Many previous red lines are getting crossed as the humanitarian toll of the Iran war mounts.

3 April 2026 – Mukesh Kapila

First published 3 April at The National

As the war between the US-Israel alliance and Iran continues, its destructive, disruptive and degrading human consequences are accelerating. All wars do that, but this one has particular features with worldwide impact.

As the war enters its second month, at least 2,000 people have been killed and 20,000 injured in Iran. More than 1,300 people have also been killed and around 3,500 wounded in the war’s secondary theatre in Lebanon. Iranian counter-attacks have killed dozens and injured scores of American combatants, civilians in Gulf countries and Israel, as well as mariners in the Strait of Hormuz.

As always, civilians bear the brunt even if they are largely collateral casualties of the deployment of the most powerful bombs and missiles known in modern warfare. How high the toll will reach depends not only on the war’s uncertain duration but on tactics.

These will inevitably shift when the US and Israel, frustrated by not achieving a quick victory, intensify their firepower, while Iran digs in and lashes out. The lethality of the violence that has already touched a dozen neighbouring countries caught between the main protagonists may not remain limited, if they suffer yet more losses. Or, if the Houthis in Yemen open another front across the Red Sea.

Around 100,000 sites have been moderately or severely damaged across the region, overwhelmingly in Iran and Lebanon. Increasing damage to medical, food, education, water, electricity, fuel and shelter infrastructure is anticipated. This is partly because such collateral damage is very difficult to avoid in the urbanised theatre of war where armed and unarmed actors function side-by-side.

In any case, despite the prohibitions of international humanitarian law, civilian-military boundaries tend to blur in prolonged or asymmetric conflicts that morph into grim whole-of-society struggles. Ideologically driven Iran is already of that mindset, having suffered economic coercion via sanctions and embargoes for many years.

The indirect consequences of war always exceed direct casualties. Thus, the impoverished and degraded living conditions for millions of Iranians and Lebanese will increase future mortality and morbidity. And, in Iran and Gulf states, toxic air, water and soil pollution from destroyed oil and industrial infrastructure particularly affects the elderly, the young and those with pre-existing medical conditions. Iran and Israel are additionally vulnerable if their nuclear facilities are damaged and release radiation.

However, the most acute humanitarian consequences are felt by uprooted populations. They number 3.2 million in Iran and are likely to double if the war continues at current pace. Spillover into neighbouring countries is currently modest because Israel-US bombardments have been geographically focused and people have escaped internally. Besides, Iran imposes strict exit controls and neighbours – especially Turkey, Iraq and Pakistan – face political, economic and security pressures that make them reluctant to welcome Iranian refugees.

The situation of other refugees is more perilous. Iran has pushed back two million Afghan refugees since last year with numbers accelerating since this war started. They join a million others returned from Pakistan to face a tough life in Afghanistan, complicated further by armed hostilities between the neighbours.

There is nowhere safe amidst the renewed Israeli-Hezbollah confrontation in Lebanon that has already displaced more than a million people, a fifth of the population. Many are repeat displacements. Also spurred to return to their own fragile state are 125,000 Syrians. Around 7,000 Lebanese refugees have joined them with numbers expected to increase.

Obviously, the newly displaced, refugees and returnees have humanitarian priority. The UN has launched a $308 million flash appeal for Lebanon while the International Federation of Red Cross and Red Crescent Societies has asked for $50 million for Iran. That is on top of previous appeals for ongoing crises in the Middle East and West Asia.

The international response to new demands is muted. Earlier donor cuts have obliged UN and other agencies to trim capacities and undergo a massive “humanitarian reset”. With much trust also frittered away, there is less appetite for the additional humanitarian effort now required.

The politics that accompany all crises is also in play. Sympathy for Iran’s suffering is stretched in view of the Islamic Republic’s brutality towards its own citizens, restrictive access, hostile rhetoric against the west and reckless attacks on its Islamic neighbours who worked hard to prevent this war.

Gaza is an egregious political casualty, the condition of its besieged population as bad as ever. It only had minimal humanitarian access despite promises under US President Donald Trump’s 15-point peace plan. That has further eroded after Israel tightened control when Hezbollah joined Iran’s attacks.

There are additional negative impacts for other crises. With political attention diverted to the Middle East, efforts to resolve the wars in Sudan and the DR Congo, and the Russia-Ukraine war, are overshadowed, deepening their associated humanitarian suffering.

The war’s humanitarian ramifications extend wider still. Dubai Humanitarian City and its related ports and airports are the world’s largest hub for receiving, storing and forwarding essential emergency supplies. It normally holds over $220 million of stock to serve more than 80 countries. The world’s biggest aid agencies rely on this, and hampered air and maritime transport routes have affected life-saving deliveries of foodstuffs, medicines and vaccines around Africa and Asia. The impacts are already felt in crisis-torn Sudan, Yemen, Somalia and Afghanistan.

The war’s worldwide economic fallout translates directly into additional humanitarian pain. Sharply reduced oil and gas production and flows through the Strait of Hormuz have precipitated a grave energy crisis affecting all sectors, including via a projected 2 per cent rise in global inflation and one per cent decline in manufacturing output.

Global food security is immediately impacted. Petroleum byproducts provide feedstock for fertilisers, without which crop yields plummet. Costlier farming inputs and transport via longer and more expensive routes translate into an additional 45 million acutely hungry and malnourished people.

Meanwhile, rich countries face budgetary pressures as they mitigate impacts on their own populations and afford less to relieve humanitarian suffering elsewhere. The social safety nets of poor countries struggle with reduced purchasing power from the persistent downward pressure on their currencies and increased joblessness as enterprises falter.

Populous countries like India, Indonesia, Bangladesh and the Philippines are already suffering as energy and financial constraints bite into the coping capacities of their teeming millions who were barely managing beforehand. That is not helped if migrant workers in Gulf countries are unable to return to work and send money home. Their remittances were worth more than $130 billion in 2023.

In short, increased poverty and suffering from the war are inevitable not just in Iran and Lebanon but worldwide as the globalised interconnections via the Gulf that brought prosperity and progress flip into crisis-spawning vulnerabilities. Only a small part of that can be mitigated through limited available humanitarian resources.

What are the implications for global stability when the volume of unmitigated human suffering rises fast and furiously? At the least, it challenges universal norms around humanity. If they break more fully than is already the case, more red lines will get crossed. Such a scenario in the context of a changed international order with broken guardrails takes us into yet more risky territory.

That is why the humanitarian dimensions of the Middle East war deserve greater and more concerted attention even while comprehensive permanent solutions – not just ceasefires – are sought.