The latter report also focused upon the issue of Iran’s usage of the death penalty, which is more frequent in that country, relative to total population, than in any other country on Earth. Iran Human Rights Monitor determined that at least 42 executions had been carried out in September alone, although only about half of these were acknowledged by the Iranian government. The regime’s selective secrecy leaves open the possibility that figures for any given month are incomplete, as some killings may not have been revealed to human rights advocates through independent channels.

It is estimated that about 3,500 executions have taken place since Iranian President Hassan Rouhani took office in 2013 on promises of moderation and greater domestic freedoms. Those promises were repeated during Rouhani’s successful reelection campaign in May of this year, although no recognizable human rights initiatives had been put into effect during his first four-year term. Despite this fact, Rouhani has publicly claimed that his administration made significant strides, increasing levels of domestic satisfaction.

This position was evident in Rouhani’s September 20 speech to the United Nations General Assembly, which the NCRI identified as “dismissing claims that there was a problem” in the country and doing so on the same day that 14 death sentences were being carried out at once. Shirin Ebadi, the co-founder of the Defenders of Human Rights Center, called attention to this apparent hypocrisy in a statement accompanying the release of her organization’s report.

According to IranWire, Ebadi pointedly accused the Iranian president of lying about the country’s human rights system. She also noted that to the extent that Rouhani acknowledges the existence of political prisoners and questionable judicial practices, he tends to blame these incidents on the judiciary and the Intelligence Ministry, despite the fact that his office wields considerable influence over both, especially the Ministry, the head of which is part of his personally-appointed cabinet.

The DHRC report indicates that between August 23 and September 22, at least 75 civil and political activists were arrested by Iranain security forces. Many went on to receive illegal sentences. Certain political crimes including “enmity against God” can be legally punished with death in the Islamic Republic, and while this may not have been the case during the month in question, the DHRC report focused less on explicit death penalties than on what Ebadi referred to as the “silent death” of political prisoners who are locked away in Iranian jails and made subject to routine mistreatment and the denial of access to medical care.

This latter issue has been highlighted in a number of recent reports. But the problem is virtually omnipresent in Iranian jails, and the unique recent attention may be partly due to the prominence of recently-released images of Alireza Rajaei, who lost an eye and part of his jaw to surgery after his cancer went undiagnosed for years while he was serving a sentence as a prisoner of conscience. Rajaei’s case was prominently highlighted last week in another report that compared him to another political prisoner, the human rights lawyer, Abdolfatah Soltani, who is suffering from several ailments including a colon ulcer and anemia while serving a 10-year prison sentence for his human rights activism.

Soltani is the other co-founder of the DHRC, and this was among the charges that led to his initial 18-year sentence, which was later reduced on appeal. Even so, Soltani’s defenders, including journalist and former cellmate Siamak Ghaderi, allege that his case has been handled illegally since its start. And this illegality arguably encompasses the authorities’ refusal to consider either parole or medical furlough. According to Soltani’s family, his condition is worsening as a result of the harsh conditions of Iranian prisons and he cannot recover while still in detention.

“By withholding proper medical attention, the prosecution hopes that these prisoners will die or become disabled, or that they will lose courage and be tired out,” Ghaderi said in an interview with IranWire. Additionally, Soltani’s wife declared that “Alireza Rajaei is not the first victim of injustice, nor the last.” And indeed, several Iranian political prisoners are known to be suffering from untreated medical problems at this very moment.

For instance, the Center for Human Rights in Iran reported last week that imprisoned activists Maryam Akbari-Monfared is suffering from thyroid disease and other worsening issues, but has reportedly had her requests for medical furlough blocked by the Intelligence Ministry. Akbari-Monfared was arrested during the mass protests against the disputed 2009 reelection of President Mahmoud Ahmadinejad and was changed with collaboration with the People’s Mojahedin Organization of Iran, for which four of her siblings were killed in the 1980s, one of them in the massacre of political prisoners in the summer of 1988.

Akbari-Monfared has pushed for inquiries into those deaths and she also made headlines in August when she wrote an open letter protesting the heavily stage-managed tour of Evin Prison that was given to selected foreign diplomats. This continuation of her activism from behind bars has no doubt given hardline authorities reason to put additional pressure on her, and this could account not only for the denial of medical furlough but also for the simple fact that she remains behind bars to this day despite having been eligible for conditional release since 2015.

In fact, the continued defiance of abusive authorities is a contributing factor in many examples of the regime denying medical treatment or otherwise exerting pressure on political prisoners. In another such case, the Iran Human Rights website reported that human rights activist Atena Daemi was initially transferred to hospital for gallbladder surgery but was returned to prison without undergoing the procedure, after she refused to wear handcuffs and shackles throughout her hospitalization.

Daemi’s mother told Iran Human Rights that the shackling was not initially a condition of her transfer, but was imposed at the last minute and falsely identified as a prison regulations. Female, non-political prisoners reportedly visit outside medical facilities on a regular basis without being shackled, and the order in Daemi’s case was regarded as an effort to humiliate her. What’s more, her illness is reportedly related to an earlier hunger strike, which in turn led to the judiciary opening a new case against her before ever considering a hospital transfer.

Such hunger strikes are a familiar outlet for the continued defiance that is sometimes associated with cases of withheld medical treatment. Currently, a leading example of this phenomenon is Soheil Arabi, a prisoner of conscience who has been a hunger strike for over a month and has also been refusing fluids since September 23, according to IranWire. The protest was specifically motivated by instances of Arabi’s family being harassed by regime authorities.

Arabi’s case dates back to November 2013, when he was arrested for criticizing the Islamic Republic online, for which he was initially sentenced to death before an appeals court reduced the sentence to seven and a half years. He was later told that he would be released after serving four years, then also told that this arrangement had been withdrawn. IranWire suggests that this and other forms of mistreatment, including the harassment of his family, may be partly the result of Arabi and his wife filing suit against two websites affiliated with the powerful Iranian Revolutionary Guard Corps for “publishing slander and lies.”

In any event, the untreated health effects of Arabi’s hunger strike have gotten so serious that he recently wrote an open letter describing himself as “one step away from death.” The case has apparently received considerable attention from both domestic and international activist communities, and the National Council of Resistance of Iran reported that a protest had been organized in front of the Iranian parliament building in response to a call from Arabi’s mother.

Previously, the issues of hunger strikes and withheld medical treatment had been highlighted by approximately 20 political detainees at Rajai Shahr Prison who engaged in a coordinated, month-long hunger strike motivated by their forced transfer to a more repressive wing of the facility. As a result of appeals from their families, many of those prisoners converted the outright hunger strike into a daytime fast after their health deteriorated considerably. But the protest as a whole reportedly continues to this day and was highlighted in the Iran Human Rights Monitor report for September.