North Macedonia

Safety and security

Emergency phone numbers

Local authorities are responsible for investigating and prosecuting crimes and providing emergency services.

• Dial 112 for emergencies.
• Dial 192 for police.
• Dial 194 for ambulance.
• Dial 141-700 or 0800 11 111 for toll-free domestic violence hotline.  

Terrorism

Terrorists and their supporters may target U.S. citizens abroad.

Terrorists may target:

• Large public events (sporting contests, political rallies, demonstrations, holiday events, celebratory gatherings, etc.)
• Popular hotels, clubs, and restaurants
• Places of worship
• Schools
• Parks
• Shopping malls and markets
• Public transportation (subways, buses, trains, and commercial flight North Macedonia has not had any recent terrorist events.  There were some significant terrorism-related arrests in the past.
• There is concern about the risk of radical extremists conducting lone-actor terror attacks.  Authorities in North Macedonia have determined that ISIS members and sympathizers are present within the country.

Demonstrations

Demonstrations occur sporadically. They often result in traffic disruptions, particularly near the center of Skopje. They may take place in response to political or economic issues, or during major holidays or international events.

• Demonstrations can be unpredictable. Avoid areas around protests and other demonstrations.  
• Demonstrations intended to be peaceful can turn confrontational and become violent.
• Check local media for updates and traffic advisories.

Crime

• Violent crime against U.S. citizens is rare. Theft and petty street crimes occur in areas where tourists and foreigners gather.
• Do not leave anything of value in plain view in unattended vehicles.
• Organized crime is present in North Macedonia. Violent confrontations between rival organizations occur on occasion. Pickpockets are a problem in crowded areas of Skopje.

Safety tips:

• Lock the windows and doors of your house when not at home.
• ATM use is generally safe. Take standard safety precautions.
• Be aware of your belongings and surroundings.
  • Know that pickpockets use various diversionary tactics to distract victims. They may use children to swarm the victim.
  • If pickpocketed, report the crime to the police.
  • Cancel your credit cards immediately.
  • North Macedonia and the neighboring Balkan region continue to face challenges related to corruption and organized crime.  These challenges include drug trafficking, money laundering, migrant trafficking, extortion, and property crime.

Scams

Follow the Department of State guidelines to protect yourself from scams.

If you are a victim of a scam, learn how the FBI can help.  

Financial and internet romance scams can occur in North Macedonia.  Be careful of anyone asking for money, especially those who start a "romantic" relationship online or claim local authorities want money.

Scams often begin through online posts, emails, or letters. Scammers frequently pretend to be U.S. citizens in need of help, or locals seeking financial assistance to obtain a U.S. visa or travel to the United States.

Common scams include:

• Romance and online dating
• Money transfers
• People claiming to be detained, involved in an accident, or hospitalized abroad
• Work permits and job offers
• Fake “fines” through Skopje’s Safe City speed cameras

If using dating apps or websites in North Macedonia:

• Criminals may use dating apps to target potential victims for robbery or assault.
• Let your friends and family know where you are and consider sharing your location on your phone.  
• Meet in a popular public place.
• Tell your family or friends all the details about the person you are meeting and how you met them (which app).
• Set up and talk using a video call before agreeing to meet in person.
• Avoid locations where you can be isolated, like hotel rooms, private apartments or houses.
• Never leave food or drinks unattended at a bar or restaurant.
• Observe the preparation of your food or drink order when possible.
• Refuse offers of food or drinks from strangers.
• Have a communication plan with friends or family. Send updates to them on an agreed schedule. 

Victims of crime

Local authorities are responsible for investigating and prosecuting crime. You may report crimes to the local police by dialing 192.

• Review our information for Victims of Crime.  

The U.S. embassy or consulate can:

• Replace a stolen or lost passport.
• Help you find medical care.  
• Assist you in how to report a crime to the police.
• Contact relatives or friends with your written consent.
• Provide general information regarding the criminal justice system.  
• Provide a list of local attorneys. We do not endorse or recommend any specific attorneys.
• Provide information on victim’s compensation programs in the United States.
• Provide an emergency loan for repatriation to the United States or limited medical support in cases of need.
• Help you find accommodation and options to travel home.

Sexual assault and domestic violence

U.S. citizen victims of sexual assault or domestic violence are encouraged to contact the U.S. Embassy and local law enforcement for assistance. 

Technology use abroad

Mobile devices are vulnerable to compromise, theft, and damage anywhere in the world. Follow these safe practices:

• Update all software (operating system and apps) before leaving the United States.
• Use reputable, U.S.-based VPN or VoIP applications.  
• Don’t connect to public Wi-Fi networks.
• Research the safety of routes recommended by GPS. The fastest route is not always the safest.

Be cautious using dating apps abroad, as scammers often target U.S. citizens.

Drones

• All foreign citizens must register as a drone operator before flying.  Registration is free. You must register online through the Civil Aviation Agency of the Republic of North Macedonia. After registering, you must report each planned flight through the government's web application.

Tourism safety

The tourism industry is not well regulated:

• Safety inspections for equipment and facilities are rare.
• Dangerous areas and activities are not always marked with signs.
• Staff may not be trained or certified.
• If you get injured, you will likely need to travel to a major city for appropriate medical care.
• First responders cannot reach remote areas in case of emergencies.
• U.S. citizens are encouraged to have medical evacuation insurance.
• Review our information on Travel Insurance. 

Adventure travel

• Review the U.S. Centers for Disease Control and Prevention (CDC) tips for Adventure Travel.

Local laws and customs

Criminal penalties

• U.S. citizens must follow local laws. If you break local laws, even by mistake, you could be deported, arrested, or imprisoned.
  
• Travelers who accidentally break local laws have been detained. Sometimes, this can be for a long time. They may also face criminal charges and even be convicted of a crime.
• There are strict laws on exporting historically valuable or significant artifacts.  Exporting these items without the proper permit may lead to arrest, financial penalties, and imprisonment. North Macedonia's Customs Administration provides more information on customs regulations. Not declaring currency over 10,000 euros or its equivalent may lead to confiscation and legal proceedings. Penalties typically include a fine and a percentage of the undeclared amount.
• You may be prosecuted in the United States for crimes committed abroad regardless of the local law. Review the information provided by the U.S. Department of Justice about crimes against minors abroad.
• Before you start a business or a profession in North Macedonia seek information from the local authorities about what permits or licenses are required.  

Photography

• Visitors should follow “no photography” signs.
• If you are in doubt, ask for permission before taking photographs.
• Do not photograph subjects that could be viewed as related to national security or military operations.

Arrest notification

If you are arrested or detained, ask officials to notify the U.S. embassy immediately.  

Counterfeit and pirated goods

Counterfeit and pirated goods are common in many destinations.

• They may be illegal according to local laws.  
• Counterfeit and pirated goods may pose significant risks to consumer health and safety.  
• You may be subject to fines or have to surrender counterfeit and pirated goods to authorities if you bring them back to the United States.  

Learn more about U.S. restrictions on counterfeit and pirated goods:

• U.S. Customs and Border Protection
• U.S. Department of Justice

Faith-based travelers

Faith based travel includes pilgrimages, service projects, and mission work. Prepare for your travel using these resources:

• Faith-Based Travel
• Volunteering Abroad
• International Religious Freedom Reports

Gay and lesbian travelers

• There are no legal restrictions on consensual same-sex sexual relations.
• Lesbian, Gay, Bisexual, and Trans (LGBT) individuals continue to encounter considerable discrimination.  
• Same-sex marriages are not legal.
• The country lacks permanent, easily accessible gay-friendly venues.
• Recent reports indicate a rise in transphobic and homophobic language, and physical violence targeting LGBT persons.
• We recommend exercising caution when attending LGBT events.
• Review our information for Gay and Lesbian Travelers.

Travelers with accessibility needs

• The law in North Macedonia prohibits discrimination against people with physical, sensory, psychosocial, intellectual or mental disabilities. However, the law is only partially enforced.
• The most common types of accessibility may include ramped access or elevators in modern shopping centers, newly constructed government buildings, and major international hotels.
• Expect accessibility to be severely limited in public transportation. Most city buses and intercity transit lack ramps or lifts.  
• Lodging in historic or budget accommodations rarely has elevators.
• There is a lack of Braille signage, accessible websites, or sign language interpreters.
• There are high curbs, severely uneven or broken sidewalks, and cobblestone streets in historic areas.
• Accessibility is more common in newer commercial areas and large hotels in the capital. There is a significant difference between Skopje and the rest of North Macedonia. Outside of Skopje's center, accessible infrastructure is uncommon, and rural or adventure tourist areas present major physical barriers.
• People in North Macedonia have mixed feelings about disability. Locals are friendly and often quick to help, like lifting a wheelchair over a curb. However, there is still lingering social stigma and a lack of institutional awareness regarding independent accessibility. Many places haven't done enough to make things accessible for people who want to get around on their own.
• Be prepared to directly ask for help. Accommodation is rare and hospitality staff generally lack formal training on how to assist travelers with specific accessibility needs
• Review our information on Accessibility Needs.

Students

• Review our information on Studying Abroad.  

Women travelers

• Review our information for Women Travelers.
• Review our information on Marriage.
• Review our information for Victims of Crime.

Human rights

• Review the Department of State’s Human Rights Report for your destination prior to traveling.

Health

Health resources

• Centers for Disease Control and Prevention (CDC) North Macedonia Traveler Information 
• CDC Medical Tourism information
• World Health Organization
• Medicine and Health
• Travel Insurance

Emergency phone numbers

• Dial 112 for emergencies.
• Dial 194 for emergency medical services.  

Ambulance services

• Ambulance services are not widely available, except in Skopje and major tourist areas, such as Ohrid. Training and availability of emergency services may be below U.S. standards.
• Government-operated emergency services are substandard. Ambulances generally transport to state hospitals unless specifically requested to a private hospital. Private emergency services in Skopje meet higher quality standards.
• If an ambulance is unavailable or delayed beyond 15 minutes, travelers with non-life-threatening injuries or illness may use a taxi or private vehicle to reach the nearest major hospital if the patient can travel safely. Those with severe or life-threatening conditions should await emergency medical assistance.

Medical payments and insurance

Make sure you know if your health insurance plan covers any medical expenses abroad.  Most U.S. plans do not.

• The U.S. government does not pay medical bills.
• U.S. Medicare and Medicaid do not cover expenses or bills abroad.
• Most hospitals and doctors abroad do not accept U.S. health insurance.
• Medical care is not free in North Macedonia. If you require medical attention, you will incur expenses, even if you are treated in a public healthcare facility.
• Public hospitals and rural clinics typically require cash payment in Macedonian denars) upfront.
• Private hospitals often need payment upfront or proof of good international insurance before providing treatment or admitting a patient. While private facilities generally accept major credit cards, public facilities often do not.
• Make sure you know if your health insurance plan provides coverage abroad or reimbursement of payments. The CDC provides more information on types of insurance.
• We strongly recommend supplemental insurance to cover medical evacuation.
• If you purchase supplemental insurance, you are responsible for seeking reimbursement from the insurance provider. Follow their instructions for filing claims. 

Vaccinations

Stay up to date with the vaccines recommended by the U.S. Centers for Disease Control and Prevention.

• CDC Travelers’ Health
• World Health Organization Travel Advice

Healthcare facilities

• Health facilities are available in Skopje and other major cities, such as Bitola, Ohrid, and Tetovo. However, it is much harder to find adequate health care and specialized facilities in rural areas and smaller towns.
• The U.S. Embassy maintains a list of doctors and hospitals. We do not endorse or recommend any specific medical provider or clinic.
• While private hospitals in Skopje offer advanced care and modern technology, public medical clinics often lack basic resources, supplies, and updated equipment.  
• The quality of care does not match that of U. S. healthcare.
• Hospitals and doctors often require payment upfront prior to service or admission.
• Medical staff at public facilities and rural clinics may speak little or no English.  However, doctors and staff at private hospitals in Skopje frequently speak English.
• Generally, in public hospitals only minimal staff is available overnight in non-emergency wards. Consider hiring a private nurse. Another option is to have family stay the night with the patient, especially a child.
• Patients must cover all costs for transfer to or between hospitals.
• Psychological and psychiatric services are limited, even in larger cities.

Medical tourism and elective surgery

• Medical tourism is a fast-growing industry. If you want healthcare abroad, you need to know that their medical systems are different from the United States. They don't follow the same rules. Before you travel for medical reasons, talk to your doc
• Visit the CDC’s Medical Tourism website for information on medical tourism. Find out about the risks of medical tourism and what you can do to prepare before traveling to North Macedonia.
• We strongly recommend supplemental insurance to cover medical evacuation in the event of unforeseen medical complications.  
• Your legal options in case of malpractice may be limited in North Macedonia.  

Prescription medications

Always carry your prescription medication in original packaging, along with your doctor’s prescription.

• Check with the North Macedonia Agency for Medicines and Medical Devices (MALMED) to ensure the medication is legal in North Macedonia.
• Exercise caution when purchasing medication abroad. Pharmaceuticals may be easy to buy with few controls.
• Counterfeit medication is common and may not work, have the wrong strength, or have dangerous ingredients. You should buy medication with the help of a medical professional and from trusted places. North Macedonia strictly regulates medications containing narcotic drugs or psychotropic substances such as ADHD stimulants, strong pain relievers, and anti-anxiety medications. You must have an official medical certificate and declare it to customs.  

U.S. Customs and Border Protection (CBP) and the Food and Drug Administration (FDA) have rules for bringing medication back into the United States. If you buy medications abroad, the medications must meet CBP’s and the FDA’s requirements to bring them back legally.

The medications must also be for personal use and approved for use in the United States.

For more information:

• U.S. Customs and Border Protection
• Food and Drug Administration

Assisted Reproductive Technology (ART) and Surrogacy

• If you are considering traveling to North Macedonia to have a child through use of assisted reproductive technology (ART) or surrogacy, please review our information on ART and Surrogacy Abroad.
• Surrogacy is legal in North Macedonia. There are strict procedures that must be followed. Individuals who attempt to circumvent local law may face criminal prosecution.
• If you decide to pursue parenthood in North Macedonia via ART or surrogacy, consider hiring a reputable local attorney and be prepared for long and unexpected delays with local authorities while documenting your child’s birth or citizenship status.
• People who try to avoid local law risk legal consequences.  

Water quality and food safety

• Tap water is generally safe to drink and use in cooking in Skopje.
• In other areas, tap water is not safe to drink.
• Bottled water and beverages are generally safe. Use major brands and ensure the seal is intact.
• Many restaurants and hotels serve tap water unless bottled water is specifically requested.
• When outside of Skopje, you may want to request no ice in your drinks since it may be made using tap water.
• Make water safe by filtering, boiling, disinfecting, or distilling.
• Impure water can cause diseases like typhoid, cholera, hepatitis, and dysentery.

Air quality

• Air pollution is a significant problem in several major cities in North Macedonia. Consult your doctor before traveling. Consider the impact smog and pollution may have on you.
• Check NASA’s Air Quality Forecast. It uses Artificial Intelligence (AI), historical data, and global pollution modeling to generate a 3-day forecast of expected air quality in North Macedonia.
• For information about common air pollutants, check the CDC’s Air Quality page.
• For information about the U.S. Air Quality Index and health guidance, check out the EPA’s AirNow.
• The air quality changes with the seasons. It is worst in the winter season. The air pollution levels in Skopje range from double to triple that of the most polluted regions in the United States. People at the greatest risk from particle pollution exposure include:
  • Infants, children, and teens.
  • People over 65 years of age.
  • Individuals with lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD), including conditions like chronic bronchitis and emphysema.
  • People with heart disease or diabetes.
  • People who work or are active outdoors.
• For general health information, visit the Medicine and Health page.

Transportation

Road conditions and safety

• Road quality in North Macedonia varies significantly; major highways such as Corridors VIII and X are generally well-maintained, while secondary and rural roads may be narrow, poorly lit, or in disrepair.   
• North Macedonia has historically recorded high traffic fatality rates. Travelers should exercise heightened caution at all times. The Safe Cities initiative was launched on February 1, 2026, aimed at reducing traffic deaths through a network of cameras, speed detection sensors, and automated traffic citations. 
• Aggressive driving, speeding, and inadequate signage are common hazards, particularly outside of urban centers.  If you drive in North Macedonia, remain alert, obey posted speed limits, and avoid driving after dark on unfamiliar rural roads. 
• Drivers should be prepared for frequent tailgating, sudden lane changes without signaling, and dangerous overtaking on blind curves, or solid double lines.

Traffic laws

• You must have both a valid U.S. driver's license and an International Driving Permit to legally drive a vehicle in North Macedonia. You must obtain the International Driving Permit in the United States before you travel.
• If you are involved in a traffic accident, regardless of severity, it is mandatory to call the police and wait at the scene for them to arrive and complete a formal report. Do not move your vehicle until the police instruct you to do so, as this report is necessary for any insurance claims or if you are driving a rental car. The authorities may keep a U.S. citizen's passport until the matter is settled. This depends on the seriousness and circumstances of the incident.
• You are required by law to carry your U.S. passport, valid driver's license, IDP, and all original vehicle registration and insurance documents while driving. Traffic police frequently conduct routine stops.
• While the government has made efforts to combat corruption, there is still a small likelihood that local officials may request a bribe. If asked for a bribe, politely decline and request an official written citation. You can pay it later at a local bank or post office.

Taxis and ride-shares

Ride-share apps are not available in North Macedonia.

• Officially licensed taxis are generally safe, widely available, and relatively inexpensive. However, unmetered and unofficial taxis are common and frequently target tourists with high fares.
• Use metered taxis to avoid conflicts about the fare.
• Most taxis accept cash payments only.

Public and commercial transportation

• Public transportation options are limited.
• Buses are available in Skopje, and most are reliable.
• North Macedonia does not have a subway system.
• There are intercity buses that run between most cities. These are generally regarded as reliable and safe.
• Rail conditions are poor, limited, and service is unreliable.
• There are no commercial domestic flights.
• Review our information on Driving and Transportation Safety Abroad. 

Aviation safety oversight

The U.S. Federal Aviation Administration (FAA) has not assessed North Macedonia for compliance with international standards for aviation safety oversight.

FAA's website includes more information on its assessment program.  

Weather and natural disasters

Weather conditions

Earthquakes 

• North Macedonia is in an active seismic zone.  Earthquakes can occur year-round without warning. While most tremors are minor, moderate to severe earthquakes are possible and have historically caused significant damage.

Wildfires 

• During summer months from July through September, wildfires are common, particularly in forested and mountainous regions. These fires can lead to sudden road closures, destroy hiking infrastructure, and significantly reduce air quality in the surrounding valleys.

Flooding and landslides 

• Heavy rains and rapid snowmelt frequently cause flash flooding and landslides, primarily in the spring from April to June and autumn from October to November.  Flooding can quickly wash out secondary or rural roads and overwhelm local drainage systems, even in parts of Skopje.

Severe winter weather

• The mountainous regions and higher elevations experience heavy snowfall, ice, and freezing fog during the winter from December through March.  This creates dangerous driving conditions on mountain passes and poses an avalanche risk for backcountry skiers and hikers.

U.S. citizens living abroad

Living abroad resources

If you live outside the United States for a long time, you or your family may experience various life events, wish to exercise U.S. citizenship rights, or need to meet U.S. legal obligations while abroad.

• Learn how to prepare for voting in U.S. elections, the birth of a child, or getting married.
• Ensure you have a plan for healthcare and medical insurance abroad.
• Even abroad, you still have certain obligations such as paying your U.S. taxes or registering for military selective service.
• Review information on federal benefits, such as Social Security and 

Embassies and consulates