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.