Summary

The US-Israeli war is driving a displacement crisis in IranBMJ 2026; 393 doi: https://doi.org/10.1136/bmj.s879 (Published 08 May 2026) Cite this as: BMJ 2026;393:s879 - Seyed Aria Nejadghaderi, research fellow1, - Mohammad Sharif Razai, clinical lecturer2, - Hamid Sharifi, professor3, - Majid Fasihi Harandi, professor4, - AliAkbar Haghdoost, professor5 - 1Knowledge Hub for Migrant and Refugee Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran - 2Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK - 3HIV/STI Surveillance Research Centre, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran - 4Research Centre for Hydatid Disease in Iran, Kerman University of Medical Sciences, Kerman, Iran - 5Social Determinants of Health Research Centre, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Hundreds of thousands of people have been internally displaced by the ongoing US-Israeli war on Iran, creating a public health emergency. At the time of writing, more than 170 000 people had crossed from Iran into neighbouring countries, mostly Turkey,1 and over 100 000 people were relocated within Iran owing to the air strikes.2 The public health response must therefore distinguish between the cities people leave from and the places that receive them. This approach requires moving from ad hoc crisis responses to proactive health system resilience, integrating community networks, charities, and voluntary groups. The war has forced hundreds of thousands of Iranians to leave their homes, primarily from the capital Tehran and other urban centres to northern and rural areas.3 Many host regions have shown remarkable solidarity, opening their homes to strangers and sharing scarce resources. This internal migration follows patterns seen in other Middle Eastern conflicts but carries unique health repercussions.23 The speed and scale of the current displacement crisis have deepened vulnerabilities within a society already strained by decades of economic sanctions.1 People are crowded into collective sites, often living with host families or in makeshift accommodation without adequate infrastructure.2 While some population movement is temporary and precautionary, persistent hostilities risk causing prolonged internal displacement. Lessons from regional experience show that such movements compound existing ethnic, economic, and social tensions, leaving displaced people more exposed to exploitation and isolation.4 Income loss and inflated prices are pushing many displaced households deeper into poverty.5 Health challenges for internally displaced people are immediate and wide ranging. Environmental hazards from attacks on energy infrastructure have caused petrol fires and pollution leading to widespread reports of breathing difficulties, skin and eye irritation, and potential contamination of food and water sources.2 Access to routine care, including maternal health services, vaccinations, and treatment for chronic conditions, has been curtailed owing to medical facilities being damaged or repurposed. Severe overcrowding has weakened healthcare services for displaced populations and local residents in host cities. Psychological trauma from the uprooting of communities, attacks, and insecurity will likely increase rates of anxiety, depression, and post-traumatic stress disorder. The current stressors are exacerbating pre-existing vulnerabilities, creating a public health emergency that requires urgent, coordinated action.6 The war unfolded against the backdrop of Iran’s recent smaller scale conflicts, which prompted the authorities to take contingency measures for fuel and food supplies, meaning that some provinces were relatively prepared for the current escalation. However, the sharp rise in population in host areas places pressure on underresourced primary care facilities, hospitals, fragile water and sanitation systems, and supply chains. A small number of essential health workers remain in urban centres, facing danger and high stress, while host communities struggle to meet the combined demands of displaced people and locals.7 National preparedness plans should adopt scenario based planning for different levels of national and local crises, with particular attention to basic needs such as fuel and food supplies. International medical and human rights organisations must advocate for the protection of civilians and public infrastructure, increased funding for health facility repairs, and data sharing protocols to track health needs in real time. Measures such as joint rapid assessments, capacity building for local non-governmental organisations, and contingency planning for disease surveillance, would help close current gaps and prevent secondary disasters.89 Experiences from this war show that community based organisations, local charities, and informal volunteer groups can reduce harm when integrated into formal responses. For example, they can deliver vaccines to remote areas or relay real time health data to official surveillance systems. Strengthening partnerships with these groups and sustaining social solidarity during crises will be essential for future resilience. Prolonged internal displacement and conflict carry a substantial mental health burden. Iranian health policymakers must prioritise the rapid expansion of mobile clinics and community based mental health support tailored to internally displaced populations. While the scale of suffering demands immediate compassion and action, it also offers an opportunity to draw on hard learned lessons from past conflicts towards more humane, forward looking policies. Proactive preparedness by national authorities and international partners can reduce the human cost of future forced displacements and turn tragedy into a catalyst for more resilient health systems. Footnotes Competing interests: MSR is an NIHR Clinical Lecturer in Primary Care. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. AI use: The authors used the AI tool Grok in the preparation of an earlier draft of this article to assist with language refinement. Provenance and peer review: Not commissioned; not externally peer reviewed.