As US-Israel war intensifies, Tehran and major Iranian cities face unprecedented humanitarian crisis

On the fourth day of the joint US-Israeli war, Iran crossed into what aid workers and residents are calling an unprecedented humanitarian catastrophe.

With 787 confirmed dead across the country since strikes began on 28 February, 153 cities and villages affected, and more than 1,000 attacks recorded, Tuesday brought a new wave of strikes on Tehran and major urban centres, hitting not only military infrastructure but the daily rhythms of civilian life with a force that left residents with nowhere to go and no clear path out.

Airports and schools are closed. Hospitals are overwhelmed. Internet and mobile networks are failing intermittently across multiple districts. And for millions of people in Tehran, Isfahan, Shiraz, and Karaj, the question is no longer whether to leave but whether leaving is any safer than staying.

In east Tehran, the neighbourhoods of Souhanak and Payam were among the hardest hit on Tuesday. Residents reported building sections collapsing as they attempted to flee, with cries audible from beneath the rubble before rescue teams could reach them.

Qom Ahmad Rezaei, 42, a civil servant at Iran's Ministry of Transport who lives in the Tajrish neighbourhood in northern Tehran, described what he encountered when he stepped outside.

"Smoke was rising from almost every street, and the sound of explosions grew with every minute that passed. Cars were overturned in the roads, people were running without direction, and everything around us looked as if it was collapsing. I heard children and women screaming everywhere, and it was impossible to ignore the pain everyone was living through," Rezaei described.

He tried to reach colleagues at the ministry to find out whether the building had been struck. The network was completely down. "All I could think about was how to protect my family. But even leaving wasn't safe. The streets were congested with abandoned cars and rubble, and there was no clear road out. I saw neighbours who were injured, and some who lost relatives in front of my eyes," he said.

Farzad Najafi, 28, a taxi driver from the Sadeghiyeh district in west Tehran, was on his way home when the strikes intensified.

"I heard the sound of missiles falling near the road and smoke covered everything around me. It felt as if the entire world was collapsing in a single moment, and the city I loved had become a field of terror. People were running in the streets, trying to escape the death that was chasing them. Some were carrying children in their arms, others were screaming looking for relatives," Najafi said.

He described watching entire sections of neighbourhoods reduced to rubble, saying, "In every corner there was screaming and injuries. Even the birds in the sky looked confused and terrified by the sound of the explosions. I felt complete helplessness as I tried to help whoever I could, but the danger surrounded us from every side."

Ali Jahanbaghshi, 50, a merchant in Tajrish market, was closing his shop when the explosions began closing in rapidly.

"I felt the ground shake, and all the buildings around me trembled. Smoke filled the sky and debris flew everywhere. People ran through the market trying to save themselves and their children. There was continuous screaming, people losing consciousness, injuries right in front of me," he said. 

Jahanbaghshi watched neighbours lose their homes, some their entire families, describing, "There was a collective feeling of despair, as if death had become present in every corner."

Majid Foroughi, 39, a software engineer from the Niavaran neighbourhood in northern Tehran, was in his car heading to work when he encountered a road buried under dust and rubble, vehicles overturned, people trying to move through the wreckage.

"The city I knew had become unrecognisable. I tried to call my family to check on them but the phone wasn't working. All I could do was stop for moments to help whoever I could, then keep moving through streets full of chaos. With every explosion I thought about how fragile life is," Foroughi remarked. 

Tehran's hospitals reached critical capacity on Tuesday as casualties arrived in waves. The Iranian Red Crescent confirmed the national death toll had risen to 787 since the campaign began, figures that include civilians and military personnel, among them women and children.

Medical teams described working under conditions that were deteriorating by the hour. Wards designated for routine care were converted into emergency units. Electricity and water supplies were disrupted in several facilities, complicating basic medical procedures. In some hospitals, patients were partially evacuated after nearby buildings were struck.

Across the city, medical staff faced a near-constant influx of casualties presenting with fractures, burns, and severe bleeding, often with resources inadequate for the numbers arriving. Mothers arrived in shock having lost children. Children arrived alone.

The Ghandi and Motahhari hospitals in Tehran were among facilities forced to initiate evacuation protocols during the day's strikes.

Beyond Tehran: Isfahan, Shiraz, Karaj

US-Israeli strikes are not confined to the capital. Isfahan and Shiraz saw explosions in and around residential areas and educational facilities. Stone and shattered glass covered streets. Residents described children who had been on their way to school falling to the ground in fear, sheltering behind cars and lampposts.

Main roads became scenes of gridlock and collision as residents attempted simultaneous flight. Utility services including electricity and water were cut in multiple districts.

In the southern suburbs of Tehran, including Karaj and Damavand, residents reported hundreds wounded after missiles struck populated neighbourhoods. One witness said: "Every time we tried to move, we saw death getting closer. A new explosion, just metres away. It was as if the sky was falling on us."

In Shiraz, strikes on residential areas near military installations resulted in civilian deaths in the streets before rescue teams could arrive. Residents described streets covered in blood, wreckage, and smoke, calling what remained "a ghost city, where death follows every step."

For those who have not yet fled, the calculation of survival is being reconsidered hour by hour.

Mohammad Rezaei, 62, a retired public relations officer at the University of Tehran, has a small bag packed near his front door with documents and a change of clothes, ready to move if the situation deteriorates further. His plan is to head north toward Gilan, where he has relatives who describe conditions as relatively calmer.

"But the problem is not the destination," he said. "The road could become a danger point at any moment. With strikes this frequent, no one knows what might happen."

Every time the family resolves to leave, a new explosion causes them to delay. "My wife believes that staying inside the house is less dangerous than being on an open road in an unstable time. And I am torn between wanting to protect my children and fearing that I might put them in greater danger by trying to escape."

Mahdi Mousavi, 56, an engineer at Iran's Ministry of Transport, has the same destination in mind and the same paralysis preventing departure.

"We are living in a state of constant hesitation. We cannot sleep deeply, and we cannot make a final decision. I have friends who tried to leave and some came back after finding the roads severely congested. That made me think: what if we get stuck on the road for hours? During bombardments, an open road may be more dangerous than staying home," said Mousabi.

His children ask why they are not going north like others. He tries to explain that the decision is not simple, saying, "Leaving means abandoning everything behind us: work, home, the routine that gives us a false sense of stability."

"We are now living between a packed bag and a postponed decision. We watch developments hour by hour. If the bombardment intensifies further, we will leave immediately. But until that moment, we will remain in this painful suspension between staying and going," he added.

This story was produced in collaboration with Egab.