Freelance journalist
A chronic shortage of nurses and auxiliary staff in Iran’s hospitals has quietly given rise to a new and largely unregulated job: the “patient companion.”
Across Tehran and other major cities, advertising websites, job boards and even the walls outside hospitals are plastered with notices offering such services.
The role is not filled by relatives. Instead, patient companions are hired—often informally—to care for hospitalized patients, helping with eating, hygiene and mobility.
According to the head of Iran’s Nursing Organization, the country faces a shortfall of at least 100,000 nurses. The deficit appears to have created a parallel, low-wage labor market with little oversight and frequent abuse.
A nurse working at a hospital in Tehran told Iran International that the tasks assigned to patient companions often go far beyond what their wages suggest.
“They do work that no one would normally accept for this pay,” she said, requesting anonymity. “They care for patients who cannot go to the toilet or bathe on their own.”
Exploited
A search for “patient companion” (hamrah-e bimār) on Iran’s largest classifieds website, Divar, produces dozens of listings from across the country. The companies share a familiar pitch: assurances of experience, professionalism and official registration.
One company advertises an eight-hour shift for a mobile patient who does not require personal hygiene care at 800,000 tomans (about $6 at December 16 exchange rates). Many others list prices as “negotiable.”
Alongside these firms, individuals also advertise their services directly. Many claim to have first-aid training or nursing experience and say they are willing to travel nationwide.
Yet trust remains a major barrier.
“People don’t feel comfortable hiring individuals directly,” said another nurse in Tehran, who also asked not to be named. “So they turn to companies, even though the companies take most of the money.”
According to this nurse, nursing service firms often keep close to two-thirds of what families pay, leaving companions with little compensation despite the physical and emotional demands of the work.
No better option
To avoid company fees, some companions eventually try to secure work through hospital staff. After being introduced repeatedly by agencies, they ask nurses or aides to connect them directly with families in need.
The practice is most common in public hospitals, where staff shortages are most acute.
A doctor at a Tehran hospital told Iran International that families struggling to pay medical bills sometimes plead with doctors or nurses to help a relative find work as a patient companion. “It becomes a way to cover treatment costs,” he said.
A male nurse in Tehran described hiring a companion through an agency several years ago to care for his grandmother, who had cancer.
“She was a nursing student, working to support herself while studying,” he said. “She told us the companies demand large promissory notes from workers and then take two-thirds of the family’s payment.”
For many companions, the job is a temporary lifeline rather than a chosen profession.
Home-care assignments can carry additional risks, especially for women. Reports of assault or sexual harassment are not rare, the nurse added, but few are willing to come forward, fearing that agencies may move to cash promissory notes at the first sign of dispute—effectively blacklisting workers from future employment.
That lack of regulation cuts both ways. Families often prefer companies, believing them to be safer. But, as nurses acknowledge, the skills of agency-provided companions are far from guaranteed.
“Most companions are women, many of them heads of household,” one nurse in Tehran said. “Few have formal training. Most learn on the job from hospital staff. They do this because they have no other option.”
While authorities say medicines remain available for now, they acknowledge that delays in transferring allocated foreign exchange, growing arrears to suppliers and shrinking inventories have pushed the sector close to a breaking point, raising the risk of shortages in the final months of the year.
Mehdi Pirsalehi, head of Iran’s Food and Drug Administration, said on Tuesday that worsening currency constraints in recent months had left the industry in a sensitive position.
“There are significant foreign-currency debts to overseas suppliers, and resolving them requires serious cooperation from the government, parliament and other decision-making bodies,” he said, according to ISNA.
Pirsalehi apologized to the public for shortages of even “a single item” of medicine and said the agency considered itself accountable.
He added, however, that without adjusting drug and medical equipment prices in an inflationary environment, “it is not possible for manufacturers to sustain stable operations.”
He said that if prices had not been increased last year, “a significant part of the country’s pharmaceutical industry would have exited the production cycle by now.”
Officials argue that in an economy grappling with chronic inflation and currency volatility, holding drug prices steady shifts pressure onto manufacturers and ultimately threatens national drug security.
Price adjustments, they say, are an economic necessity to prevent factory shutdowns and protect domestic production, a move that could nonetheless increase pressure on patients unless insurers reimburse costs on time.
According to ILNA on Tuesday, a month-on-month rise in medicine prices, uneven insurance approvals and gaps in access to original drugs are pushing patients toward out-of-pocket purchases, leaving wealthier households able to buy on the open market while poorer patients increasingly walk away empty-handed.
Debts, FX delays and thinning stocks
Alongside currency shortages, accumulated government and insurance arrears have emerged as one of the most serious challenges facing the market.
Ebrahim Hashemi, chairman of the board of the Association of Pharmaceutical Distribution Companies, said recently that debts to drug distributors had reached 1.57 quadrillion rials (about $1.2 billion at today’s rates) by November 2024, warning that failure to settle them could severely disrupt the production and import of essential medicines.
According to figures cited by industry representatives, distributors’ claims on medical universities alone exceed 31 trillion rials ($240 million), while total government liabilities – including those linked to social security and insurance funds – amount to about 47 trillion rials ($360 million).
“Which economic sector can survive more than a year without receiving its payments?” Hashemi asked, warning that the final three months of the year (ending on March 20) would be among the toughest for the drug sector.
Pharmacies, the frontline of access for patients, are also under acute liquidity pressure. Shahram Kalantari, head of Iran’s Pharmacists Association, has said insurers owe private pharmacies, and warned that each wave of currency volatility inflicts tens of trillions of rials in fresh losses, sharply reducing pharmacies’ ability to restock.
Kalantari said shelves and warehouses had grown “thinner” in recent months, with strategic reserves steadily eroding – a development he described as an early alarm for broader shortages.
Abdollah Abdollahi Asl, director general for medicines and controlled substances at the Food and Drug Administration, said inventories had fallen below critical thresholds: less than one month at factories, under two months at distribution companies and under three months at pharmacies, compared with a recommended minimum of three to four months.
He said around 800 of the roughly 3,000 medicines on Iran’s official list are in a shortage warning status, awaiting foreign exchange and liquidity. He added that 21 essential hospital medicines and 56 essential non-hospital drugs are already in short supply.
The warnings echo recent statements by industry figures who say Iran could face a sharp deterioration in drug supplies within months if current conditions persist.
Alireza Chizari, head of Tehran province’s association of medical and pharmaceutical equipment producers, said earlier this month that the crisis had not yet fully hit society because regulators were managing depleted warehouses, but warned the situation could become “disastrous within one or two months.”
Iran’s pharmaceutical sector has been squeezed by foreign exchange shortages, sanctions-related payment hurdles and rising costs. Drug prices, medical equipment and healthcare expenses have jumped by about 70% since the government removed a subsidized exchange rate for medicine imports earlier this year, while insurance coverage has lagged behind.
Medical specialists have cautioned that sudden switches from imported medicines to domestic alternatives can pose risks for some high-risk patients, even though local drugs are effective in most cases.