Fourteen newborns are dead after a fire tore through the neonatal area of the Pakistan Institute of Medical Sciences (PIMS), Islamabad but the most difficult questions facing investigators now begin long before the flames erupted.
PIMS had previously faced documented concerns about under staffing, insufficient infrastructure and deficient safety measures. Fire authorities had reportedly issued repeated warnings over deficiencies, while an earlier fire in July 2026 at the nursing hostel exposed the absence of basic emergency systems.
The government has now launched a high-level inquiry. Prime Minister Shehbaz Sharif has ordered investigators to determine the immediate cause of the fire, establish a timeline and examine the emergency response by hospital staff and relevant institutions.
But the investigation's most important task may be to determine whether the tragedy was the result of an unavoidable accident — or whether a chain of foreseeable and preventable failures helped turn a hospital fire into the deaths of 14 newborns.
The warnings came before the deaths
One of the most serious issues now confronting PIMS is the reported history of fire-safety warnings.
The Islamabad Metropolitan Corporation's Fire Disaster and Management Department had reportedly been raising concerns about fire-prevention and protection arrangements at PIMS for years. Reports published after the tragedy say notices had been issued since at least 2018, with the hospital instructed to address deficiencies, complete fire-protection and life-safety equipment, maintain the system around the clock with trained personnel and conduct evacuation training. A 2024 notice reportedly again pointed to incomplete fire-safety measures.
The significance of those warnings is difficult to overstate.
During questioning after the fire, Minister of State for Interior Talal Chaudhry acknowledged that notices had been issued to PIMS over the previous seven years, while saying investigators would have to establish which deficiencies had been rectified and which had not because PIMS comprises multiple buildings.
That leaves a brutally simple question:
If fire-safety deficiencies had repeatedly been communicated to PIMS, why were they still potentially relevant when a fire struck a neonatal facility?
The answer must come from records, inspections, maintenance logs, compliance reports and the people responsible for acting on those warnings.
What did PIMS actually have in place?
Reports emerging after the tragedy have raised allegations that critical fire-safety infrastructure at PIMS was either inadequate or non-functional.
Questions have been raised over fire hoses, water availability at fire points, evacuation routes and other firefighting arrangements. Some reports have also alleged that emergency exits were locked or inaccessible.
The hospital, meanwhile, has presented a different account.
According to a PIMS statement cited by Dawn, two doctors and two nurses were on duty inside the nursery, responded immediately, called security staff and attempted to enter the nursery. The hospital said staff rescued one newborn from the nursery, four babies from an adjacent room and three mothers, while 73 other patients in the adjoining gynaecology ward were evacuated. It also said 35 fire extinguishers were used.
This clarification itself leaves several critical questions unanswered: Why could the two doctors and two nurses reportedly on duty inside the nursery rescue only one baby? What prevented them from reaching the remaining newborns? Adults may be able to run down a corridor and escape a fire; a newborn lying in an incubator cannot move, run or save itself. So why were staff able to evacuate patients from adjoining areas while the babies trapped inside the affected nursery could not be reached?
These are not questions that can be brushed aside by citing the number of staff on duty or fire extinguishers used. At some point, the PIMS administration will have to provide clear, evidence-based answers to these questions—and there should be no escape from them.
The locked-door question
Parents and relatives have questioned access to the affected area, while other reports carried allegations that the NICU door was locked and that staff were absent. PIMS administration has disputed the allegations and said staff were present.
There may be a legitimate security rationale for controlled access to a neonatal unit.
PIMS officials have cited the risk of infant abduction as one reason for restricting access.
But controlled access and emergency evacuation are not mutually exclusive.
A properly designed neonatal unit should have secure access and an immediate emergency-access mechanism.
The investigation must therefore establish exactly what happened.
A fire had already occurred at PIMS weeks earlier
Perhaps the most disturbing part of the chronology is what happened on July 6, 2026.
At about 3am, a fire broke out at the reception area of the PIMS Nursing Hostel. The blaze destroyed three sofas, while all 78 female students residing in the hostel remained safe.
The subsequent inquiry reportedly found that the hostel had no CCTV cameras, no fire alarm and no emergency plan. The precise cause of the fire could not be established because electrical and forensic reports were unavailable. The inquiry recommended departmental action against the hostel warden and security personnel.
The report also reportedly found that two security guards were absent from their assigned positions and identified other shortcomings in the hostel's administration and security arrangements. Reports further say recommendations from the July inquiry had not been implemented before the August 26 nursery fire.
That chronology demands answers.
- What corrective measures were taken after the July fire?
- Were all PIMS buildings immediately audited?
- Were fire alarms installed?
- Were emergency plans prepared?
- Were electrical systems checked?
- Were security arrangements strengthened?
- Were the inquiry recommendations implemented?
- And why was the federal health minister reportedly unaware of the July incident?
Mustafa Kamal said he was not aware of the July 6 fire when questioned after the August tragedy.
If an earlier fire inside the same hospital complex did not trigger a comprehensive safety review, that itself is an accountability question.
The IHRA letters raise another uncomfortable question
The fire-safety questions do not end with PIMS management.
The Islamabad Healthcare Regulatory Authority (IHRA), which regulates healthcare establishments in Islamabad, has a statutory role in registration, licensing and enforcement of healthcare standards. IHRA itself states that healthcare establishments cannot operate without the required licence.
According to letters from IHRA to PIMS cited in the material reviewed for this report, the authority had reminded the hospital that, when seeking renewal of its licence, it was required to obtain the relevant fire department NOC, including the requisite fire-safety and training clearance.
The letters reportedly made clear that the fire-safety component was part of the regulatory requirements and that PIMS should obtain the relevant clearance along with its application for renewal.
PIMS had already been told to “put house in order”
The current crisis also echoes an inspection from June 2024.
An adviser to the Federal Ombudsperson visited PIMS and found the hospital under severe pressure.
According to Dawn, the inspection team found the hospital crowded, with four patients lying on a single bed with no staff to attend to them, while some wards had no fans.
The inspection also exposed a substantial staff shortage.
At that time, PIMS had 396 doctors working against 415 vacant doctor posts and 283 vacant nursing posts, with a total of 1,265 vacancies, including paramedical positions. The ombudsperson directed the administration to fill vacant positions and improve facilities.
The adviser effectively told the administration to put its house in order.
More than two years later, the staffing problem has not disappeared.
In fact, figures presented by the federal health ministry in Parliament on August 25 — one day before the nursery fire — showed 467 doctors working against 852 sanctioned positions at PIMS. The hospital also had 363 vacant nursing positions out of 1,093 sanctioned posts and 215 vacant paramedical positions.
These figures demonstrate something important:
PIMS continued to carry substantial staffing vacancies despite the issue having been formally documented and flagged years earlier.
A hospital can have equipment on paper — but can it work when lives depend on it?
This is ultimately the larger institutional question.
A fire extinguisher sitting on a wall is not the same thing as a functioning fire-safety system.
A written emergency plan is not the same thing as trained staff who know what to do.
An exit marked on a floor plan is not an emergency exit if it is inaccessible.
A regulatory certificate is meaningless if the conditions it certifies do not exist in reality.
And a hospital staffed on paper is not adequately staffed if critical positions are vacant when an emergency occurs.
That distinction is particularly important in neonatal intensive care.
A healthy adult may be able to run down a corridor.
A newborn in an incubator cannot.
A baby dependent on oxygen cannot independently escape smoke.
A premature infant cannot wait for a rescue plan to be improvised.
That is why fire safety in a neonatal unit is not an administrative luxury.
It is part of patient care.
This is where criminal negligence enters the debate
It would be premature to declare that PIMS officials or the federal government are legally guilty of criminal negligence before the investigation establishes the facts.
But asking whether criminal negligence may have contributed to the deaths is now entirely legitimate.
If investigators establish that responsible officials knew of serious and potentially life-threatening safety deficiencies, had a duty to correct them, failed to do so despite repeated warnings, and those failures materially contributed to the deaths, the case for serious legal accountability would become much stronger.
If the evidence shows otherwise, that must also be established.
The investigation therefore should not begin with a predetermined conclusion.
It should begin with the entire chain of responsibility.
The federal government's responsibility cannot be separated from hospital management
PIMS is not an isolated private facility.
It is one of Pakistan's largest public-sector hospitals and operates under the federal health system.
That means accountability cannot stop at the hospital gate.
The inquiry should examine the roles of:
- PIMS administration.
- Relevant federal health officials.
- Fire and emergency authorities.
- Regulatory authorities.
- Maintenance and engineering departments.
- Those responsible for staffing and recruitment.
- Those responsible for inspection and certification.
And, where evidence supports it, senior officials who had the authority to intervene but failed to do so.
Individually, each issue may have an explanation.
Collectively, they demand a serious investigation.
Because the most important question after the PIMS tragedy is no longer simply:
What caused the fire?
It is:
What allowed a fire in a hospital nursery to become a death sentence for 14 newborns?
And if the answer includes warnings that were ignored, safety systems that were not maintained, staffing failures that were allowed to persist or regulatory requirements that were not enforced, then Pakistan will have to confront a much more uncomfortable possibility:
The tragedy may not have been simply an accident.
It may have been the culmination of systemic failures that were foreseeable, documented and preventable.
That is precisely what the investigation must establish.
Fourteen newborn lives demand nothing less.
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