Karachi’s silent emergencies

Unsafe medical waste and failing public services expose the cost of fragmented urban governance in Pakistan’s largest city

Karachi’s silent emergencies are unfolding in plain sight, steadily eroding the city’s health, environment, and civic stability. Two recent Social Track reports — on unsafe infectious medical waste disposal and on the rising distress caused by Karachi’s failing public services — show how these quiet, persistent crises are tightening their grip. Together, they reveal a megacity struggling with systemic neglect, fragmented governance, and an alarming decline in the protections that should safeguard its people.

The medical waste report revealed unsettling gaps that directly threaten public health. Every day, hospitals and clinics across Karachi generate tonnes of infectious materials, yet the systems meant to collect, segregate, transport, and incinerate this waste remain fragmented. Several facilities still lack functional incinerators or rely on outsourced operators with minimal monitoring. In some cases, infectious waste is mixed with municipal garbage, ending up in open dumps where scavengers — including children — rummage without protection.

Regulators themselves acknowledge the weaknesses. Oversight teams cannot maintain regular inspections across the hundreds of public and private hospitals in the city. Agencies dispute who is responsible for what: municipal bodies control some waste streams, private contractors manage others, while provincial authorities oversee policy without ensuring compliance on the ground. This mix of weak enforcement and overlapping mandates has created dangerous blind spots, allowing untreated medical waste to flow back into neighbourhoods as contaminated air, water, and soil.

Parallel to this, Karachi’s wider civic infrastructure has been grinding down. Concerns voiced by experts during a recent seminar — as reflected in the second report — highlighted rising citizen stress as residents navigate leaking water lines, unplanned construction, crippled drainage channels, and unreliable waste disposal. Public transport reforms remain stalled, environmental regulation inconsistent, and the absence of neighbourhood-level management means small problems grow into chronic hazards. Communities living near nullahs describe stench, flooding, and disease as part of daily life, while heatwaves and record humidity further compound the strain.

These issues are not occurring in separate silos. The same structural weaknesses that allow medical waste to remain uncontrolled — fractured jurisdiction, lack of accountability, and poor local-level governance — also underlie the city’s broader civic decay. Karachi is being administered through scattered authorities with overlapping powers but no unified mandate. As a result, even straightforward tasks, such as enforcing biomedical waste rules or maintaining drainage infrastructure, become unmanageable.

Karachi needs more than periodic clean-up drives and circulars. It urgently requires a coherent, citywide urban management framework that clearly assigns responsibility, empowers local institutions, and links public-health priorities with environmental and municipal management. Medical waste oversight must be strengthened through transparent licensing, regular audits, and strict penalties for violations, while hospital-based waste units should be tied to monitored disposal chains, not loosely supervised contractors.

More broadly, civic systems must operate as connected urban services, not fractured bureaucratic territories. Karachi can no longer afford piecemeal fixes. Its residents deserve a city managed with intelligence, urgency, and accountability.

Karachi remains Pakistan’s economic engine and a megacity whose future will shape the country’s stability. The warning signs documented in our recent reports are unmistakable: without a comprehensive rescue plan rooted in integration, transparency, and empowered local governance, the city risks sliding into deeper dysfunction. Karachi’s millions deserve a city that protects their health, dignity, and resilience — not one that leaves them to navigate its failures alone.

This editorial was originally published in weekly Social Track

ST file photos