The publication of statistics on the average age at death across different Iranian provinces has once again raised the issue of health inequality. This indicator should not be equated with “life expectancy,” but the differences it reveals raise a more important question: Why can a citizen’s place of residence still determine how far they are from a doctor, hospital, emergency services, and even the possibility of receiving timely medical treatment?
This question has more complex dimensions in Iran’s Kurdish regions. Kurdistan, Kermanshah, Ilam, and the Kurdish areas of West Azerbaijan do not have identical conditions, but parts of these regions face a combination of dispersed populations, difficult geography, weak infrastructure, limited economic opportunities, and unequal access to healthcare services. Studies conducted in Kermanshah, for example, have shown significant differences among counties in access to doctors, hospitals, beds, and specialized medical centers.
However, one variable receives less attention in discussions about development in these regions: sustainable security.
In areas where non-state armed groups operate, armed cross-border movements occur, sporadic clashes take place, or economic actors face threats or extortion, the cost of insecurity is not recorded solely in security-incident statistics. Its effects can gradually extend into the economy, infrastructure, and public services.
A specialist doctor deciding to remain in a border county needs more than a salary and a hospital; the security of their family, road quality, freedom of movement, and a predictable outlook for daily life also matter. The same logic applies to nurses, teachers, engineers, contractors, and private investors. As a result, insecurity can have effects that extend far beyond the location and duration of an individual confrontation.
This is where security and human rights intersect. The right to security should not be placed in opposition to the right to development; security should enable development to take place.
The activities of Kurdish armed groups based across Iran’s border, particularly in the Kurdistan Region of Iraq, are part of this equation. Reports have been published concerning extortion targeting citizens and economic actors, threats, and the destruction of economic equipment in border areas. Where such actions are independently established, they are not merely violations of the property rights of an individual or company; they may also affect local employment, project implementation, and economic confidence in a region.
From this perspective, an attack on or extortion of a contractor is not merely a security case. If project machinery is put out of operation, a project is halted, or contractors consider operating in the region too risky, the ultimate cost may be transferred to local residents: a road that takes longer to build, investment that does not enter the region, a job that is never created, and services that remain difficult to access.
But this reality does not reduce the responsibility of the Iranian government.
The state has a duty to protect the security of its citizens. However, if the response to armed threats leads to the permanent dominance of a security-based approach over regional policymaking, the result can be a vicious cycle: the existence of an armed threat increases security deployments and security considerations; development and civic activity are overshadowed; deprivation persists; and that deprivation can, in turn, create greater vulnerability within society.
The issue, therefore, is not a choice between “security” and “development.” The challenge is moving from reactive security toward sustainable, development-oriented security.
At the same time, the responsibility of the Kurdistan Regional Government in Iraq cannot be overlooked. The presence of armed groups opposed to Iran on the territory of the Kurdistan Region raises a legitimate legal and political question: To what extent are the region’s authorities able and willing to prevent territory under their administration from being used for armed activities, recruitment, training, or actions that affect the security of civilians on the other side of the border?
This question becomes more significant when the cost of tensions is borne not by the leaders of armed groups, but by ordinary residents of border areas.
Tehran, meanwhile, must also answer what measurable plans it has for reducing the development gap once security has been provided. Security cannot substitute for hospitals, roads, schools, employment, and equitable access to services. If a region becomes secure but doctors do not remain there, rural roads remain inadequate, or patients must spend hours traveling to reach a specialized medical center, only part of the problem has been resolved.
Studies concerning Kermanshah show that even within a single province, access to healthcare can be highly uneven. Under such circumstances, the number of hospitals alone is not an adequate measure. Emergency response times, distance to specialist doctors, road quality, transportation costs, and the ability to retain skilled personnel provide a more accurate picture.
For this reason, reducing the health gap in Iran’s Kurdish regions requires a policy that goes beyond the Ministry of Health. Road construction, investment, employment, emergency services, education, and security are components of a single interconnected issue.
A sustainable solution also requires two responsibilities to be addressed simultaneously: Iran must both ensure the security of citizens in border areas and prevent security considerations from replacing development policy; the authorities of the Kurdistan Region of Iraq must also provide a clear and practical response regarding the presence and activities of armed groups that use territory on the other side of the border.
Ultimately, the main victims of the vicious cycle of insecurity and underdevelopment are neither governments nor political groups, but ordinary people. A patient who reaches a hospital too late, a young person without employment opportunities, a contractor who decides to stop operating, and a doctor who is unwilling to remain in the region are all different manifestations of the same problem.
The central question, therefore, is not simply how many hospitals have been built in Iran’s Kurdish regions. The more difficult question is: Have conditions been created in which security, investment, skilled professionals, and public services can remain in these regions?
The answer to this question may reveal more than many provincial statistics about the true distance these regions still have to travel toward development.
