Iran’s Supreme Leader Ayatollah Ali Khamenei, 75, was hospitalized for a week earlier this month following prostate surgery, and inevitably rumors surfaced that he has cancer (which may be true) and is dying (which may not be). What is certain is that Iran’s ultimate decisions on everything from nuclear weapons to the war with ISIS remain with Khamenei, and if his health suffers, so could his judgment.
The day he got out of the hospital, he seemed to be hale and hearty enough to denounce the American effort to contain the so-called “Islamic State” as “pointless and superficial.”
Dr. Alireza Marandi, the head of Khamenei’s medical team, said the procedure Khamenei underwent was straightforward, taking only half an hour under local anesthesia. “Old or middle-aged men’s prostates often become enlarged, so surgery is quite common among this age group,” the doctor said. He noted that Khamenei had a pre-existing condition, but provided no further details.
Marandi kept the aged ayatollah under observation and advised him not to work so hard. Khamenei’s website has reported that the Supreme Leader has made a full recovery.
Mehdi Khalaji, an Iranian-American Islamic studies scholar and political analyst, pointed out that rumors about Khamenei having cancer are nothing new. “Iran’s political system means that the physical condition of the leader is treated as a national security issue,” he told IranWire, and this was as true for the Shah when he had cancer as it has been for Iran’s Supreme Leaders.
Recently, the Persian-language newspaper Keyhan of London published parts of a 2012 with the son of former president Hashemi Rafsanjani, Mehdi Hashemi, who said Khamenei had cancer but “is cured.”
It’s not just the press and the general public who have raised the subject of Khamenei’s medical situation. Dr. James J. Elist, a prominent urologist in Los Angeles, says it’s been a topic of conversation among medical experts and physicians for years. Elist says that since there’s a lack of accurate medical information about the Supreme Leader, any conclusions are speculative, but judging from what Khamenei’s medical team has said, it’s reasonable to assume that the surgery could be related to prostate cancer.
According to Elist, if Khamenei has had prostate cancer in the past, he would have most likely undergone one of two kinds of surgery and the recent procedure, as described publicly, most likely addressed complications resulting from a previous operation. “The two types are open surgery on the prostate and resection of the prostate,” he says. “In both cases, one of the frequent complications can be the stricture of the urethra.” A procedure to reopen his urinary tract could have been done under local anesthesia.
“It is also possible that he has had this operation before and his prostate cancer has recurred,” Elist says. “They will want to know if this is indeed the case, so they will have taken sample tissues. Sampling tissues can be done under local anesthesia as well.”
A third possibility is that based on an enlargment of Khamenei’s prostate, or a high PSA reading indicating the possibility of cancer, they could have been carrying tests to verify the presence of cancer, or not. “If the test results are positive then he will need to have an operation in the next few months.”
The potential political consequences are hugely important. Mehdi Khalaji points to Ayatollah Khomeini’s ailments and Mohammad Reza Shah’s cancer, both of which were kept secret for a long time.
“Ayatollah Khomeini had a stroke in 1986 and became comatose,” says Khalaji. From 1986 to 1989, a number of crucial historical events took place, from the conclusion of the war between Iran and Iraq to the removal of Ayatollah Montazeri as heir apparent to Khomeini, to the fatwa against novelist Salman Rushdie and the revision of the constitution. But later “we realized that in 1986 Khomeini was actually on death’s doorstep” and his ability to deal with these developments afterward was extremely limited.
In the case of the Shah, Khalaji points out, even Queen Farah did not know about his cancer until a few months before leaving Iran. “The Shah’s cancer affected his decisions; it made him a passive decision-maker,” Khalaji says. “If the Shah did not have cancer, major events could have gone in another direction.”
Elist, a surgeon with long experience, notes that a bout with cancer, fatal enough, often results in “change of direction” affecting attitudes toward life and responsibility, but there is no way, really, to predict how. He cites several figures who have suffered from prostate cancer: Former Secretary of State Colin Powell, former presidential candidate Bob Dole, General Norman Schwarzkopf and Nelson Mandela. “Who knows how this illness affected decision-making and changed people’s lives?”
Khalaji, looking at the question from a political rather than a medical perspective, tends see the whole question of Khamenei’s hospitalization as something hidden by the Iranian government’s usual tissue of lies. “I do not think the operation was really prostate surgery,” he says, “and I do not think Ayatollah Khamenei was hospitalized the day that they say he was. It could be that all of it was staged and we have no idea how serious the operation was.”
Khalaji says he is certain about one thing only: “The physical condition of the Leader is a national security issue.”