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Iran
Risk:
Very High
Health Overview
Do not travel. Iran is Level 4 with five risk indicators — unrest, terrorism, kidnapping, wrongful detention and other. The US-Israel war with Iran began February 28 2026 and remains unresolved: the 14-point Memorandum of Understanding signed June 17 2026 expired August 17 2026 with no permanent agreement, and Iran's foreign minister states there is no ceasefire in effect. The Strait of Hormuz remains contested. Separately and independently of the war, the State Department warns that having a US passport or connections to the United States can be reason enough for Iranian authorities to detain someone. There is no US Embassy, and the Swiss Foreign Interests Section in Tehran — which normally handles US matters — is temporarily closed until further notice; the working contact is the US Embassy in Bern, Switzerland at +41-31-357-7011. Iran does not recognize dual nationality: dual US-Iranian nationals are treated solely as Iranian citizens and are denied consular access even when it is available to others. Clinically, malaria chemoprophylaxis is recommended for Sistan-Baluchestan Province near the Pakistan border, and US sanctions mean non-Iranian cards do not work while hospitals require cash upfront.
Key Health Risks
Very High
Wrongful Detention of US Citizens
'Iranian authorities unjustly detain US nationals without warning or evidence they committed a crime.' 'Having a US passport or connections to the United States can be reason enough.' Dual US-Iranian nationals treated ONLY as Iranian citizens, and Iran will not permit Swiss consular officers to visit detained dual nationals. There is no US Embassy to provide assistance, and the Swiss Foreign Interests Section in Tehran — which normally handles US matters — is temporarily closed until further notice. The working contact is the US Embassy in Bern, Switzerland at +41-31-357-7011. Iran has also imposed exit bans preventing US citizens from leaving.
Very High
Active Armed Conflict — US-Iran War (since Feb 28 2026)
The US-Israel war with Iran began February 28 2026 and remains unresolved as of August 2026. Sequence: an initial two-month air campaign; a two-week ceasefire agreed April 8 2026 and extended indefinitely April 21; a 14-point Memorandum of Understanding signed June 17 2026 (mediated by Pakistan — the 'Islamabad Memorandum') that formalized a ceasefire, ended the US naval blockade, reopened the Strait of Hormuz, and opened a 60-day negotiating window. The MoU broke down within weeks: Iran struck commercial vessels that bypassed its approved Hormuz route, the US answered with strikes on Iranian coastal and military targets, and on July 7-8 the US declared the agreement over and struck roughly 90 military targets. The 60-day MoU expired August 17 2026 with no permanent deal; the US declined to extend it. Iran's foreign minister has stated there is no ceasefire in effect. The Strait of Hormuz remains contested — both sides claim control and the US has fired on commercial shipping it deems in violation of its blockade. Iran has repeatedly struck Gulf states hosting US bases, including Bahrain and Kuwait. Note also that Iran's leadership changed during the war: Supreme Leader Ali Khamenei was killed in February 2026 and Mojtaba Khamenei now holds the position; Masoud Pezeshkian remains president. Verify current status immediately before any decision — this situation changes week to week.
High
Terrorism and Unrest
Terrorist groups active. Domestic unrest (Woman; Life; Freedom movement and ongoing civic tensions). Kurdish areas (western Iran) and Baluchistan (southeast) have elevated terrorism/kidnapping risk.
Health Risk Callout
Iran is the most dangerous Level 4 destination for US citizens. DO NOT TRAVEL THERE
Other Health Risks
Crimean-Congo hemorrhagic fever (tick-borne and via infected body fluids — a viral hemorrhagic fever that belongs on the differential for any febrile returning traveler with tick exposure or animal contact); MERS (listed by CDC for Iran; camel contact and close contact with infected people); Tuberculosis; Leishmaniasis (sand fly); Hantavirus (rodent urine, droppings and saliva); Leptospirosis and melioidosis (contaminated fresh water, mud and soil, particularly after heavy rain); Schistosomiasis (contaminated fresh water); Payment access (non-Iranian credit and bank cards do not function in Iran, there is no Western Union and bank transfers are not possible, while hospitals require payment upfront); Road traffic injury (the second highest cause of mortality in the country per the State Department); Air pollution (significant in Tehran, Ahvaz and Zabol); Extreme heat (southern Iran exceeds 122°F in summer)
Regional Information
Regional Risk Callout
Uniformly Very High risk for US citizens throughout Iran. Tehran: all services but detention risk. Isfahan; Shiraz; Persepolis: extraordinary cultural sites but same detention risk. Border areas (Iraq; Afghanistan; Pakistan; Azerbaijan; Turkmenistan): elevated security risks. Kurdish areas (west): additional unrest. Baluchistan (southeast): terrorism and kidnapping.
Regional Healthcare Callout
Academic only. Tehran has functional private hospitals, but access is limited by payment rather than capability — non-Iranian cards do not work, there is no Western Union or bank transfer, and hospitals require payment upfront. Public clinics lack basic resources and supplies. Medical staff may speak little or no English. There is no US Embassy, and the Swiss Foreign Interests Section in Tehran is temporarily closed; the working contact is the US Embassy in Bern at +41-31-357-7011. Active military hostilities.
Vaccine and Malaria Prevention
💉 Entry Vaccine Required
No vaccine required for direct travel from the United States. Yellow fever vaccination is required for travelers 9 months and older arriving from countries with risk of yellow fever virus transmission, including airport transits or layovers longer than 12 hours in those countries — verify the full routing, not just the destination. A tourist visa is required except for Kish Island. Note separately that per the State Department, holding a US passport or having connections to the United States can itself be grounds for detention.
🛡️ Recommended Vaccines
CDC recommends routine vaccines including MMR, DTaP/Tdap/Td, polio, varicella and influenza, plus COVID-19 for all eligible travelers. Hepatitis A for all unvaccinated travelers one year and older. Hepatitis B for unvaccinated travelers under 60. Typhoid for most travelers to Iran. Rabies pre-exposure worth serious consideration — CDC notes infected dogs are commonly found in Iran and that post-exposure vaccine may only be available in larger suburban and urban medical facilities. Malaria chemoprophylaxis for Sistan-Baluchestan Province along the Pakistan border. Yellow fever is not recommended by CDC and is not required for direct travel from the United States, but is required for arrivals from countries with risk of YF transmission. Discuss all of the above with your Dr. prior to travel.
🦟 Malaria Information
- Risk Level: Low
- Areas: Recent outbreaks in Sistan-Baluchestan Province near the border with Pakistan. Previous transmission March–November in rural areas of Fars Province, Sistan-Baluchestan Province, and the southern tropical parts of Hormozgan and Kerman Provinces. No transmission in Tehran, Isfahan, Shiraz or the northern provinces.
- Recommended Drug: For Sistan-Baluchestan Province along the Pakistan border, CDC recommends atovaquone-proguanil, doxycycline, mefloquine or tafenoquine. For all other areas of previous transmission, no chemoprophylaxis is recommended — insect bite precautions and mosquito avoidance only.
- Drug Resistance: Yes — chloroquine
The species mix is unusual and clinically relevant: approximately 90% P. vivax and 10% P. falciparum. A predominantly P. vivax picture raises the question of relapse from dormant liver stages, so terminal prophylaxis with primaquine or tafenoquine may be discussed for travelers with significant exposure — G6PD testing is required before either. Chloroquine resistance is documented and chloroquine should not be used for prevention.
Low
Physician Note
Dr. Robert
Emergency Medicine · 25+ Years · 40+ Countries
I do not recommend travel here currently. There is no U.S. Embassy in Iran, and the Swiss Foreign Interests Section in Tehran — the channel that normally handles U.S. matters — is temporarily closed. The working contact is the U.S. Embassy in Bern, Switzerland, at +41-31-357-7011.
Two things matter beyond the security picture. First, non-Iranian credit and bank cards do not work in Iran at all, there is no Western Union, and bank transfers are not possible — while hospitals require payment upfront in cash. That combination, rather than the quality of the medicine, is what most often stops a traveler from getting care. Tehran's private hospitals are competent; paying for them is the problem.
Second, malaria is not absent here. CDC recommends chemoprophylaxis for Sistan-Baluchestan Province along the Pakistan border, where recent outbreaks have occurred — atovaquone-proguanil, doxycycline, mefloquine or tafenoquine. Roughly 90 percent is P. vivax and chloroquine resistance is documented.
Road traffic injury is the second leading cause of death in Iran, and the State Department notes an injured traveler may reach a hospital faster by taxi than by ambulance. Dual U.S.-Iranian nationals are treated as Iranian only and receive no consular access.
Pre-Departure Checklist
8+ Weeks
- Advisory status first: Iran is State Dept Level 4, Do Not Travel, issued 5 December 2025, with five risk indicators. A US passport is itself grounds for detention per the State Department. Confirm whether the trip should proceed at all before working through the rest of this checklist.
- CDC recommends routine vaccines including MMR, DTaP/Tdap/Td, polio and varicella, plus COVID-19.
- Hepatitis A — recommended for all unvaccinated travelers one year and older.
- Hepatitis B — recommended for unvaccinated travelers under 60.
- Typhoid — recommended for most travelers to Iran.
- Rabies pre-exposure — infected dogs are commonly found in Iran and post-exposure vaccine may only be available in larger suburban and urban facilities.
- Malaria chemoprophylaxis if the itinerary includes Sistan-Baluchestan Province near the Pakistan border — atovaquone-proguanil, doxycycline, mefloquine or tafenoquine, with G6PD testing before tafenoquine.
- Yellow fever certificate if arriving from a country with YF risk, including transits over 12 hours.
- Discuss all of the above with your Dr. prior to travel.
2–4 Weeks
- Establish a proof-of-life protocol with family.
- Ensure will and power of attorney are current.
- Understand that there is no US embassy and that the Swiss Foreign Interests Section in Tehran is temporarily closed — the working contact is the US Embassy in Bern.
- Carry a complete medication supply from home. Non-Iranian cards do not work and hospitals require cash upfront, so carry sufficient cash for any care you might need.
- Audit electronic devices and social media before travel.
Day Of
- State Dept 24/7: +1-202-501-4444
- US Embassy Bern, Switzerland: +41-31-357-7011 (main and after-hours). The Swiss Foreign Interests Section in Tehran is temporarily closed.
- Emergency numbers in Iran: 115 ambulance; 110 police; 125 fire.
- Do not photograph government, military or security sites.
- Assume all communications are monitored.
- Dual nationals are treated as Iranian only.
Trip Type Guidance
No trip types appropriate. Level 4 with active military hostilities and wrongful detention risk. For compelling circumstances: State Dept 24/7 +1-202-501-4444 before any Iran travel.
Notes
Special Evacuation Notes
CRITICAL: there is no US Embassy in Iran, and the Swiss Foreign Interests Section in Tehran is temporarily closed until further notice — the working contact is the US Embassy in Bern, Switzerland at +41-31-357-7011 (main and after-hours). The US-Iran war that began February 28 2026 remains unresolved; the June Memorandum of Understanding expired August 17 2026 and strikes have continued. Medical evacuation is extremely complicated by active hostilities, contested airspace, the disputed Strait of Hormuz, and sanctions — several evacuation providers will not operate in Iran at all. Confirm in writing that any provider will actually fly before relying on coverage. Ambulance response and training are described by the State Department as poor and ambulances are not well equipped; an injured traveler may reach a major hospital faster by taxi. State Dept 24/7: +1-202-501-4444.
Safety Notes
DO NOT TRAVEL. Active armed conflict: the US-Iran war began February 28 2026 and is unresolved as of August 2026 — the June 17 Memorandum of Understanding expired August 17 2026 without a permanent deal and no ceasefire is currently in effect per Iran's foreign minister. Strikes and counter-strikes have continued through July and August; the Strait of Hormuz is contested and the US has fired on commercial shipping. Wrongful detention is the separate and equally serious risk: per the State Department, a US passport alone can be grounds for detention. There is no US Embassy, and the Swiss Foreign Interests Section in Tehran is temporarily closed until further notice — the working contact is the US Embassy in Bern at +41-31-357-7011. Dual nationals are treated as Iranian only and receive no consular access. Sanctions complicate payment, communication, insurance, and evacuation. Border regions (Iraq, Afghanistan, Pakistan, Azerbaijan, Turkmenistan) carry added risk; Kurdish areas in the west and Baluchistan in the southeast carry elevated terrorism and kidnapping risk.
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