Dr Bilawal Kamran
Pakistan has, by now, investigated so many HIV outbreaks over the past decade that surprise should no longer be a permissible reaction. Each new episode arrives with the same shape: a cluster of infections traced back to a healthcare facility, a wave of public alarm, an official inquiry, and a set of recommendations that rarely survive the news cycle long enough to be implemented. The findings now linked to Karachi’s Valika Hospital fit this pattern precisely, and that familiarity is itself the most damning part of the story.
More than ten thousand five hundred people living in the vicinity of the hospital have been screened so far. Of these, one hundred and twenty have tested positive for HIV. Official inquiries have confirmed seventy eight infected children, and six deaths have already been recorded. These are not abstract statistics. Each number represents a family whose ordinary contact with a healthcare facility, the most basic and unavoidable form of engagement with the state’s medical infrastructure, has resulted in a lifelong and entirely preventable illness.
The Sindh government has responded with a set of measures that deserve acknowledgment. Screening is continuing. Treatment is being made available at public expense. A long-term fund has been proposed for the children affected by the outbreak. These are the right things to do once an outbreak has occurred, and no one should begrudge the provincial government for taking them. But it is important to be honest about what these steps actually represent. They are responses to consequences. They do nothing to address the cause, and unless the cause is addressed, Pakistan will simply be back in this position again, at another hospital, in another city, within a few years.
The investigation into Valika Hospital has already revealed a familiar catalogue of failures. Infection control protocols were poorly followed. Single use medical equipment appears to have been handled improperly, very likely reused in circumstances where reuse should have been impossible. Supervision within the facility was weak. Essential supplies, including the equipment needed to maintain basic sterile practice, were in short supply. None of these are exotic or unusual failures. They are the same failures that infectious disease specialists have documented for years, and infectious disease specialists working on this current outbreak have gone further, cautioning that similar lapses have been identified beyond this single hospital, including within some private clinics. This detail should worry policymakers more than the outbreak itself. It suggests that Valika Hospital is not an isolated failure but a visible symptom of a much broader pattern of weak infection control across Pakistan’s healthcare sector, public and private alike.
It is worth remembering that none of this is new information for the country. In 2019, the outbreak in Ratodero saw hundreds of children contract HIV, and the subsequent investigation uncovered almost exactly the same set of problems that are now being documented at Valika Hospital: unsafe injection practices, poor sterilisation procedures, weak regulatory oversight, and inadequate enforcement of the rules that do exist on paper. At the time, there were promises of reform. There were commitments to strengthen oversight, to regulate clinics and laboratories more closely, to train healthcare workers properly in infection control, and to build surveillance systems capable of catching unusual disease clusters before they grew into full outbreaks. Six years later, many of those same shortcomings are surfacing again, in a different city, in a different facility, among a different population of patients. The lesson has clearly not been learned, or if it has been learned, it has not been acted upon with any seriousness.
This cannot
