Abstract

This article examines how causal responsibility for healthcare harm is linguistically constructed and contested in Human Rights Watch's 2019 advocacy report Maximum Pressure: US Economic Sanctions Harm Iranians’ Right to Health. The analysis applies two complementary instruments: Halliday and Matthiessen's (2014) transitivity system, which maps process types and agency attribution at the clause level, and Fairclough's (1995, 2003) concepts of nominalisation, recontextualisation, and interdiscursivity, which account for the transformations produced when official policy language is embedded within an advocacy frame. Applied to the full report as a multi-genre corpus, the analysis identifies three grammatical mechanisms through which the gap between formal humanitarian exemptions and practical healthcare access is discursively translated into invisibility: the nominalisation of exemptions as self-operating objects; the generation of systemic risk through deictic indeterminacy in official rhetoric; and the diffusion of causal agency across nominalised institutional abstractions in corporate compliance correspondence. HRW’s counter-discourse responds to each mechanism through disciplined recontextualisation: it substitutes named agents and material-process verbs for institutional abstractions, embeds policy excerpts within explicit causal frames, and deploys patient narratives to make structural harm corporeally visible. Applying the same instruments reflexively to HRW’s own choices, the article demonstrates that counter-discourse is itself constituted by discursive selections (including the systematic suppression of patient political voice and the curation of maximally salient cases) that warrant critical examination. The study contributes to CDA methodology by demonstrating what sustained transitivity analysis and recontextualisation theory yield when applied rigorously to a multi-genre advocacy text as a site of active discursive contestation.