The Guardian has published a feature from inside one of the world’s few hospitals built into a working salt mine, a Soviet-era facility 770 feet (235 meters) beneath the Avan district of Yerevan where patients with asthma and other respiratory conditions spend 6 hours a day underground. The report was written by Pjotr Sauer from Yerevan, with photographs by Sofia Maria Bergmann.
The facility is the Republican Center of Speleotherapy, opened in 1987 inside a mine that is still in operation. It occupies about 4,000 square meters of tunnels converted into treatment and rest areas, reached by an industrial lift that drops patients through rock salt into chambers lit by rows of electric lamps.
Narrow beds sit behind curtains along the walls, closer in appearance to a cold war bunker than a hospital ward. Patients rest, walk the tunnels, play billiards, or run through breathing exercises during the hours below.
The treatment is called speleotherapy, and it rests on the premise that salt-saturated, allergen-free air eases respiratory disease. A full course runs 3 weeks, with the first week given over to letting the body adjust to the underground environment.
Anush Voskanyan, a doctor at the clinic since 1989, told the Guardian that the idea came from an observation made by Soviet physicians, who noticed that salt miners appeared to suffer unusually low rates of respiratory illness despite spending their working lives underground. Researchers studied the microclimate of the mines, and specialized clinics opened across the Soviet bloc.
Voskanyan attributes the effect to the salt-rich air, a year-round temperature of about 66°F, and the absence of allergens, pollution, noise, and radiation.
The Guardian reports that thousands of patients a year descended into the Avan mine at its peak, most of them treated free of charge through Armenia’s healthcare system. Reporting by AFP and Euronews earlier this year put the more recent figures at more than 300 patients annually before the funding was cut and roughly 50 now.
That changed in 2019, when the Armenian government withdrew state funding on the grounds that speleotherapy lacked sufficient scientific evidence to justify public support. The decision came as Armenia was reforming its healthcare system and preparing to introduce universal health insurance, which forced officials to decide which treatments the state would continue to cover.
Health ministry spokeswoman Mariam Tsatryan told AFP in April that priority is being given to diseases with high mortality rates such as cancer and cardiovascular illness. “Alternative and wellness treatments cannot be included in insurance coverage,” she said.
Patients now pay 10,000 drams, about $26, for each visit. Doctors offer those who cannot afford the fee an alternative, suggesting they buy salt lamps made by the center for the same price. The Guardian gives the cost as roughly £20 per session.
Clinic director Gurgen Hakobyan told JAMnews last year that the center once employed 16 people and is now down to 4 working on civil contracts and 2 on staff. State support ran 28 million drams a year against about 4 million drams in income from paying patients, which together covered expenses and salaries. Patient fees are now the only income, and they barely cover wages for 6 employees and the cost of running the lift. He told AFP that the center struggles to pay salaries and cannot renew equipment that has not been replaced since it opened.
Voskanyan said the clinic used to take 60 patients at a time and now sees somewhere around 5. “We’re on the brink of closing down,” she said.
Mikayel Torosyan, an asthma patient interviewed underground, told the Guardian he had exhausted other treatments and had dismissed this one as nonsense before trying it, and now credits it with saving him. Alvart Alihanyan, another patient, has traveled back from Russia for treatment repeatedly over 10 years and would not keep returning if it did not help.
Few large-scale studies of speleotherapy have been conducted despite decades of practice across Eastern Europe and the former Soviet Union, and most clinics of this kind have since closed. Respiratory specialists generally treat it as a complementary therapy that may ease symptoms rather than a replacement for conventional medical care. The clinic’s own doctors say the same, describing speleotherapy as an aid to conventional medicine.
Voskanyan maintains that the treatment works, particularly for children with asthma and allergies, and said some patients have seen attacks stop entirely after a single course, an outcome that has not been established in clinical trials.
Euronews reported in April that officials were exploring private investment to keep the site open, with a research center or a medical tourism operation among the options discussed. No formal process has been announced.
For now the lift still runs each morning, carrying its handful of patients down through 770 feet of rock salt into chambers with no wifi and no sound from the surface.
