Bilal’s relatives took drastic action. Speedily, they collected funds to send him to hospital in Turkey, a trip organised by one of several companies operating in the booming air ambulance industry.

“When my life was in danger, we took the decision to get me to Turkey on a chartered flight,” he told BIRN.

Several hundred Albanians have made the same difficult and expensive choice since the COVID-19 pandemic started, BIRN has learned.

Albania’s Civil Aviation Authority told BIRN in a written answer to a FoI request that by November 18 this year, some 565 flights “for medical purposes” had taken off from Albania’s sole international airport.

The overwhelming number of these took off from Tirana in October and November, as the country confronted an explosion in infections.

Data show that the number of such medical flights grew from just five in May, when the COVID-19 outbreak seemed under control, to 152 in October. Over only 18 days in November, another 206 flights were carried out.

Information provided by two companies that operate air ambulances shows that COVID-19 patients spent some 6.7 million euros over that period on flights abroad to get help.

Data from private hospitals in Turkey meanwhile suggest that Albanian patients may have spent some 12 million euros more once they got there.

BIRN has learned that a typical chartered flight to Turkey costs in some 10,500 euros if its not urgent while in urgent cases, the price goes up to 20,000.

An overnight stay at a private hospital in Turkey cost some 1,200 euros, rising to 3,500 euro if it offers deluxe service. COVID-19 patients might need to stay there for at least 15 nights.

According to the Civil Aviation data, 87 per cent of the medical flights from Tirana went to Turkey, most to Istanbul. Some 20 flights out of 496 went to Ankara. There were 37 more flights to Italy and a few others to Austria, Germany and Switzerland.

With an average salary of some 400 euro per month, costs of medical treatment in Turkey are well beyond reach for most of the county’s 2.8 million inhabitant. But even those who have a better life find themselves in difficulties.

Bilal’s trip has left him in the red. “Overall I spent 45,000 euros – 15,000 for the flight and 30,000 for a 20-day hospital bill,” he said. After he recovered, he took a commercial flight along with his brother back home.

“What I can say more?” he told BIRN by phone. “I am deep in debt.” He is, however, alive.

Hospitals at home pushed to the limit

A health worker wearing Personal Protective Equipment (PPE) conducts COVID-19 tests in Istanbul, Turkey, 2020). Photo: EPA-EFE/SEDAT SUNA

COVID infections grew fast in Albania in October and November. By November 20, Albania had 15,732 active cases, 436 of whom were hospitalized. Some 672 people had died.

The official figures do not include all the cases, however. According to information collected by BIRN in the field, they do not use SARS-CoV-2 tests but rely only on scanners to identify cases.

Asked about the number of Albanian patients seeking help in foreign private hospitals, Prime Minister Edi Rama told a TV interview that his government could not “stop anyone” from traveling.

But as the number of infections grew, it became clear some Albanian hospitals were struggling to deal with the strain.

One paramedic at the Shefqet Ndroqi hospital in Tirana told BIRN on condition of anonymity that her hospital was short of both beds and staff. “Scores of medical personnel have become infected and the burden is extraordinary,” she said.

Erion Dasho, a doctor and outspoken critic of the government’s handling of the pandemic, told BIRN that human resources were the only factor making a difference between Albanian hospitals and foreign ones.

“A relative of mine traveled to Turkey and paid 1,200 euros a day [for treatment]. But from the medical point of view there wasn’t any difference to make the price worth it. The only difference was a dedicated paramedic and better hotelier service at the hospital,” he said.

Dasho added that the Albanian government could have spared its citizens such expense if it had listened to the experts.

Even some of the companies that organise the medical flights agree. Arjana Sina, a doctor working for the International Turkish Hospital in Tirana, called the situation “extraordinary”.

She was obliged to interrupt her conversation with BIRN several times as the two mobile phones at her desk rang almost continuously. A specialist in radiology, she says that “the demand is scary; we do 60 scans per day and 80 of them of them are positive, with many at an advanced stage of the disease.”

Sina told BIRN that that the influx from Albania had grown fast since the start of October. “There are flights each night,” she said.

Sina added that they didn’t accept all the requests, either, underlining that the chances of survival for intubated patients were pretty much the same in Albania as in Turkey.

“I want to emphasize this, as I don’t want people to go in to debt or sell their homes,” she added.

Margarit Dado, director at Albanian Intercare Services, a company specializing in healthcare emergency transportation, agreed that demand had soared since the start of the COVID-19 infection. She added that requests for transportation were often refused.

“There are four specific criteria for transportation. You must have a valid passport for at least six months, a medical report, including blood saturation, blood pressure and others, proof of payment and a letter from a hospital confirming they will admit the patient,” Dado said.

Intermediaries in trade include tourist firms

The high demand for treatment abroad has also created a booming market for intermediaries and speculators.

According to Dado, several non-specialist companies have entered the market. “We are getting tourist companies booking medical charters. There are funeral companies as well,” he added.

He acknowledged that patients were paying dearly. “They are being seen as chips,” he said, adding that the intermediaries receive 10 to 20 per cent of the invoices issued by the hospitals.

Sina also confirmed that dozens of operators are now in the market, and that intermediaries often have no link to healthcare. “There are plenty of them out there,” she said.