The tragic fire in the nursery of the Pakistan Institute of Medical Sciences (PIMS), Islamabad, in which newborn babies lost their lives, has shaken the conscience of the entire nation. These were not ordinary patients who could run, call for help or protect themselves. They were newborn babies—fragile, innocent lives that had only just entered this world and were completely dependent on adults for their safety and protection.

Reports indicate that the fire was caused by an explosion involving an air-conditioner compressor installed in the nursery. The precise cause and circumstances must, of course, be established through a transparent and technically competent investigation. But regardless of the final technical findings, one fundamental question cannot be avoided: How could an appliance installed in such a critical hospital area become a source of such a devastating tragedy?
This is where the issue of preventive maintenance becomes critically important.
An electrical appliance, compressor, wiring system, generator, oxygen installation, fire alarm or any other mechanical or electrical equipment does not remain in the same condition throughout its service life.

Components deteriorate, connections become loose, insulation weakens and equipment can develop faults. This is precisely why every responsible institution must have a system of routine inspection, preventive maintenance and timely replacement.

If an appliance has been installed for years, its age should make regular inspection more important—not less. If equipment is operating continuously, it requires periodic servicing. If it has reached the end of its safe operational life, it should be replaced. In a critical-care area, potentially hazardous equipment cannot simply be assumed to be safe because it continues to function.
This is the real meaning of the title of this article: The Cost of Negligence: When Maintenance Fails, Newborn Lives Are Lost.

Negligence is not always a dramatic act. Sometimes it begins with something that appears small: an inspection that was not carried out, a maintenance schedule that was not followed, an old appliance that was not replaced, a warning sign that was ignored or a safety certificate that was treated as a formality.

Individually, each may appear insignificant. But when several such failures come together, the consequences can be catastrophic.
In a nursery, the consequences are even more serious because newborns cannot protect themselves. They cannot escape from a burning room, understand an emergency, raise an alarm or move themselves to safety. The responsibility for their protection rests entirely with the adults and institutions entrusted with their care.

There is, unfortunately, a dangerous tendency in our institutional culture to consider maintenance an expenditure that can be postponed. An appliance is still working, so it is left alone. An electrical system is still functioning, so nobody examines it. A fire extinguisher is hanging on the wall, so nobody checks whether it actually works. An emergency exit exists, so nobody asks whether it is accessible.
This culture must change.

“It is working” does not necessarily mean “it is safe.”
Preventive maintenance exists precisely because equipment can develop dangerous faults before it completely stops functioning. Hospitals, in particular, cannot afford a reactive approach to safety. Waiting for equipment to fail before repairing it is unacceptable when human lives depend upon that equipment.

The tragedy also exposes another, perhaps deeper, weakness in our institutional culture: we often wake up only after the damage has been done.
We wait for an accident, a fire, a building collapse or the loss of precious lives before asking questions that should have been asked months or years earlier. After every tragedy, there is public outrage, statements of sorrow, demands for an inquiry and promises that such an incident will never happen again. For a few days, the tragedy dominates public attention—and then, all too often, the system returns to business as usual.
This cycle itself is a tragedy.

The real test of governance is not how loudly we react after a disaster. It is how effectively we prevent the disaster from happening in the first place.
That is why the investigation into this tragedy must go beyond identifying the immediate technical cause. It should establish whether proper maintenance and safety procedures were followed and, if not, why they were not.

When was the compressor last inspected? When was the nursery’s electrical system last examined? Was the appliance within its recommended service life? Was there a documented maintenance schedule? Were previous faults reported? Who was responsible for inspection and maintenance? Were fire alarms and emergency systems functioning? Were adequate evacuation procedures in place?

These are not questions of blame for the sake of blame. They are questions of institutional accountability.
The standard of safety in a hospital must be considerably higher than in an ordinary public building. A patient under anaesthesia cannot evacuate himself. A critically ill patient may be dependent on oxygen or life-support equipment. And a newborn baby may be completely helpless.

Hospitals therefore require layered safety systems. Electrical installations must be regularly inspected. Critical appliances must have maintenance records. Fire alarms and smoke detectors must be tested. Fire extinguishers must be functional. Emergency exits must remain accessible. Staff must know evacuation procedures. Backup power must be available. Critical areas should have adequate emergency arrangements so that the failure of one system does not immediately threaten lives.

Most importantly, these arrangements must be tested in practice, not merely recorded on paper.
The PIMS tragedy should lead to a comprehensive review of safety arrangements in hospitals across the country, beginning with neonatal units, intensive-care units, operation theatres, maternity wards and emergency departments.

Every critical appliance should have a documented maintenance history showing its installation date, service record, defects identified, repairs undertaken and next inspection date. Electrical systems, air-conditioning units, generators, oxygen installations and fire-safety equipment should be professionally inspected at defined intervals.

There should also be independent safety audits of critical hospital areas. Hospitals should conduct regular emergency drills, including specific evacuation plans for newborns and patients who cannot walk.

Above all, responsibility must be clearly assigned. When a maintenance schedule is ignored, someone must be answerable. When a potentially dangerous appliance remains in service without proper inspection, someone must be answerable. When a fire-safety system is defective, someone must be answerable.

An inquiry should not become another file that is opened after public pressure and forgotten when the headlines disappear. If negligence is established, responsibility must be fixed in accordance with law. More importantly, the findings must lead to concrete reforms.

The loss of newborn lives cannot be reversed. No inquiry can bring these children back to their parents. No compensation can replace a child who had only just entered the world.
That is why this tragedy must become a genuine wake-up call—not for a few days, but as a permanent change in the way our public institutions approach safety.
Pakistan does not need systems that become active only after something goes wrong. We need a culture of prevention, inspection, maintenance and accountability.

Buildings must be inspected before they become unsafe. Appliances must be serviced before they become dangerous. Fire systems must be tested before there is a fire. Emergency procedures must be practised before an emergency occurs.

The most important lesson from this tragedy is painfully simple:
Safety cannot be taken for granted. Maintenance cannot be postponed indefinitely. Prevention is always better than investigation after lives have been lost.

The title of this article—“The Cost of Negligence: When Maintenance Fails, Newborn Lives Are Lost”—is not merely a statement about one tragic incident. It is a warning to every institution entrusted with human lives.

The newborns who died in that nursery had no responsibility for what happened to them. They had barely begun their journey in this world. They depended entirely upon the adults around them for protection.
They deserved nothing less than the highest possible standard of care and safety.

Their deaths must not become another statistic, another inquiry or another brief period of public outrage followed by silence. Their deaths must become the reason we finally break this cycle and take preventive maintenance, institutional safety and accountability seriously.

Because when maintenance is ignored, the price may not be a damaged machine or a repair bill.
The price can be a human life. And in this case, the lives were those of newborn children.

Dr Alamdar Hussain Malik
Advisor Academics, University of Veterinary and Animal Sciences, Swat
Former Financial Advisor, Finance Division, Government of Pakistan