Some tragedies leave a nation in mourning, some make it ask the question: “Could this have been prevented?”
The Pakistan Institute of Medical Sciences, Islamabad, is an example of the second type of fire.
A fire in the nursery of the Mother and Child Health ward at PIMS claimed the lives of 14 newborn babies on Wednesday morning. The fire started at about 7am with at least 15 babies inside the nursery, it is reported. Only one was rescued. Eventually the fires were extinguished, but for 14 families, the following day brought the death of their children just out of the womb. UNICEF termed the deaths as a "tragic loss of newborn lives.
When such a tragedy occurs the question is always, what cause could there have been for the fire? Could it have been a short circuit? Has the air conditioner broken down? Did oxygen make the fire burn faster? These questions are important and investigators need to be able to respond to them. However, there are other questions that are also important.
The more awkward question is this: How can a fire in a modern tertiary care hospital kill nearly an entire neonatal intensive care unit?
Faulty electrical connection can cause a fire. Compressors can go bad. Equipment can malfunction. These things happen. The difference between a safe hospital and an unsafe hospital is the time that follows when things go wrong.
A good prepared hospital should have a rapid fire detection system, an alarm, a containment system, a cut-off system, procedures for patient evacuation for hospital staff and should move the vulnerable patient to safety. Patients at the most vulnerable to protect themselves are newborns in intensive care. Many need incubators and continuous medical support and oxygen. They must be evacuated on a scheduled basis and not during a fire.
Therefore, emerging of details about PIMS is so disturbing.
The Capital Development Authority's fire department has reportedly found the hospital's fire prevention and life safety plans inadequate and not up to the standard of the law. External emergency services' response was not always the problem as the fire company said it responded with its first engine to the hospital within six minutes of the call. The questions become more focused on what went on in the building in the six minutes that led up to and occurred during those minutes.
Worse, the fact that the CDA had issued fire safety notices to PIMS in the past few years. State Minister for Interior Talal Chaudhry said that notices had been given to the institution but he did not say at the time what parts had been fulfilled and what had not. The inquiry has been asked to look into evidence from CCTV and the number of doctors and nurses on duty, and check on the state of the doors and the safety measures at the nursery.
The tragedy becomes more than a mere accident and begins to feel like an institutional responsibility.
It's not an irony that can be missed. PIMS has formal fire emergency procedures. Its policies tell personnel how to evacuate from burning rooms, how to use an extinguisher (if trained), and how to try to confine the fire. Additionally, the rules outline a definite evacuation procedure for patients.
Having a procedure is not a sign of preparedness, however.
A document cannot evacuate a newborn.
A fire safety manual cannot carry an infant down three floors.
Try a drill or simulate a disaster without an emergency plan and you'll see how ineffective it might be.
This is especially significant in Pakistan, where government hospitals are under extreme stress. According to the Pakistan Economic Survey 2025-26, the public health system spending on health services is 0.8 per cent of GDP in FY2025-26. Official figures indicate that in 2025, there were 1,934 hospitals and 5,746 basic health units in the country, while the infant mortality rate in 2024 was 47 deaths per 1,000 live births.
PIMS is not a small neighbourhood facility. It's performance monitoring report for 24-25 has 1,282 beds in PIMS with 85 per cent bed occupancy, which is higher than the 80 per cent planned occupancy. It is a large tertiary care center that’s a huge burden for public health.
According to its own accounts, it spent approximately Rs7.92 billion on the entire PIMS system, which includes over Rs637 million on the Mother and Child Health Centre in the fiscal year 2023-24.
That complicates the appeal that it was a money issue.
The question is getting more and more to do with priorities, maintenance, oversight and accountability.
Pakistan has seen hospital fires before. In June 2024, four babies in Sahiwal Teaching Hospital lost their lives in a fire, which allegedly started with a short circuit in the air conditioner. The evacuation was assisted by parents and staff and dozens of children were evacuated, with questions raised concerning the availability of firefighting equipment in paediatric wards.
The pattern should have indicated the warning.
Instead, the country is once again debating extinguishers, emergency exits, electrical wiring, alarm systems and evacuation procedures only to lose lives in the process.
It's not just a hospital issue. This is a management issue.
Dawn's report on the hospital fires since 2010 indicated that fires happen often in Pakistan, and the report identified concerns of weak safety laws, building code deficiencies, and enforcement. Recently, a study conducted in public hospitals of Karachi revealed that there were some hospitals that had no emergency exit, there were no built-in fire suppression systems, and no adequate firefighting arrangements. In 2024, only five electrical short-circuit fires were reported in government hospitals in the city.
The issue is not that Pakistan does not know what it takes to make something fire safe. It's the compliance that is needed after the incident as opposed to before.
All great tragedies have a common plot. Condolences are issued. The inquiry committee is established. Authorities pledge an "iron fist" response. Safety assessments are notified. Reports must be demanded within days. Then there's a diversion of the masses.
The PM has already launched an inquiry into the PIMS fire and told the Federal Health Secretary, Aslam Ghauri, to step down. The district administration has set up an eight-member fact finding committee comprising representatives of emergency services, CDA, police, IESCO and PIMS and tasked it with 24 hours to submit its findings.
These measures are required. However, it is not enough to suspend one official and submit one report for accountability.
The real test will be if the findings result in structural change.
Every government hospital should know, before the next emergency, whether its alarms work. Whether its exits open. Whether its sprinklers function. Whether oxygen systems can be safely isolated. Whether staff know who carries which patient. Whether nurses have actually practised an evacuation. Whether electrical systems have been inspected. Whether fire drills happen regularly. Whether an external safety authority can certify the building without institutional pressure. And these answers should not be obtained after the death of a person.
The 14 newborns who died at PIMS did not have a political voice, a voice at all, nor could they flee a blaze. They were handed to a state institution by their parents because a hospital should be one of the safest places in a city where a kid is in a battle for life.
This trust has now been broken.
The country doesn't need yet another pledge to take the "strictest action”. It requires a system that identifies negligence in advance of death. Since the worst thing a hospital can do is have a machine go down.
The day that an institution no longer questions the safety of that machine, that wire, that exit, that alarm, or that oxygen line for the life depending on it.
Fourteen babies are born without a chance of recovery.
Whether these deaths turn out to be another statistic or if the day that Pakistan finally takes the issue of hospital safety seriously as a matter of life or death will depend on what transpires beyond the camera once the cameras have left PIMS.
