An additional organisational hurdle is having to swiftly transform hospitals wards that were not designed to treat infections into COVID-19 centres.

Doctors say this results in bad conditions in hospitals, with complaints ranging from disregard for safety protocols to lack of equipment and having to pay steep prices for essential medicines that should come at the state’s expense.

For some, family doctors are hard to reach

For many people across the Balkans, family doctors are the first base in order to get tested and get help.

But in North Macedonia, Maja aged 31 from Skopje told BIRN that she went through a “indescribable nightmare” when she and her parents, with whom she lives, became ill this month, and suspected they had the coronavirus.

It took six days after they initially sought medical help to get the COVID-19 test results, which turned out positive. It then took another day before her father, who was worst affected, was admitted to hospital.

“We lost two days trying to reach our [family] doctor. First he would not pick up the phone, and then he made us fill in a questionnaire and said he would see what he could do. We lost three days, just getting the referral so we could get tested,” Maja said.

During that time, Maja called the emergency state healthcare and a few private hospitals, as her father was becoming seriously dehydrated, but the emergency services refused to come without a COVID-19 test result.

In the end, the family ignored the referral and got tested in a private clinic on day four, hoping the results would come sooner. But they had to wait for the weekend to pass, when even the private clinic did not conduct tests or issue results.

On the seventh day, her father was finally admitted to hospital, where Maja says he got “not ideal but perhaps, realistically speaking, proper care”. Since being sent home, he is feeling much better.

But Maja feels scarred by the experience. “Only God watched over us, he and my brother, as he was the only one who wasn’t ill and was able to provide for our needs, drive my father to hospital wearing three face masks to protect himself and bring medicine,” she recalled.

“At that point you are confused, scared, angry and perhaps not even thinking straight,” Maja reflected.

“We all live in some sort of denial and hope someone will help, that the system is working … At first I expected our doctor to know how to handle things … the one time when we really needed him, but no. The system is broken and we were left on our own,” she concluded.

In neighbouring Kosovo, the situation is just as worrying for many patients. Ardian Elezaj told BIRN that when he went to three hospitals for help, he did not receive either help or even proper advice about what to do.

One month ago, he started experiencing typical COVID-19 symptoms of fever and lack of taste. Elezaj went to the health centre in the Dardani neighbourhood of the capital, Pristina, only to be told: “We are prohibited from dealing with these cases; you should go to Bregu i Diellit”, another health centre in a different neighbourhood.

The health centre there did not work at all, so Elezaj then went to the University Clinical Center of Kosovo, UCCK, in Pristina where he was told to go at the Infections Clinic.

“They [the infections clinic staff] told me to come the next day. The next day, they did not work,” Elezaj said.

The only other option, one that many people choose out of necessity, is paying for tests at private laboratories.

These tests cost 40 to 60 euros per person. A family of four would need 200 to 240 euros to all get tested, which is far too much for many people who live on the minimum wage or on welfare, which in most cases means 200 to 300 euros a month.

Health authorities in Serbia, North Macedonia, Albania, Kosovo and elsewhere have recently acquired so-called rapid tests that supply results within a few hours. They cost only 15 to 20 euros a go.

But supplies of these tests ran out in only a few days, although more are now on their way.

Race to secure more beds for COVID patients

In the past few weeks, North Macedonia, Serbia, Montenegro, Croatia and other Balkan countries have been facing thousands of new COVID infections a day.

Authorities describe the situation as alarming, warning that health systems are facing the biggest challenge in their entire history and that they are having to focus almost entirely on the virus.

According to the National Civil Protection Authority, Croatia currently has 1,944 patients in hospital with COVID-19, 204 of them on respirators.

Doctors there say the situation is dire. The Croatian Association of Hospital Physicians, HUBOL, warned in early November that Croatia had “lost control of the epidemic in several segments”.

“Epidemiological services are no longer functioning, hospitals are rapidly filling up with patients, and there are fewer and fewer free respirators every day,” it said.

“It is time for stricter epidemiological measures over a period of time to regain control of the epidemic,” HUBOL continued.

In October, several doctors and patients warned of the inadequate treatment of COVID patients at Zagreb’s Dubrava Hospital, which is now exclusively dealing with COVID patients.

After his condition worsened, when 34-year-old Domagoj Kovac was hospitalized, he saw this at first hand.

“They put me in the hospital … but after that, nothing happened,” Kovac told the media later.

“I waited a day-and-a-half for the doctor. I was lying in bed, sick, couldn’t breathe, and not getting anything. The doctor did not visit me until I lost my temper and cried out,” he told Jutarnji list newspaper on October 29. “Only after that did they react,” he went on.

With more than 13,000 active cases, North Macedonia has over 1,200 hospitalised COVID patients. Over 90 per cent of all available beds for intensive care of COVID patients are now occupied.

More beds are available in other hospitals across the country, but before they can be used for COVID patients, authorities must secure strict protocols to prevent the spread of the infection, which is not an easy task.

The Skopje neurology clinic is one hospital that was recently completely turned into a so-called COVID centre, but this caused a revolt among the medical staff who said they were not prepared to treat infectious diseases. A former Health Minister, Arben Taravari, slated the decision to turn the clinic into a COVID centre as “scandalous”.

Patient’s relatives allowed in some hospitals

Some hospitals in Kosovo seem in an even more chaotic state, judging by recent reports.

In many countries, relatives or friends of patients in COVID hospitals are not allowed to visit, or can only do so under strict conditions.

But a relative of a recently deceased patient from COVID who saw the conditions at the Pristina Infections Clinic’s intensive care unit told BIRN under condition of anonymity that relatives of patients came in and out, and were sometimes more engaged in helping patients than the staff.

“Family members are allowed in patient rooms and often the rooms [with more than one patient] were filled with other patients’ family members,” this source said.

Among other things, the source said, “Family members administered oxygen therapy without any prior advice from medical staff” and even “removed the tubes after performing therapy, such as infusion.

“The oxygen cylinder in our case was taken in the middle of the night by the nurse, and was not replaced by another. This damaged our mother’s health,” the source claimed, adding that with the exception of few doctors, the medical staff spent little time checking on patients’ conditions.

Doctors complain of exhaustion and understaffing

Serbia has 5,317 COVID-19 patients in hospital, 182 of them on respirators. Nominally, the country has 41,988 hospital beds, which is slightly above the European average per 100,000 inhabitants.

What is lacking is trained staff. Dr Rade Panic, from the main hospital in Kraljevo, in central Serbia, said the lack of medical staff and the total focus on COVID leaves patients who suffer from other diseases in a critical situation.

“Everything is subordinated to COVID-19. With the lack of staff, the other departments cannot meet their obligations. COVID-19 is not the only disease around here, so other patients suffer because of the situation,” Dr Panic told BIRN.

Panic, who is also heads the doctors’ union, says the state is now hiring new staff, but cannot find enough  of them as the authorities have not done anything to keep medics in the country for years.

“One Belgrade hospital is seeking 80 anesthesiologists, but we have maybe two or three on the market,” he noted.

In Romania, according to the latest figures, the public health system has just over 3,000 beds capable of supplying intensive care to COVID-19 patients, some 1,000 of which have been filled.

While Romania’s overall supply is better compared to some other countries in the region, perhaps due to its larger size, having available beds in one region does not mean that other regions are not running short.

Doctors have told the media that hospitals have already run out of ICU beds in some regions.

Last week, a doctor from the Timis County in western Romania said that six people had died because they could not be admitted to an ICU, as all the beds were full.

President Klaus Iohannis later denied this was the case, attributing the six deaths to communication errors.

Turkey, on the other hand, insists it has things more under control. Official data show that COVID-19 patients occupy 54.7 per cent of hospital beds and ICUs are operating at 70.8 per cent capacity.

Official data say there are currently some 64,000 symptomatic patients in the country, almost 4,000 in a critical condition.

However, Turkish doctors, patients and their relatives do not have much faith in government data.

A doctor at one public hospital in Istanbul told BIRN that the health system was heavily burdened, and risked collapse if the surge of COVID-19 cases continued.

“Every day we have more patients and the number of occupied beds reaches a critical level. The number of beds has increased in ICUs, but I am afraid it will not be enough in the near future,” he said.

“The situation is much worse in Istanbul, which is the hotspot for the pandemic in the country. The government does not report the real figures in the pandemic, including the total of number cases, but only the number showing symptoms,” the doctor said, adding that this number does not illustrate the whole situation.

Albania has more than 400 COVID patients in hospital. The number of cases there doubled over the last 26 days, but hospitalization rates have actually fallen, from 3.4 per cent of all active cases to 2.8 per cent.

Meanwhile, a parallel market for COVID-19 patients who opt to take care of themselves at home – who refuse hospitalization but have the money to pay private doctors – seems to have grown.

Under criticism for doing too little to help the sick, the government decided lately to offer COVID-19 patients some money in order to cover some of the cost of medicines needed for home treatment.

In Montenegro, with 10,207 coronavirus infections, the number of active cases had doubled since November 1.

With 1,620 active cases for every 100,000 citizens, Montenegro also has the highest infection rate in the region.

Montenegro has opened three regional COVID-19 centres, in Podgorica, Berane and Bar, while in other hospitals in the country some parts are dedicated to COVID patients.

But a male nurse from a clinical centre told BIRN under condition of anonymity that his fellow staff were working overtime and felt exhausted. He said there were enough free beds for coronavirus patients as only the most severe cases are hospitalized.

“But some of our medical stuff are infected, so we have to work overtime and sometimes on double shifts,” he said.

“People are at the end of their strength, working constantly under pressure,” the nurse said. “If the number of active cases continue to rise, the situation will only get worse,” he concluded.