Abstract: Air pollutants from fossil fuel fired power plants harm the environment and human health. More than 91% of Irans electricity production is from thermal power plants that use natural gas, diesel, and fuel oil. We apply the impact pathway approach to estimate the health impacts arising from Iranian fossil-based electricity generation emission, and in a next step, we calculate monetary costs of the estimated damages, for a one-year period starting from 20 March 2016 through 2017. We use the new version of SIMPACTS (International Atomic Energy Agency, Vienna, Austria) to investigate the health effects from 61 major Iran fossil-based power plants separately. The selected plants represent 95.6% of total Iran fossil-based power generation. Using the individual and different power plant estimates, we avoid extrapolation and our results can be considered more reliable, taking into account spatial differences. The total damage cost is 723.42 million USD (2000). The damage cost per generated electricity varies from 0.06 to 22.41 USD/MWh and average plant damage cost is 2.85 USD/MWh. Accounting for these external costs indicates the actual costs of fossil energy. The results are useful for policy makers to compare the health costs from these plants and to decide on cleaner energy sources and to take measures to increase benefits for society.