Humanitarian exemptions in sanctions regimes often fail in practice. Discuss the ethical dilemma this poses for states like India.

Medicines and medical equipment are formally exempt from most sanctions. Yet the UN Special Rapporteur on unilateral coercive measures (sanctions imposed by one country alone) finds they still face serious hurdles in purchase and delivery [2]. In October 2026, India refused to let Iran Air fly medicines to Tehran, citing the risk of U.S. sanctions [1]. The case shows how this gap becomes a hard ethical choice for third countries.

Why exemptions fail in practice

• Over-compliance: Banks and firms adopt "excessive de-risking policies" and refuse even lawful humanitarian trade [2].
• UN vs unilateral sanctions: UNSC Resolution 2664 (2022) created a humanitarian carve-out, but only from UN asset freezes [3]. U.S. secondary sanctions on Iran fall outside it.
• Costly workarounds: India suggested sending the medicines through Armenia, but temperature-sensitive medicines spoiled in transit [1]. The exemption held on paper, but the patients still lost out.

The ethical dilemma for India

Duty to its own citizens and institutions

• Secondary sanctions could hit Indian airports and air operators [1]. Protecting national infrastructure is a legitimate duty of the state.
• India did not deny the aid outright. It offered an alternative route [1].
• India has consistently worried about misuse. It was the only abstention on Resolution 2664, citing the risk that terrorists would exploit carve-outs [3].

Duty to humanity and partners

• The right to health is universal. The Rapporteur warns that good intentions "should not be invoked to legitimize" harmful sanctions measures [2]. That reasoning also applies to states that enforce them.
• Iran's Speaker skipped the BRICS Parliamentary Forum in New Delhi over the row [1]. This weakens India's claim to speak for the Global South.
• The core conflict is between consequentialist reasoning, which protects the wider system, and a deontological duty, which forbids blocking life-saving aid.

Way forward

• Seek case-specific U.S. assurances for named medicine flights, as India did after its representations on Chabahar port [4].
• Make sure any third-country route has cold-chain handling at every transfer point.
• Push in BRICS and the UN for norms against over-compliance, while keeping anti-terror safeguards [3].

The real dilemma is how to deliver aid without exposing national infrastructure, not a choice between aid and sanctions. India can use negotiated carve-outs and reliable cold-chain corridors to reconcile national interest with Vasudhaiva Kutumbakam and SDG 3 (good health). That would turn a refusal into a principled, workable model for humanitarian access.