Fajar Rehman
A twenty-two-year-old woman who was once at the top of her class is dead. She did not fail her examinations. She did not abandon medicine. She was, by every academic measure, succeeding. And then, according to those who knew her and those who have since spoken publicly, the sustained harassment of her teachers wore her down until she saw no way forward. She took her own life. Her name deserves to be remembered. What happened to her deserves more than a regulatory circular.
The Pakistan Medical and Dental Council has responded. In the wake of nationwide protests by medical students who recognised in her story something of their own daily reality, PMDC has mandated that all medical and dental institutions implement mental health screening protocols. The intention, presumably, is prevention. The impulse is not wrong. But the response reveals a pattern of governance that mistakes the announcement of a measure for the delivery of one.
This is not the first time PMDC has issued an instruction of this kind. In November 2024, the council directed all institutions to establish anti-harassment committees, formally charged with preventing and addressing complaints from students. That directive is now less than a year old. In the intervening months, a student was harassed by her teachers until she could no longer bear it. The committee, if it existed at her institution in any functional sense, did not save her. One is entitled to ask, with some urgency: what exactly happened between the issuing of that instruction and its implementation on the ground? Who verified that committees were formed? Who checked that they were independent, accessible and taken seriously? Who followed up?
These are not rhetorical questions. They are the precise questions that distinguish a government that governs from a government that merely announces. Pakistan’s regulatory authorities have developed an unfortunate habit of treating the issuance of a directive as the conclusion of a problem rather than the beginning of a solution. A tragedy occurs. Protests follow. A circular is issued. The public anger subsides. The circular is forgotten. Another tragedy occurs.
Mental health screening protocols, layered on top of anti-harassment committees that were never properly enforced, will not change the culture inside Pakistan’s medical colleges. Culture is not changed by paperwork. It is changed by accountability, by consequences that are real and consistently applied, and by the slow, deliberate work of reshaping the norms that govern how people in authority treat those beneath them.
The norms inside Pakistan’s medical institutions are badly broken. One in five medical students shows signs of depression, anxiety or suicidal thinking. That is not a figure at the margins. It describes the interior life of a significant portion of every lecture hall in every medical college in the country. These students are not simply struggling with a difficult curriculum. They are struggling inside an environment that has been allowed to become hostile to their humanity. Students who reach out for emotional support are mocked. They are told, explicitly and implicitly, that sensitivity and medicine are incompatible, that acknowledging struggle is proof of inadequacy, that those who cannot endure whatever is inflicted upon them do not belong in the profession. This is not academic rigour. It is institutional cruelty, and it is taught by example from the very teachers entrusted with forming the next generation of doctors.
A mental health screening test administered in this environment will not produce honest answers. Students who have already learned that vulnerability is punished will not disclose their suffering to an institution they do not trust. A helpline number printed on a noticeboard will not be called by someone who has watched peers ridiculed for admitting they were struggling. The infrastructure of support is meaningless if the culture that surrounds it makes seeking help an act of courage that few can summon.
What is actually required, and what no circular has yet demanded, is mandatory sensitivity training for faculty, not as a one-afternoon workshop but as a substantive and ongoing condition of teaching in a medical institution. What is required are penalties with teeth: real consequences for teachers who harass, demean or abuse their power over students, consequences that are investigated independently, applied transparently and not quietly dissolved when the accused holds seniority or institutional favour. What is required is an honest reckoning with the fact that the academic culture being protected in the name of “high standards” is producing broken students and, in the worst cases, dead ones.
The young woman who died was at the top of her class. She had already proven she belonged. What failed her was not her capacity for medicine. What failed her was every adult in a position of authority who either participated in her harassment or stood by and allowed it to continue.
Pakistan keeps failing its young people in exactly the same way and calling each new failure a surprise. It is not a surprise. It is a choice. And choices can be changed, if the will exists to change them.
