The commander-in-chief has spent much of his term trying to muzzle the Iranian regime, which, despite ever-tougher American sanctions, and more recently the coronavirus pandemic, has retained power and thumbed its nose at the White House.
Director of National Intelligence John Ratcliffe said this week Iran is working to prevent another four years of Trump.
National security officials, Ratcliffe said, have "seen Iran sending spoofed emails designed to intimidate voters, incite social unrest, and damage President Trump." Iran dismissed the accusation as an administration effort to undermine the vote.
Faced with a looming election—one Trump looks increasingly in danger of losing—the administration has imposed new sanctions on 18 Iranian banks that had previously been spared some measures, effectively cutting Iran off from global financial markets.
But critics have long argued the sanctions impact the general population far more than they do the regime, and that voters in Iran are as likely to be pushed toward more conservative politicians perceived as standing up to American pressure as they are toward compromise.
"Our sanctions programs will continue until Iran stops its support of terrorist activities and ends its nuclear programs," Mnuchin said when announcing the new measures.
"The country never really went into a national lockdown because the economic trade-off was something that the state simply couldn't afford given they were already starting from—in early 2020—with the rial in freefall, with sanctions, plus a whole other load of issues with corruption domestically," said Ellie Geranmayeh, an analyst at the European Council on Foreign Relations and an expert in U.S.
"It's basically a gamble between thousands of people getting infected versus millions of people not having enough food," said Vira Ameli, a PhD researcher at Oxford University focused on the COVID-19 pandemic in Iran.
Speaking to Newsweek from Tehran, Ameli said: "If it was possible to have a few weeks of lockdown, I think that would have changed it completely.".
As winter approaches and a vaccine remains out of reach, medical staff in Iran and analysts told Newsweek that 2021 could prove even deadlier than 2020.
One Tehran doctor—who did not wish to be named for fear of reprisal and is referred to here only as Dr B—told Newsweek: "The medical staff in Iran are very tired, medical equipment is worn out, and a lack of specialized equipment may lead to the collapse of the treatment system in Iran.".
Dr B said equipment shortages have left as many as four patients connected to a single ventilator.
Dr J, a doctor in northern Iran who also spoke to Newsweek on the condition of anonymity, said: "Hospitals don't have enough beds, supplies, medicine, protection gear.".
Regardless, medical staff have been staging protests—largely tolerated by security forces—demanding unpaid salaries and criticizing the government for failing to provide sufficient protective equipment for those fighting the virus.
Another Tehran doctor who did not wish to be named—referred to here only as Dr G—said the government did nothing to help medical staff in the early days of the pandemic, leaving medical workers to source their own protective equipment.
"The reduction of the number of deaths is due to the sacrifice of medical staff and their experience, not the support of the government.".
"It's an epistemological issue," she told Newsweek, noting that many other nations have also struggled to decide how best to count and report coronavirus infections and deaths.
"This focus on trying to say that Iran has been trying to hide the numbers is very political and is very politicised from outside Iran as well," Ameli said.
The Iranian mission to the UN in Geneva, Switzerland, told Newsweek that American sanctions now risk ending its participation in the Vaccine Alliance's COVAX coronavirus treatment project.
The mission also said that sanctions have impeded the importation of two million flu vaccine doses into Iran.
The Trump Administration has repeatedly dismissed concerns about the human impact of the sanctions, noting the measures have a loophole allowing humanitarian aid and medical supplies into the country.
A State Department spokesperson told Newsweek: "It's unfortunate that the Iranian government turned down our offer of assistance for coronavirus.
is gaslighting the whole world by giving an arbitrary minimal definition of 'humanitarian,' suggesting that having bread and butter to survive is enough," the Iranian mission in Geneva told Newsweek.
The State Department spokesperson would not say whether the administration would ease sanctions if the COVID-19 situation in Iran deteriorates further.
But Geranmayeh and other observers warn that even if medical equipment is ostensibly exempt from the sanctions, companies producing the technologies are wary of engaging with Iran, fearful of intense U.S.
Geranmayeh told Newsweek: "The cost-benefit for a bank to basically process these transactions is just not worthwhile.
"These handful of banks were facilitating the bulk of Iran's humanitarian trade to import food, medicine and medical equipment," Geranmayeh said.
export licenses approved for specialist medical equipment, The Washington Post reported, which may include goods used to treat COVD-19.
"We are likely to see potential bigger hits to Iran's ability to access food and medicine in the coming months ahead as it's trying to manage the next wave of epidemic," Geranmayeh said.
Sina Toossi, an analyst at the National Iranian-American Council, told Newsweek the sanctions "are creating an added hardship on top of this pandemic," and described the new measures as "incredibly cruel.".
Kirsten Fontenrose, the senior director for Gulf affairs at the National Security Council until 2018, and now the director of the Atlantic Council's Scowcroft Middle East Security Initiative, told Newsweek: "The landscape has been so murky for businesses because Iran has refused to comply with FATF regulations.
"Iran is suffering under the dual kind of pressures of these unprecedented, severe draconian sanctions and this pandemic," Toossi said.
"It's going to be very tricky in the next few months," Ameli said.
A Biden victory in November may bring some limited sanctions relief to Iran.
For Iran's doctors and medical staff, the battle against the virus—and the deaths—goes on
"Death is a great event in Iran, greater than marriage or birth," Dr G told Newsweek
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