In Albania, COVID-19 and an overloaded health system have given rise to an informal, unregulated and dangerous market in supplementary oxygen equipment, to the concern of medical professionals.

COVID-19 patients and their families have told BIRN of spending hundreds of euros, in some cases up to 1,500 euros, on oxygen equipment for home use. Some said they subsequently offered the equipment for sale on social media.

“Both my parents were sick but I wasn’t able to find any to rent so I had to buy it,” said Dritan Selmani, a paramedic in the southern Albanian coastal region of Saranda. Having spent 1,000 euros, Selmani said he was now trying to sell the equipment on via Facebook.

The sale of oxygen cylinders in Albania is strictly regulated by the law and limited to companies with permits to operate in the market. Experts, however, estimate that tens of thousands of items of uncertified equipment are now circulating the black market, with no one regulating whether they are fit for use.

Medical-grade oxygen is classified as a medicine, and as such should only be used with a prescription and in accordance with medical guidance. The National Agency of Medicines and Medical Equipment, AKBPM, is responsible for monitoring the quality of supplementary oxygen.

The AKBPM did not respond to a request for comment. But Dr Krenar Lilaj, who works with COVID-19 patients at Tirana’s Mother Tereza University Hospital, said many patients arrived suffering from the effects of improper oxygen treatment at home.

“Oxygen is a medicine,” Lilaj told BIRN. “And as with any other medicine, if it is given in inadequate conditions and quantities it causes damage.”

He acknowledged, however, that the demand created by the COVID-19 pandemic was enormous, and far outstripped the availability of specialists to monitor the situation.

“Patients need specialised doctors, but in this situation there aren’t enough specialists for all of them,” Lilaj said.

Oxygen demand multiplies

Oxygen truck belonging to the company Messer Albagaz. Photo: Vladimir Karaj

There have been more than 118,938 confirmed cases of the novel coronavirus in Albania since the start of the pandemic a year ago. According to the Health Ministry, there are currently some 34,000 active cases and 500 people in hospital with COVID-19. As of March 18, 2,092 people had died.

A rise in cases over the past several months has triggered a similar demand for medical-grade oxygen.

According to the two companies licenced to operate in the market – GTS and Messer Albagaz – demand from hospitals was up more than sixfold in January-February this year compared with the same period of last year, just before the pandemic struck. In total, the companies sold some 2.4 million litres during the first two months of this year, compared to some 382,000 litres a year ago.

Both companies said they had difficulties meeting the demand given it had grown across the Balkan region, with Albania and its neighbours Montenegro and Kosovo reliant on imports of oxygen.

A GTS representative, who declined to be named, said Albania was fortunate in the fact that demand for oxygen in the country had spiked at different times from export countries. With most oxygen supplied by two major multinationals, storage and transport had been stepped up rapidly, he said.

“An hour delay in this market could cause up to 260 deaths,” the representative told BIRN.

Hospital supplies hired out

Paramedics transport an oxygen cylinder at the Infectious Diseases Hospital in Tirana, the main hospital dedicated to COVID-19 patients. Photo: LSA

In Albania, the technical safety of oxygen equipment is monitored by the State Technical Inspectorate, while the AKBPM is in charge of the quality of the oxygen.

The State Technical Inspectorate told BIRN that the two companies licenced to operate in the market in total have some 5,770 oxygen cylinders inspected and certified. The Inspectorate said it had carried out roughly 30 inspections since 2019, 25 of which were at GTS and Messer Albagaz and five at their customers.

Both companies told BIRN that their own suppliers also conducted checks and that the quality of the oxygen they supply is monitored all the way from productions to consumption.

The GTS representative, however, said he believed there are some 20,000 oxygen cylinders currently in use in Albania, some of them very old and very dangerous.

Both companies told BIRN they do not sell on the open market and that some of the cylinders being traded on the black market had been stolen from hospitals.

That appears to have been the case in the central Albanian town of Kavaja, where Mensur Shtylla, a specialist in the local hospital, was arrested in January and charged with theft and abuse of power for allegedly selling oxygen cylinders to COVID-19 patients being treated at home.

According to the prosecutors’ request for his arrest, Shtylla was found out after the director of the hospital inspected the storage facility and that discovered that of 30 cylinders that should have been there, there were only six. Prosecutors said cylinders were found in the garden of the Shtylla’s home, having been returned by people after they found out he was under investigation.

Shtylla denied taking any money, telling investigators that he was only trying to help sick friends and that he made no personal gain.

One customer, however, indicated that money had changed hands. Ervin Kollacaku, whose father tested positive for COVID-19, told BIRN: “I am not able to disclose to you how much money my brother paid for the cylinders.”

Another, identified by prosecutors as Eduart C., said he had received 10 cylinders for his sick father but returned seven after Shtylla’s arrest.

“Three are still in my house. My father still needs them,” he told prosecutors.

In Fieri, a town in southern Albania, Edmond Sulejmani said that he had also decided to care for his father at home rather than take him 100 kilometres to Tirana. As his father’s condition deteriorated, the father tracked down oxygen privately. “We were obliged to do so,” Sulejmani told BIRN.

Later, two employees at the private company that sold Sulejmani the oxygen cylinders were placed under investigation on suspicion of selling non-medical grade oxygen.

Erjon Hajderaj, technical director of Albagaz sh.p.k, told BIRN that medical grade oxygen cylinders differ from industrial oxygen, and that Albagaz’s certified cylinders went only to hospitals.

Private oxygen dealers

A COVID-19 patient receives oxygen in an ambulance outside the Infectious Disease Hospital in Tirana. Photo: LSA

As demand for oxygen in Albania grew, so too did the adverts on social media offering to sell equipment. Some seen by BIRN are placed by people who have recovered from COVID-19, while others purport to sell newly-imported oxygen.

Prices on the market vary, from 400 euros to 1,300 for equipment from Canada.

But specialists question the quality and worry about the harm they could do.

“Medical grade oxygen should be 99.5 per cent pure,” said the GTS representative, speculating that some of the oxygen being imported was no better than 88 per cent pure.

He also noted that not all oxygen equipment would be suitable for COVID-19 patients, who frequently need more than can be provided by the kind of equipment that might be used by a person with a chronic respiratory disease.

But that has not stopped some entrepreneurial Albanians.

In the northern Albanian town of Kukes, Nezir Ferhati said he first got hold of oxygen in neighbouring Kosovo for his own needs, but on seeing the explosion in demand he decided to start trading.

“My son opened an Instagram account where people contact us,” Ferhati told BIRN by phone. “I can’t keep up with the demand.”