A mining cage drops deep beneath the Armenian capital, carrying asthma patients in helmets down into a salt cave clinic -- an alternative treatment center whose future is now at risk.
State funding for the speleotherapy center in the Avan salt mine was recently cut as the small Caucasus nation rolls out a new universal healthcare system that does not cover alternative medicine.
The fate of the facility is a snapshot of a global debate over the effectiveness and role of alternative treatments in modern healthcare, a particularly pressing issue in developing countries, AFP said.
Speleotherapy -- where patients spend several hours a day in caves breathing mineral-rich underground air believed to reduce respiratory irritation -- has been practiced for decades in parts of Eastern Europe and the former Soviet Union.
At the bottom of the Avan salt mine, a dim tunnel carved from grey rock salt leads to the Soviet-era center.
"We are 235 meters (770 feet) underground, and yet this is a hospital," doctor Anush Voskanyan said as she guided visitors into a vast chamber illuminated by rows of electric lamps.
Opened in 1987 inside a former mine, the center spans about 4,000 square meters of tunnels converted into treatment and recreation areas. For decades, patients received therapy for free under the state's healthcare program.
But in 2019, Armenia's health ministry stopped financing the clinic, arguing that speleotherapy does not meet evidence-based medical standards required for public funding.
Annual patient numbers dropped from more than 300 to around 50.
"We struggle to pay salaries and cannot renew equipment that has not been replaced since opening," clinic director Gurgen Hakobyan told AFP, saying its future was "uncertain."
- Global strategy -
Globally, supporters of traditional or complementary remedies say they have been overlooked by Western medicine.
The World Health Organization's members have called for a global effort to build a solid evidence base, regulate practitioners and integrate treatments that are proven safe and effective.
Supporters of speleotherapy say the cave environment, free from dust and allergens and with a constant temperature of around 19-20C, helps ease symptoms of asthma and allergies.
Voskanyan, the doctor, said she had seen children make full recoveries after treatment.
But the scientific evidence remains limited.
"Since 1985, only two dissertations have been written on the subject," said Lamara Manukyan, chair of the Armenian Association of Internal Medicine.
"We lack statistics and large-scale research."
She said speleotherapy "helps conventional medicine ease a patient's condition" and should be considered a "complementary therapy rather than a standalone treatment."
- 'Salvation' -
Armenia's health ministry said its decision to stop the clinic's funding reflects broader healthcare priorities as the country transitions toward universal medical insurance.
"At this stage, priority is given to diseases with high mortality rates such as cancer and cardiovascular illnesses," ministry spokeswoman Mariam Tsatryan told AFP.
"Alternative and wellness treatments cannot be included in insurance coverage."
Many of the centers's patients -- and its doctors -- lament the decision to strip funding.
Armen Stepanyan, a 63-year-old engineer from Russia's Siberian city of Kemerovo, has travelled to Yerevan annually for more than a decade after developing severe asthma.
"I tried everything -- sanatoriums, treatments -- nothing helped," he said. "Here I felt improvement after the first course."
Supporters argue the center's significance extends beyond medicine.
Manukyan, the chair of the internal medicine association, described it as part of Armenia's tradition of natural therapies, including mineral springs and spa resorts.
"There is no reason to dismantle an existing structure and lose a valuable tradition."
The government, which holds a stake in the center, is trying to privatize its shares, raising hopes that private investment could preserve or repurpose it as a research or medical tourism center.
"It would be really sad if the clinic had to shut down because it simply ran out of funding," said Stepanyan, the patient.
"I realized this was my salvation. This is the only place where I see real results."
