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People and the world, Article

Who bears the costs? Sanctions and the Global South

· Helfen statt Blockieren editorial team

Most sanctions are decided in Washington, Brussels and New York. Many of the people who live with their consequences live in Latin America, Africa, Asia and the Middle East. How large the costs are is disputed in research. What is certain is where they arise: in the money families send, in medicines, in wages and food.

54countries were under sanctions according to a 2024 count, around 27 percent of all countries with 29 percent of the world economyRodríguez, Journal of Economic Studies, 2024
564kdeaths a year (exactly 564,258) are associated by one study with sanctions of individual states; range 367,838 to 760,677Lancet Global Health, August 2025
3.5 billionUS dollars of Afghanistan’s frozen reserves were allowed in 2022 to go to a fund in GenevaUS Treasury, 14 Sep 2022
4.3 millionpeople in Niger urgently needed aid in December 2023 while sanctions of the West African community appliedOxfam, 12 Dec 2023

Who is under sanctions

In 2024 the economist Francisco Rodríguez counted how many countries are affected by sanctions: 54, around 27 percent of all countries, together accounting for 29 percent of the world economy. In the 1960s it was about 4 percent of countries. The number of cases has also risen: the Global Sanctions Data Base counts 615 active sanctions cases for 2023, after 181 in 2010; 46.5 percent of them were imposed by the US. Behind each case are countries whose hospitals, schools and workshops have to buy, pay and plan differently. Of 31 quantitative studies he reviews, 30 found negative effects on income, poverty, inequality, mortality or human rights. How the number of sanctions has developed since 1950 and who imposes them is shown in the lead article “Who blocks whom”.

The dispute: how many deaths?

In August 2025 The Lancet Global Health published a study by Francisco Rodríguez, Silvio Rendón and Mark Weisbrot. It analyses age-specific mortality in 152 countries from 1971 to 2021 and uses several methods to separate cause from chance. Its result: sanctions of individual states are associated with around 564,258 additional deaths a year, with a range of 367,838 to 760,677, most strongly among children under five. For UN sanctions the authors found no statistical evidence.

The figure should be taken seriously and read with care. It is based on observational data; countries that are sanctioned are often already in crisis or war. The study was funded by the Center for Economic and Policy Research, of which Weisbrot is co-director and which has criticised sanctions for years. And it contradicts another peer-reviewed study: in 2021 Gutmann, Neuenkirch and Neumeier found that UN sanctions lower life expectancy much more than US sanctions, and women more than men. Most studies find that sanctions harm health; how strongly, and which sanctions most, is not settled. A review in BMJ Open from October 2026 found harm in 42 of 43 studies on US sanctions, but called the quality of the studies variable.

The path of money

For many families in the South, money from relatives abroad is the most important income. In 2024 low- and middle-income countries received 685 billion US dollars according to the World Bank estimate, most of it South Asia and Latin America. Where sanctions apply, this path becomes narrower and more expensive: banks withdraw, transfer operators lose their accounts. Why is described in the article “Banks worldwide”.

Remittances to low- and middle-income countries, 2024

Billion US dollars by region, World Bank estimate. Total 685 billion US dollars.

RegionBillion US dollars
South Asia207
Latin America and Caribbean163
East Asia and Pacific136
Europe and Central Asia64
Middle East and North Africa58
Sub-Saharan Africa56

Source: Ratha, Plaza, Kim, World Bank blog “People Move”, 18 Dec 2024, table 1 (2024 estimate). File daten/weltbank_rueckueberweisungen_2024.csv.

Cases from four world regions

Afghanistan shows how quickly wages stop when money stops. After the Taliban took power in August 2021, payments by development agencies and financial institutions ended; the Red Cross took over the salaries of nearly 10,500 staff in 33 hospitals. Of the central bank’s frozen reserves, the US approved up to 3.5 billion US dollars in September 2022 for a fund in Geneva meant to make targeted payments, for example for electricity imports.

Niger shows that sanctions are not a tool of the North only. After the coup in July 2023 the West African economic community ECOWAS imposed sanctions and closed borders. The UN refugee agency warned that the sanctions had no humanitarian exemption. In December 2023 Oxfam counted more than 4.3 million people in urgent need and 185,000 children who could no longer reach treatment for malnutrition. In February 2024 the community lifted the sanctions.

Syria is the case that now shows what comes after sanctions. The US revoked its sanctions programme on 30 June 2025 and repealed the Caesar Act in December 2025. President Ahmad al-Sharaa spoke of “the first day that Syria is without sanctions”. Whether and how quickly supply and wages recover cannot yet be shown.

Medicine and food: permitted, but hard to get

Almost everywhere food and medicines are exempt, and still they are missing. In 2019 Human Rights Watch documented for Iran that a European manufacturer stopped selling special wound dressings for about 800 people with the skin disease epidermolysis bullosa, and that a children’s cancer centre lacked three chemotherapy drugs on the WHO list in May 2019. In Venezuela Mark Weisbrot and Jeffrey Sachs attributed tens of thousands of deaths to US sanctions from 2017; Ricardo Hausmann and Frank Muci countered that oil output and imports of food and medicine had collapsed before the sanctions, imports by more than 80 percent. The dispute shows how hard it is to separate sanctions from mismanagement. Why what is permitted still gets stuck is described in the lead article “Permitted and still blocked”.

Cases from four world regions
Region and caseMeasureDocumented consequenceWhat stands against or alongside
AfghanistanDonor and financial institution funding halted, reserves frozen (2021)ICRC paid salaries of nearly 10,500 staff in 33 hospitalsPart of the reserves in a fund for targeted payments since 2022; UN exemption for aid since December 2021
NigerSanctions of the West African community after the coup (2023)UNHCR: no humanitarian exemption; Oxfam: 185,000 children without access to malnutrition treatmentResponse to a coup; sanctions lifted on 24 Feb 2024
SyriaComprehensive US and EU sanctions since 2011After the 2023 earthquake a dedicated US general licence for 180 daysUS programme revoked on 30 Jun 2025, Caesar Act repealed in December 2025
IranUS sanctions, tightened in 2018HRW: special dressings for about 800 patients no longer supplied, chemotherapy drugs missing (2019)US cites nuclear and missile programmes; food and medicine formally exempt
VenezuelaUS financial and oil sanctions from 2017 and 2019Disputed: CEPR attributed tens of thousands of deathsHausmann and Muci: oil output and imports collapsed before the sanctions
CubaUS embargo, tightened in 2026Western Union stopped (2025), reportedly about 200 banks withdrewPayment route via firms under military control; 1,351 political prisoners (September 2026)

Sources: see list of sources; for Iran and Venezuela the in-depth chapters on this website.

Cuba: the same calculation, two responsible parties

What the table shows for Latin America applies to Cuba: the US embargo hinders payments, imports and credit; some 200 foreign banks have reportedly ended their relations, according to information given to the UN Special Rapporteur. At the same time the Cuban leadership has routed remittances through firms that press reports describe as military-controlled, and it persecutes critics: 1,351 political prisoners in September 2026 according to Prisoners Defenders. According to the statistics office, the population fell to 9.4 million by the end of 2025. Details are in the lead article “Cuba 2026 as a case” and the topic sheet “Migration as a consequence”.

Two perspectives

What those who impose sanctions say

Sanctions respond to war, coups, nuclear programmes or grave human rights violations; the alternative is often not trade but military force or looking away.

Almost all programmes exempt food and medicine. Economists such as Hausmann and Muci argue that in Venezuela oil output and imports collapsed before the sanctions.

What those affected and critics say

Exemptions on paper help little when banks and suppliers withdraw; that hits people, not governments.

In 2025 the UN Special Rapporteur Alena Douhan wrote that de-risking and over-compliance had considerably aggravated the humanitarian situation in Cuba. In 2026 the UN General Assembly called for the 34th time for an end to the embargo; 130 states voted in favour, 17 against.

This piece is information, not legal, investment or health advice. It makes no diagnoses. It reflects the view of the editorial team, relies on the sources listed and names opposing positions. “Helfen statt Blockieren” is non-partisan.

Sources

All online sources accessed on 3 November 2026. Data files for checking: daten/ of this series.

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