Shipowners are facing confusion over the safest route out of the Persian Gulf as Iran, the United States and western insurers issue conflicting guidance on travel through the Strait of Hormuz, the Financial Times reported on Tuesday.
Shipping traffic through the strait has increased, but Iran has warned that vessels could face penalties or be forced to turn back if they do not seek advance permission from Tehran and sail close to the Iranian coast, the report said.
At the same time, the United States and some western insurers are advising ships to use a route protected by US air cover on the Omani side of the strait, the report said, citing three shipping executives.
The conflicting guidance has left shipowners unsure whether to risk possible Iranian interference or ignore advice from insurers and US authorities, it added.
“Shipowners and operators find themselves caught in a difficult position. If they follow the guidance of underwriters and US authorities by navigating closer to Oman, they risk interference, detention or potential hostile action from Iranian authorities,” said Dr SV Anchan, chair of the US shipping company Safesea Shipping.
The warnings point to a new phase in Iran’s long-running drug crisis. The problem is no longer only that medicines are expensive or hard to find. The formal supply chain itself is weakening, while the black market grows around patients who cannot obtain medicine through pharmacies.
Haleh Hamedifar, head of the Association of Medical Biotechnology Product Manufacturers, told the semi-official ISNA news agency that the main challenge facing Iran’s pharmaceutical industry is not simply a shortage of foreign currency, but “instability in decision-making and lack of coordination in implementation.”
“The pharmaceutical industry cannot be managed with daily decisions, changing circulars and unpredictable processes,” she said.
Hamedifar warned that sudden policy changes disrupt the supply of raw materials, production and distribution, with effects that appear months later “in pharmacies, hospitals and ultimately at the patient’s bedside.”
Iran says it produces most of the medicines consumed in the country, but domestic production still depends on imported raw materials, equipment, packaging, machinery and spare parts. That leaves even locally made drugs exposed to banking restrictions, currency decisions and import delays.
Hamedifar said recent shifts in currency rules have forced some raw materials out of preferential currency categories and into exchange-rate systems that are not reliably funded. Alternative routes, including the use of export proceeds or privately held foreign currency, were introduced before the administrative infrastructure was ready, she said.
Companies have been forced to amend files, repeat import registrations and restart procedures they had already completed, she said.
“The problem in many cases is not the decision itself, but how it is implemented,” Hamedifar said.
She said outages and errors in government platforms, including disconnects between trade, drug-regulation and banking systems, should not be treated as technical glitches because each delay can postpone the arrival of raw materials and later disrupt drug supply.
Interior Ministry spokesman Ali Zeynivand separately acknowledged that high medicine prices are real and said the government does not deny that internal failures may be part of the problem.
“Part of the problems are caused by the imposed war, another part by the sanctions that already existed, and part may be due to our shortcomings or lack of precision,” he told the Dideban Iran news website. “We do not reject any of these.”
Zeynivand said President Masoud Pezeshkian, himself a physician, is personally sensitive to the issue and that the Health Ministry, Plan and Budget Organization and Central Bank are working on measures to contain the situation. But he cautioned that Iran’s economic problems would not be solved simply by signing a memorandum.
For patients, the consequences are already visible in higher out-of-pocket costs, incomplete prescriptions, empty pharmacy shelves and growing reliance on unofficial sellers.
Mehdi Sanei, an investigator at Iran’s medical crimes prosecutor’s office, told the Iranian daily Shargh that Iran has only one legal medicine market: the official network supervised by the Health Ministry and Food and Drug Administration. Any medicine sold outside that chain is illegal, he said.
“In the field of medicine, there is no such thing as a legal free market,” Sanei said.
He said shortages are the starting point for much of the illegal trade. When patients cannot find medicine in pharmacies, they turn to dealers, Telegram channels, middlemen and informal networks.
“As long as medicine shortages exist, the smuggling market will exist,” he said.
Sanei warned that the illegal drug market is unusually profitable because patients cannot postpone treatment. Families dealing with cancer or chronic illness may sell savings, jewelry, cars or even homes to obtain scarce medicine.
“I do not know of a commodity whose profit is as guaranteed as smuggled medicine,” he said.
He said some black-market medicines are official Iranian-made drugs diverted from the legal system through fake prescriptions, distribution violations or other routes. But he described an even more dangerous trend: the growing presence of counterfeit or unauthorized medicines made inside Iran.
Sanei estimated that more than 80 percent of medicines in the illegal market are now unauthorized domestic products rather than genuine imported drugs.
Those products may be made in illegal workshops with unknown or ineffective materials and fake packaging, he said. Some may contain no active ingredient, contamination or harmful substances.
“People pay heavy costs, and there is no guarantee that what they receive is really medicine,” he said.
The result is a self-reinforcing cycle: shortages weaken the legal market, patients move toward illegal sellers, the black market becomes more profitable, and the official system loses more ground.
“The smaller the legal market becomes, the larger the illegal market becomes,” Sanei said.
