The deaths of 14 babies at Pakistan Institute of Medical Sciences were not an isolated tragedy. They were the reflection of a system that repeatedly reacts to catastrophe without confronting the structure that allows catastrophe to happen again. A neonatal intensive care unit is supposed to be among the spaces in a hospital. Its patients cannot run, escape or protect themselves. They depend entirely on the institutions around them. That is what makes the deaths of newborns in such a place than a question of how a fire started. The larger question is how a system responsible for protecting the helpless citizens failed to prevent a disaster contain it and ensure that those responsible could be immediately held to account.
Pakistan has seen this pattern before. From the Baldia Town factory fire to the Gul Plaza tragedy from repeated failures in hospitals to the deaths of children and young people whose names briefly become national headlines the cycle has become painfully familiar. There is grief, outrage, promises of action an inquiry, suspensions or transfers and eventually silence. The system remains. The names change; the victims change; the institutions change; the underlying failure does not. The deaths and cases associated with children and young people, including Muntaha Zehra, Aizal, Meer Raza and others should not be remembered merely as hashtags. Should the deaths of newborns at PIMS be reduced to another days headline. Each case raises a question about a government that appears far better at launching inquiries after a tragedy than building institutions capable of preventing one.
The tragedy of children is particularly devastating because they represent the citizens capable of protecting themselves and most dependent on the government their families and public institutions. A newborn in care has no choice. A young child cannot navigate a failing emergency system. A family cannot personally compensate for the absence of safety inspections hospital management, effective child protection or professional emergency response. This is why every such tragedy is ultimately a test of governance. The same question must also be asked about failures in Sindhs public health system, including the HIV infections among children linked to unsafe medical practices and the failures surrounding Kulsum Bai Valika Hospital. When vulnerable children repeatedly become victims of negligence the problem can no longer be described as an individual mistake. It becomes a question of whether the institutions themselvesre structured to protect lives, or simply to protect those who control them.
At the heart of this problem is Pakistan's centralized system of authority. Power, resources and decision-making remain concentrated in political and bureaucratic centres while citizens experiencing the consequences often have no direct route to the people responsible. A hospital may fall under one authority its safety standards under another emergency services under an financial decisions under yet another layer of government. When disaster strikes responsibility travels through this maze until it becomes difficult to establish who was supposed to act, who failed to act and who must answer. A minister can point towards a department, a department towards an official an official towards a committee and a committee towards an inquiry. Meanwhile the family that lost a child is left waiting for an answer that may never come, the mother who is grieving over the loss of a child, she just gave birth to.
This is why accountability cannot depend solely on the removal of an individual after every disaster. The question is not whether one secretary should be transferred or one official suspended. The question is why the system makes it so easy for responsibility to disappear in the place. Centralization is not simply an arrangement; it can become a mechanism for insulating power from the people affected by its failures. The greater the distance between a citizen and a decision-maker the easier it becomes for authority to be exercised without accountability.
Pakistan needs to confront the case for smaller empowered administrative units, not as a way of dividing the country but as a way of bringing governance closer to the people. Decentralization should mean more than creating boundaries or holding symbolic local elections. It should involve financial authority, administrative autonomy, professional institutions and clear lines of responsibility. A citizen should know who is responsible for the safety of their hospital the inspection of their local buildings the functioning of emergency services and the protection of their children. Importantly that responsible authority should be accessible enough to be questioned and accountable enough to face consequences.
Smaller and genuinely empowered units would not magically eliminate incompetence or corruption. They could make failure more visible and accountability harder to escape. A local administration with authority over health services building safety, emergency response and public infrastructure would bring decision-makers closer to the communities they serve. Resources could be allocated according to needs oversight could become more direct and the chain between public failure and official responsibility could become shorter and clearer. What Pakistan needs is not fragmentation. Functional devolution as a system in which power is distributed enough to be monitored and authority is close enough to be challenged.
The lesson of PIMS therefore must not end with the question of who will be suspended. The 14 newborns who died should force Pakistan to ask a harder question: how many more lives must be lost before the system itself is put on trial? Until power is balanced by checks institutions are professionally managed and authority is brought closer to the people every new inquiry risks becoming another document in the archive of preventable tragedies. These victims should not remain stories. Baldia Town, Gul Plaza failures in hospitals the deaths of vulnerable children and now the PIMS tragedy all point towards the same national crisis: a system in which power is concentrated responsibility is diluted and accountability arrives only after lives have already been lost. Pakistan does not need another cycle of grief followed by silence. It needs a governance structure in which public interest's stronger, than institutional self-preservation, where power is not something to be guarded by political and bureaucratic elites but a responsibility to be shared monitored and questioned. The real reform is not simply to find someone to blame after every tragedy. It is to build a system where no authority's too distant to answer no institution is too powerful to be questioned and no childs life is lost because accountability came only after the disaster.
