June 21, 2013

For more than a year, Médecins Sans Frontières (MSF) has been working in Darvazeh Ghar, one the poorest neighborhoods of Tehran, the capital of Iran. Here, merchants and customers rub shoulders with drug addicts, prostitutes and street children. Obtaining medical care can be difficult for these at-risk populations.

“Most people like me don’t know Darvazeh Ghar,” says MSF midwife Mona Lashkari. “When I tell my family and friends that we have a clinic here and that we treat drug addicts, prostitutes and very poor people, they can’t believe it.” Housing in the neighborhood is inexpensive, but often poorly maintained, if at all. This is where people end up if they lack the resources to live somewhere else.

“We treat refugees, gypsies and pregnant drug-addicted women here every day. It’s hard for them to pay for their treatment and they can’t travel to the Ministry of Health clinics,” Mona explains. “We treat them here and it’s all free.”

Marginalized, stigmatized, sometimes fearing arrest or imprisonment, these women do not carry the identity papers that would allow them access to the Iranian public health system. Mona sees about 30 patients a day, offering prenatal, maternal and newborn care, family planning advice and contraception.

“This clinic offers prostitutes some hope,” says Zarha, a nurse. “When they come for the first time, they are suspicious, but by the third visit, they’re completely changed. They are more at ease because they know that we want to help them. This is the only place where they can receive the medical care they need.”

Zarha is in charge of triage. She examines patients and prioritizes them based on the seriousness of their conditions. This can be a source of tension in the waiting room, where women in full black chadors sit next to others in bright red lipstick.

Shukrieh is 22. She has two children and first came to the MSF clinic seeking care for her little boy, at the advice of the drug detox center where she receives methadone and social support.

“My son is ill,” she says. “He bangs his head against the wall. Sometimes his hands are clenched so tight that you can’t open them.” The little boy suffers from epileptic seizures.

Shukrieh married at 17. “I was already addicted when I lived with my mother. She and my brothers were addicts.”

“I don’t have money to pay rent. My husband is Afghan. He doesn't have a work permit and when he does find work, he makes barely enough to pay for our daily living expenses. Since he doesn’t have a permit, he could be arrested and sent back to Afghanistan. That happened once.”

Her children lean against her and play with the folds of her black veil. Shukrieh covers her mouth to hide her damaged teeth when she speaks. “Our life is nothing but ruins.”

She stands, arranges her billowing black chador and gathers her children, who flit around her impatiently. She must hurry to get to the detox center on time, take her dose of methadone and hold on until the next day.

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