Roma Exclusion Undercuts North Macedonia’s EU Bid

The Big Picture: Persistent exclusion of Roma communities lays bare North Macedonia’s governance deficit and undermines the credibility of its EU membership bid.

Governance failures in North Macedonia have left the country's most vulnerable communities, especially Roma, facing sustained hardships. While Romani people officially make up just 2.53% of the population, other estimates suggest the actual number is as high as 9.6%. This community is disproportionately impacted by the country's infrastructural neglect. 

In towns like Tetovo and beyond, Roma communities are often excluded from basic public services. As North Macedonia pursues EU accession, this ongoing marginalization poses serious questions about the country's readiness to meet EU standards for inclusion and human rights. 

Key Insight: Vibrant Roma identity endures in North Macedonia, yet outside Šuto Orizari’s bilingual exception, structural marginalization persists.

The Roma in North Macedonia maintain a rich cultural identity shaped by centuries of movement, adaptation, and resilience, yet they face systematic marginalization that threatens their communities' survival. Balkan Romani is the most widely spoken language within Roma communities, though many also speak Macedonian, and in certain regions, particularly around Tetovo, Albanian and Turkish are used as secondary or working languages. 

In Šuto Orizari, a predominantly Roma municipality in Skopje, both Romani and Macedonian are official languages, a rare institutional recognition of Roma linguistic rights. The majority of Roma in North Macedonia identify as Sunni Muslims, while the remaining population is primarily Christian. These identities are often blended with localized traditions and practices. 

Key Insight: Zoning and routine service denials hard-wire segregation into Roma neighborhoods, turning municipal planning into a technology of exclusion.

Roma communities in North Macedonia are routinely excluded from essential services, deepening their marginalization. Roma neighborhoods suffer from systemic neglect, especially in sanitation and health care. Discrimination is institutionalized through deliberate policy choices: Roma settlements like Vardarska and Triangla in Skopje are strategically located near open sewage canals and waste dumps, while the surrounding majority areas receive full municipal services. This stark disparity in infrastructure reveals long-standing governance failures that perpetuate social exclusion and erode public trust. 

Key Insight: Bureaucracy, clinical bias, and patriarchal permission chains turn care from an entitlement into a checkpoint, compelling Roma women to petition for basics and normalizing preventable harm.

Health care inequalities demonstrate the deadly consequences of discrimination. Up to 50% of Roma individuals lack health insurance due to bureaucratic barriers and gaps in documentation, leaving them vulnerable and unprotected. 

In an interview with a Roma health patient, the woman from Kumanovo shared how non-Roma patients in her hospital ward received regular care while her linens went unchanged. When she raised the issue, a hospital worker reportedly told her, “You sleep on the floor at home, so don't expect more than what you deserve.”

Roma women face even more specific challenges: 18% give birth without medical assistance, and 8% receive no prenatal care, putting both mother and child at greater risk. Social norms also create additional barriers to care. More than half of Roma women (53.3%) need family permission to seek medical attention, compared to just 23.2% of ethnic Macedonian women. This cultural barrier is compounded by healthcare systems that fail to provide culturally sensitive outreach or strong educational programs that could overcome some of these barriers. As a result, exclusion has become institutionalized. 

The Bottom Line: North Macedonia’s EU readiness starts in Šuto Orizari. The EU should tie North Macedonia’s accession track to time-bound Šuto Orizari upgrades and enforced healthcare access, unlocking funds only under independent monitoring as each delay hardwires exclusion into the next generation.

North Macedonia must implement immediate, targeted benchmarks for Šuto Orizari infrastructure improvements and health care access enforcement as concrete steps toward genuine EU readiness. The EU, along with neighboring countries, can play a crucial role in raising awareness and supporting initiatives that strengthen North Macedonia's infrastructure, particularly in Roma areas, through specific monitoring mechanisms and funding allocations. 

The question is no longer why this exclusion persists but how quickly North Macedonia can demonstrate its commitment to human rights through measurable progress. These issues demand urgent action because for Roma families enduring discrimination daily, each delayed reform represents another generation denied basic dignity and opportunity. 

Further Reading 

• UNICEF: Barriers to Health Insurance Access for Roma Families 
• Council of Europe: Environmental Protection and Roma Rights in North Macedonia 
• Roma in North Macedonia – Minority Rights Group Profile 
• PMC Study on Roma Women's Access to Healthcare