Islamabad, September 15, 2026: An inquiry committee investigating the deadly fire at the Pakistan Institute of Medical Sciences (Pims) has found “systemic and institutional failure” and determined that an electrical fault was the most likely cause of the blaze that killed 14 newborns.
The fire broke out on August 26 at a nursery in Pims’ Mother and Child Hospital, raising serious concerns over fire safety arrangements and accountability. Criminal action had subsequently been ordered against eight officials.
The inquiry committee, headed by former interior secretary Shahid Khan, was constituted on the directives of Prime Minister Shehbaz Sharif on the day of the incident.
The committee concluded that “systemic and institutional failure is established, while individual responsibility varies with the strength of the evidence”.
It held Pims and its senior management principally responsible for failing to address known risks, prior warnings and assigned safety responsibilities through an effective system.
“The electrical spark explains how the fire began; the institutional system explains why it became a catastrophe,” the report said.
It added that the 14 newborns died not because of a single failed safeguard, but because multiple safeguards were absent, weak, delayed or had never been verified as functional.
According to the report, a localised electrical failure most probably triggered the fire, while combustible materials and an oxygen-supported environment accelerated its spread. Inadequate detection and protection systems failed to contain the blaze, while overcrowding, limited evacuation capacity and the absence of a rehearsed neonatal emergency system hampered rescue efforts.
The committee also identified delayed institutional activation and longstanding governance, maintenance and regulatory failures as factors that allowed the vulnerabilities to persist.
The report pointed to a history of known but incompletely addressed risks.
It cited earlier correspondence from the Capital Development Authority (CDA), findings of the Federal Ombudsman from 2015, Pims’ own 2025 acknowledgement of ageing fire-safety infrastructure and, in particular, the July 6, 2026 Nursing Hostel fire.
These incidents had highlighted deficiencies in fire detection, alarms, electrical inspections, evacuation arrangements, firefighting equipment, emergency drills and planning.
“Yet those warnings had not been converted into a comprehensive, time-bound and independently verified corrective programme before the Nursery fire,” the report said.
It added that while the specific defect involving AC Unit No. 2 might not have been foreseeable, the need for stronger fire preparedness was clear.
The committee said its findings were based on a structured 52-task investigation involving forensic evidence, CCTV footage, call records, engineering and maintenance documents, clinical and casualty records, duty and attendance records, witness statements, contracts, regulatory records and earlier inquiries.
Citing CCTV footage that established an “exceptionally rapid emergency”, the report rejected any generalised allegation that frontline personnel abandoned the newborns.
It noted that Charge Nurse Nasreen Akhtar, Security Guard Maria Saleem and Staff Nurse Razia Noreen responded within moments, adding that several staff members acted promptly and courageously as the situation became untenable within minutes.
The committee highlighted the vulnerability of the nursery, where 15 medically fragile and non-self-evacuating neonates were housed in a 10-bed unit, with several dependent on oxygen or respiratory support.
Only two doctors and two nurses were immediately available, while protected evacuation resources were limited.
The report said no adequately documented, approved, trained and rehearsed nursery-specific fire and neonatal evacuation standard operating procedure (SOP) had been demonstrated. Nor was there evidence of a functional automatic smoke detection, alarm or sprinkler system serving the affected area.
It noted that combustible materials and the oxygen-supported environment further intensified the fire and smoke after ignition.
The committee distinguished between the response of individual frontline staff and the institution’s overall emergency activation.
According to the report, frontline staff acted within seconds at 6:38am, external notification was made at 6:54am and emergency responders arrived at 7:01am.
It therefore identified the principal concern as the interval between the visible fire and external activation, rather than the response of Capital Emergency Services (CES).
“Pims had not demonstrated a tested incident command system capable of immediately converting detection into alarm, external notification, evacuation, hazard isolation, access management and coordinated rescue,” the report said.
The National Forensics Agency provided the strongest technical evidence, identifying the electrical supply cable of AC Unit No. 2 near or over AC Unit No. 1 as the most probable point of ignition.
The report said abnormal localised electrical heating, potentially caused by excessive current, a high-resistance connection or another localised defect, most probably led to insulation failure and ignition of nearby combustible material.
The evidence did not establish arson, multiple ignition points, an external fault involving Islamabad Electric Supply Company (Iesco), a pre-fire oxygen leak, or an incubator or warmer as the source of the blaze.
“The fire was therefore most probably electrical in origin, although the precise defect and the person or entity responsible for preventing it require separate determination,” the report said.
The inquiry found that although maintenance records showed the nursery’s air conditioners had been serviced, they did not demonstrate a systematic and traceable electrical safety regime covering cables, terminations, insulation, earthing, breaker protection and thermal hotspots.
It stressed that keeping equipment operational was not the same as demonstrating that its electrical installation was fire-safe.
The engineering, electrical and HVAC chain remained the “most significant unresolved technical accountability line”, the report said, adding that contractors should be examined only in relation to duties actually assigned to them.
The report said the available record did not presently establish criminal guilt against any named individual.
However, it recommended focused investigation into four possible areas: culpable electrical installation or maintenance failure involving AC Unit No. 2; culpable obstruction of a mandatory emergency route; culpable failure to act despite specific prior warnings; and any proven culpable delay in seeking external assistance.
It said criminal responsibility must be assessed on the basis of the duty owed, knowledge or foreseeability of risk, authority to act, the relevant act or omission, degree of negligence, failed safeguard, causal contribution and applicable offence.
The committee emphasised that frontline responders whose rescue conduct had been objectively established should not be blamed merely because the outcome of the incident was catastrophic.
