward, responsibility… was beyond the government’s capacity” underscores the gap between what society demands and what the state is prepared to change. As a physician himself, Pezeshkian also knows what is at stake: he is trying to keep the medical community aligned with the government and prevent it from moving toward the protest movement.
A historical test: professional ethics under state pressure
In modern history, physicians—and, in different ways, engineers—have repeatedly faced moments when professional ethics collided with state demands. Physicians, as guardians of life and health, are bound by international ethical standards such as the Declaration of Geneva (1968) and the Declaration of Tokyo (1975), adopted by the World Medical Association. These standards require doctors to refuse any participation—active or passive—in torture, violence, or human-rights violations. That obligation includes refusing to issue falsified medical certificates, refusing to “monitor” torture under the pretext of assessing a victim’s physical or psychological “tolerance,” and refusing to conceal or ignore injuries caused by state violence. In such conditions, the physician’s duty to the patient must take priority over political or administrative pressure.
Engineers, although less directly involved in torture, can face parallel ethical dilemmas when asked to design detention spaces, surveillance systems, or security technologies that enable or facilitate abuse. Their ethical responsibility likewise extends beyond compliance with domestic rules to universal human-rights principles and professional integrity.
For both professions, the decisive test is maintaining independence when governments attempt to use expertise to justify, normalize, or conceal violence. Resisting such pressure does not only protect professional ethics—it defends human dignity and the possibility of truth.
From this standpoint, the physician’s responsibility to bear witness to violence they have seen is rooted in medical oaths, core ethical duties (to do no harm and to act for the patient’s good), and a broader commitment to dignity and justice. This responsibility is explicitly affirmed in international medical standards. It may collide in practice with intimidation and risk, but ethically its core is not negotiable. Acting on it is not a partisan act; it is a professional and human duty aimed at truth and accountability. Pezeshkian, as a physician, has presumably studied these principles.
