Masoud Pezeshkian: the heart surgeon who became Iran’s president-elect

Only four months ago it was unclear whether reformist Masoud Pezeshkian would even be allowed to run for Iran’s parliament: hardliners controlled all the centres of power, with other factions consigned to the political wilderness.

But now Pezeshkian is set to become the Islamic republic’s first reformist president in two decades, after pulling off an unexpected victory in Friday’s election run-off. The 69-year-old defeated his hardliner rival, Saeed Jalili, with promises of change to Tehran’s domestic and foreign policies.

Pezeshkian’s electoral success has rejuvenated the marginalised reformist camp, which was initially amazed that the leadership approved his candidacy following a string of elections in which other reformers were barred.

Now they are heading back to power, the reformers hope to reshape the direction of the republic by diluting the hold of ideological conservatives and pushing through social and economic reforms. The previous president, hardliner Ebrahim Raisi, died in a helicopter crash in May.

“The difficult path ahead will not be smooth without your co-operation, empathy, and trust,” Pezeshkian wrote on social media platform X in his first public reaction to his victory. “I extend my hand to you and swear on my honour that I will not leave you alone on this path. Do not leave me alone.”

The task facing Pezeshkian and his backers is daunting. The heart surgeon inherits one of the world’s most heavily sanctioned economies, a deeply disillusioned population, and a political system in which most power lies with Ayatollah Ali Khamenei, the supreme leader, and institutions such as the Revolutionary Guard.

During the campaign, Pezeshkian vowed to re-engage with the US and European states to negotiate an end to Iran’s nuclear stand-off with the west, and to secure sanctions relief to help the economy.

He also committed to relaxing social restrictions such as online censorship and harsh treatment of women who refuse to wear the hijab.

“Today is a turning point in Iran’s transition from tradition to modernity, where top leaders finally concede that it is the job of technocrats to run the government,” said Saeed Laylaz, a pro-reform economist and analyst.

Yet at the same time, Pezeshkian made clear his obedience to Khamenei, portraying himself as a reformer but also as a loyalist unlikely to upset the status quo.

Pezeshkian thanked Khamenei in his victory speech on Saturday, saying he would not have been allowed to succeed if it were not for the supreme leader’s support. When Pezeshkian ran for re-election to parliament in March, many believed it was Khamenei’s intervention that led to the approval of his candidacy.

Pezeshkian has been a regime loyalist since the 1979 Islamic revolution.

As a young doctor, he mobilised medical teams to help the wounded during the Iran-Iraq war in the 1980s. At that time, he was also among the radicals who campaigned to make the hijab compulsory for women working in hospitals and universities.

But this year on the campaign trail, he argued that there were no Islamic texts to support women being harassed for not covering their heads — a nod to the public backlash triggered by the death in 2022 of Mahsa Amini in police custody after she was arrested for not properly wearing her hijab. Pezeshkian also promised to end patrols by Iran’s notorious morality police.

Personal tragedy changed Pezeshkian’s life, and possibly his outlook, when his wife and a son were killed in a car accident three decades ago. Pezeshkian chose not to remarry, raising a daughter and two other sons as a single parent. He referred repeatedly to this experience during his campaign, often tearing up as he spoke.

“As I was loyal to my family, I will be loyal to you,” he told supporters. 

Speaking up for women’s rights, Pezeshkian said he never tried to coerce his daughter while raising her. As an Azeri who grew up in Kurdistan province speaking Kurdish, he also appealed to Iran’s minorities.

Pezeshkian rose to political prominence during the two terms of Mohammad Khatami, the last reformist president, from 1997 to 2005, first as deputy health minister, then as the head of the ministry. In the years since, he has been an MP, while working as a surgeon in public rather than private hospitals.

As president, his ability to push through change will depend heavily on his relations with Khamenei analysts said, as Pezeshkian is expected to encounter stiff resistance from hardliners elsewhere.

Laylaz, the reformist analyst, said that Pezeshkian had no intention of confronting Khamenei, and this approach would be “key to his success”.

Previous presidents who sought to drive reformist agendas — such as centrist Hassan Rouhani, who signed the 2015 nuclear deal with world powers, and Khatami — have since said they failed because of resistance from within the system. 

Pezeshkian and his team insist that his government will be different, by sidelining radicals in both the reformist and hardline camps and fostering unity within the ruling system.

Reformers also argue that Pezeshkian will be helped by the premise that the regime wants to avoid factional infighting to maintain political stability as it prepares for the eventual succession to Khamenei, 85, after he dies.

However, pessimists — who include many in the business community, along with western diplomats and millions of disillusioned Iranians — believe the system is too rigid to change.

Diplomats say they would welcome less hostile rhetoric from the new government — but they question how much influence Pezeshkian will wield, given that all key policies are determined by the supreme leader and his primary arm of power, the Revolutionary Guard.

“We listen to Pezeshkian’s words with great interest, but the time for words is over. We need to see action,” said one senior western diplomat in Tehran, who added that relations could only improve following change in areas where the president had little control.

These include Tehran’s aggressive expansion of its nuclear programme as it enriches uranium at levels close to weapons grade, its military and financial support for regional militant groups, such as Lebanon-based Hizbollah, and the sale of armed drones to Russia.

“Pezeshkian is talking sense,” the diplomat said. “But . . . how is he going to do it?”

Convincing sceptical Iranians that change is coming will be harder still.

“The votes for Pezeshkian were conditional,” said Farid, a taxi driver in Tehran. “If he fails to improve our lives, voters will reclaim their votes through protests.”