Introduction and summary
On April 7, 2026, in what was possibly a threat of genocide,1 President Donald Trump posted on his social media that “a whole civilization will die” if Iran does not reach a deal or open the Strait of Hormuz.2 The U.S.-Israeli war in Iran may be remembered in much of the United States as a reckless war of choice that imposed enormous costs on Americans.3 Civilians in the region, however, will remember the loss of innocent life and what the war did to the land beneath their feet, the air they are forced to breathe, and the water they rely on to survive. American and Israeli objectives for the war remain unclear, with statements from President Trump suggesting an array of justifications that change by the day—from dismantling the Islamic Republic to liberating the Iranian people to destroying alleged nuclear capabilities.4 Yet the result is the same: widespread destruction inflicted on a population and environment already scarred by decades of suffering. Iran’s retaliation has only compounded the damage, targeting key infrastructure in Arab states and pushing one of the world’s most environmentally vulnerable regions toward catastrophe.
Public attention in the United States has largely focused on the war’s effects on the economy and household finances at home, but the far more severe consequences for civilian populations across the region must not be overlooked. The entire war is unconstitutional on multiple fronts;5 the United States and Israel failed to account for the reverberating effects of their conduct on civilians,6 while attacks on infrastructure violate international humanitarian law7 and should be considered “collective punishment.”8 Failure to distinguish between combatants and civilians has consequences: More than 1,700 civilians and around 250 children have been killed9—including as a result of a U.S. military strike on a girls’ elementary school.10 The true civilian death toll, however, is most likely higher; the warring parties’ destruction of hospitals,11 combined with Iran’s internet blackouts,12 restrictions on journalists,13 and intimidation of medical staff,14 has made systematic documentation nearly impossible.
Alongside the direct violence, strikes on oil facilities, water infrastructure, and industrial sites have damaged the environment on which communities rely. Civilians—especially children,15 the elderly, people with chronic illnesses, the poor, and those displaced from their homes—bear the overwhelming share of suffering.16 These harms compound over time, as environmental damage hardens into scarcity; scarcity fuels unrest; unrest invites repression; and governance weakens further, creating fertile ground for renewed violence and destruction. Even once the war ends, the humanitarian toll will continue given the risk of toxic exposure, untreated disease, hunger, dehydration, and deep psychological trauma.
The war deepens the suffering of an already vulnerable population under massive environmental degradation, and its immediate consequences—especially worsening health outcomes and water scarcity—demand humanitarian assistance and accountability before the full scope of devastation manifests.17
The war exacerbates existing environmental stressors in the region
Long before the first strike of the Trump administration’s Operation Epic Fury, Iran and the broader Gulf region had been experiencing a severe five-year-long drought brought on by climate change and compounded by socioeconomic water stressors.18 Rainfall has declined sharply, and 2025 marked one of the driest periods in the past 50 years—with Tehran’s reservoirs falling to just 12 percent of capacity.19 Snowmelt in the surrounding Alborz and Zagros mountains, which for centuries fed Iran’s rivers and replenished its aquifers, has been steadily declining as temperatures rise.20 In 2023, a heat wave drove temperatures to 123 degrees Fahrenheit, forcing a two-day nationwide shutdown.21 Water rationing has become routine in major cities.22 Wetlands that once sustained local fishing communities have dried to cracked earth.23 In parts of Tehran, so much groundwater has been extracted from beneath the city that the street level is sinking by more than 10 inches per year.24
When oil facilities, chemical plants, and weapons depots are bombed, toxic residues accumulate in soil, enter waterways, and travel across borders.
Onto this strained foundation, the war is causing new and compounding harms. More than 300 incidents of potential environmental harm have been documented across 12 countries in the region,25 with the highest-risk incidents concentrated along the Gulf coast and in Tehran. After an initial phase targeting military sites, strikes have expanded into civilian and industrial infrastructure.26 When oil facilities, chemical plants, and weapons depots are bombed, toxic residues accumulate in soil, enter waterways, and travel across borders—harms that fall on communities already living at the margins of environmental tolerance.27 Additionally, while the United States and Iran may have agreed to a two-week ceasefire on April 7, 2026,28 it remains tenuous, and the risk of attacks on Iranian nuclear sites29—whose conditions are currently unknown by the United Nations nuclear watchdog, the International Atomic Energy Agency30—remains omnipresent. While some Iranian nuclear sites may be legitimate military targets under international law, that does not mean it would be wise to prosecute them. Airstrikes, for instance, could release radiation, causing widespread health, environmental, and humanitarian damage that would cross borders, last for generations, and inflict consequences that would be irreversible on any human timescale.
Pollution from aerial bombings produce acute and long-term health crises
The aerial bombardment of Iran has triggered a compounded health crisis, where immediate toxic exposure meets a health care system already overwhelmed by sanctions and domestic unrest. The environmental and health consequences of this conflict are worsened by Tehran’s geography. Sitting in a valley at the foot of the Alborz Mountains, the city is a natural trap for airborne contaminants.
Even before the first missile struck on February 28, temperature inversions and industrial emissions had pushed Tehran’s PM2.5, or soot, concentrations to more than 17 times the World Health Organization’s recommended limit.31 The bombing of oil refineries in Tehran, Aghdesieh, Shahran, and Karaj transformed the existing smog into an “apocalyptic” toxic haze32 and caused fires that raged on for days.33 Iran’s Environmental Protection Organization warned residents to stay indoors,34 as the explosions had caused a massive release of toxic hydrocarbons, sulfur oxides, and nitrogen compounds into the air.35 This was followed by black rain. Scientists confirmed that the rain contained soot, ash, and toxic chemicals36 from the burning of heavy fuel,37 and that it may also contain asbestos- and silica-laden debris from the bombing and subsequent destruction of older residential and commercial properties.38 These contaminants do not merely linger in the air; heavy metals and PFAS compounds leach into groundwater and agricultural soil,39creating a persistent toxic legacy,40 as the post-conflict landscapes of Iraq, Afghanistan, and Lebanon have demonstrated at enormous human cost.
The health impacts of this “chemical soup” are both acute and intergenerational.41 While residents immediately reported difficulty breathing, burning eyes, sore throats, migraines, dizziness, and cardiac triggers,42 the long-term burden is equally insidious.43 Prolonged exposure to the aromatic compounds now suspended in Tehran’s air,44 seeping into its soil, and entering its water supply is “known to interact with DNA”45 and is associated with elevated risks of stroke, lung and other cancers, elevated blood pressure, and cognitive decline.46 Numerous studies have established a link between toxic smoke exposure and elevated cancer incidence, yet the long latency periods involved mean this burden will not become fully visible in health statistics for years or even decades.47
Pregnant women and young children are among the most vulnerable; toxic exposure in utero can contribute to preterm birth and lower birth weights in newborns,48 as well as impaired lung growth.49 The civilian populations absorbing this disproportionate toxic burden are protected persons under international law, and the foreseeable severity and duration of these harms cannot be reconciled with the principles of distinction or proportionality, particularly given military objectives that were never clearly defined.
A lack of access to health care compounds humanitarian crises
Health care facilities in the Middle East have been targeted once every six hours across Lebanon, Iran, and Israel.50 Iran’s health care system, specifically, was fundamentally unequipped to absorb this war and its severe health consequences, having arrived at the conflict already compromised by three converging pressures.
First, years of U.S. sanctions have hollowed out medical supplies.51 Though medications are technically exempt, the fear of secondary sanctions made it difficult to import raw materials and medications, which resulted in a 50 percent increase in drug prices, affecting approximately 6 million Iranian patients suffering from chronic diseases or requiring emergency procedures.52
Second, the system was already reeling from the January 2026 crackdown.53 Between late December 2025 and late January 2026, anti-government protests spread to more than 200 cities across Iran following the collapse of the rial and record inflation.54 The ensuing crackdown resulted in massacres that left thousands of protesters dead—the largest killings in modern Iranian history. While the official death toll from the protests stood in the thousands, Time magazine reported that as many as 30,000 civilians had been killed.55 The sheer magnitude of the violence left the health care system56 and its workers reeling from the unprecedented influx of casualties just weeks before the first missiles struck.57
According to the Iranian Red Crescent, 307 health, medical, and emergency care facilities have been damaged as of April 3, 2026.
Finally, the airstrikes themselves have systematically dismantled remaining medical infrastructure. According to the Iranian Red Crescent, 307 health, medical, and emergency care facilities have been damaged as of April 3, 2026.58 On the second day of strikes, an in vitro fertilization clinic at Gandhi Hospital was hit and seriously damaged, severely injuring at least one health care worker and devastating parents who had children and samples in the ward.59 Pregnant women across the region are being forced to give birth in unsafe conditions,60 without essential services, and sometimes without electricity.61 On the morning of April 1, 2026, Tofigh Darou Engineering Research Company, Iran’s first and largest firm focused on pharmaceutical raw materials, was hit by two drones.62 Such attacks on Iran’s health care infrastructure will not only prevent short-term care for civilians; it risks preventing essential care from being administered for years to come.
The physical toll is mirrored by a psychological crisis. Aerial bombings have exposed civilians to acute stressors, including sudden violence, loss of family members, and forced displacement. These are all risk factors for acute stress disorder, post-traumatic stress disorder, depression, and somatic symptom disorders.63 The ongoing internet blackout64—imposed on January 8, 2026, and still in effect at the time of this report’s publication—has further intensified the psychological burden across a society already under extreme strain, severing people from family networks, information, and support. None of this was unforeseeable. The combination of a health care system overwhelmed by sanctions, a crackdown, and then bombs would be bound to produce the exact outcomes documented here. The failure to account for these reverberating effects is not a gap in judgment but a violation of international law.
Water scarcity becomes a driver of conflict, violence, and instability
Iranian officials have accused the United States of striking a desalination facility on Qeshm Island, potentially disrupting water access for more than 30 villages.65 Meanwhile, reports indicate potential damage by debris from intercepted Iranian missiles to the Fujairah F1 power and water complex in the United Arab Emirates and the Doha West Station in Kuwait early in the war.66 Water systems are the most fragile and politically consequential domains in this war due to their potential to transform environmental destruction into prolonged violence.67 The Middle East and North Africa already face acute water scarcity due to arid climates and rapid population growth, with roughly 83 percent of the region’s population considered water‑insecure.68 In this context, deliberate attacks on water infrastructure could be strategic acts of war, echoing Russian strikes on water systems in Ukraine.69
Across the Gulf, civilian populations depend heavily on large‑scale desalination plants to convert seawater into drinking water. Qatar, for instance, derives roughly 99 percent of its potable water from desalination.70 Disruption to these facilities carries immediate humanitarian consequences, as water, energy, and food systems are tightly interlinked. Damage to desalination infrastructure forces overextraction of already stressed groundwater reserves,71 while contamination from strikes on industrial or military sites risks introducing petrochemicals and heavy metals into irrigation systems and food chains, deepening food insecurity.72 The World Food Programme estimates 45 million people will face acute hunger if the war continues.73
The World Food Programme estimates 45 million people will face acute hunger if the war continues.
In already water‑stressed settings such as Iran, even limited damage can push fragile systems past their tipping point. Decades of water-intensive farming policies drained groundwater,74 replaced sustainable traditional systems with diesel-powered deep tube wells,75 and led to sinking land,76 salty aquifers, soaring water costs, and the dramatic drying of iconic lakes such as Lake Urmia.77 Water scarcity, in turn, compounds other drivers of instability, including unemployment, food price volatility, weak governance, and displacement.78 Estimates suggest that water stress has already contributed to the displacement of roughly 16 million people in Iran while fueling recurring protests and social unrest.79
Iran’s crackdowns on water‑related protests,80 alongside broader unrest linked to food price spikes in early 2026, contributed to Trump’s stated rationale for recent external military intervention—yet, paradoxically, the conflict itself is more likely to intensify these pressures.81 In drought‑stricken environments, such attacks function as environmental accelerants, locking communities into chronic scarcity and heightening risks of unrest, repression, and violence long after active hostilities end—with particularly severe gendered harms.
Gendered dimensions of water insecurity
Past drought cycles in Iran82 show that water scarcity disproportionately burdens women and girls, undermining access to potable water, sanitation, and hygiene, while increasing risks of gender‑based violence.83 In water-deprived rural parts of Iran such as Sistan, Baluchestan, and South Khorasan, the long-standing water crisis has contributed to girls’ school dropouts and child marriages, along with the neglect of women’s health and hygiene.84
At the same time, war weakens state capacity and environmental governance, marginalizing civil society precisely when local expertise is most needed. For example, Iranian women and environmental leaders85—who articulate the links between climate stress, gendered harm, and political repression—have been systematically silenced by the Iranian regime.86 Successor Mojtaba Khamenei now presides over intensified repression and a renewed internet blackout that has blocked communication and human rights monitoring during the war.87 Further suppression of these voices could turn water insecurity from a manageable crisis into a perpetuating source of instability—eliminating local expertise, blocking early warning and reform, and allowing environmental damage to harden into long‑term food shortages, displacement, and political repression long after the war ends.
Recommendations: Immediate and long-term humanitarian support
To prevent long‑term ecological and humanitarian harms from unfolding in their most severe forms, sustained support for the Iranian people means addressing both immediate humanitarian needs and long‑term recovery in the country and greater region.
Immediate humanitarian needs
The immediate obligation is unconditional humanitarian assistance focused on environmental health harms, air pollution regulation, water access, and food security. These needs extend to neighboring countries, particularly Lebanon,88 where Hezbollah’s decision to support Iran prompted Israel to launch strikes across the country, killing more than 1,000 people and displacing 20 percent of the population in just two weeks.89 Post-conflict, the United Nations typically renders humanitarian aid,90 which is important in respect of the dignity of human life and is also the best way to interrupt a cycle of violence and instability. Now, the Trump administration’s active efforts to interfere with humanitarian aid risk exacerbating post-conflict instability.
The Trump Administration has cut up to $15 billion in U.N. humanitarian assistance and slashed international climate finance.91 Congress’ core responsibility is to therefore protect existing humanitarian lines from executive overreach and ensure relief budgets cannot be programmed away from civilians.92 The Trump administration has already demonstrated its willingness to do exactly that by siphoning, freezing, and clawing back foreign assistance funds. It has instead allocated these funds toward the administration’s self-defined “America First” priorities,93 which have decimated global humanitarian infrastructure on which conflict-affected populations have long depended. Congress should, at a minimum, demand transparency around how funds are being spent to protect humanitarian assistance in future-year appropriations.
Support for the Iranian people to pursue accountability for environmental harms
Iranian self-determination and recovery must be led by civil society. Environmental defenders, labor unions, health workers, women’s rights groups, and diaspora‑based monitoring networks—not external militaries or political elites—have sustained communities and confronted the long‑term ecological and humanitarian impacts of repression and war.94 In an ideal scenario, the United States would have coordinated humanitarian efforts to support post-conflict recovery.95 However, America, Israel, and Iran are warring parties who have weakened civilian protection mechanisms and committed repeated violations of international law. The conflict may have inadvertently set back prospects for internal reform within Iran by compelling the population to rally around the regime in the face of external aggression.
The clearest path away from perpetual crisis and toward a healthy future is defined by climate resilience rather than ruin.
Furthermore, this collapse of U.S. leadership has created an opening for China to assume an expanded role in humanitarian coordination,96 further weakening America’s reputation on the world stage.97 Neutral state actors who can provide post-conflict designs, such as Nordic countries, as well as the donor community, including the private sector and philanthropies, should prioritize funding for material, legal, and institutional backing for civilians inside Iran and across the region.98 Practically, this means providing resources for survivors and grassroots networks to document environmental damage, toxic exposure, health outcomes, and water contamination—using satellite imagery, open‑source tools, and regional research partnerships where in‑country access is limited—alongside legal, digital, and mobility protections that enable accountability without increasing civilian risk.
Long-term recovery
Finally, environmental harm must be treated as an immediate civilian protection issue and central responsibility of post-conflict recovery. The relationship between environmental degradation and instability runs in both directions: War destroys environments, and degraded environments fuel the resource scarcity, displacement, and grievance that can produce more conflict.99 Long‑term planning by international actors must therefore prioritize environmental remediation and health surveillance for chronic disease, water, and soil recovery—particularly investments in a more resilient water management system to ensure the water crisis does not become catastrophic.
See also
Conclusion
Recovery and accountability cannot be postponed until some distant political deal is reached. The war has already taken thousands of civilian lives, and its environmental legacy threatens millions more. The global institutions responsible for supporting post-conflict recovery and post-disaster humanitarian assistance need a clear focus on protecting people and the air, water, and ecosystems on which they depend. The clearest path away from perpetual crisis and toward a healthy future is defined by climate resilience rather than ruin.
Acknowledgments
The authors would like to thank Andrew Miller, Allison McManus, Frances Colón, Courtney Federico, Cathleen Kelly, Ben Greenho, Damian Murphy, Trevor Higgins, Michael Clark, Bianca Serbin, and Steve Bonitatibus for their feedback, support, and guidance on this piece.