A recent death at the Pakistan Institute of Medical Sciences (Pims) has spotlighted a chronic problem: ventilators, the last-resort machines that keep patients alive while doctors fight to save them, have been in critically short supply in public hospitals for over two decades. The case of journalist Abid Raza Kazmi, who suffered a stroke and could not be placed on a ventilator because all 12 ICU machines were occupied, is not an isolated tragedy—it reflects a systemic failure that combines high equipment costs, a shortage of trained staff, and a lack of sustained political will. Main Developments Abid Raza Kazmi died at Pims after doctors recommended shifting him to a ventilator but found none available. His relative Asim Raza Kazmi told Dawn that the patient was initially admitted to the emergency ward, then moved to a medical ward, and finally to a surgical ward before the ventilator shortage became critical. Despite efforts to transfer him to a private hospital, Kazmi did not survive. Pims Executive Director Prof Dr Rana Imran Sikander confirmed that the hospital has over 90 ventilators across multiple ICUs—medical, surgical, pediatric, neonatal, and cardiac—but nearly 100% are always occupied. He noted that patients in neurology and pulmonology ICUs often remain on ventilators for around 20 days, exacerbating the shortage. The hospital operates a no-refusal policy, accepting patients referred from across the country even if they must be treated on a stretcher. Read also: How Punjab's Railway Land Parks Aim to Tackle Smog Dr Abdul Jabbar Bhutto, spokesperson for Polyclinic, reported that his hospital has 35 ventilators, all constantly occupied. He added that even if more machines were acquired, a severe shortage of trained staff would prevent them from being used effectively. Both doctors emphasized that wealthy families often seek to transfer patients from private hospitals—where ventilator care can cost Rs300,000 per day—to public facilities, creating a priority list that never ends. Background Former minister for science and technology Fawad Chaudhry told Dawn that during the Covid-19 pandemic, his ministry made efforts to manufacture ventilators in Pakistan. Simple machines were produced that could handle up to 60% of patient needs, but after he left office, no further interest was shown. He attributed the failure to the poor quality of local engineers, who he said were not capable of producing high-end ventilators. Chaudhry suggested that Chinese companies should be engaged in joint ventures to manufacture ventilators locally. The issue is compounded by the fact that most ventilators cost between Rs3 million and Rs5 million each. At Pims, the daily expense of running a single ventilator is approximately Rs200,000—but the hospital does not charge patients for this care, adding to the financial strain on already limited budgets. The population of Islamabad has grown from 500,000 when Pims was established to about 5 million today, yet hospital capacity has not kept pace. A new block with 40 ventilators is being built at Pims following intervention by Prime Minister Shehbaz Sharif and Health Minister Mustafa Kamal, but this will only partially address the deficit. Why It Matters The ventilator shortage directly affects patient survival in critical care. With government hospitals serving as the safety net for those who cannot afford private treatment, the lack of machines means that preventable deaths—like Kazmi's—continue to occur. The financial burden on public hospitals is immense: they provide free care to emergency and ICU patients, yet receive no additional funding to cover the high per-day cost of ventilator operation. The human resource gap is equally critical. Even if more ventilators were donated or purchased, there are not enough specialized staff to run them. This dual bottleneck—equipment and personnel—undermines the entire intensive care system in the federal capital and beyond. During the pandemic, private hospitals and companies offered beds and ventilators, but such assistance is not available during normal times, leaving public hospitals to bear the full load. What's Next Construction of the new block at Pims, with 40 additional ventilators, offers some hope, but it is unlikely to meet the demand of a city whose population has grown tenfold since the hospital was built. Dr Sikander urged people to change their lifestyles—exercising in parks and adopting physical activity—to reduce the burden on hospitals, but this is a long-term solution. Fawad Chaudhry has called for renewed government interest in local ventilator manufacturing, possibly through joint ventures with Chinese firms. Without sustained political commitment and investment in both equipment and training, the shortage will persist. The question remains whether policymakers will treat this as a recurring crisis or a structural failure requiring systemic reform.