Dr Bilawal Kamran
Medical negligence in Pakistan is too often treated as an abstract issue — a systemic flaw, a resource limitation, or the inevitable by-product of poverty. But the current situation in Sindh, where nearly 4,000 children are living with HIV, reveals the brutal human consequences of these abstractions. Many of these children did not acquire the virus at birth or through personal behaviour; they were infected in the very healthcare facilities meant to heal them. In this context, negligence is no longer a theoretical problem. It is a crime in plain sight.
The Pakistan Medical Association’s (PMA) high-level alert on the rising paediatric HIV cases should serve as an urgent wake-up call for authorities. The numbers are stark and damning: 3,995 registered HIV-positive children in Sindh, with over 100 new cases reported in Karachi in 2025 alone. These figures are not isolated anomalies; they reveal a systemic collapse of infection control, regulation, and oversight. Despite previous warnings, Pakistan’s health administration appears trapped in habitual inertia, unable to translate policy rhetoric into meaningful action.
This is not the first time the country has faced such a tragedy. The 2019 Ratodero outbreak, which infected hundreds of children, should have been a watershed moment. Investigations were launched, inquiries were promised, and reforms were pledged. Yet, six years later, the PMA is once again forced to raise alarm. If any lessons were genuinely learned, they clearly did not reach the level of practical enforcement. The repetition of such crises speaks volumes about institutional failure, regulatory laxity, and political indifference.
What makes the current situation particularly disturbing is its entirely preventable nature. Unsafe medical practices — including reused syringes, unregulated blood transfusions, and informal clinics run by unqualified practitioners — continue unchecked. Clinics that should be bastions of healing have, in many cases, become sites of contagion. Illegal or unlicensed practitioners operate with impunity, while blood banks routinely flout standards that are commonplace in other countries. In short, preventable negligence has turned routine healthcare into a life-threatening risk for some of the most vulnerable members of society.
The PMA rightly describes this not merely as a medical emergency, but as a socio-economic catastrophe in the making. The impact of a lifelong HIV diagnosis on children and their families is devastating, both psychologically and financially. These children face a lifetime of treatment, stigma, and compromised opportunities — a burden entirely preventable through enforcement of basic healthcare standards.
Addressing this crisis requires decisive action, not statements of concern. First, strict enforcement of infection-control protocols across all medical facilities is essential. Syringes, needles, and other invasive instruments must be single-use, and healthcare workers must be trained and monitored continuously. Second, the government must crack down on quackery — informal and illegal practitioners who operate outside the law are directly contributing to the epidemic and must be held accountable. Third, blood banks must be tightly regulated, with criminal and civil penalties for violations. Any lapses in these areas should be treated not as administrative oversights, but as criminal negligence, with those responsible facing serious consequences.
Health officials and administrators who oversee repeated failures must also be held accountable. In the absence of enforcement, policy reforms remain symbolic rather than transformative. The public health system cannot rely on goodwill or voluntary compliance alone; it requires robust oversight, clear accountability, and the political will to implement standards without exception.
Pakistan’s children deserve a healthcare system that protects, not harms. The Sindh paediatric HIV crisis is not just a medical issue — it is a moral indictment of governance, regulation, and societal responsibility. The time for incremental change has passed. Swift, uncompromising action is the only path to prevent history from repeating itself and to ensure that no more children fall victim to preventable infections in the very places meant to heal them.
In the end, medical negligence is not just a failure of the system; it is a crime against the innocent. Pakistan has the knowledge, the expertise, and the resources to prevent such tragedies. What is lacking is the political courage and institutional resolve to act decisively. For the sake of nearly 4,000 children in Sindh today, and countless more in the future, that resolve cannot be delayed.
