On the twenty-sixth of August a fire broke out in the neonatal ward of the Pakistan Institute of Medical Sciences in Islamabad. Fourteen babies died. A staff nurse named Razia Noreen went into the ward and carried out the one who had not.
On Wednesday the President approved the Tamgha-e-Shujaat for her. The Prime Minister had already approved the Sitara-e-Khidmat and ten million rupees. We reported it here yesterday morning.
The child she saved died on Thursday, after twenty-two days. Sepsis, then disseminated intravascular coagulation, then bleeding in the lungs, then cardiac and respiratory arrest. The death certificate is the only document in this story that appears to have been produced promptly.
Fifteen.
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I want to say something about the medal before anything else, because there is a cheap move available and I do not want to make it.
The award is not diminished by the child’s death. Razia Noreen went into a fire for a stranger’s baby and brought her out breathing, and the girl lived three more weeks because of that. What she did was complete at the moment she did it. Outcomes at that altitude of injury were never in her hands, and a country that only honours rescues that end well will find itself honouring very little.
So: the medal was right. I would give it again this morning.
What I cannot leave alone is the arithmetic of speed.
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Consider the sequence, because it is all on the public record.
Twenty-sixth of August: the fire. Twenty-seventh of August: the inquiry findings reported — oxygen equipment exploded beside an incubator, treatment and facilities below international standards, the cause of the fire itself never established. The Prime Minister orders criminal proceedings and the termination of eight employees.
Twelfth of September: the Senate’s Functional Committee on Human Rights convenes, and is told by a PIMS official that no FIR exists. Seventeen days after a head of government ordered criminal cases, the police record of the deaths of fourteen infants was a blank page. The committee orders an FIR registered, assets attached, names placed on the Exit Control List.
Sixteenth of September: the President approves a gallantry award.
Seventeenth of September: the fifteenth child dies.
Eighteenth of September, this morning: we still cannot confirm that an FIR has been registered.
The state took twenty-one days to produce a medal and has not, in twenty-three, been confirmed to produce a police report.
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I wrote a version of this observation yesterday, in the story about the award. I said the state had moved quickly to honour the one person who behaved well and slowly to investigate the circumstances that required her to. I did not expect to be writing the sequel within a day, and I take no satisfaction in it.
But it is worth being precise about why this asymmetry exists, because “the system is broken” is not an explanation, it is a shrug.
A medal has one decision-maker and no defendant. It requires a summary, a signature, a photograph. Nobody’s liberty or career is at stake in granting it, and everybody in the chain gains something from its being granted — the government gets to associate itself with courage, the hospital gets a story that is not about its wiring, and the public gets someone to admire.
An FIR has the opposite properties. It names people. It creates exposure for officials who authorise it and for officials named in it. It converts a tragedy into a file that can be subpoenaed, and it starts a clock that somebody will eventually have to answer to.
The state is not slow in general. It is fast at the things that cost nobody anything and slow at the things that cost somebody something. That is not a malfunction. That is the machine working as built.
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There is one more thing in this record that I keep returning to.
The inquiry never established what started the fire.
Everything else has been settled — that oxygen equipment exploded next to an incubator, that the facilities were substandard, that eight employees should go, that a nurse was brave. The one fact from which liability would actually flow, the cause, remains open three weeks later.
I am not alleging that the gap is deliberate. I have no evidence for that and will not imply it. But an unestablished cause is a remarkably convenient thing for an institution to be left with, and it is the single finding that should be hardest to leave unresolved, because a hospital that does not know why its neonatal ward caught fire cannot promise that it will not happen again in the ward next door.
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Fifteen families have now buried a newborn from one night in one ward in the capital city.
The nurse has her medal, and should. The eight employees may or may not have been terminated; nobody has published confirmation. The FIR may or may not exist. The cause is unknown.
If a case has been registered since the twelfth, the health ministry can end this paragraph tomorrow by saying so, with a number and a date. That is the whole of what I am asking for, and it is not very much to ask on behalf of fifteen children who were, three weeks ago, alive.
[Image: The Express Tribune]
