Médecins Sans Frontières (MSF) has been working in Darvazeh Ghar, one of Tehran’s poorest neighborhoods, south of the Grand Bazaar, for more than a year. Merchants, hurried customers and street vendors rub shoulders with drug addicts, prostitutes and street children there. Obtaining medical care can be particularly difficult for these highly at-risk populations.
Tehran is a megalopolis of more than 12 million residents and stretches approximately 20 kilometers from north to south, seemingly poised to swallow the mountain. Leaving the northern part of the capital under a sky hazy with pollution, drivers should expect to spend time in bumper-to-bumper traffic, staring at the murals lining the highway. In just under an hour (depending on the traffic), the car passes through part of the Grand Bazaar and in front of the train station and then enters the maze of Darvazeh Ghar’s tiny streets, finally reaching a handsome three-story brick building, where MSF's clinic is housed.
“Most people like me don’t know Darvazeh Ghar,” says MSF midwife, Mona. “They come as far as Molavi Street to buy their curtains and then they leave. When I tell my family and friends that we have a clinic here and that we treat drug addicts, prostitutes and lots of very poor people, they can’t believe it.” The Grand Bazaar draws all kinds of business and day workers survive on small handling or construction jobs. 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 further to the Ministry of Health clinics,” Mona explains. “We treat them here and it’s all free.” Marginalized, stigmatized, sometimes fearing to be arrested or jailed, these women do not carry the identity papers that would allow them access to the Iranian public health system. Mona sees approximately 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 and that we are here for them. This is the only place where they can receive the medical care they need.” Zarha is in charge of triage. She examines all the patients and assigns them priority based on the seriousness of their medical condition. This can be a source of tension in the waiting room, where you can’t assume that women in full black chadors and others in bright red lipstick will sit patiently next to each other.
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 fits. Shukrieh married at 17. “I didn’t become an addict in my husband’s home. I was already addicted when I lived with my mother. She and my brothers were addicts.”
She goes to the center every day to receive her methadone. “I used to take 25 pills but now I swallow three teaspoons of syrup. But if I get there too late, they won’t give it to me.” To restore the women’s sense of order – which many of them have lost – the clinic has fixed hours for administering methadone. If a woman arrives too late, she must wait and come back the next day. “The house is overrun with mice and there are cracks everywhere. But 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.