The conflict between Iran and the United States has long been studied as a geopolitical standoff, marked by a cold war of sanctions, proxy forces, and nuclear brinkmanship in recent decades. As of 2026, that framework no longer holds, since what once seemed like a managed rivalry has collapsed into open warfare, dragging many countries into it, and millions of civilians across West Asia are facing displacement, medical collapse, economic ruin, and death on account of the open hostilities. The human security consequences are no longer theoretical; they are increasingly documented, ongoing, and devastating.
From Cold Conflict to Open War
For decades, the United States and Iran maintained a posture of hostility without direct military confrontation. It changed in stages over the years. The collapse of the 2015 Joint Comprehensive Plan of Action (JCPOA) after the Trump administration’s withdrawal in 2018 marked the beginning of a new phase of a “maximum pressure” campaign. Various sanctions were reimposed, crippling Iran’s economy. Iran’s currency entered freefall, particularly after a brief Israeli–US military exchange known as the Twelve-Day War in June 2025, which targeted Iranian nuclear and military infrastructure.
By late December 2025, Iran’s economic collapse had produced its most serious popular uprising since the 1979 revolution. Protests spread across more than 200 cities, fuelled by record inflation and crumbling infrastructure. The Iranian government’s response was catastrophic, and security forces massacred thousands of demonstrators, with Iran’s own Ministry of Health reporting at least 30,000 killed in the January 2026 crackdown. This is the largest such killing in modern Iranian history.
On 28 February 2026, the United States and Israel launched joint military operations against Iran that were codenamed Operation Epic Fury and Operation Roaring Lion, respectively. They started by striking Tehran and other cities across the country, killing Supreme Leader Ali Khamenei and several senior military and government officials. Hundreds of civilians died in the first days alone, including more than 100 children at a primary school in southern Iran. What may have been feared as a potential escalation had become all-out war, leading to many casualties and damage to property and infrastructure.
The Humanitarian Collapse
The scale of civilian suffering since February 2026 has been severe. According to UNHCR, the escalation triggered major displacement across West Asia, including large-scale internal displacement in Iran and Lebanon. In Iran alone, government estimates cited by UNHCR suggest that between 600,000 and 1 million households temporarily fled their homes. Meanwhile, thousands of Afghans living in Iran were returned to Afghanistan, often under coercive circumstances, placing additional pressure on a country already facing a profound humanitarian and food-security crisis.
Healthcare infrastructure, already weakened by years of sanctions, has been systematically dismantled. According to figures cited by the World Health Organisation from the Iranian Red Crescent, more than 300 health, medical, and emergency facilities had been damaged by early April 2026. The conflict caused severe disruption to Iran’s healthcare infrastructure, including reported attacks on hospitals, laboratories, and research institutions. Humanitarian organisations also warned that interruptions to electricity, communications, and medical supply chains were placing pregnant women, chronically ill patients, and emergency responders under growing strain.
Sanctions as a Weapon Against Civilians
Even before the open hostilities started, sanctions had already constituted a form of structural violence against ordinary Iranians. Iran’s inflation rate reached 40% by 2024, according to IMF projections and has risen further since then. The rial’s collapse and trade restrictions made it nearly impossible for hospitals and pharmacies to import life-saving medicines, despite technical humanitarian exemptions in US sanctions law. The broad nature of economic sanctions, particularly those targeting the global banking system, restricted Iranians’ access to healthcare, food security, and income in ways that humanitarian exemptions could not adequately offset.
The economic data tell a similar story: Iran’s GDP growth is projected to slow in 2024, and the country has entered economic contraction since then, meaning it is producing fewer goods and services than in previous periods. Oil exports had fallen, and youth unemployment remained persistently high. Economic misery, compounded by political repression, created the conditions for the December 2025 uprising that ultimately preceded the war.
A Region in Crisis
Iran’s retaliatory strikes following the February 2026 attacks broadened the conflict when it launched missiles and drones at Israel, US military bases, and civilian infrastructure across all six Gulf Cooperation Council (GCC) states – Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the UAE- as well as Iraq and Jordan, killing many and causing damage to military and non-military infrastructure. In Lebanon, the conflict reignited fighting that killed more than 2,000 civilians and militants. In Iraq, at least 118 people were killed, according to health authorities. UNICEF verified that 200 children had been killed and 800 injured in Lebanon alone since the March escalation.
The Strait of Hormuz, through which approximately 20% of the world’s oil passes, became a flashpoint of the war, with Iranian attacks targeting vessels and oil infrastructure. Disruption to one of the world’s most critical energy corridors sent reverberations through global commodity markets, raising fuel and food costs in countries that had no part in the conflict.
The Failure of Political Calculation
The 2026 Iran war is a case study in what happens when diplomatic failure is treated as an opportunity rather than a warning. Indirect nuclear negotiations between the US and Iran had been underway as recently as February 2026. Omani mediators reported significant progress, with Iran willing to make concessions. Those talks were abandoned. The human cost of that abandonment is now measured in thousands of lives, millions of displaced persons, and a regional humanitarian system that, as UNHCR has warned, is critically underfunded, with more funding required for Iran alone having been secured.
This conflict, which was a manageable geopolitical rivalry in which sanctions nudge governments and military posturing deters escalation, has now moved beyond it. But this proposition has been exposed as dangerously naïve by this conflict. Economic strangulation, when sustained long enough, does not produce compliance. It produces collapse and protest. The civilians of Iran, Lebanon, Iraq, and beyond did not choose this conflict. They are paying for it with their health, their homes, and their lives.
Sustainable security cannot be built through collective punishment or military dominance. The closure of the Strait of Hormuz since March 2026 has exposed a reality often hidden in discussions of energy security. What moves through the Strait is not merely fuel for global markets, but also the foundation of everyday life in electricity, transport, food production, medicines, and employment. When those flows are disrupted, the consequences are felt far beyond the Gulf, especially by populations already living with economic insecurity.
The IMF warned in April 2026 that the global outlook had “abruptly darkened” amid surging energy prices and intensifying inflation. Yet the real significance of the crisis lies less in macroeconomic indicators than in what they mean for ordinary households. For fuel-importing countries across Africa, South Asia, and Latin America, rising oil prices translate into higher transport costs, more expensive food, and shrinking purchasing power. Governments with limited resources are forced into difficult choices between subsidising essentials, servicing debt, or cutting welfare spending.
Food insecurity has become one of the clearest human consequences of the disruption. Rising fertiliser and fuel costs threaten agricultural production and drive up food prices, pushing vulnerable populations closer to hunger. The World Food Programme warned that millions more could face acute food insecurity despite having no connection to the geopolitical decisions that produced the crisis.
The same pressures extend to health systems. Higher energy costs affect the transportation of medicines, vaccine storage, and hospital operations, particularly in poorer states with already fragile healthcare infrastructure. The disruption of the Strait of Hormuz is the most analytically important dimension of the Iran–US conflict precisely because it exposes the central weakness in how human security is conventionally understood: the assumption that its dimensions are separable. Economic security, food security, and health security are treated in most policy frameworks as distinct categories, each with its own indicators and interventions. The human security framework makes clear that wars fought over strategic dominance do not remain confined to battlefields. They travel through supply chains and commodity markets into the lives of ordinary people far removed from the conflict itself. They are the foreseeable, measurable, and in many cases modelled consequences of decisions made by actors who had access to precisely this evidence and proceeded to take military action regardless.
Abhinav Mehrotra is an Associate Professor and Assistant Director, and Amit Upadhyay is an Associate Professor and Senior Fellow at Jindal Global Law School, O.P. Jindal Global University.
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