Emergency Rooms or Obstacle Maze? Why Pakistan's Healthcare System is Failing Its People and How We Can Fix It

In the most terrifying moments of your life when your child is losing and regaining consciousness in your arms, or your elderly parent cannot catch their breath, you rush to the nearest hospital. You don't look for luxury or reputation, all you need is help.

But when you get to the emergency room, you're not met by a doctor or a stretcher. You're met with a chilly question:

"Do you have money for admission?"

Until that fee is paid, no treatment is administered. No drip is given. No doctor appears. At that very moment, the patient is not seen as a human being fighting to live, they are seen as a pending transaction. 

This is not a tragedy of a single person. It is the everyday reality of millions of working-class Pakistanis, the 80% who lack any insurance, financial safety net, and very frequently any free cash in their pockets. Most of the middle class Pakistanis live paycheck to paycheck. There is a little opportunity for them to save for emergencies. In a situation like this when they need their state to support them the most, the very system turns them away.

I have observed these challenges both in private or public hospitals, patients and their families typically encounter a system organized not for healing. It only tests your patience and limits. 

Patients are denied emergency care until they:

1.Pay an advance payment (even in emergencies)

2.Purchase their own medications from external pharmacies. Or sometimes they force you to buy medicines from their own registered pharmacies , this mafia itself is another debate. 3.Ideally cost of Emergecy medicines should be same across all pharmacies but this price check is missing in our country. 

4.Trail a path of paperwork that has relatives scurrying between departments. It’s very agonizing and distressing. 

This is not an emergency care system. It is a ruthless obstacle course that harasses the very people most in need of urgent care. Instead of stabilizing the patient first and worrying about logistics later,as any decent system would,we ask families to become pharmacists, accountants, and runners in the middle of trauma. This is not medical care. It is systemized suffering.

The Tragedy of Government Hospitals

Government hospitals, though free on paper, are riddled with dysfunction:

1.Essential medicines are often unavailable

2.Equipment is broken or outdated.

3.Staff are overworked, underpaid, and emotionally unavailable. They feel disrespectful behavior towards patients is their right. 

4.Cleanliness and hygiene are negligently disregarded

5.During times of emergency, families are prescribed and told to bring medicine before treatment can begin. 

Government Hospitals: Free in Theory, Broken in Reality

Government hospitals, once the poor man's lifeline, are now a source of desperation. Run-down facilities, shortage of medicines, and staff driven to their emotional and physical breaking points have turned them into places one visits only when one has no choice.

Nurses are exhausted. Doctors are underpaid. The majority don't have proper emergency training. Worst of all, empathy does not exist. Patients are spoken to with frustration. Attendants are screamed at. Pain is normalized.

But let's not blame individual doctors or nurses, they too are victims of a neglected, under-funded system.

If you have money, it's another story. Private hospitals offer:

1.Immediate attention

2.Medication in-house

3.Cleanliness, peace, and attention

No questions asked before treatment begins.But for the ordinary citizen, the teacher, the driver, the tailor, the fruit seller, emergency services are a humiliation. It's a place where their pain is ignored and their poverty punished. This isn't just inequality. It's a violation of basic human rights. What has happened to our ethical values ? When we are differentiating people based on their financial status even on how they will receive Emergecy treatment , then we must realize that as a society, we are at a very dark place. 

Countries across the world, give emergency medicine the priority and dignity it deserves.

For example 

In Canada, UK and Europe, a health card is all one needs to access health care.

In United States, healthcare is private but it is against the law to deny emergency care to anyone. They will treat the patient first, whether he can pay for it or not. 

Why? Because when it's a matter of life and death, the first concern should be saving a life, not checking a wallet. When a life is on the line, compassion must come before cost.

In my view , this is not an unstoppable crisis. It is a stoppable one, if we find the will to act. I propose following recommendations : 

Make emergency care free for all: 

No emergency patient should be turned away due to their inability to pay. This should be law. Treat first. Bill later.

Renovate Existing Facilities:

Public hospitals require urgent renovation, a facility management team should be formed who should address issues of sanitation, ventilation and infrastructure improvements.These teams should be trained and certified ; with regular inspections and accountability of their performance in place. 

Expand Ambulance Networks:

Our public and private ambulance services network should be expanded and medical technicians (EMTs) must be deployed at strategic locations to provide pre-hospital care, stabilizing patients before they even arrive at the ER.

Attract and Retain Skilled Professionals:

Emergency staff should be offered good salaries and opportunities for career growth. I recommend to create a program where public and private sector come together , enabling cross-sector learning and address resource gap management. 

Decentralized Emergency Care:

Establish urgent care centers to manage non-life-threatening conditions like minor injuries,infections e.t.c This will relieve pressure on the ERs which as of now are extremely crowded and will help manage patient inflow.

One-Window Emergency Admission:

There should be a one-window facility in hospitals where one CNIC is enough to initiate the emergency treatment. No more running around from room to room in an emergency.

Stock Life-Saving Drugs On Site:

Hospitals must be legally required to maintain a cache of emergency essentials, oxygen, drips, heart medication, at all times. A standard should be maintained across all public and private facilities which must be audited and reviewed bi yearly. 

Train Medical Staff in Compassion:

Empathy workshops, crisis communication, and patient dignity must be standard hospital policy, not optional training.

Establish Independent Complaint Systems:

Hospitals must be made accountable. QR-code or SMS-based feedback systems must enable families to complain about delays, abuse, or negligence with real consequences.

How to Pay For It: In-House Solutions

A common pushback is, "But where will the money come from?"

The truth is: Pakistan has sufficient resources, we just have to reprioritize. In my view , here are realistic, compassionate solutions to generate revenue from within:

Health Impact Tax (Sin Tax)

Tax or impose higher taxes on:

1.Cigarettes and tobacco

2.Sodas and imported crisps

3.High-sugar processed foods

Even an increase of Rs. 1-2 per pack or item can generate billions, all ring-fenced for emergency healthcare.

Corporate Zakat & CSR Integration

Create an open platform to allocate a share of corporate Zakat and CSR budgets directly to:

1.Upgrades to public ERs

2.Staff training

3.Ambulance services
Have total public transparency to build trust.

Luxury Real Estate & Import Levies

Apply a health levy on:

1.Sale of properties above a certain value

2.Luxury car imports that are non-essential

3.High-end commercial developments

4.Purchase of luxury items

Let the top 5% of society pay for healthcare for everyone, efficiently and equitably.

Crowdfunding & People's Involvement

Develop a national digital platform facilitating:

1.Overseas Pakistanis to directly finance equipment or medicines

2.People to "sponsor a bed" or fund staff training

3.Let people give but with transparency, traceability, and impact.

Repurpose from Prestige Projects

Divert even 5–10% of budgets from non-essential infrastructure to emergency room upgrades.

Hospitals save lives, not marble buildings.

A Final Plea:

Emergency rooms should never feel like courtrooms or ATM machines. They should be places where the door opens without condition, where doctors act without hesitation, and where every life is treated as equally valuable.This is not just about policy. It's about humanity.

No child should ever suffer because their mother doesn't have cash.No senior should ever die waiting for a stamp.No human being should ever be turned away in their moment of need. It's our moral responsibility.If we believe in compassion, in equality, in Muslim values of mercy and community, then this is where we must begin.

A country is measured not by its malls or motorways but by how it cares for its weakest in their darkest hour.We cannot afford to wait any longer. Because the very next person denied care could be someone we love.