ISLAMABAD: The syringe was in Razia Noreen’s hand when she saw the flames.
She and her colleagues had just checked on the 15 newborns in the nursery at the Pakistan Institute of Medical Sciences and were preparing injections for some of them in an adjoining room.
Then the fire appeared.
Noreen dropped what she was holding and went into the nursery.
She did not know whether she would come back out.
Inside, she found a newborn and pulled the baby into her arms, pressing the child against her chest as smoke rapidly filled the room. About eight seconds later, CCTV footage shows her emerging with the baby and handing the child to a doctor nearby. The infant was the only one of the 15 newborns in the nursery to survive the Aug. 26 fire.
For Noreen, however, those eight seconds were not a story of one life saved.
They were the beginning of a question that she may carry for years: What about the others?
She turned back toward the burning nursery almost immediately.
She and another nurse tried again, dropping low to the floor where the smoke was thinner and attempting to crawl through the doorway. But the smoke choked them, her coughing made it difficult to breathe and the flames forced them back. By then, the conditions inside were becoming impossible to survive.
Within minutes, Noreen learned that the other 14 newborns had died.
She collapsed in shock.
An impossible choice
It is tempting to reduce what happened next to a story about extraordinary bravery.
Noreen herself does not.
She describes it in much simpler terms: she was a nurse, the babies were in her care, and their mothers had entrusted them to her.
“I acted as a mother,” she told The Associated Press.
For her, the decision was made almost instantly.
She said she had one mission — to save lives — and did not think about her own safety before entering the nursery.
That is what makes the moment larger than the eight seconds recorded on CCTV.
Noreen was not simply confronted with danger. She was confronted with an impossible choice between her own safety and the lives of newborns who could not protect themselves.
She chose to try.
And then, when she was forced back, she tried again.
The distinction matters because newborns in intensive care are among the most vulnerable patients in any hospital. They cannot run from smoke, call for help or understand what is happening around them. Their survival depends almost entirely on the systems, equipment and people around them.
On that morning, Noreen was one of those people.
More than patients
Nurses who care for newborns occupy an unusual space in the lives of families.
They feed infants when their mothers cannot. They administer medication. They monitor fragile patients through the night. They notice changes that may be invisible to anyone else.
Noreen said nurses become like mothers when newborns are separated from their own mothers and placed in their care.
That understanding gives her actions a different dimension.
She was not thinking about an abstract group of patients behind a door. She was looking at babies whose mothers had handed them over to the hospital believing they would be protected.
That trust became part of the burden she carried into the fire.
And it became part of the grief she carried out.
The baby she saved — and the 14 she could not
The newborn Noreen rescued became the sole survivor of the nursery fire.
But the survival of one baby has not brought her peace.
She has said she has barely slept since the tragedy. When she approaches the nursery, memories of the flames and the babies overwhelm her. At times, she says, she feels as though she can still hear their cries.
The deaths, she said, have traumatized her and may take years to recover from. She was still physically unwell when she spoke to AP, reporting a fever of 103 degrees Fahrenheit (39.4 Celsius).
Then came perhaps the most painful words she has spoken since the fire.
She asked the mothers who lost their newborns to forgive her for not being able to save their babies.
It is a striking burden for someone who had already done what the available evidence shows she could: enter a rapidly deteriorating burning nursery, rescue a baby and attempt to go back.
The inquiry's CCTV reconstruction shows just how quickly the situation changed. The first visible emergency appeared at about 6:38:15 a.m. Staff nurse Razia entered at approximately 6:38:56 and emerged with the baby at 6:39:04. By about 6:40:08, smoke had obscured the relevant camera view. The committee concluded that conditions in the nursery deteriorated catastrophically within approximately two minutes.
Those details do not diminish the 14 lives lost.
They help explain the extraordinary speed at which the nurses and doctors were confronted with an environment that became increasingly impossible to enter.
Courage should not become a substitute for safety
Noreen's story deserves admiration. But it should not become a convenient way of looking away from the circumstances that made her choice necessary.
The government inquiry has identified serious failures in fire safety, emergency preparedness and response at PIMS. It found deficiencies involving fire alarms, sprinklers, fire drills, emergency procedures and staff training, among other concerns. The committee also said the precise technical source of ignition remained unresolved, with several possibilities still under examination.
Prime Minister Shehbaz Sharif ordered the suspension of eight officials and the initiation of disciplinary and criminal proceedings against those found responsible. The interim inquiry also noted that the hospital administration had failed to take necessary measures after an earlier fire at the PIMS nursing hostel in July, including steps related to fire-safety drills, firefighting equipment and emergency procedures.
That distinction is essential.
A nurse's courage can save a life.
It cannot replace a functioning fire alarm.
It cannot substitute for sprinklers, evacuation procedures, emergency training or properly maintained electrical and medical equipment.
And no healthcare worker should be required to gamble with their life because an institution failed to provide the safeguards that should protect both patients and staff.
A recognition she did not seek
The government has now formally recognized Noreen's actions.
Prime Minister Shehbaz Sharif approved the conferment of the Sitara-i-Khidmat, or Star of Service, and a Rs10 million cash prize for the staff nurse who risked her life to rescue the surviving newborn.
The recognition is significant not merely because of the award itself, but because of what it represents: an acknowledgment that public service is ultimately measured in moments when responsibility becomes personal risk.
Yet Noreen has made clear that she did not enter the nursery for a medal or money.
She was trying to save the babies.
That is perhaps the most powerful part of her story.
What a nurse carries
There are moments in healthcare when professional responsibility becomes almost impossible to separate from human instinct.
A doctor may stand beside a patient in crisis. A paramedic may enter a dangerous scene. A nurse may remain at the bedside long after a shift has ended.
But newborn care carries an especially profound responsibility because the patient has no voice and almost no ability to protect themselves.
Noreen's story puts that responsibility into stark human terms.
She was a nurse.
She was also a mother.
And when she saw babies trapped in a burning nursery, the distinction between those two identities appears to have disappeared.
She went in.
She brought one baby out.
She tried to go back.
She could not save the other 14.
That last fact is what makes her story painful rather than triumphant.
Pakistan can honour Razia Noreen for what she did without pretending that the tragedy ended with her rescue. The 14 newborns who died still demand answers about safety, preparedness and accountability.
But her actions deserve to be remembered for what they reveal about the best of healthcare service: that when a helpless patient needs someone, duty is not merely a word written into a job description.
Sometimes, it is a decision made in seconds.
And on Aug. 26, inside a burning nursery at PIMS, Razia Noreen made hers.
Stay connected with Medical News Pakistan
CLICK HERE TO JOIN the official Medical News Pakistan WhatsApp Channel for verified healthcare news, inspiring stories of medical professionals like Nurse Razia Noreen, major developments in Pakistan’s health sector, global medical breakthroughs, clinical research and the people shaping the future of healthcare.