Saturday saw Iran’s highest single-day COVID-19 death toll of the pandemic, as 684 people succumbed to the disease and more than 36,400 new cases were confirmed.

This latest surge in infections, driven by the highly contagious delta variant, is Iran's fifth, bringing the total number of cases to more than 4.5 million and deaths to 102,000, numbers even Iran’s health officials admit is an underestimate of the real toll. Worse is yet to come, with deputy health minister Iraj Harirchi acknowledging, “Infections and hospitalization numbers have stabilized in 14 provinces... but fatalities are expected to be on a relatively rising trajectory in coming days.”

One of the top doctors in Mashhad, Iran’s second largest city, declared that such is the gravity of the situation that no families in the city are without a patient or someone who has died in the pandemic. Without citing statistics, he said infections and deaths “are very high” and younger people are dying. Video clips of hospitals full of patients lying on the ground or in courtyards and long lines at pharmacies are circulating widely.

By far the worst affected country in the Middle East, Iran has suffered decades of US sanctions that have had a devastating impact on its health care system, preventing access to medicines and supplies to treat coronavirus cases, cancer patients, and other deadly diseases. But fraud, mismanagement and profiteering by Iran’s pharmaceutical companies are widespread, with multiple reports of the hoarding and stockpiling of vital medical supplies.

Like its counterparts internationally, the Iranian government has put profits before lives and shunned comprehensive measures that would ensure the closure of all non-essential work, schools and universities. Instead, it has imposed short-term, piecemeal measures that most recently have included a ban on private travel between provinces until August 27 and a five-day closure of government buildings, banks and non-essential shops that ended Saturday.

Only 5.4 million of Iran’s 85 million population have been fully vaccinated, with more than 16.3 million people awaiting their second jab. Vaccination centres are swamped with kilometre-long lines of people queuing for their jabs, largely imported from China, Russia, India, Cuba, Japan and via the global COVAX initiative. Some of these vaccines may be less effective against the delta variant. A study by the Statistics and Information Technology Management Center found that 2,072 Iranians out of the 2.85 million fully vaccinated at the time of the study had died, a far higher rate than elsewhere.

In the run-up to last June’s presidential elections, amid growing popular anger over the Rouhani government’s mismanagement of the economy, the pandemic and the lack of vaccines, the vaccination issue became deeply politicised. The so-called hardline or principalist faction around Iran’s Supreme Leader Ayatollah Ali Khamenei and the Islamic Revolutionary Guard Corps (IRGC), which answers directly to Khamenei, used it as an opportunity to attack the faction around President Hassan Rouhani who negotiated the nuclear accord with the Obama administration that was suspended by Trump, and to engineer the shoo-in of its favoured candidate, the conservative chief justice Ebrahim Raisi.

Strangled by US sanctions that made it impossible to import vaccines, Khamenei banned the import of vaccines from the US, Britain and France, denouncing them as untrustworthy and forcing the Iranian Red Crescent Society to refuse 150,000 vaccines donated by Pfizer. One of those who signed an open letter in January warning against importing western vaccines was Bahram Eynollahi, chosen by Raisi as his health minister.

While various state bodies vowed to produce domestic vaccines, the attempt has generally failed as only one million doses of COVIran Barekat have been administered after several unexplained delays to large-scale production. This has forced the authorities to partially reverse the ban on Western vaccines, manufactured outside the US and UK, with Raisi announcing that the import of 30 million doses has been finalised. A further 60 million doses are needed.

The pandemic has exacerbated Iran’s economic problems. The international Financial Action Task Force has blacklisted the country for failing to adopt financial transparency measures. Nearly a quarter of Iran’s young population are out of work, annual inflation is heading towards 50 percent and the currency has fallen from 40,000 rials to the dollar in 2017 to nearly 250,000 in Tehran’s unofficial exchange markets today. Around 40 percent of the population, more than 32 million people, live below the poverty line.

Workers and their families face frequent electricity shutoffs, while water supplies are erratic at best, forcing nearly 10 million people in several provinces, including Khuzestan, Markazi and Baluchestan, to abandon their homes and farms in the last eight years and move to the big cities in search of work, as well as leading to last month’s protests in the oil-rich province of Khuzestan.

Iran has also been hit by the forest fires that devastated the eastern Mediterranean region. Large swathes of the forest in the Zagros Mountains that stretch from southern Turkey to southwestern Iran have been destroyed, with the government making no serious efforts to battle the fire. The IRGC sent firefighting planes and helicopters to combat fires in forests near Antalya and Mersin in Turkey, causing outrage in Iran’s fire-devastated regions.

Contract workers in Iran’s state-owned oil industry have gone on strike in support of higher wages and an end to subcontracting that enables employers to evade paying the minimum wage and other benefits. Iran’s ruling elite is acutely conscious that the 1978 oil workers’ strike, amid a wave of mass protests by workers, students, and the urban poor, was key in toppling the blood-soaked US-backed regime of Shah Reza Pahlavi.

Iran has also seen a spate of attacks on its nuclear facilities and basic infrastructure, attributed to Israeli attacks and sabotage.

It is these conditions that brought Raisi to the presidency with the votes of just 30 percent of Iranians, after the Guardian Council, at the behest of the Supreme Leader, disqualified all but seven of the 592 candidates. As well as his close links to the IRGC, whose supporters now control all branches of the state, Raisi has a track record of repression, most notably in 1988 when as Tehran’s deputy prosecutor he ordered the mass execution of thousands of political prisoners.

But all factions of the Iranian bourgeoisie view the resumption of the 2015 nuclear accord, known as the Joint Comprehensive Plan of Action (JCPOA), and the lifting of more than 1,600 sanctions that have targeted Iran’s oil exports as the way out of the economic, social and political crisis confronting the country. Tehran paused talks in Vienna, pending Raisi’s inauguration earlier this month. Raisi has expressed his support for the JCPOA, but the two sides remain far apart.

In addition to pressing Tehran to curtail its nuclear programme, Washington is reportedly seeking to wring further concessions on its conventional missile programme as well as demanding it surrenders its influence in the Middle East, bowing to the US quest for hegemony.

It is for this reason Tehran has largely refrained from inflammatory comments on the US debacle in neighbouring Afghanistan, hoping to take advantage at the bargaining table of the collapse of Washington’s puppet regime. While Raisi said the US withdrawal amounted to a “military defeat,” he pledged that Iran, which hosts around three million refugees, would seek to ensure stability in the country.

Tehran would encourage “all groups in Afghanistan to reach a national agreement.” He added, “While consciously monitoring developments in the country, Iran is committed to neighbourly relations,” implying Tehran would recognize a Taliban-led government in the country.

Similarly, Iran had sought to avoid escalating Israel’s covert maritime war on the country, aimed in part at least at torpedoing the resumption of the JCPOA. However, once the Wall Street Journal and the New York Times revealed Israel’s long-running attacks on Iranian vessels earlier this year, Iran had no option but to mount a naval offensive targeting merchant ships linked to Israel. This culminated in the drone “suicide” attack on MV Mercer Street that killed the Romanian captain and the British security officer three weeks ago.

In a bid to further boost his bargaining position, Raisi said, “Our foreign policy will not be limited to the nuclear deal… We will have interaction with the world. We will not tie the Iranian people’s interests to the nuclear deal,” indicating that he wants to further strengthen ties with Russia and China, in line with Tehran’s “look to the east” policy.