The Bulgarian Foreign Ministry said it will continue using all available diplomatic and legal mechanisms to ensure that Iva Mihaylova receives necessary medical treatment after a North Macedonian appeals court again refused to allow her to leave the country for treatment.
The Court of Appeal in Stip on August 20 upheld a decision by the Basic Court in Kocani denying Mihaylova permission to travel outside North Macedonia for medical care. The Bulgarian Foreign Ministry said it was particularly concerned that the ruling did not give sufficient weight to conclusions from competent medical institutions about the seriousness of her condition, the treatment prescribed to her and the fact that the procedure is not available in North Macedonia.
According to the ministry, the intervention Mihaylova needs is not an optional procedure requested simply at the patient's discretion. Specialists in both Bulgaria and North Macedonia have determined that it is a necessary part of treating her serious condition and that it should be performed to prevent further deterioration, including potentially irreversible consequences.
The Foreign Ministry criticized what it described as an inhumane approach to the case, saying that the need for treatment should not be questioned simply because the most serious consequences have not yet occurred.
"The point of timely treatment is precisely to prevent the occurrence of these consequences, and not to wait for them to materialize so that a court can recognize the existence of medical necessity," the ministry said.
It warned that the continued delay was becoming increasingly serious because of the nature of Mihaylova's condition and the possibility that the chances of successful treatment and recovery could diminish with time.
The ministry said it had already taken urgent measures within its powers to protect Mihaylova's rights and would continue to use diplomatic and legal channels to ensure she receives treatment without further delay.
Mihaylova, 23, holds both Bulgarian and North Macedonian citizenship. Her case has been ongoing for about 10 months following a traffic accident in North Macedonia last October. She has been prevented from leaving the country while proceedings related to the accident are underway.
According to Mihaylova's account, she was traveling toward Stip when she encountered a civilian vehicle that she recognized as a police car stopped while officers were checking another vehicle. She says an oncoming car moved into her lane to pass the police vehicle and collided head-on with hers.
The prosecutor's account differs, maintaining that the two vehicles collided on the center line and that Mihaylova was responsible for the accident. However, two independent expert reports reportedly reached similar conclusions that the other vehicle had entered Mihaylova's lane, by either 90 or 95 centimeters, and identified this as the cause of the crash.
Mihaylova said the collision left her badly injured. After the crash, she was taken to a hospital in Kocani, where initial X-rays reportedly did not identify serious injuries. At her request, she was subsequently transferred to Skopje, where an MRI showed that she had fractured her L5 vertebra and suffered a crack in L4.
"I felt like I was not fine at all. Literally everything hurt," Mihaylova said, describing her condition after the accident.
She remained hospitalized for four days and was guarded by police around the clock. According to her, officers took both her Bulgarian and North Macedonian passports within hours of her admission and imposed restrictions preventing her from leaving North Macedonia and, initially, even the town of Kocani.
Mihaylova says she was effectively treated as responsible for the accident before expert examinations had been completed. She has also questioned the continued restrictions, saying that for months she and her lawyers did not know precisely what charges she would have to defend herself against.
An indictment was eventually issued eight months after the accident, followed by a summons for a court hearing scheduled for July 6.
Her medical condition has remained a separate concern. Mihaylova says doctors have recommended specialized surgery that is not performed in North Macedonia but is available in Bulgaria, Turkey and Israel.
Her lawyers have repeatedly asked the courts to allow her to leave the country for treatment, but the requests have been rejected. The latest ruling represents the fifth refusal.
The first application was filed in December or January, citing Mihaylova's health insurance in Bulgaria and the suitability of treatment there. A further request was submitted at the end of March and included a neurologist's opinion recommending the surgery. The Court of Appeal in Stip subsequently rejected an appeal.
On April 27, Mihaylova's defense submitted another request, this time providing real estate as a guarantee and an expert opinion from a forensic physician stating that the treatment was urgent. The court nevertheless did not grant permission for her to leave North Macedonia.
Mihaylova maintains that eyewitness accounts support her version of the accident. She says witnesses included people traveling behind both vehicles and others who saw the oncoming car enter her lane. According to her, all of these witnesses were identified to the prosecutor's office, but only one was questioned, and that happened five months after the accident.
The Bulgarian Foreign Ministry has now placed renewed emphasis on the medical aspect of the case, arguing that waiting for irreversible damage before recognizing the necessity of treatment defeats the purpose of timely medical intervention. It said it would continue pursuing the case through all available diplomatic and legal mechanisms.
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