By Dr. H. U. Khan
MBA, Ph.D., Post – Doc
On August 26, a fire tore through the neonatal nursery at the Pakistan Institute of Medical Sciences in Islamabad. Fourteen newborns died.
They were not statistics. They were babies who came to a major public hospital for care, and whose parents left with grief no compensation can undo. The government has announced Rs 5 million for each family, ordered suspensions, and launched criminal investigations.
These are necessary steps. But they are not enough.
The real test is whether our institutions will learn. Because this was not an accident. It was a failure of systems that were supposed to protect the most vulnerable.
What Went Wrong
Preliminary findings point to basic failures: alarms that did not work, sprinklers that were non-functional, no emergency protocol, and no staff training. Most damning, there was no supervisory staff in the nursery when the fire broke out.
In a neonatal ward, this is unforgivable. Newborns on ventilators cannot cry for help. They cannot run. They depend entirely on the building, the equipment, and the people around them.
This was also not the first warning. Fire safety concerns at PIMS had been flagged before. When institutions ignore such warnings, negligence stops being about one person. It becomes a collective failure to act.
A hospital should learn from every near-miss. After any fire risk, there should be audits, drills, equipment checks, and repairs. If these happen only on paper, then the hospital remains dangerous.
Beyond Individual Blame
Those on duty who abandoned their posts must face legal consequences. That is clear.
But accountability cannot stop there. We have to ask harder questions.
Who was responsible for testing the fire alarms? Who checked the air conditioning units and wiring? Who ensured oxygen lines were secure and exit doors were accessible? Who trained the nurses? Who certified the building? And when previous safety issues were reported, who failed to act?
This is the chain of responsibility. It runs from the ward to the maintenance office to the hospital administration.
Parliament is right to demand more. Both the National Assembly and Senate Health Committees have questioned the initial reports and asked for full records on maintenance budgets, procurement, oxygen installations, and staff training.
We need independent technical investigation, not quick blame. We need to know exactly how the fire started, why it spread, and why every safety layer failed.
Ending the Cycle of Reaction
Pakistan has a predictable pattern after every disaster:
This is not governance. It is managing crises after they happen.
Real governance means preventing them. In a hospital, especially a tertiary care center like PIMS, risk management must be continuous. Fire systems should be tested before there is smoke. Exits should be open before people need them. Drills should be real, not filed away.
Every hospital must have verified fire equipment, working smoke detectors, clear signs, accessible exits, safe oxygen lines, and staff who know exactly what to do.
Training is critical. In the first five minutes of a fire, panic kills. Every staff member must know who raises the alarm, who calls emergency services, who shuts off oxygen, and who leads evacuation.
In a NICU, evacuation is even more complex. Babies on life support cannot be carried out like other patients. It requires special transport, trained teams, and practiced procedures.
We should acknowledge the doctors and nurses who risked their lives to save others that night. Their courage matters. But a health system should never rely on heroism to make up for missing systems. Good design and training allow ordinary people to respond well under pressure.
A National Audit, Not Just PIMS
PIMS is not an isolated case. If our premier federal hospital in the capital lacks basic fire safety, what about district hospitals, private clinics, and rural centers?
The federal and provincial governments must immediately order a nationwide safety audit of all healthcare facilities. Priority should be ICUs, operating theaters, and neonatal units.
The findings must be public. Hospitals should be given strict deadlines to fix gaps. And operating licenses should be tied directly to meeting verified safety standards. No compliance, no license.
Transparency is non-negotiable. Families deserve the full truth. Parliament deserves complete records. Citizens deserve to see that real changes have been made, not just announcements.
The Way Forward
Fourteen lives cannot be brought back by money or suspensions.
But Pakistan can decide what comes next. We can choose to move from reactive damage control to proactive accountability.
That means building systems where safety is routine, not a response to tragedy. Where audits are regular, not after a fire. Where staff are trained, not just hired.Where responsibility is tracked, not scattered.
The babies at PIMS deserved that. Every patient who walks into a public hospital deserves that.
Author is Executive Director, Excellence Consultants Policy Institute and writer on international Affairs.
