Yesterday was a day of profound sorrow and heartbreak. Pakistan witnessed a man-made catastrophe in Islamabad, while Nepal was struck by its own bolt from the blue. Across the world, humanity has once again been confronted with the fragility of human life and the terrible consequences of disaster.
But there is something particularly unbearable about the tragedy that unfolded at Pakistan Institute of Medical Sciences (PIMS), Islamabad.
Fourteen newborn babies died in a fire in the Mother and Child Health Ward of the country’s capital. Fourteen lives that had barely begun. Some were only hours old. Some had been born just a few days earlier. They were lying in incubators or receiving oxygen, utterly incapable of saving themselves. They were not old enough even to know what danger meant.
And this was not a remote village hospital. This was PIMS, one of the country’s principal government hospitals, situated in Islamabad, the federal capital of a country that is supposed to be governed, administered and supervised from this very city.
That is what makes this tragedy so much larger than a hospital fire. It is a question about the state itself.
According to preliminary reports, the fire began in or around equipment in the nursery and spread with extraordinary speed, with oxygen contributing to the intensity of the flames. Questions have already been raised about fire-safety arrangements, emergency exits, firefighting equipment and the preparedness of hospital staff. Investigations will determine the precise sequence of events and assign responsibility. The government has also suspended the federal health secretary and ordered an inquiry.
But even before an inquiry produces its final report, one question refuses to go away: How could a nursery containing fifteen critically vulnerable newborn babies become such a death trap?
A fire does not normally leap from a spark to fourteen dead babies in an instant. Between the first spark and the final death there should have been alarms. There should have been detection. There should have been trained staff. There should have been emergency procedures. There should have been functioning extinguishers and firefighting systems. There should have been safe exits. There should have been people whose immediate instinct, training and responsibility was to get those babies out. There should have been layers upon layers of protection between a small fire and the death of fourteen newborn children.
Yet fourteen babies are dead. And that is the real horror. We have become accustomed to discussing disasters as though they were acts of fate. A fire breaks out. A building collapses. A bridge gives way. A school bus catches fire. A hospital becomes unsafe. Children die. Officials visit the scene. Ministers express sorrow. An inquiry committee is formed. A few suspensions are announced. The nation mourns for a few days. Then everything goes back to normal. Until the next tragedy.
This is not merely administrative failure. It is something deeper and more frightening: a culture of institutional indifference.
For years we have been told that better governance requires smaller administrative units. New provinces are presented as the answer to our political, administrative and economic problems. We are repeatedly assured that smaller provinces will bring government closer to the people and make administration more efficient.
There is another argument that has been running for years: after the 18th Amendment and the expansion of provincial autonomy, the federal government has supposedly been reduced to little more than a small administrative island, with much of the responsibility transferred to the provinces.
Very well. But let us look at that “small” federal island. Islamabad has a President, a Prime Minister, a Speaker of the National Assembly, a Chairman of the Senate, federal ministers, ministers of state, advisers, special assistants, secretaries, additional secretaries, joint secretaries, deputy secretaries, directors, commissioners and hundreds upon hundreds of highly paid officials. It has the Supreme Court, the Islamabad High Court, the federal ministries, regulatory bodies, diplomatic missions and the entire machinery of the federal state.
And sitting within this supposedly well-governed federal capital is PIMS – one of the country’s most important public hospitals.
If this is what governance looks like in the country’s administrative headquarters, what exactly are we expecting a new province to accomplish?
If fifteen newborn babies cannot be adequately protected in a major government hospital in Islamabad, how will another province, another chief minister, another cabinet, another secretariat and another army of bureaucrats magically solve the problem?
The disease is not necessarily the size of the province. The disease is the quality of the people running it.
We can divide Pakistan into four provinces, ten provinces, twenty provinces or a thousand administrative units. We can create new capitals, new assemblies, new ministries, new secretariats and new bureaucratic hierarchies. We can appoint thousands more ministers, advisers, secretaries and officials.
But if the institutional culture remains unchanged, the result will remain unchanged. Perhaps it will become worse. Because our problem is not simply that there are too few administrators.
Our problem is that too many people in positions of authority have become disconnected from the human consequences of their decisions and their negligence. We have created a system in which a file can be more important than a human life, a designation more important than responsibility, a protocol more important than urgency and a position more important than performance.
And ordinary citizens are left standing outside the gates, shouting for help. That is the most painful image from this tragedy: helplessness. Parents helpless before a hospital. Families helpless before officials. Patients helpless before an institution. And, ultimately, citizens helpless before the state.
One father reportedly said that his three-day-old daughter died while he and others waited desperately for help. Other witnesses described thick black smoke, broken glass and frantic attempts to reach the nursery. Families had to identify their dead newborns through wristbands or their ages. Some babies were only a few hours old.
What could be more devastating than that?
A newborn should be surrounded by the greatest possible protection. A neonatal ward should be among the safest places in an entire hospital. These babies cannot walk. They cannot scream for help in any meaningful way. They cannot run towards an exit. Many cannot breathe without assistance. It is more than obvious that this ward was unattended completely, at the mercy of the Almghty.
Their entire survival depends upon the adults and institutions entrusted with their care. And yet, when danger came, they were the most helpless beings in the building. This is why the PIMS fire cannot be dismissed as an unfortunate accident. An accident may explain the beginning of a disaster. It does not explain the scale of its consequences.
A faulty electrical component, an exploding compressor or a technical malfunction may ignite a fire. Equipment can fail. Electricity can short-circuit. Machines can malfunction. But institutions are supposed to be designed precisely on the assumption that things will sometimes go wrong.
That is what safety systems are for. A hospital is not supposed to operate on the assumption that nothing will ever catch fire. It is supposed to operate on the assumption that something eventually might. The question, therefore, is not merely: Who caused the fire? The more important question is: Why was the system incapable of stopping a fire before it became a massacre of newborn children?
And if PIMS, in Islamabad, the federal capital, is vulnerable in this way, what should ordinary Pakistanis expect from hospitals in smaller cities, towns and villages? What happens in a government hospital far away from Islamabad when a similar fire begins at dawn? Who will hear the alarm? Who will carry the babies? Where are the emergency exits? Who has been trained? Are the extinguishers functional? Are sprinklers installed? Are alarms working? Are oxygen systems safely designed? Are emergency drills conducted? Are neonatal wards inspected? Who checks these things before tragedy strikes? Or do we wait for fourteen children to die before discovering that the system was unsafe?
These questions should not be buried beneath another inquiry report. Nor should accountability stop with the suspension of one secretary. If negligence is established, responsibility must travel upwards and downwards through the entire chain of command. Those who failed to maintain safety standards, those who failed to inspect them, those who ignored deficiencies and those who had responsibility but failed to exercise it must all answer.
And more importantly, the country must stop treating every tragedy as an isolated tragedy. There is a pattern here. We are governed by an administrative culture in which the citizen is frequently treated not as the reason for the existence of the state, but as an inconvenience to the state.
We pay taxes. We stand in queues. We fill forms. We obtain certificates. We obey regulations. We vote. We send our children to government institutions. We place our lives in government hospitals. And in return, too often, we receive indifference, negligence and excuses. This is why the real tragedy of PIMS is not simply that fourteen babies died.
The tragedy is that fourteen babies had to die before the nation was forced to ask whether the institution designed to protect them was actually capable of doing so. We are, in many respects, living in the hands of people who have forgotten the meaning of public service. They feed upon the resources, taxes, patience and helplessness of ordinary citizens while remaining insulated from the consequences of institutional failure.
They are, metaphorically speaking, vultures fed on the blood and flesh of the people they are supposed to serve. And that is the tragedy of our nation. We keep changing governments, laws, administrative boundaries and political slogans. We keep creating new positions and new institutions. We keep debating provinces. But we rarely confront the one reform that matters most: the reform of the mindset of those who govern us.
Until that happens, no number of provinces will save us. A thousand provinces with the same mentality of the savage and insensitive ruling officials will produce a thousand versions of the same disaster. The fourteen newborns who died at PIMS cannot be brought back.
But perhaps their deaths can force us to confront a question that is much bigger than one hospital, one secretary or one fire: How many more innocent lives must be sacrificed before we finally understand that the greatest administrative crisis in Pakistan is not the size of the state, but the absence of responsibility within it?
