The Big Picture: Prevent Proactively, or Just React

In Sindh, especially Karachi, we keep responding to crises instead of building systems that stop them

By Mukhtar Alam

Every time there’s a fire safety lapse in a big hospital, we have the same conversation. The news cycle runs for 48 hours. Questions are asked. Promises are made. And then, slowly, we go back to business as usual.

The recent tragedy at PIMS, Islamabad — where 14 newborns lost their lives — brought that conversation back with painful urgency. We wish wellness and strength to the families affected. But if we look past the headlines, the real question isn’t about one building or one night. It’s about the system that’s supposed to keep thousands of buildings safe every single day.

Let’s talk about Sindh. And more specifically, Karachi — because this is where the maximum number of healthcare establishments are located. Both government and private. From small clinics in North Karachi to large tertiary hospitals in Clifton, this city carries the biggest burden of patients in the province.

And yet, the licensing and safety oversight data we keep hearing is hard to ignore. In more than a decade, fewer than 170 health facilities across Sindh have managed to get permanent licenses. Fewer than 2,000 are operating on temporary ones. Out of government facilities, the number with permanent clearance is in single digits.

That’s not a report. That’s a pattern.

The pattern is this: we start with energy, we announce fire safety audits and inspections, and we form teams. But follow-through is where it gets thin. Temporary certificates are issued after a first visit and then... forgotten. There’s talk that even the relevant oversight board in Sindh hasn’t been fully reconstituted to monitor performance consistently. And questions keep coming up: are the teams doing this work equipped for it? Are the right technical people on the panel? Or is it becoming more of a procedural exercise than a preventive one?

This isn’t just about fire safety. It’s the same story we see in public health. We mobilise after a dengue spike. We react to an HIV outbreak among children. We scramble when dog bite cases surge. We rarely build the system before the crisis.

In health, we call it “preemptive and preventive.” In hospitals, we could call it the same. Regular electrical checks. Functional civil defense coordination. A licensing process that doesn’t end at the first meeting. A board that actually meets.

Karachi deserves that consistency. With the largest concentration of patients, doctors, and facilities, the stakes here are the highest. A temporary paper on a wall doesn’t protect anyone. A certificate delivered after real inspection does.

Maybe it’s time we stop waiting for the next alarm. Maybe the work isn’t glamorous — audits, renewals, checklists — but it’s the work that saves lives before anyone has to protest or mourn.

So here’s the thought to sit with: 

Are we building systems to prevent, or are we jusst getting better at reacting?