PRISTINA -- After a wait of more than three years, Kujtim was finally admitted to Kosovo's state-run hospital in the capital, Pristina, on September 9 for vascular surgery.
The health issues he faced were never life-threatening, but "the wait was exhausting," explained the 30-year-old from the central town of Drenas, who requested that his full name not be used.
His tale is not unique. In Kosovo, more than 10,000 people are languishing on waiting lists -- some waiting years like Kujtim -- for various essential medical procedures, from heart surgery to eye operations, according to a recent report by Kosovo's National Audit Office.
For the failure to provide timely care, the National Audit Office leveled blame not only at the Health Ministry but the Kosovo Hospital and University Clinical Service (KHUCS), which oversees the country's seven regional state-run hospitals. The University Clinical Center of Kosovo (UCCK) in Pristina, where Kujtim was treated, was also criticized in the report.
In its report, the audit office put the blame for the patient backlog on the critical shortage of medical personnel, in particular, anesthesiologists.
Neither the Health Ministry nor the KHUC responded to requests from RFE/RL's Kosovo Service for comment on the findings.
The auditor did observe in its report that Kosovo was now spending more on supplies and medications, with outlays increasing from 25 million euros ($28 million) in 2019 to 38 million euros ($42 million) in 2024.
Not Enough Doctors
Since gaining independence from Serbia in 2008, Kosovo has struggled on numerous fronts, from reviving the economy to fending off efforts by Belgrade to stymie its sovereignty. Health care is just one of many headaches officials face.
As the National Audit Office report noted, Kosovo, which has a population of 1.5 million, has a severe lack of medical personnel. After getting their medical training, young Kosovars often leave for better pay abroad, a common problem across the former communist countries of Eastern Europe. Hospitals are not only poorly equipped but are short of drugs and medications, which sometimes forces patients to buy them themselves.
RFE/RL's Kosovo Service has previously reported on the lack of basic supplies -- from bedsheets to soap, or cancer patients receiving chemotherapy in makeshift rooms at the UCCK hospital.
Kosovo has seven regional hospitals as well as UCCK, the top institution where many of the most difficult medical procedures are performed and where aspiring medical personnel are schooled inside the Balkan country. Beyond those hospitals is a network of state-run clinics found in many cities and towns.
Growth Of Private Clinics
Alongside the state-run sector, Kosovo also has many private clinics and hospitals whose numbers have grown in recent years. Those who can afford this option often cite the timely and better quality care they receive.
For Kujtim, such a clinic was never an option.
"I might have gone to a private institution, but I didn't have the means. I also trust the public system more," he explained to RFE/RL.
The math is simple. The surgery Kujtim needed would have cost $1,000 at a private clinic but nothing at UCCK.
Given that economic reality, it's perhaps not surprising most patients endure the wait to get treated there.
Kosovo's audit office found that waiting times at UCCK's Vascular Surgery Clinic, where Kujtim was treated, can reach up to more than four years.
There are two reasons for that, according to the clinic's director, Hajriz Rudari: a lack of hospital beds and anesthesiologists.
"Our clinic handles various diseases, including arterial and venous problems.... We are the only place in Kosovo that deals with diabetic foot complications. Treating diabetic foot requires long-term care in the clinic, and [the lack of beds] -- on top of the shortage of anesthesiologists -- is why the waiting lists are so long," Rudari told RFE/RL.
The vascular clinic has 24 beds at its disposal, and data shows that, between 2019 and 2023, it treated on average 106 patients a month, stretching capacity to the breaking point, management has complained.
UCCK also has an Anesthesiology Clinic, staffed with 48 anesthesiologists, a number below what is needed, according to its director.
"Difficulties are compounded by their frequent on-call duties -- every sixth day and sometimes every third day," Gazmend Spahija told RFE/RL.
Poor Pay, Poor Conditions
For years, the clinic has had to contend with a dearth of anesthesiologists, with 29 having left between 2019 and 2023. In addition to anesthesiologists, other specialists have also left UCCK. In the past five years, a total of 142 have departed.
Poor working conditions and low pay -- around 1,200 euros ($1,300) a month -- are given as the reasons for the exodus, according to the Kosovo Medical Chamber. (Average monthly wages in Kosovo are about 600 euros) For those not eager to leave Kosovo, private clinics with their higher pay and better working conditions are an attractive option.
One of the anesthesiologists who left his job at the UCCK hospital and asked not to be identified, told RFE/RL recently that, "for a big amount of work at UCCK, you get paid as much as those who do much smaller jobs."
During two recruitment drives for anesthesiologists between 2019 and 2023, only 23 were recruited, far below the minimum of 100 needed.
According to director Elvir Azizi, the shortage will continue for some time. Next year, over 15 doctors are expected to complete their specialization in anesthesiology, but it is uncertain how many will work inside the state-run health system since many have funded their education themselves, meaning they aren't obligated to work inside the system once their schooling ends.
