After midnight, one evening in late January, a doctor ushered a young man with a mangled hand into her car and sped to a private clinic on the outskirts of Tehran. She took back roads to avoid security checkpoints, where hulking officers were strip-searching passengers to look for injuries or any evidence of their participation in the uprising that had recently swept the country. Around 2 A.M., the doctor arrived safely at the clinic, where she slipped a glove over the man’s hand to hide his injury. Then she led him past reception, to a specialist who was waiting to receive him.

In late December, mass protests erupted across Iran, leading security forces to massacre thousands of people over the course of several days in January. Scores of wounded demonstrators were left scrambling for medical help. Many government-run hospitals began operating as an extension of the regime’s security forces, targeting anyone who dared to seek treatment. Some of the injured were detained in wards, sometimes while under anesthesia. Others were denied care altogether. Many didn’t make it as far as the hospital before they were detained. In response, medical professionals throughout the country have forged secret units to treat those injured in the assault.

During the demonstrations on January 8th, after snipers started firing at protesters, the doctor in Tehran, whom I will call Narges, followed a trail of blood into an apartment building, where an injured woman had taken cover. Narges, a general practitioner in her thirties, fashioned a tourniquet from a head scarf to save the woman’s leg from a bullet wound. “Within twenty-four hours, I went from treating flu patients to treating war injuries,” she told me. Her phone started ringing with calls for help from the relatives or friends of the wounded. She and a friend rallied a network of young doctors and began treating people in living rooms, kitchens, and restaurants.

Over the next few days, she stocked her backpack full of essentials, such as pain medication—supplied by friendly pharmacists—and scalpels, which she sanitized in ovens and on stovetops. She had no choice but to numb herself to the butchery, the likes of which she had never seen before: a fourteen-year-old boy with rail-thin legs that had been sprayed with metal pellets; a man with a tennis-ball-size hole in his calf that she helped sew shut. “It was hell,” she told me.

The dangers to people like Narges are clear. The Iranian regime, in addition to arresting protesters, has started targeting anyone who has attempted to help them. The clampdown is part of a broader campaign by the Iranian government to reassert control over its streets amid mounting threats of war from abroad. In recent weeks, President Trump has ordered a large buildup of forces, which he has called a “beautiful armada,” close to Iran’s shores, in preparation for an attack that he warned would “be far worse” than the U.S. strikes on Iran’s nuclear sites last June. U.S. and Iranian officials held indirect discussions last Friday, in Oman, about how to de-escalate the crisis, and they are expected to continue negotiations.

Over the past several days, I spoke with a number of Iranian doctors, lawyers, and journalists, who described a campaign of quiet terror in the wake of the massacres. (For their safety and security, I have kept them anonymous, and will use pseudonyms to refer to them throughout the piece.) One thirtysomething filmmaker from Tehran said that the streets of his city had been “washed of blood, but were still dusted by death.” An activist sent me photographs that she had taken of rows of fresh graves, many marked by the same date, that continue to multiply on the outskirts of the capital. Some people told me that they were staying at home, hoarding water, generators, and dried food, in anticipation of an American bombardment. A man in Mashhad, a city in northeastern Iran where security forces massacred hundreds of protesters, said that he felt stuck between “waiting for war and preparing for prison.”

Arbitrary arrests and disappearances have increased, according to human-rights groups. “It’s a mafia-style cleanup operation,” Sanam Vakil, an Iran expert at Chatham House, a policy institute based in London, told me. She said that the regime “is trying to sanitize everything and restore law, order, and normalcy as quickly and as effectively as possible.” A source in Iran’s judicial system told me that due process in the courts appears nonexistent, leaving families with “little to no recourse.” The source said that they were receiving calls every day from parents who wanted to know if their missing children had appeared on execution lists. Their only advice to them, they said, is “to go to the court and beg for mercy.”

As the regime imposes a forced forgetting of the massacres in January, it has increasingly targeted medical workers, who have borne witness to some of the worst atrocities. Some have suffered assaults and interrogations, including Alireza Golchini, a surgeon in the northern city of Qazvin. On January 7th, he posted his phone number on Instagram, inviting injured Iranians to contact him for help. Days later, officers entered his home and beat him, before hauling him off to jail. (Golchini’s cousin told me that he is currently out on bail and awaiting trial.) Such arrests and surveillance have increased over the past few weeks, according to activists and doctors outside the country who have been tracking disappearances. One network told me that they had confirmed dozens of medical-worker arrests since the start of the demonstrations. The president of the Iranian Medical Council has said that seventeen health-care workers faced legal action in connection to the uprising, but he denied that they had been prosecuted for aiding demonstrators.

“The government is in a battle to control the narrative,” Saman Zia-Zarifi, the executive director of Physicians for Human Rights, a U.S.-based organization that documents attacks on medical workers, told me. “It knows how the truth emerges in the halls of hospitals.” The scope of the carnage has been widely obscured by an internet blackout enforced by the regime, which has admitted that more than three thousand people were killed in the unrest. Medical staff across the country have reported casualties from their wards to doctors and activists outside Iran, who have estimated that the real death toll is much higher.

The extent of the casualties will be difficult if not impossible to quantify, according to several doctors I spoke with, because the influx of cases far exceeded the capacity of many hospitals. Many patients were not admitted, and some who were admitted were not logged in hospital systems. The medical records that do exist have, in some cases, been tampered with or destroyed, either by security forces or hospital workers coöperating with the regime. Medical workers sympathetic to the uprising, meanwhile, have also changed the names and injuries listed on some patients’ medical charts, to protect their identities from authorities.

Medical workers have begun quietly doing their own record-keeping. One hospital employee in the northern city of Rasht told me that he had photographed hundreds of pieces of evidence, including CT scans and X-rays, from two emergency wards where he had volunteered during the massacre. “I want the world to know that these people existed, and that they have paid a price for their freedom,” the employee, who I will call Anush, told me. So far, he has collected records for nearly five hundred admitted patients, the majority of whom suffered trauma injuries. The images and scans, which he shared with me, compose an eerie tableau of the dystopian scenes that he witnessed in January: one X-ray showed a bullet that shattered the femur of a forty-seven-year-old mother, who had tried to shield her son from gunfire. One brain scan showed a metal pellet, which had partially blinded a nurse after she was shot in the head while exiting the hospital. “The wards felt like a war zone, run by regime thugs,” Anush said. Agents in plain clothes followed protesters into operating rooms, then detained them when they had completed their medical treatment. On several occasions, Anush said that he saw officers intervene during a surgical procedure, resulting in scuffles with medical staff. A medical intern was hospitalized after he was shot with metal pellets at close range.

He recalled a mother rushing into the ward to show surgeons and nurses a photograph on her phone of her missing son. Soon after she left, officers dragged in a corpse, which “had the face of that mother’s son,” Anush said. He recognized the man easily from the photo she had shown him. “His hands were bound and there was a bullet wound in his head.”

Once it became clear that the emergency wards themselves weren’t safe, “many colleagues started calling in sick—or not showing up for their shifts,” Anush said. He began volunteering at a privately owned clinic, which was filled with injured people. And yet word of the clinic’s existence soon reached security officers, who vandalized it and interrogated the doctor who ran it.

For many of the wounded, the threat of disappearing into Iran’s prisons far outweighs the risks of forgoing medical help. The problem has been especially grim in remote regions, where private clinics are scarce, and patients must travel long distances to get care. Volunteers have organized medical convoys and ferried patients across the country to safe operating rooms.

On a recent January evening, a team of volunteers set out to collect protesters from a city in northern Iran, where they were stranded in their homes with trauma wounds that they had sustained earlier that month. The protesters needed to be transferred to private hospitals, which were better equipped, and where specialists could operate on them. Several of the wounded had bullet holes in their legs or feet. One young woman, who had been struck in the eye by a rubber bullet, was at risk of going blind.

The convoy’s destination was another city, about two hundred miles away. Relatives of the injured drove ahead, in separate cars, and alerted the convoy to checkpoints or police who patrolled intersections along their route. “It was stressful,” one of the volunteers told me. “It was a long drive, and they had a lot of pain.” The driver, nicknamed Renas, tried to keep pace while avoiding potholes. He played music, and sang folk songs to “distract them from their fear—and from mine.” Five hours later, just before sunrise, he delivered the injured to another team of volunteers, who escorted them into safe houses before they could draw attention from police. “I was relieved,” Renas told me. But they did not arrive in time to save the young woman’s eye, which was removed by an ophthalmologist days later. “We are fighting with a wooden spoon,” he said, “against a government that is armed to the teeth.”

The group that organized the convoy was connected to a broader network of nurses, doctors, and volunteers, which had been coördinating dozens of surgeries for protesters marooned in their homes, in obscure corners of the country. One of the main organizers was a surgeon, whom I will call Karim. He had directed an undercover group of medical professionals since 2018, through several political uprisings. A few years ago, he was detained by security agents, after they discovered he was operating on demonstrators. Fear of imprisonment had not deterred him from reactivating his network in January, shortly after a gunman sprayed him with plastic pellets in Tehran. “I knew that I had to do something,” he said. “The brutality this time was different. These officers were shooting to finish a generation in the streets.”

Karim had treated patients in their homes, hospitals, and cafés across five cities. He shared CT scans he had stored on his phone of patients who died in surgery. He recalled one man whose neck had been sliced by a machete, severing both his carotid and vertebral arteries. “For every one I could not save, I see my own children,” Karim said. “I am in a battle for their future.” The cases he had encountered across the country haunted him, even more than the prospect of war.

Some feared that a foreign attack would give the regime more pretext to direct violence toward its own civilians, and to execute prisoners en masse. This would place even more of a strain on the medical community: many hospitals had already run out of blood and basic medications, Karim told me, leaving doctors unprepared for another influx of injuries. Yet he echoed the enthusiasm that I heard from many Iranians who welcomed foreign intervention. “We are already in a war with our own government—there has been so much death,” he said. “These people will take the hand of anyone offering to pull them from drowning. Literally anyone.” ♦