IRAN
More than nine weeks after the war in Iran began, the impact of the war continues to be felt across the health system, supply chains, and access to basic services. Although the ceasefire has brought some relief, the situation remains fragile and uncertain.
Scaling up activities
While other actors have focused on trauma care, MSF teams have scaled up activities to address the “hidden needs” that continue during war. Our primary healthcare teams are providing sexual and reproductive healthcare, treatment for infectious diseases, chronic disease management, referrals to specialised care, and mental health support. Teams are also seeing a deterioration in mental health among many people who have lived through weeks of war, displacement, and uncertainty.
MSF has recently opened a second clinic in South Tehran to further expand access to primary healthcare. The clinic officially opened on Wednesday 29 April and welcomed its first patients on Saturday 2 May. It currently sees around 100 patients per day.
At the height of the violence, intense bombing forced MSF to temporarily suspend activities at its other clinic in South Tehran. The clinic has since reopened, and MSF has received authorisation to operate it as an advanced medical post, able to receive wounded patients and stabilise those in critical condition if needed. Since the ceasefire, consultations at the clinic have doubled, with around 250 patients now treated each day. MSF has also expanded services there to all Iranians.
MSF’s primary healthcare activities in Kerman and Mashhad continue. These services remain particularly important for Afghan refugees, many of whom face serious barriers to accessing healthcare. In both Kerman and Mashhad, MSF sees around 150 patients each day.
In case of re-escalation, MSF remains ready to adapt and further scale up its activities in response to evolving medical needs, in collaboration with the authorities.
Immediate emergency response
In response to growing needs since the start of the escalation, MSF has donated medicines and medical supplies to the Iranian Red Crescent Society for distribution and use. These include paediatric care kits for 6,000 patients, surgical kits for 2,500 patients, burns kits for 40 patients, ER kits for 1,500 patients, and outpatient care kits for 10,000 patients. MSF has also donated essential relief items, including 13,000 blankets and hygiene kits for 5,000 people.
LEBANON
Humanitarian needs remain immense, with many people unable to return home because their houses and villages have been destroyed, or because continued attacks, evacuation orders, and the presence of Israeli forces prevent them from reaching their towns.
Scaling up activities
Following the ceasefire, MSF scaled up its presence across southern Lebanon, including in Nabatiyeh, Sour/Tyre, Qana, and towns surrounding Sour, reaching areas that teams were previously unable to access. Through mobile medical units, MSF teams are providing primary healthcare, sexual and reproductive healthcare, mental health support, and referrals for patients in need of secondary care. As people continue moving between shelters and homes, MSF teams are adapting their response and assessing evolving needs across the country. \u200b
MSF teams are also supporting hospitals facing growing trauma and emergency needs. This includes support to hospitals (Beirut Governmental Hospital, Jabal Amel and Lebanese Italian hospitals in Sour, Nabatiyeh Governmental and Najdeh al Shaabiyeh hospitals in Nabatiyeh, and Qana Governmental hospital in southern Lebanon) through donations of fuel and medical supplies. In some facilities, including Beirut Governmental, Qana Governmental and Jabal Amel hospitals, MSF has deployed emergency room doctors to reinforce care. This support comes as healthcare workers remain overwhelmed by repeated mass casualty incidents, and hospitals continue to be pushed to their limits by the influx of injured people. \u200b
MSF teams have contingency plans in place and are prepositioning supplies in case access to activities is lost. Supply teams have increased stock and expanded warehouse capacity. On Sunday, 26 April, MSF received its largest-ever air charter shipment for Lebanon at Beirut Rafic Hariri International Airport, arranged by MSF Supply. The shipment included around 150 m³, or 37,000 kg, of essential medicines and medical devices, to support the ongoing emergency response in coordination with the Ministry of Public Health.
MSF continues to call for the immediate protection of civilians, healthcare workers, medical facilities, and ambulances, and for full respect of international humanitarian law. As needs remain overwhelming, MSF is also calling for an urgent scale-up of humanitarian assistance and unhindered access of aid to people in need. \u200b
Immediate emergency response
In response to the escalation on 2 March, MSF rapidly launched a nationwide emergency intervention. In the first days, MSF teams began distributing essential relief items, including blankets, mattresses, hygiene kits, and drinking water, to displaced people and collective shelters.
To complement on-the-ground activities and support people in areas that are difficult to reach, MSF has also opened a mental health helpline and launched localized telemedicine support. Through this service, patients receive medications via an ambulatory service, with follow-up consultations conducted by MSF doctors by phone. MSF is also trying to fill gaps in psychological care and sexual and reproductive healthcare, particularly in locations where other actors are only providing primary healthcare.
As of 2 May, MSF had distributed 37.4 million litres of water and 523,892 litres of drinking water, conducted 35,000 medical consultations, provided mental health support to 26,000 people, and deployed 25 mobile medical units, including three mental health mobile units.
IMPACT ON MSF GLOBAL SUPPLY CHAINS
The Strait of Hormuz crisis is placing additional strain on MSF global supply chains. Delivery times are increasing significantly — by up to one month — as shipping routes bypass the Persian Gulf and are redirected via the longer Cape of Good Hope route. As a result, MSF is currently spending more on transport, including a shift from sea freight to air freight where necessary.
Since 28 February, MSF has shipped 42 tons of medical supplies to countries across the Middle East, including Iraq, Lebanon, Palestine, Syria, and Yemen.
Although MSF currently maintains full medical activities, our teams are working under high uncertainty. Without fuel, critical activities would not be sustainable, and our teams may have to make difficult choices. MSF is not yet at that stage but is actively preparing and working through different scenarios.
MSF teams are adapting procurement planning, revising forecasts based on available stock, and building additional buffer supplies. Our teams are also working to reinforce capacity for medical logistics and fuel stocks in all our programmes. Essential items, including mosquito nets and medical gloves, are already becoming more expensive. MSF international supply centres in Europe are trying to secure stocks and stabilise prices, but pressure on the system is intensifying. MSF is also shipping more items from Asia, as delivery times are shorter.
In Syria, MSF teams report a direct impact on logistics and supply. During the escalation, air cargo was completely stopped when Syrian airspace was closed, road cargo through Türkiye or Iraq was not possible, and sea cargo could be received only with difficulties. Although road routes via Lebanon, Jordan, Iraq, and Türkiye are now back to normal, teams are still bringing road cargo through Türkiye cautiously. Delays in receiving medications have already started, with a direct potential impact on patients, while higher costs may delay construction or rehabilitation plans. Cross-border movements from Lebanon have slowed since the ceasefire, but needs among arrivals remain high. IOM data cited in the Syria update shows continued gaps in food, non-food items, shelter, cash assistance, medical support, and transportation. Many returnees are living in damaged homes, overcrowded shelters, or unsuitable temporary arrangements. Psychological distress is also widespread, while lack of access to services, absence of legal documentation, child protection risks, and insufficient livelihoods remain major vulnerabilities. \u200b
For Yemen, given the security context affecting Yemeni airspace, it remains challenging to find air carriers willing to operate flights to Sanaa. Available options, particularly from Europe, are charging significantly higher rates, reaching $18/kg, while departures from Dubai, which previously cost around $4/kg, have now risen to approximately $8/kg. For Afghanistan, the cost per kilogramme to Kabul has increased by 65%, from $2.6 to $4.3. \u200b In North Yemen, shortages of medications and medical equipment have contributed to higher prices and reduced availability. Transport costs are also rising due to fuel pressures and disrupted routes.
In Somalia, the mission has had to revise operational costs upward because of rising fuel and freight prices. This has a direct impact on programming, particularly drought and water intervention projects in Mudug and Baidoa. Ground cargo costs across Kenya-based routes serving key project sites have increased by around 20%, while air freight costs have increased by around 40%. Air transport costs from Europe to Africa have risen by 15–25%, while routes to Asia and the Middle East have seen increases of 25–40%. War surcharges and fuel surcharges are also increasing transport costs, with fuel surcharges adding USD 200–600 per container. The mission is also monitoring secondary effects on fuel prices and food access, which could further compound vulnerabilities for already crisis-affected populations.
In Palestine, rising prices of commodities have been observed and reported in both Gaza and the West Bank. In Gaza, engine oil is essential to keep vehicles and generators for hospitals running, but supplies are rapidly being depleted. The blockage of supplies by Israeli authorities is the main cause, while the increase in engine oil prices is also linked to the Iran war, which has pushed up prices worldwide. Access to essential services, including healthcare, remains severely constrained. Since the full blockade of MSF supplies was imposed by Israeli authorities on 1 January 2026, MSF facilities inside Gaza have faced further shortages in medication and other key supplies. Interruptions in chronic care due to medication shortages are ongoing and are linked to the full blockade of MSF supply by the Israeli authorities since 1 January 2026, following deregistration. In the West Bank, medication costs have also been increasing, although this has not had a major impact on MSF operations yet. People continue to face increasing barriers to accessing healthcare and even fear in travelling to seek care due to the rise in checkpoints, increased violence and raids, and restrictions of movement enforced by both the Israeli military and armed settlers, often supported by the military.
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