Pulling back from the brink of a military strike on Iran last week, President Donald Trump announced yet more sanctions on Monday as punishment for the Islamic Republic’s downing of an expensive American drone.

Sanctions—and tariffs—have become the non-military tools of choice for the Trump administration, which has embarked on “maximum pressure” economic campaigns against at least three other nations—North Korea, Venezuela, and Cuba—with additional sanctions on Russia, a trade war with China, and threats of higher tariffs on goods from Canada, Mexico, Japan, and even the European Union.

So far, these measures have produced no great new “deals.” A modest update of the North American Free Trade Agreement is being harshly criticized by American labor interests and may not achieve ratification in a divided Congress. It is also not clear whether protracted talks with China will succeed at all.

What has occurred, however, is the steady impoverishment of people in countries that have been sanctioned.

A failed and poorly planned U.S. effort at regime change in Venezuela, combined with American sanctions on that country’s oil exports, has contributed to a humanitarian disaster in our own hemisphere. Some four million of the country’s 30 million people have fled and another one million may leave this year. Health care, food supplies, and electricity are intermittent and often out of reach for ordinary Venezuelans. One recent study estimates that there have been 40,000 additional deaths in the country from 2017 to 2018 because of U.S. sanctions. Meanwhile, the regime of Nicolás Maduro remains defiantly in power.

In North Korea—a country where as many as two million people died of famine two decades ago—the UN reports that 10 million are facing severe food shortages because of a poor harvest impacted by climate change. Despite yet another exchange of “love” letters between Trump and North Korean dictator Kim Jong-un and talk of a third summit between them, the North appears no closer to relinquishing its nuclear and missile arsenals, slowing its accumulation of fissile material and even producing a roster of its own weapons.

The impact of U.S. sanctions on Iran and Cuba has been particularly cruel, since during the Obama administration people in both countries had their expectations raised for a better life.

President Obama ended a number of restrictions on U.S. travel to Cuba, with which he restored normal diplomatic ties. The Trump administration has now reversed these moves for reasons that appear to have more to do with knee-jerk anti-communism than Cuba’s historic support for Venezuela or the post-Castro government’s slow movement on economic reforms. The result is that small start-ups that have benefited from American tourism are collapsing while ordinary Cubans are again lining up for rationed goods or trying to flee the country.

In Iran, meanwhile, hopes that the 2015 Joint Comprehensive Plan of Action (JCPOA) would spark economic growth and Iran’s reintegration into the international economic system have also been destroyed. Unemployment and inflation have risen sharply while the Iranian currency has tanked. As in Cuba, the private sector is bearing the brunt of sanctions while government entities—especially those owned by the Islamic Revolutionary Guards Corps (IRGC)—are withstanding and even profiting from the pressure.

Trump administration officials assert that all this pain serves a useful purpose: to somehow bring Iran back to the bargaining table to negotiate a new and improved JCPOA. However, Iranian officials refuse to talk without a credible offer of sanctions relief. Many observers believe the goal of American sanctions is not a new deal but simply to weaken and destabilize the Islamic Republic. Sanctioning the supreme leader of the country—and threatening to go after its pragmatic foreign minister—only strengthens this impression. It also bolsters those in Tehran who have backed a more aggressive pushback—sabotaging tanker traffic in the Persian Gulf and slowly breaching limits on nuclear activities set in the JCPOA in an effort to make the rest of the world pay for sanctions and to amass leverage for talks with Trump’s successor.

With Donald Trump’s first term more than halfway over, the cruelty and futility of his sanctions predilections are evident. Trump backtracked on a military response to the shoot-down of the drone, using as an excuse that 150 Iranians might die and that this would not be “proportionate” to the U.S. loss. But one could argue that many more Iranians have already died prematurely because of shortages of medications that they have not been able to obtain—or that have become prohibitively expensive—because of banks’ over-compliance with U.S. sanctions.

Even now, the Trump administration has refused to provide practical guidelines to European companies seeking to sell non-sanctioned goods to Iran. U.S. officials are also threatening to sanction the Iranian counterpart to INSTEX, a barter vehicle set up by the European Union for trade with Iran that has yet to become operational.

Repeated studies have shown that sanctions only work when they are truly multilateral—not just the result of the dollar’s dominance of the financial system—and when they have a well-defined goal. The Obama administration got Iran to agree to the JCPOA by trading verifiable curbs on its nuclear program for sanctions relief. The Trump administration’s requirements for a new deal keep shifting—Trump on June 24 added ending support for terrorism to his nuclear demands—and its capacity to negotiate with Iran appears limited.

Perhaps Trump will lose interest in the topic, as he apparently has with Venezuela, and pivot to North Korea and another summit with Kim. Meanwhile, around the world, ordinary people will continue to bear the brunt of his administration’s diplomatic malfeasance and cruelty.

Barbara Slavin directs the Future of Iran Initiative at the Atlantic Council. The views expressed here are her own.