In an election campaign dominated by hardliners, Iranian presidential hopeful Massoud Pezeshkian stood out as a moderate, backing women's rights, more social freedoms, cautious detente with the West and economic reform.

Pezeshkian narrowly beat hardline Saeed Jalili for first place in Friday's first round vote but the two men will now face a run-off election on July 5, since Pezeshkian did not secure the majority of 50% plus one vote of ballots cast needed to win outright.

Pezeshkian, a 69-year-old cardiac surgeon, lawmaker and former health minister was up against candidates who more closely reflect the fiercely anti-Western stance of Supreme Leader Ayatollah Ali Khamenei, the country's ultimate decision-maker.

And yet the mild-mannered Pezeshkian narrowly won Friday's vote and made it to the run-off in the election to pick a successor to Ebrahim Raisi, who was killed in a helicopter crash in May.

His chances hinge on attracting votes from supporters of current hardline parliament speaker Mohammad Baqer Qalibaf, who finished third in the first round, and encouraging a young disillusioned population hungry for change but disenchanted with the country's political, social and economic crisis to vote for him again in the run-off.

Although he advocates reforms, Pezeshkian is faithful to Iran's theocratic rule with no intention of confronting the powerful security hawks and clerical rulers.

His views offer a contrast to those of Raisi, a Khamenei protege who tightened enforcement of a law curbing women's dress and took a tough stance in now-moribund negotiations with major powers to revive a 2015 nuclear deal.

Pezeshkian's election campaign gained momentum when he was endorsed by reformists, led by former President Mohammad Khatami, and when he appointed former Foreign Minister Mohammad Javad Zarif, a key figure in crafting the nuclear deal, as his foreign policy adviser.

Implicitly referring to the appointment of Zarif, who hardliners accuse of selling out Iran in order to reach the deal, Khamenei said on Tuesday: "Anyone who is attached to America will not be a good colleague for you".

In 2018, then-U.S. President Donald Trump ditched the pact and reimposed sanctions on Iran, calling it "a horrible one-sided deal that should have never, ever been made." His move prompted Tehran to progressively violate the agreement's nuclear limits.

If Pezeshkian does go on to win, this would hinder Iranian hardliners who are opposed to the revival of the pact.

However, under Iran's dual system of clerical and republican rule the power to shape key state policies including foreign and nuclear affairs ultimately rests with Khamenei.

As a result, many voters are sceptical about Pezeshkian's ability to fulfil his campaign promises.

"Pezeshkian's power as the president to fulfil his campaign promises is zero," said Sholeh Mousavi, a 32-year-old teacher in Tehran, before Friday's first round of voting.

"I want reforms but Pezeshkian cannot improve the situation. I will not vote. "

Pezeshkian, the sole moderate among the six candidates who were approved by a hardline watchdog body to stand, has pledged to foster a pragmatic foreign policy and ease nuclear tensions with the West. Two hardline subsequently candidates pulled out.

A CRITIC LOYAL TO KHAMENEI

At the same time, Pezeshkian promised in TV debates and interviews not to contest Khamenei's policies, which analysts said risks further alienating the urban middle class and young voters. These groups no longer seek mere reform and instead now directly challenge the Islamic Republic as a whole.

As a lawmaker since 2008, Pezeshkian, who is an Azeri ethnic minority and supports the rights of ethnic minorities, has criticised the clerical establishment's suppression of political and social dissent.

In 2022, Pezeshkian demanded clarification from authorities about the death of Mahsa Amini, a woman who died in custody after she was arrested for allegedly violating a law restricting women's dress. Her death sparked months of unrest across the country.

But at a Tehran University meeting earlier this month, responding to a question about students imprisoned on charges linked to anti-government protests, Pezeshkian said "political prisoners are not within my scope, and if I want to do something, I have no authority".

During the Iran-Iraq war in 1980s, Pezeshkian, who held roles as both a combatant and a physician, was tasked with the deployment of medical teams to the front lines.

He was health minister from 2001-5 in Khatami's second term.

Pezeshkian lost his wife and one of his children in a car accident in 1994. He raised his surviving two sons and a daughter alone, opting to never remarry.