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On the first day back to school in April, after time off to celebrate the Persian New Year, students in Iran were greeted with another apparent chemical attack. This was just the most recent in a monthslong series of reports of students, in particular girls, apparently being poisoned.

These chemical attacks, as they have been called, began in November 2022 and have escalated in recent months. Starting in February, the international community became aware of large numbers of students all over the country, mostly girls, becoming ill after reported exposure to some kind of toxic gas at school. At least two have reportedly died as a result.

While there is no confirmation that this is the case, there is widespread suspicion that these chemical attacks are a government attempt to keep girls, in particular, out of school in response to the girl- and woman-led revolution that has taken ahold of the country since mid-September 2022, when 22-year-old Mahsa Jina Amini was arrested and beaten for allegedly not covering her hair properly. Shortly after Amini died from injuries sustained at the hands of the so-called morality police, photos of schoolgirls without hijab giving the finger to images of the Supreme Leader went viral, reaching all corners of the internet.

Some have suggested the symptoms the schoolgirls have shown, such as headaches and palpitations, could be due to psychogenic illness related to the ongoing political strife in Iran. However, there is no evidence to support this hypothesis. In early March, after months of denying the attacks were occurring, the interior minister admitted the government had collected suspicious samples from at least some of the more than 50 schools affected at that point. The Iranian government, which tightly controls the release of information, would likely not admit poisoning is happening unless there is so much evidence they would be embarrassed for it to come out, say, during the pending United Nations investigation into human rights violations in Iran. More than 100 people have reportedly been arrested related to the chemical attacks, although it is worth keeping in mind the governments long history of false arrests.

The poisoning of schoolgirls is not the first health care-related tragedy in Iran in recent months, and as an Iranian American physician, I have been following these events closely. The very act of practicing medicine in Iran is now hazardous.

Since the beginning of the protests, ambulances have been co-opted by security forces, and physicians and hospitals have been under attack. The government has interfered with medical care by transferring injured protesters to detention centers even when they need medical care and threatening to punish physicians who care for injured protesters. On Oct. 26, 2022, a number of physicians were beaten at a peaceful rally in which they asked to be allowed to care for patients. At least one surgeon, Parisa Bahmani, died after she was shot at the rally. Mohammad Edalttalab was attacked and beaten in his office. Hamid GhareHassanlou was sentenced to death after attending a funeral, and Iman Navabi remains imprisoned. Two other doctors, 36-year-old Aida Rostami and 24-year-old Ebrahim Rigi, were also killed by the government forces. Rostami had gone out to treat injured protesters who were afraid to go to the hospital. She never made it home, and authorities told her family she had been in a car accident. However, her injuries were inconsistent with this (there was evidence of sexual abuse, and one of her eyes had been removed). Rigi was arrested during a protest and reportedly died from injuries sustained at the hands of the police. These are just a few of the health care workers whose lives have been taken.

Injured protesters fears of going to hospitals are justified, as there are reports some patients have been abducted from hospitals. Some have turned to medical advice from physicians in the U.S. via Instagram or organizations such as MAHSA Medical. In at least one case, health care workers have even resorted to forming a human chain outside a hospital in order to protect both patients and staff from being abducted or arrested.

Yet the academic and medical communities in the United States seem relatively uninterested in the human rights violations happening in Iran. Even in the face of attacks on students at universities and poisoning of schoolchildren, and despite the urging of Iran Human Rights and others, the majority of American institutions of higher learning have said nothing. Some of the same organizations that very quickly put out statements in support of Ukraine last year have remained silent. When colleagues and I have asked our institutions to weigh in, they have privately told us that the Islamic Republic of Irans actions against its own citizens are a political issue.

But this isnt politics its a public health crisis.

As of April 4, at least 537 people, including 68 children, have been killed by security forces. Many of the deaths have been among Irans ethnic minority groups, which have been targeted in the crackdown.

In the face of internet shutdowns and a tyrannical regime, the people of Iran have not asked us for donations or for health care workers to travel to the country. All they have requested is that we be their voice. We medical workers cannot stand idly by as our colleagues in Iran are tortured, beaten, and killed just for caring for patients. It may not feel like youre doing much, but raising awareness is extremely important for creating some accountability and putting pressure on the Islamic Republic of Iran.

One way to do this is to contact your political representatives (here is one letter template you could use) and ask them to target sanctions to family of members of the regime who live abroad, to stop negotiating a nuclear deal, to ask for the release of all political prisoners (including health care workers), and, if youre in the U.S., to support the MAHSA Act, which would impose targeted sanctions on the Supreme Leader, Ali Khamenei, and the president, Ebrahim Raisi, and any individuals affiliated with them.

It may feel as though we health care workers have too much to worry about here in the United States, with attacks on abortion rightsand gender-affirming care, health care inequities, and more. But I believe we can both fight for justice here and advocate for civil rights abroad.

I find myself wondering how the physicians in Iran can show up for work, day after day, not knowing whether they will be arrested just for doing their jobs. How can they provide health care when everyone is afraid to go to the hospital? Thats exactly the point: They cant.

Arghavan Salles is a clinical associate professor of medicine at Stanford University School of Medicine.

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Practicing medicine in Iran is now hazardous - STAT - STAT