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As ailing Afghans increasingly fly to India for care, embattled airline thrives

Pedestrians and rickshaw riders pass stores with signs written in English and Pashto in the Lajpat Nagar area of New Delhi.

NEW DELHI — Bibihaji Zia plans to return to Kabul next week after knee surgery in New Delhi. She'll fly with SpiceJet Ltd., part of surge in Afghan medical tourism that's a silver lining for the indebted Indian airline.

"There are hospitals in Afghanistan, but the quality of medicine is the biggest issue," said the 54-year-old's son, Sediq, who organized the ticket. "Getting Indian visas is easy. The alternative, Pakistan, is less secure and less friendly."

SpiceJet is the only private Indian carrier with direct flights to war-torn Afghanistan, a route that's busy even after Taliban militants fired rockets at Kabul airport and the Malaysia Airlines Flight 17 disaster in Ukraine underscored risks in conflict zones. The number of Afghans seeking treatment, up 21 percent last year to more than 32,000, is set to climb further after Indian Prime Minister Narendra Modi relaxed visa rules to deepen ties.

SpiceJet's data show it flies about 1,000 Afghan medical tourists and their relatives each month from Kabul to New Delhi, which may earn the company about 156 million rupees ($2.6 million) a year based on average ticket prices. The carrier said the route is "very positive" when asked about profitability, without giving more details.

That contrasts with the mounting costs and competition in India's skies that led SpiceJet to lose 1.24 billion rupees in the April-June period, its fourth straight quarterly loss.

Zia, who like many Afghans watched Bollywood films while growing up and speaks Hindi, said he paid $3,700 for his mother's knee replacement at Saket City Hospital in India's capital. The same procedure costs about $19,200 in Singapore and $34,000 in the United States, according to Patients Beyond Borders.

Zia, 24, studies in New Delhi and stays in the city's Lajpat Nagar neighborhood, a "Little Afghanistan" that draws Afghan medical tourists and is dotted with travel agencies and restaurants bearing Pashto signboards.

"Demand is quite high for Delhi-Kabul flights," said Mehtab Singh, a manager at Welcome Travels in Lajpat Nagar. "We book 20-25 tickets to Kabul every day during peak season."

Among the other Afghans in New Delhi is 11-month-old heart patient Shukraan Nezamuddin from Mazar-e-Sharif. Her father, Nezamuddin, described India as a safer place for surgeries.

They plan to return on Kam Air, an Afghan carrier, after an operation at Fortis Memorial Research Institute on a hole in her heart. The hospital arranged for her transfer from the airport.

Afghan patients are part of an Indian medical tourism industry that will double in value to $6 billion by 2018 with 400,000 arrivals, up from about 230,000 currently, the PHD Chamber of Commerce and Industry estimates.

The two-hour, 625-mile (1,005-kilometer) trips linking the Indian capital with Kabul in Afghanistan, where the United States plans to withdraw almost all troops by the end of 2016 after its longest war, come with unusual risks.

On July 3, the Taliban attacked the airport in the Afghan capital with rockets while a SpiceJet plane was parked there. The assault on a military zone damaged three helicopters and a hangar, said Mohammad Yaqub Rassouli, head of Kabul airport.

Threats from conflicts are in sharper focus after Malaysian Airline's Flight 17 was shot down last month over Ukraine, killing all 298 aboard.

SpiceJet, which briefly suspended flights to Afghanistan after the Kabul rocket attack, wasn't the target of the firing and has security steps in place, Sudipta Das, a spokeswoman for the company, said in an email.

The airline, India's second-biggest by market share, is one of four Afghans rely on for regular direct links from Kabul to New Delhi. The others are state-owned Air India Ltd., and Kabul- based Kam Air and Safi Airways Co.

SpiceJet faces a fight to stem losses in an Indian aviation industry where Kingfisher Airlines ceased operations almost two years ago after amassing debt. SpiceJet, whose debt erased its net worth, has fallen behind on airport dues and restructured aircraft deliveries.

India introduced a medical visa for Afghans in 2005. Modi eased the rules on July 1, potentially allowing Afghans to stay for as long as two years at a time and exempting medical tourists from some police registration chores.

A fifth of Afghans had a family member or close friend who died because of a lack of access to health care within the preceding 12 months, Doctors Without Borders said in a survey published in February.

India issued about 100,000 visas to Afghans in 2013 — including more than 32,000 medical permits — up from around 85,000 in 2012, according to Niteen S. Yeola, a political officer at the Indian embassy in Kabul.

Raju Vaishya, a senior orthopedics consultant at Indraprastha Apollo Hospital in New Delhi, said he operates on about 600 Afghan patients a year "mostly for untreated problems and for complications from being badly treated."

An example is 36-year-old Nasr Zia-ul-Haq from Samangan in Afghanistan, whose broken arm wasn't fixed properly at home.

The demand for flights from patients such as Zia-ul-Haq may lead SpiceJet to increase services from three a week currently. The airline said it would expand if slots are available and it's attractive to do so.

Sediq Zia hopes flight links by SpiceJet and others keep growing. A nearby alternative for medical treatment, Pakistan, is less welcoming as the government there tries to stem militant infiltrations from Afghanistan.

"Once I was going home with my girlfriend at 2 a.m. in Delhi, and the cops gave me a lift. Can you imagine the same in Pakistan? There, they'd probably shoot me the moment they realize I'm an Afghan," he said.

Gupta reported from Mumbai. Eltaf Najafizada contributed from Kabul.

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