U.S. and Israeli attacks on Iran’s energy infrastructure, including oil refineries, gas treatment facilities and fuel storage depots, pose severe health and environmental risks to civilian populations in Iran, Physicians for Human Rights (PHR) and Human Rights Activists in Iran (HRA) warned today. All parties to the conflict must cease attacks on energy infrastructure that lead to widespread public health harm, in violation of international legal prohibitions on attacks on energy that cause disproportionate civilian harm.
These dangers are unfolding in a health system already severely impacted by overwhelming demands following violence against civilians and attacks on health workers by the Iranian regime earlier this year, direct damage to health facilities, as well as ongoing shortages in medical supplies due to sanctions and economic crisis. Iranian health care workers have reported to HRA severe consequences stemming from U.S. and Israeli attacks on energy and health care infrastructure.
“During the period following the strikes on fuel depots, even in our hospital, which is not specialized in respiratory care, we observed a noticeable number of patients presenting with breathing difficulties, persistent coughing, and signs of airway irritation,” said a general surgeon in Iran. “One of the major challenges has been supply constraints. At different points, we faced shortages of key medications.”
Patients in Iran are presenting with “severe asthma attacks[…], and several previously healthy individuals presenting with bronchospasm, persistent cough, and reduced oxygen saturation,” a specialist in Tehran told HRA.
“The strain on our facility has also been amplified by damage to smaller health care centers. Patients who would normally be stabilized or treated locally are instead referred to us, increasing the load.[…] The volume and acuity of cases exceed[ed] routine capacity,” said a health care provider at a specialized hospital in Tehran.
Environmental toxicologists have also highlighted the short- and long-term health harms populations can face from large-scale oil fires.
‘Heath effects of exposure to burning oil have been well documented in those exposed during the war in the Persian Gulf in 1991 and the Deepwater Horizon oil spill in 2010. The wide range of documented respiratory and cardiovascular effects noted were observed in relatively healthy populations, whereas effects are likely to be far more severe in the general population, which includes the very young and elderly, many with pre-existing health problems. The additional ‘oil- related combustion’ problems are easy to prevent by avoiding attacks on energy infrastructure. All parties to the current conflict in the Gulf must not attack energy facilities,” said Alastair Hay, PhD, OBE, professor emeritus of environmental toxicology, University of Leeds, and PHR Advisory Council member.
Evidence from past large-scale oil fires shows that oil combustion releases a complex mixture of toxic pollutants, including a wide range of particulates of all sizes, sulfur and nitrogen oxides, volatile organic compounds, polycyclic aromatic hydrocarbons, acid aerosols, and heavy metals. These emissions can travel over long distances, degrading air quality and contaminating water and soil.
Preliminary reports from affected areas in Iran, describing dense smoke plumes and accounts of “black rain,” are consistent with the release of hazardous combustion byproducts. Exposure to these pollutants is associated with acute respiratory symptoms such as shortness of breath, cough, eye irritation, and skin conditions, as well as exacerbations of cardiovascular disease and respiratory diseases such as sinus and asthma conditions.
In a single attack on an oil depot in Alborz, HRA documented at least six civilian deaths and 21 injuries, underscoring that these strikes are not only causing serious health impacts but also directly resulting in civilian casualties.
Evidence also indicates the potential for long-term health effects. These include chronic respiratory illness, reduced lung function, and other systemic impacts. The scale and duration of these fires raise serious concerns about sustained exposure, particularly for populations living in close proximity to the affected sites.
During recent nationwide protests, Iranian health facilities were overwhelmed by mass casualties and subjected to interference, surveillance, and the targeting of medical personnel. Security forces have reportedly entered hospitals, detained patients, and pressured providers to conceal evidence of injuries. These actions have further undermined the ability of the health system to deliver safe, independent care.
Iranian retaliatory attacks on energy infrastructure across the region carry similarly serious and foreseeable health and environmental risks, impacting civilian populations in the targeted Gulf states.
Effective mitigation of attacks on energy requires coordinated public health interventions. Among these are real-time air quality monitoring, access to protective measures such as high-efficiency filtration and appropriate respiratory protection, and the capacity to provide timely clinical care and long-term medical surveillance. During an ongoing war and with internal barriers to sufficient resources, such responses may be delayed, inadequate, or inaccessible to people most at risk.
International law generally prohibits attacks on energy infrastructure and mandates that such attacks must not cause disproportionate harm to civilians. The foreseeable, severe, and reverberating consequences of the destruction of energy infrastructure on civilian life – in the immediate and long-term – require heightened precautions and consideration in any civilian harm assessment in the planning of an attack.
PHR and HRA call on Israel, the United States, and Iran to end all threats to and attacks on energy infrastructure in violation of international law and to adhere to their obligations to protect civilians and civilian infrastructure, including facilities essential to public health and environmental safety. PHR and HRA also call on the governments of affected countries to implement immediate measures to mitigate exposure, protect affected populations, and ensure that the health system is supported to respond effectively.
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.