Mohammed Amin was eight years old when he came home from a routine hospital visit with a fever. Days later, he tested positive for HIV. His sister Asma tested positive shortly after. Their family had one explanation: the syringe used to inject Mohammed at THQ Hospital Taunsa had been used on other children before him, one of whom was already living with the virus. Mohammed died before his ninth birthday.

His story is not singular. It is a pattern. Between November 2024 and October 2025, at least 331 children in the Punjab city of Taunsa tested positive for HIV. In more than half the cases, investigators recorded “contaminated needle” as the likely mode of transmission. A year before that, over 30 dialysis patients at Nishtar Hospital in Multan, south Punjab’s largest public medical facility, contracted HIV due to what a government probe described as “scandalous negligence.”

And six years before that, the city of Larkana in Sindh watched as 876 people, 82 percent of them children, were diagnosed with HIV in the space of three months through unsafe medical injections. These are not accidents. They are the predictable consequence of a state that has consistently failed to enforce the most basic standards of medical safety.

Pakistan’s HIV outbreaks are not medical anomalies. They are human rights violations: foreseeable, preventable, and repeating. Under international law, the state bears an obligation to ensure that its healthcare infrastructure does not become a site of harm. That obligation is going unmet. This is the story of how Pakistan’s public health system turned the act of seeking care into a vector of catastrophe.

The scale of what happened in Larkana was, at the time, almost impossible to comprehend. A WHO-led investigation in 2024 found that 99 percent of the HIV-positive children had received a medical injection or intravenous infusion within the previous 12 months. Field teams visiting clinics documented direct and indirect reuse of syringes and drip sets, unsafe disposal of sharps, and the repackaging of used syringes for resale to doctors. In Sindh province alone, investigators identified over 500 clinics, laboratories, and blood banks with unsafe practices or evidence of medical quackery.

The first HIV-positive case had been reported internally as early as 26 October 2024, and was suppressed by senior management until a patient’s death forced the issue into the open

The first HIV-positive case had been reported internally as early as 26 October 2024, and was suppressed by senior management until a patient’s death forced the issue into the open

Similarly, a case-control study published in PubMed identified the reuse of infusion drip sets administered by private practitioners as the primary transmission pathway. More than 90 percent of both infected and uninfected children had received outpatient care from qualified private physicians, meaning the failure was systemic, not confined to unlicensed practitioners.

The state’s response was reactive and, ultimately, insufficient. One paediatrician was arrested on charges later reduced to “criminal medical negligence”. The province allocated 30 million rupees for test kits. International agencies, the WHO, UNICEF, UNAIDS, and the CDC, sent rapid response teams. But as the WHO’s own report acknowledged: “These outbreaks were not followed by systematic infection prevention and control interventions that could have led to improved national IPC practices.” The lesson was noted. The lesson was not learned.

If Larkana implicated private practitioners in impoverished rural settings, the 2024 Multan outbreak exposed something more alarming: the failure of a flagship public institution. Nishtar Hospital is not a rural clinic. It is the largest public hospital in South Punjab, a tertiary care facility attached to a medical university. And yet, between October and December 2024, at least 30 dialysis patients contracted HIV there, with one dying from complications.

A government fact-finding committee found that mandatory HIV screening of dialysis patients, required every six months under national guidelines, had not been conducted for over a year. Dialysis machines were found to be malfunctioning. Sterilisation protocols had not been followed. An infection control committee, which is supposed to convene regularly as part of any hospital’s patient safety programme, had not met for months.

What followed the Multan outbreak was equally disturbing. Police investigations revealed that up to 35 hospital employees had been involved in falsifying patient test records to conceal the outbreak. The first HIV-positive case had been reported internally as early as 26 October 2024, and was suppressed by senior management until a patient’s death forced the issue into the open.

The right to safe healthcare is not a demand being made of Pakistan from outside. It is a promise Pakistan has already made, to its own children, in its own name, and broken, repeatedly, at the cost of hundreds of young lives

The right to safe healthcare is not a demand being made of Pakistan from outside. It is a promise Pakistan has already made, to its own children, in its own name, and broken, repeatedly, at the cost of hundreds of young lives

The Pakistan Medical Association, far from condemning the negligence, held a press conference declaring the suspension of guilty doctors “illegal, illogical and against the rules”. A phylogenetic analysis subsequently confirmed that all Multan outbreak sequences shared a common origin, a monophyletic cluster consistent with a single point-source transmission event.

The most recent outbreak, documented by BBC Eye through 32 hours of undercover footage at THQ Hospital Taunsa, Punjab, is the clearest demonstration yet that Pakistan’s healthcare system has not reformed. Footage showed staff injecting patients without gloves, reusing the same syringes across multiple children, and drawing medicine from multi-dose vials and redistributing it, each time with contamination risk.

Microbiologist Dr Altaf Ahmed, reviewing the footage, warned that even replacing the needle is insufficient. The syringe barrel itself can harbour the virus. The Punjab government had intervened in March 2025 when cases exceeded 100, suspending the hospital’s then head. But BBC findings confirmed the unsafe practices continued months later. Of 97 mothers of infected children tested, only four were HIV-positive, ruling out perinatal transmission and pointing unambiguously to healthcare exposure as the source.

UNDP Pakistan, in its human rights analysis of the country’s HIV response, has estimated that only 23 percent of those living with HIV in Pakistan know their status, and just 15 percent are receiving antiretroviral treatment. With an estimated 290,000 people living with the virus, the gap between legal obligation and lived reality is vast. WHO warned as recently as December 2025 that Pakistan is experiencing a 200 percent surge in HIV cases and has the fastest-growing epidemic in the region. The primary drivers identified were not behavioural but structural: unsafe blood management, unsafe injection practices, deficiencies in infection prevention and control, and inadequate HIV testing during antenatal care.

Every outbreak examined here follows the same structure: unsafe practice, delayed disclosure, suppressed data, reactive suspension, partial investigation, and no systemic reform. In Larkana, a doctor convicted of negligence was subsequently cleared and went on to practice medicine at a public hospital outside the city. In Multan, hospital administrators suppressed the first HIV-positive case report for weeks. In Taunsa, the Punjab government’s own intervention in March 2025 failed to stop the unsafe practices that BBC cameras documented months later.

The structural causes are well documented: an underfunded national health budget that allocates almost nothing to HIV control; thousands of unqualified medical practitioners operating illegally across Pakistan; a culture of institutional self-protection that criminalises whistleblowers rather than enabling them; and a supply chain for medical consumables so dysfunctional that used syringes are repackaged and resold to hospitals.

The solutions are not unknown. They are not expensive relative to the cost of continued inaction. Auto-lock syringes, which mechanically prevent reuse, have been recommended by health officials since the Larkana outbreak. Mandatory pre-dialysis HIV screening every six months is already required by national guidelines; it simply is not being enforced. Infection control committees are already legally mandated at every public hospital; they simply are not convening.

What is needed is not another emergency committee. It is the conversion of existing legal obligations into operational reality: a credible and independent inspection regime; criminal accountability for institutions that suppress outbreak data; mandatory adoption of auto-lock syringes across all public healthcare facilities; and a national HIV response funded from domestic resources rather than dependent on international donors who, as every cycle of outbreak and neglect demonstrates, cannot substitute for state commitment.

Pakistan ratified the International Covenant on Economic, Social and Cultural Rights. It is a party to the Convention on the Rights of the Child. Its own law makes syringe reuse a non-bailable offence. The right to safe healthcare is not a demand being made of Pakistan from outside. It is a promise Pakistan has already made, to its own children, in its own name, and broken, repeatedly, at the cost of hundreds of young lives. Mohammed Amin’s mother has not been told when, or whether, anyone will be held accountable for her son’s death. She is still waiting.

© The Friday Times