Twelve Incidents, Nine Cities

The Surgeon

Somewhere in Tehran — in a location that still cannot be disclosed — a surgeon converted a cosmetic clinic into a trauma ward on January 7, 2026.¹ For four days, working without anesthesia, he treated over ninety patients with gunshot wounds, fractures, and shrapnel injuries. He did this because the hospitals had become too dangerous.

Dangerous because of the security forces inside them.

His patients arrived through back doors, carried by strangers, bleeding through improvised bandages. Some had been shot blocks from the nearest hospital and carried miles further to reach the clandestine clinic. Others had been removed from hospitals by family members who saw what was happening inside — IRGC forces monitoring treatment beds, checking identities, removing wounded patients in black bags.

This surgeon’s existence — and the underground medical network that formed around clinics like his, echoing the pre-revolutionary “Red Lion and Sun” emergency system — is itself evidence of what happened to Iran’s hospitals in January 2026.² You do not operate without anesthesia in a converted cosmetic clinic unless the alternative is worse.

What follows is a systematic accounting of that alternative.

The Record

The incidents documented below are drawn from multiple independent sources: Hengaw Human Rights Organization, Iran Human Rights (IHR), the Associated Press, Mnemonic digital forensics, Iran International, the U.S. State Department, The Lancet, and the World Health Organization. Confidence ratings reflect the strength of the evidence methodology — independent verification, verified video, established field documentation networks — rather than raw source count. Where sources overlap, confidence increases. Where a single source provides documentation, confidence is noted accordingly.

Phase 1: The Twelve-Day War (June 13-24, 2025)

Location	Facility	What Happened	Source	Confidence
Sardasht, W. Azerbaijan	Kosar Girls’ Elementary School	IRGC forces occupied school during Israeli-American air campaign	Hengaw	Medium-high
Kermanshah	Farabi Hospital vicinity	At least 7 weapons sites identified in Dizelabad and Dolatabad districts adjacent to hospital	Hengaw	Medium-high
Paveh, Kermanshah	Gzan Mountains	IRGC artillery deployed near civilian communities	Hengaw	Medium-high

Context: During Operation Rising Lion, the IRGC dispersed forces away from hardened military targets — which were being systematically struck — into civilian areas. The weapons sites near Farabi Hospital were subsequently struck by Israeli forces. The Kosar school occupation occurred during the same dispersal pattern.³

Phase 2: The Nationwide Crackdown (December 2025 - January 2026)

Location	Facility	What Happened	Source	Confidence
Ilam	Imam Khomeini Hospital	24+ hour siege: IRGC fired into courtyard, tear gas in wards, beat medical staff, seized wounded	AP, Mnemonic, U.S. State Dept.	Very high
Ilam	Rababeh Kamali School	Commandeered as staging area across from hospital to coordinate siege	Hengaw, AP	Medium-high
Tehran	Sina Hospital	Security forces breached hospital, deployed tear gas inside	The Lancet, AP	Very high
Tehran	5 additional hospitals	217 deaths across 6 Tehran hospitals on Jan 8; IRGC evacuated facilities to treat own forces	AP, IHR	Very high
Rasht, Gilan	Hospital(s)	Agents blocked doctors from resuscitating wounded; bodies removed in black bags	AP, Mnemonic	Very high
Gorgan, Golestan	Hospital(s)	Witnesses reported gunfire from hospital rooftops targeting demonstrators below	IHR	Medium-high
Arak, Markazi	School(s)	Schools served as detention and staging areas	IHR, Hengaw	Medium-high
Sari, Mazandaran	School(s)	Schools served as detention centers	IHR	Medium-high

Context: The January crackdown represented a shift from using civilian infrastructure as shields against external strikes to using it as instruments of domestic repression. Hospitals were not merely occupied — they were weaponized against the people seeking treatment inside them.⁴

Phase 3: Pre-Strike Dispersal (February 2026)

Location	Facility	What Happened	Source	Confidence
Tehran	Khatam al-Anbia Hospital	IRGC commanders held non-medical meetings inside, accompanied by security details	Iran International	Medium
Tehran	Sports stadiums	Forces gathered in stadiums and arenas to shield personnel and equipment	Multiple	Medium-high
Minab, Hormozgan	School near IRGC facility	School adjacent to IRGC facility struck Feb 28; students killed	CENTCOM acknowledgment	Confirmed

Context: The February dispersal pattern — moving military assets into hospitals and stadiums ahead of anticipated strikes — represents the explicit shielding function. Unlike the January hospital occupations, which served domestic repression, these movements were designed to raise the cost of external military action.⁵

The Hospital Pattern

The January 2026 hospital incidents deserve particular attention because they reveal not isolated abuses but a systematic pattern of medical infrastructure militarization.

On January 4, 2026, IRGC units shot protesters in Malekshahi, near Ilam. The wounded were brought to Imam Khomeini Hospital — the nearest major medical facility. What followed was documented by AP and Mnemonic through verified video: IRGC forces besieged the hospital for over twenty-four hours, firing into the courtyard, deploying tear gas inside wards, and beating medical staff who attempted to treat the wounded.⁶

The U.S. State Department described the assault in unambiguous language: “Storming the wards, beating medical staff and attacking the wounded with tear gas and ammunition is a clear crime against humanity.”⁷

Four days later, on January 8, the pattern replicated across the country. An AP investigation — published on February 27, 2026, based on nine doctor interviews and independent verification of twelve-plus videos with Mnemonic — documented security agents across multiple cities: monitoring patient care, blocking resuscitation attempts, seizing wounded protesters from treatment beds, and removing bodies in black bags.⁸

In Rasht, AP documented agents blocking doctors from resuscitating a man who had been shot in the head. He died while agents stood over the treatment bed. They collected his body in black bags.

In six Tehran hospitals, 217 people died on January 8 alone.⁹

In Gorgan, witnesses reported gunfire from hospital rooftops — security forces firing at demonstrators below from the medical facilities they had occupied.

The IRGC also evacuated several medical facilities to prioritize treatment of its own wounded forces — converting public hospitals into military treatment centers while denying care to the civilians they had shot.¹⁰

The Coup de Grâce

The most disturbing evidence came from a regime official’s own mouth.

On February 19, 2026, Javad Tajik — head of Tehran’s Behesht Zahra cemetery organization, the agency responsible for processing the dead — publicly confirmed what doctors had been reporting in whispers: the “coup de grâce.” The systematic practice of delivering fatal shots to wounded protesters during the January crackdown.¹¹

This was not an accusation from a foreign government or an exile opposition group. It was an admission from the official responsible for burying the dead.

The medical evidence corroborated Tajik’s statement. Patients were found dead on treatment beds, still connected to medical equipment, with fresh bullet wounds in their heads.¹² Doctors reported witnessing security agents entering wards, identifying wounded protesters, and executing them. The bodies were then removed — in many cases before families could be notified or cause of death could be documented.

The coup de grâce transforms the hospital from a site of healing into a site of execution. It represents the terminal point of the hostage logic described in The Shield and the Schoolyard: wounded become captives, captives become intelligence sources, and those who cannot provide intelligence — or who have already been identified — are eliminated where they lie.

The Medical Siege

The regime’s campaign against medical neutrality extended far beyond individual incidents of hospital violence.

At least seventy-nine healthcare professionals have been detained since January 9, 2026, including twelve medical students.¹³ One surgeon was charged with moharebeh — “war against God,” a capital offense — for the crime of stating his willingness to treat wounded civilians.

The charge deserves emphasis. In Iranian law, moharebeh can carry the death penalty. The regime’s legal apparatus deemed the act of offering medical care to protest victims equivalent to waging war against God.¹⁴

WHO Director-General Tedros Adhanom Ghebreyesus publicly confirmed the arrests and demanded the release of detained medical professionals. The Lancet published formal correspondence documenting the breach of medical neutrality.¹⁵

The parallels to Syria are not accidental. In 2012, Syria’s anti-terrorism law effectively criminalized treating opposition wounded — a framework the IRGC observed firsthand during its deployment alongside Assad’s forces. Physicians for Human Rights documented over 601 attacks on at least 350 Syrian health facilities since 2011, killing over 900 health workers. The Syrian Archive documented 410 attacks on 270 medical facilities, with 90% attributed to Syrian government and Russian forces.¹⁶

The IRGC commanders who served in Syria — Ground Forces commander Pakpour, former Quds Force chief Vahidi, and their subordinates — brought these methods home. The criminalization of medical care, the siege of hospitals, the “double-tap” bombing pattern of attacking first responders — all were refined in Syria before being deployed against Iranian civilians.¹⁷

The Underground

The hospital siege created its own counter-infrastructure.

The surgeon in the cosmetic clinic was not alone. An underground medical network formed during the January crackdown — doctors operating clandestine treatment facilities, smuggling medical supplies, and communicating through encrypted channels to coordinate care for the wounded.¹⁸

They called it the “Red Lion and Sun” — a deliberate echo of Iran’s pre-revolutionary equivalent of the Red Cross, which the Islamic Republic had dissolved and replaced with the Red Crescent. The symbolism was precise: the regime’s medical infrastructure had been weaponized against the people, so the people rebuilt their own.

Consider the last time you went to an emergency room and were treated without question — no one checking your identity, no one asking why you were hurt. Then consider choosing between bleeding out at home and being executed on the treatment bed.

The network’s existence is documented through doctor testimonies collected by AP and verified by Mnemonic, but specific locations, identities, and operational details remain restricted for security reasons. What can be stated: during the worst days of the January crackdown, when IRGC forces controlled major hospitals in at least six cities, an unknown number of doctors and nurses risked moharebeh charges — risked execution — to provide treatment in hidden locations to people whose only crime was being shot by their own government.¹⁹

What the Numbers Mean

The death toll from the 2025-2026 crisis varies dramatically by source.

HRANA, the Human Rights Activists News Agency, has verified 7,007 protest deaths as of February 23, 2026. Iran International, citing leaked IRGC documents, reports over 36,500. The UN Special Rapporteur estimates over 20,000. The regime’s own Supreme National Security Council acknowledges 3,117 total deaths including security forces, characterizing an unspecified portion as “terrorists.”²⁰

Each of those numbers contains the man in Rasht who died while agents stood over his treatment bed. Each contains the surgeon’s ninety patients.

Fog-of-crisis reporting is inherently imperfect — some incidents initially attributed to IRGC forces may upon further investigation prove more ambiguous in their chain of command, and the confidence ratings in this catalog reflect that uncertainty honestly. But the gap between these numbers is itself evidence. A regime that controlled the hospitals, removed bodies in black bags, detained doctors who documented injuries, and criminalized medical care created the conditions for undercounting. When you control the point of death and the point of documentation, you control the number.

The twelve documented incidents of civilian infrastructure militarization cataloged in this article are not the full picture. AP and Iran Human Rights suggest IRGC presence in dozens of additional hospitals during the January 8-9 mass killings. Each hospital becomes a node in a system designed to simultaneously suppress, conceal, and deny.²¹

The evidence is being preserved. The Iranian Archive — a joint project of the Atlantic Council’s Digital Forensic Research Lab and Mnemonic — has forensically preserved over two million digital artifacts using chain-of-custody best practices developed for international criminal proceedings. The UN Fact-Finding Mission on Iran has collected over 38,000 evidence items and conducted approximately 300 in-depth interviews.²²

The hospitals may have been controlled. The record was not.

This article is part of The Shield and the Schoolyard. For the proxy pipeline, see From Beirut to Minab. For the legal framework, see The Law Is Clear.

The clandestine trauma ward operated for four days beginning January 7, 2026, in a converted cosmetic clinic in Tehran. The surgeon treated over ninety patients without anesthesia. Source: AP investigation, February 2026. Location withheld for security. ↩
The “Red Lion and Sun” was Iran’s pre-revolutionary humanitarian organization, equivalent to the Red Cross. The underground medical network that formed during the January 2026 crackdown deliberately adopted the name. ↩
Phase 1 incidents documented by Hengaw Human Rights Organization, which maintains a network of field correspondents across Kurdish regions of Iran with established verification methodology. ↩
The distinction between shielding against external strikes (Phase 1 and 3) and weaponizing civilian infrastructure for domestic repression (Phase 2) is analytically important: both violate international humanitarian law but serve different strategic functions. ↩
Phase 3 dispersal pattern reported by Iran International and consistent with satellite imagery showing IRGC force movements away from military installations. ↩
AP and Mnemonic verified video documentation of the Imam Khomeini Hospital siege in Ilam, January 4, 2026. Multiple independent sources corroborated the 24-hour timeline. ↩
U.S. State Department statement on the Ilam hospital assault, describing it as “a clear crime against humanity.” ↩
AP investigation published February 27, 2026. Nine doctor interviews, twelve-plus verified videos with Mnemonic digital forensics. ↩
The 217-death figure for January 8 across six Tehran hospitals is drawn from AP and Iran Human Rights documentation. ↩
IRGC evacuation of medical facilities to prioritize treatment of own forces documented by AP and IHR. ↩
Javad Tajik, head of Tehran’s Behesht Zahra cemetery organization, publicly confirmed the coup de grâce practice on February 19, 2026. ↩
Medical evidence of patients found dead on treatment beds with fresh bullet wounds corroborated by multiple doctor testimonies in the AP investigation. ↩
Iran Human Rights documentation: seventy-nine healthcare professionals detained since January 9, 2026, including twelve medical students. ↩
Moharebeh (“war against God”) is a capital offense under Iranian law (Articles 279-285 of the Islamic Penal Code). A surgeon was charged with moharebeh for stating willingness to treat wounded civilians. ↩
WHO Director-General public statement; The Lancet correspondence on breach of medical neutrality in Iran. ↩
Physicians for Human Rights documented 601+ attacks on 350+ Syrian health facilities since 2011, killing 900+ health workers. Syrian Archive documented 410 attacks on 270 facilities, 90% attributed to government/Russian forces. ↩
The “Syrianization” of domestic tactics includes criminalization of medical care (Syria 2012 anti-terrorism law as template), siege of hospitals, and double-tap patterns targeting first responders. ↩
Underground medical network formation documented through multiple sources. Operational details restricted for security of participants. ↩
Security restrictions prevent full disclosure of the underground medical network’s scope, locations, or personnel. What is documented: the network operated during the January crackdown across multiple cities. ↩
Death toll estimates: HRANA 7,007 verified (Feb 23, 2026); Iran International 36,500+ (citing leaked IRGC documents); UN Special Rapporteur 20,000+; Supreme National Security Council 3,117 total including security forces. ↩
AP and Iran Human Rights reporting suggests IRGC presence in dozens of additional hospitals beyond the twelve documented incidents. ↩
The Iranian Archive (Atlantic Council DFRLab + Mnemonic): 2+ million digital artifacts. UN FFMI: 38,000+ evidence items, ~300 in-depth interviews. ↩