Early on August 26, a fire destroyed the nursery at the Pakistan Institute of Medical Sciences (PIMS) in Islamabad. Hospital management attributed the blaze to a short circuit involving an air-conditioning unit in the ward. Fifteen babies were inside.
Fourteen did not survive. The ward door, which authorities later said was routinely kept locked as a precaution against infant theft, may have cost precious minutes. For those children, minutes were the only distance between life and death and between them and their parents.
What makes the tragedy almost unbearable is that it was not entirely unforeseen. Just seven weeks earlier, a fire had broken out at the Female Nursing Hostel at PIMS.
The subsequent investigation identified the very weaknesses that would prove fatal in August: non-functioning smoke detectors, unreliable alarms, a lack of evacuation drills, outdated electrical inspections, and weak security and record-keeping systems that could not cope effectively with an emergency.
Recommendations were made. Warnings were issued. Yet little appears to have changed. An institution had effectively been warned in writing that a faulty wire could lead to disaster. Disaster came anyway.
At this point, the story stops being simply about negligence at one hospital and becomes a question of whom the state is designed to serve. PIMS is not an obscure private clinic. It is the federal capital’s principal public hospital, an institution repeatedly presented as a symbol of the state’s capacity to provide quality medical care.
It was also the hospital to which former prime minister Imran Khan was transferred following Supreme Court directions when he required treatment for an eye condition. The state has demonstrated that when the needs of the powerful become urgent, attention, resources and institutional capacity can be mobilised.
Yet the same institution could not ensure that fire extinguishers were properly maintained, alarms were functional, electrical systems were adequately inspected, or ward doors allowed for rapid evacuation.
The resources required to respond to the powerful can be found. The far smaller investment needed to make a nursery safe was not.
This is elite capture in its most ordinary form. It does not require a conspiracy; it requires only a pattern of attention. Public institutions retain enough capacity to respond when powerful people need them, while the routine and unglamorous work of maintaining systems that protect everyone else is repeatedly neglected.
Pakistan spends less than one percent of GDP on public health, while the World Health Organization has long argued that substantially greater public investment is required to move towards universal health coverage. The consequences are not confined to PIMS.
Those without access to private hospitals such as Shifa International, air ambulances, influential contacts, or a well-equipped hospital in their own city are left exposed to the same institutional failures.
In 2024, eleven infants died when a paediatric ward in Sahiwal caught fire, with expired fire extinguishers among the issues reported in connection with the disaster. There were then promises of accountability, arrests and reform.
The recurrence of a similar tragedy at the capital’s premier public hospital two years later raises the obvious question: how seriously were those promises ever implemented?
This failure also has a legal and constitutional dimension.
Pakistan ratified the International Covenant on Economic, Social and Cultural Rights in 2008. Article 12 recognises the right to the highest attainable standard of physical and mental health. Yet within Pakistan’s own constitutional framework, health does not enjoy the same status as an enforceable fundamental right.
It appears principally through the Principles of Policy, including Article 38, alongside provisions concerning social welfare and basic necessities. Such provisions do not provide citizens with the same direct constitutional remedy available for fundamental rights. The contrast is striking.
Through the 26th Amendment, parliament inserted Article 9A, recognising the right to a clean, healthy and sustainable environment as a fundamental right. When parliament chooses to constitutionalise a right, it can do so. Health has simply not received the same priority.
The immediate response to the PIMS fire has been to suspend eight officials, as the prime minister has ordered. That may establish administrative responsibility, but it does not answer the larger questions. Why did a written warning issued only seven weeks earlier fail to produce urgent corrective action? Why were basic safety systems allowed to remain inadequate? And why does the machinery of the state respond with such speed and resources when the powerful require its attention, yet struggle to perform the routine duties that protect ordinary citizens?
Suspensions may satisfy the immediate demand for accountability. They cannot, by themselves, repair a system in which warnings are ignored until lives are lost.
Pakistan needs to treat healthcare not as a discretionary service or a privilege available through influence, but as a right owed to every citizen.
Until that principle is reflected in law, funding, hospital management and basic safety standards, PIMS will not be the last public ward where preventable failures turn cradles into graves.
