Fourteen newborn babies died in a fire in the nursery of the Pakistan Institute of Medical Sciences in Islamabad on Wednesday morning. Fifteen infants were in the room. One was rescued.

Four days on, with the funerals held and the inquiry under way, the question worth asking is not what happened — that is broadly established — but why this particular kind of disaster keeps happening in the same kind of room.

Why a neonatal ward burns differently

Accounts agree the fire began in an air-conditioning unit, either through a short circuit or a compressor failure, at around a quarter to seven in the morning. Rescue officials said it then spread rapidly because of the oxygen cylinders and oxygen pipework in the room.

That second sentence is the heart of it. Oxygen does not burn, but it makes everything else burn far faster and at a lower ignition threshold. In an oxygen-enriched atmosphere, materials that would ordinarily smoulder catch immediately, and a small electrical fire becomes a fully involved room fire in seconds rather than minutes.

A neonatal unit concentrates every element of that risk in one space: piped oxygen, incubators drawing continuous power, air conditioning running constantly because the room must be kept warm and stable, and occupants who cannot move, cannot be carried more than one or two at a time, and cannot survive being taken outside for long.

This is well understood in fire engineering. It is why standards for these wards specify oxygen shut-off valves accessible from outside the room, compartmentation to contain a fire to one area, and staff drilled specifically on evacuating infants.

The pattern

It has happened before, in almost identical form. In June 2024, a fire traced to air-conditioning killed eleven babies in the paediatric ward of a teaching hospital in Sahiwal, in Punjab. An inquiry then found the hospital’s fire extinguishers had expired, and the medical superintendent and three senior doctors were arrested.

Neighbouring countries have their own versions. A fire in a neonatal intensive care unit in Jhansi, India, killed ten babies in November 2024, with parents reporting that the alarms did not sound.

The recurrence tells you something the individual inquiries do not. Arresting the people on duty establishes blame for one night. It does not replace ageing wiring, fund maintenance contracts, or buy compartmentation into buildings that were not designed with it.

The disputed minutes

Where the accounts diverge is on the response. Sources at Islamabad’s Capital Development Authority told CNN that hospital authorities closed the main gates after the fire began, that responders reached those gates within about six minutes of the call but needed more time to get through, and that they were then directed to the wrong location inside the complex.

A hospital spokesperson rejected the account of the gate closure as inaccurate. The district administration’s own statement gives a timeline in which fire tenders and ambulances arrived promptly.

Families at the hospital have said help came too late. We are not in a position to adjudicate between these accounts, and we are not going to pretend otherwise: the timeline is precisely what a formal inquiry with access to call logs and gate records can establish and outside reporting cannot.

The claim about closing gates is worth understanding rather than dismissing. Hospitals in the region have shut their complexes during emergencies to stop crowds of relatives overwhelming the site. It is a policy with a rationale. Whether it should ever apply while a fire is burning is the question the inquiry has to answer.

What would count as a real response

Three things, none of them dramatic: a published audit of oxygen shut-offs, alarms and extinguisher servicing across public hospitals; a rule on emergency access that cannot be overridden by site security; and funding attached to both. Prosecutions may be warranted, but they are not a substitute for any of it.

Fourteen families are waiting for the inquiry’s findings. The measure of whether this one is different from Sahiwal will be whether anything is bought, rather than only announced.

Sources

CNN; Al Jazeera; ABC (Australia); Reuters; statements from Pakistan’s Ministry of Parliamentary Affairs, the Islamabad district administration and PIMS; reporting on the 2024 Sahiwal and Jhansi hospital fires.