Pakistan’s health crisis is no longer confined to the wards of government hospitals. It has become a measure of how much state capacity has been outsourced, neglected or quietly abandoned. The latest warning by an Islamabad-based thinktank Tabadlab on shrinking foreign assistance should therefore be read with some alarm. It says what governments have avoided saying for years: many of the functions that keep the health programmes alive are financed, designed or technically sustained by outsiders. Diagnostics, vaccines, medicines, disease surveillance, procurement systems and specialist staffing have been carried by donor money in ways ordinary citizens rarely see until the support begins to disappear. USAID’s suspension has already disrupted care for 1.7 million people, while a $27.2m Global Fund reduction has hit tuberculosis monitoring and HIV treatment support. Our public health spending remains around 0.9 per cent of GDP, a figure so low that it barely covers the architecture of care, let alone the operating system that makes care possible.
The rise in paediatric HIV cases is a chilling indictment of unsafe healthcare itself. Many children appear to have been infected through reused syringes, contaminated drips, unscreened blood and poorly sterilised instruments, the same channels that continue to spread hepatitis B and C. Pakistan has the world’s heaviest hepatitis C burden, with about 10 million infections, and another 3.8 million people living with hepatitis B. To add to the tragedy, only a quarter to a third of those infected are aware of their status.
Other diseases tell the same story in a different language. 33,394 dengue cases were reported in 2025, largely driven by urban sprawl, stagnant water and poor waste management. Polio, after decades of campaigns, still found a four-year-old child in Sujawal this year, after 31 cases last year. Across rural districts in Sindh, Balochistan, and Khyber Pakhtunkhwa, 2.71 million children are acutely malnourished, including more than seven hundred thousand severe cases. Over two hundred thousand pregnant and breastfeeding women are also said to suffer from acute malnutrition.
Then there is the anguish no dashboard captures properly. Mental illness has become one of the country’s largest untreated epidemics, with experts estimating that 38 per cent of citizens suffer from some form of mental disorder, with severe depression affecting about a quarter of the population. At least 17,000 suicide attempts are reported annually, with stigma hiding many more. Inflation, joblessness, addiction, family pressure and digital isolation are producing a generation that is exhausted before it has had a chance to begin. The country has almost no serious community mental-health infrastructure.
Pakistan’s health crisis is now a governance crisis. The answer lies in domestic financing, enforceable regulation, district surveillance, climate-linked disease planning, mental-health services in schools and primary care that reaches people before catastrophe does. Health cannot remain a donor file, an NGO project or a ribbon-cutting exercise. It is the state’s most basic promise. Pakistan has broken it too often. *