While a number of reports in recent weeks have focused on efforts to formally revoke the right of access to legal representation in “national security” cases, even more recent reports point to a growing number of instances of political prisoners being barred from accessing potentially life-saving medical services.

Last Tuesday, human rights groups reported upon the case of Sanaz Allahyari, a journalist who has been detained since January 9 on the basis of her professional reporting and activism. Her time in Evin Prison has reportedly given rise to worsening health conditions, with symptoms including physical weakness, chills, stomach pains, and weight loss. Despite authorities’ awareness of this situation, Allahyari has been refused permission to receive even so much as a simple check-up outside the hospital. After purchasing over-the-counter medicine for the prisoner and being rebuffed by the Tehran public prosecutor, her family attempted to hand-deliver a letter to parliamentary lawmakers asking for an investigation, only to find that no one would read it.

Prison authorities have insisted to those family members that the symptoms in question are not serious enough to warrant furlough or specialized treatment. But the history of Iran’s coordinated medical deprivation is filled with examples of prisoners who have been refused medical attention in the early stages of an illness, only for it to develop into something much worse, resulting in permanent health effects, surgical disfigurement, or even death. In September 2017, the journalist Alireza Rajaee became something of a poster image for this particular human rights issue when he lost an eye and part of his jaw as a result of cancer surgery, after a growing tumor went untreated for many months of political imprisonment.

In cases where the denial of treatment is justified with reference to the supposedly non-serious nature of the illness, it is difficult to know whether the mistreatment is deliberate or just the result of overcrowding, ignorance, inadequate training, or ordinary cruelty. In any event, the human rights effects are the same. But it Allahyari’s case, allegations of deliberate mistreatment are substantiated by the nature of the charges against her and also by the fact that her medical deprivation is not the only issue that is known to have affected her.

As a precursor to the aforementioned ban on legal representation, Allahyari was one of many political prisoners who were forced to choose lawyers from a list that had been pre-approved by prosecuting authorities. However, human rights groups report that in her case, rather than complying with the demand, Allahyari opted to allow her case to proceed without defense counsel.

Her trial is still pending, but it is extremely likely that he will face a multi-year sentence along with her co-defendants: two fellow reporters and her husband, who is also the editor-in-chief for Gam, a news channel on the Telegram messaging app. The group faces charges of “assembly and collusion against national security,” “forming groups with the intention to disturb national security” and “contacts with anti-state organizations.”

Another well-known instance of medical deprivation came days before the Allahyari story. Well-known human rights activist Narges Mohammadi, who has suffered a range of health problems since she began serving a 16-year prison sentence in 2015, has recently developed a severe infection following a brief transfer to hospital during which she underwent a hysterectomy.

The infection shines a light upon another aspect of the judiciary’s use of medical access as a tool of reward and punishment. Frequently, the targets of extrajudicial punishment are permitted enough specialized medical care to forestall death or to give the impression that the prisoner is being cared for, but not enough to permanently correct the underlying issues. In Mohammadi’s case, the high risk of infection was well known at the time of the procedure, and doctors recommended that she spend a month recovering either in hospital or at home. Instead, the authorities returned her to her cell after one week.

Far from allowing her to return to hospital after the infection developed, those authorities have reportedly barred her from even taking antibiotics. And in an apparent effort to exert pressure on the prisoner’s family as well as the prisoner herself, prison officials have provided her husband and children with little to no information about her condition, have cancelled scheduled phone calls, and have prevented Mohammadi from having direct contact with her husband.

Iran is a signatory to multiple international conventions that affirm these standards, and yet the theocratic regime has unilaterally declared that it is exempt from any provisions that are deemed to contradict Iranian law or sharia law. In this way, the regime has continually sought to justify the execution of juvenile offenders and other vulnerable groups, despite widespread outcry over the violation of international law.

In some cases, the judiciary has also sought to minimize this outcry by ordering the review of cases where capital sentence has been passed on persons who were under the age of 18 at the time of their alleged crimes. This review generally entails forensic examination to determine the mental maturity of the defendant. But in almost all such cases, the appeals court has upheld the original sentence after insisting that forensics confirmed the applicability of capital punishment. In still other cases, no such forensic examination has been ordered, and all danger of legal constraints have been avoided, regardless of age, mental illness, or any other deficiency.