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Pakistan’s mainstream conversation has a way of looking up when it should be looking down. Television studios and front pages can spend days on intrigue in Islamabad, on who met whom, on which capital now takes Pakistan seriously, on whether the country has brokered a diplomatic opening.
Far less attention is paid to the slow violence unfolding in hospitals, clinics and poor neighbourhoods where children are infected not by fate but by negligence. The Taunsa scandal, the recurring HIV outbreaks in Sindh and the steady drip of fresh cases among children should have forced a national reckoning. Instead, they have been treated as grim local stories, shocking for a day and then quietly folded away. What happened in Taunsa ought to have changed the country. The BBC’s undercover investigation into the Tehsil Headquarters Hospital showed syringes being reused, injections being administered through clothing and unqualified volunteers treating children with contaminated vials months after the authorities had promised a crackdown.
At least 331 children in Taunsa tested positive for HIV between November 2024 and October 2025. Fewer than one in 20 parents tested positive, strongly suggesting transmission within the healthcare system rather than within households. Nineteen new cases were reportedly identified in the following four months and nine of Taunsa’s children had died after contracting the virus. This is an indictment of a system. The obvious temptation is to present Taunsa as an exception. It is not.
The WHO and UNAIDS warned in December 2025 that Pakistani children had been exposed to HIV through unsafe injections and blood transfusions in outbreaks across several places, including Shaheed Benazirabad, Hyderabad, Naushahro Feroze, Pathan Colony, Mirpur Khas, Jacobabad, Shikarpur and Larkana, as well as Taunsa. In several of these outbreaks, more than 80 per cent of detected cases involved children. That pattern is too consistent to be dismissed as bad luck. It points to a healthcare culture in which infection control is not consistently enforced and in which unsafe practices are tolerated until they become a catastrophe.
Sindh offers a wider warning. The Pakistan Medical Association’s alert in January described 3,995 registered HIV-positive children in the province and more than 100 fresh incidents in Karachi alone. By April 2026, Sindh had reported 894 new HIV cases in just the first three months of the year, including 329 children under 14. Seven years after Ratodero shocked the country in 2019, the province is still discovering new pediatric cases while experts continue to point to reused syringes, unsterilised equipment, unsafe blood and weak oversight. When an outbreak keeps returning in different districts, it stops being an outbreak in the dramatic sense. It becomes infrastructure.
It is fashionable in Pakistan to speak of public health only when a crisis becomes impossible to hide. Even then, the language is narrow: suspend an official, seal some clinics, announce a committee, move on. Yet the problem is deeper than one negligent superintendent or one ward caught on camera. It lies in the thinness of the public health state itself. Pakistan’s public health expenditure in FY2024 was slightly over Rs900 billion, equivalent to less than one per cent of GDP. The same official economic survey records only 1,696 hospitals and 5,434 basic health units for a country whose population in 2025 stood at 255 million.
A poor country cannot spend like a rich one. But a state of this size cannot keep pretending that less than one per cent of GDP is a serious answer to the needs of a vast and growing population. Pakistan’s underinvestment is even starker in comparative terms. A major English newspaper’s analysis last year noted that meaningful progress towards universal health coverage requires around five percent of GDP and that Pakistan was hovering around one per cent, below regional peers such as India, Sri Lanka, China and Iran on that measure.
Governments in Pakistan have long approached health as a residual item, something to be padded with slogans, donor projects and emergency campaigns rather than built patiently as public infrastructure. The result is visible everywhere: crowded hospitals, erratic supplies, weak monitoring and rural or peri-urban communities pushed towards informal practitioners because qualified care is too far, too expensive or simply absent. That vacuum is filled by quackery and improvisation.
In October 2025, Sindh’s health minister was told that more than 600,000 quack doctors were operating in the province, 40 per cent of them in Karachi alone. Officials listed the familiar horrors: unsafe blood transfusions, illegal clinics, the reuse and repackaging of syringes, contaminated injections, unscreened blood, unsafe dental tools and even the reuse of razors. When poor families cannot rely on timely, affordable and safe public care, they will turn to whoever is available. Moral outrage is not enough. Quackery survives because the state leaves room for it to survive. There is also a political economy to unsafe medicine.
In many places, patients still expect injections because injections look like treatment. Doctors and paramedics, or those posing as such, oblige. Hospitals that run short of supplies stretch what they have. Families are asked to buy medicines outside. Supervisors look away. Training is weak. Record-keeping is poor. Accountability is intermittent. What should be treated as criminal negligence gradually becomes normal routine. This is why the Punjab government’s insistence that no conclusive epidemiological link has been established to Taunsa hospital sounds so unsatisfactory. Footage of contaminated practice does not prove every infection pathway, but it proves something almost as damning: the system remained unsafe even after a public scandal had already erupted.
The burden does not end with diagnosis. The WHO and UNAIDS say that only 14 per cent of pregnant women in Pakistan who need treatment to prevent mother-to-child transmission receive it. Among children aged 0 to 14 living with HIV, only 38 per cent are on treatment. That should terrify any serious government. HIV in children is not merely a clinical issue. It is a sentence to lifelong treatment, repeated vulnerability to infection, school disruption, stigma and household impoverishment. Each avoidable pediatric infection creates new future costs in medicine, caregiving, lost income and social exclusion.
A country already struggling to generate enough jobs and human capital cannot afford to damage its children through preventable harm. This is where the argument moves beyond health policy into national priorities. Pakistan has recently enjoyed a measure of diplomatic visibility. Islamabad hosted direct US-Iran talks in April 2026, and even after those talks ended without a breakthrough, officials presented Pakistan’s role as proof of renewed relevance. That may well be true. Diplomacy matters. Mediation matters. International standing matters. But prestige abroad cannot compensate for decay at home.
A state that can secure headlines for peace talks but cannot guarantee a clean syringe for a child is not yet a successful state. What would real seriousness look like? Not another brief surge of outrage, nor another round of promises that fade with the headlines. It requires greater investment in health and better use of that money. Hospitals must have reliable procurement systems to ensure essential supplies are always available. Infection-control audits should be regular, rigorous and mandatory in both public and private facilities. Licensing systems and databases need to be properly maintained, transparently monitored and strictly enforced.
No country can drift through one pediatric HIV outbreak after another and still speak confidently of progress. The real test of the state is not whether foreign powers pass through Islamabad for talks but whether ordinary Pakistanis can enter a public hospital without being exposed to avoidable danger. Pakistan’s diplomatic successes and recent peace negotiations may flatter the national ego. They should not blind the country to the real condition of its public.
The writer is dean of the faculty of liberal arts at a private university in Karachi. He tweets/posts @NaazirMahmood and can be reached at: [email protected]
