For years, the government of Pakistan-administered Jammu & Kashmir has failed to provide uniform, basic, and modern healthcare facilities to over 150,000 residents of Nakyal—the tehsil and area most affected along the cease-fire line. Consequently, the overall health situation is extremely alarming, and the state, governments, and authorities have persistently shown disinterest and a lack of urgency in resolving these issues.
Although Nakyal is strategically located along the cease-fire line and borders two districts (Rajouri and Poonch) of Indian‑administered Jammu & Kashmir—covering 70% of its border area—it is continually targeted by gunfire and military aggression. This relentless violence has resulted in massive loss of life and property. Yet, despite these hardships, no comprehensive measures have been taken to improve healthcare facilities or resolve administrative problems. No positive, revolutionary, or transformative reforms have been introduced.
A Cascade of Failures in Healthcare and Related Sectors
The mismanagement of healthcare has become a routine affair for 150,000 people. Beyond the neglected health centers, other critical areas—such as sanitation systems, basic health education, and public awareness—have also been left untouched. For example, faulty sewage systems allow typhoid-causing germs to mix with human waste, contaminating drinking water and endangering public health.
Effective treatment of viral diseases requires not only better hygiene and advanced drainage systems but also improvements in basic education, health literacy, food quality and distribution, and a robust, active municipal system. Sadly, the “One Health” concept, which emphasizes the interconnectedness of these factors, is entirely absent here.
Aren’t healthcare challenges—and their solutions—the responsibility of the state, governments, and the health department? With the proper implementation of a practical health policy, up to 70% of diseases could be prevented. But who is taking the necessary steps to ensure access to high‑quality, nutritious food, balanced diets, regular exercise, clean drinking water, and effective sewage management?
Current government measures regarding vaccination, environmental sanitation, sewage systems, healthcare infrastructure, and budgeting are deeply disappointing. In addition to failing to control prices, there is also no meaningful quality control.
Providing equal healthcare facilities to all citizens is the state’s constitutional, legal, and moral obligation. Yet even today, taxpayer money is not being invested in public health, education, or welfare. Meanwhile, the ruling class has repeatedly sought treatment abroad using funds meant for public welfare, such as zakat.
Instead, under government patronage, these institutions have been rendered ineffective—turning them into breeding grounds for disease, despair, dependency, corruption, and even organized looting.
Crippling Shortages and Institutional Decay
There is a severe shortage of doctors and support staff in the tehsil headquarters hospital, basic health centers, and rural support centers. Most available doctors are unwilling to work in villages or in the remote centers along the cease-fire line. The situation is further aggravated by the proliferation of untrained midwives, quacks, fake doctors, and a surplus of private medical stores and clinics. Drug inspectors are rarely seen, and hospital dispensaries suffer from a critical lack of facilities, equipment, medicines, and staff.
Inside hospitals, senior doctors tend to focus on their private clinics rather than public service. Unlicensed clinics have opened the floodgates for counterfeit and substandard medicines—supplied by both national and multinational companies—turning doctors into profit‑making instruments through dubious “welfare” packages.
Due to a chronic shortage of manpower, available resources are stretched so thin that institutions struggle to fulfill even basic responsibilities, leaving the impoverished and vulnerable in deep despair. Moreover, there is no active, independent, and transparent system in place to monitor operations, check discrepancies, or resolve the persistent shortage of medicines. The idea of quality medication has all but faded away.
Part 2 – The Final Installment
Every day, hundreds of patients—grappling with life‑and‑death struggles amid poverty and helplessness, often unable to pay even 100 rupees for transport—face the added misery of medicine shortages when they reach the THQ hospital.
Far from being a place of healing, this hospital has become more akin to a “disease lodge” where, one by one, patients perish until all cries fall silent. It is now viewed merely as a caretaker for the sick and injured in the community.
Though officially called the Tehsil Headquarters Hospital, its severe shortage of facilities, staff, and medicines means it practically functions as nothing more than a rudimentary health unit. This facility is the first THQ hospital in Kotli district, burdened with the direct responsibility of serving the entire cease‑fire line and a population of 150,000.
On paper, there are rural health centers in areas like Qamrooti, Kareela, and Dabbsi, and BHUs (Basic Health Units) in Mohra and Jandrot Methrani. In reality, these are nothing more than empty structures due to a lack of staff, proper buildings, and essential medicine supplies—often not even providing basic first aid, and rarely visited by qualified doctors.
The 50‑bed THQ in Nakyal suffers from a dire shortage of doctors, particularly Medical Officers (MOs), which lies at the root of most issues. In contrast, the tehsil hospital in Sahanasa (Kotli district) is nearly ideal and should serve as a model for upgrading Nakyal’s facilities.
All injured by gunfire are brought to this hospital, only to be later referred to Kotli for further treatment. The hospital’s annual budget is shockingly low—around 2.6 million rupees—when it should ideally exceed 10 million rupees. With over 250 patients visiting the outpatient department every day, even a single Panadol tablet per patient would exhaust the available supply. The medicine quota has never been increased, despite monthly patient numbers exceeding 8,000.
Based on its current budget, the state effectively spends only about five rupees per capita on health for Nakyal’s residents. There are no posts for radiologists or specialized medical officers, no visiting surgeons, and not even an anesthesiologist is available. Even basic infrastructure is lacking—a digital X‑ray machine is considered a must‑have, yet no better equipment is provided.
The THQ’s standard policy remains: the moment a patient is seen arriving, they are immediately referred to DHQ Kotli or Pindi. Meanwhile, the hospital’s two ambulances are 30 years old—rickety, rusted, and in a deplorable state—barely clinging to life. A month ago, a new front headlight was added, but the ambulance’s stretcher is fixed in place, making it impossible to remove a patient.
There is no first aid kit, no COVID‑prevention kit, and no oxygen cylinder. When a patient arrives, a large oxygen cylinder is simply loaded into the ambulance, and the patient’s relatives are told to hold on to it. On many occasions while transferring patients from Nakyal to Kotli, the ambulance breaks down—tires burst, and the vehicle often endures rough shocks.
For the past 30 years, health department drivers have been forced to manage what is essentially a “living coffin” on wheels. We interviewed one such driver—whose account is posted on the official Facebook page of the Social Change Movement—and his story is heartbreaking. Despite being honest, responsible, and experienced, he remains a victim of governmental incompetence, as he has never been provided with a modern ambulance.
Due to the ongoing violence along the cease‑fire line, over 70 people have been killed, hundreds disabled or injured, and billions of rupees lost—but no viable solution has been found for the public’s suffering. When a military officer is killed by gunfire, he is evacuated by helicopter; meanwhile, ordinary citizens are left with a 30‑year‑old ambulance.
We even urge the Department of Antiquities to take this vehicle and display it in a museum—after all, it is a rare relic in all of Pakistan-administered Kashmir.
Those who claim to lead Nakyal’s development—the so‑called champions of Nakyal—and pseudo‑officials granted power in exchange for sham patronage should be utterly ashamed of their grand appointments. The public is suffering the worst form of exploitation in healthcare, and the THQ hospital has utterly failed.
A large number of people avoid coming to the hospital. Ironically, one “advantage” of visiting is that you can get a prescription from a doctor and thereby save a fee of 300 rupees. But the reality is stark—often not even a single pill is provided.
Two ambulances are far from enough for the patients and gunshot victims; three additional ambulances and two more drivers, along with proper equipment, are urgently needed. To protect against injuries from gunfire, establishing bunkers is not optional—it is an absolute necessity for the staff. Bunkers should be made mandatory at Nakyal hospital and its satellite centers, and for long‑term stability, trauma centers should be constructed underground because open facilities are inherently unsafe.
According to a survey, among doctors, Dr. Umar is particularly favored—especially by the working class—for his responsible attitude and commitment. It is such dedicated officers and doctors who truly benefit society. Yet in the THQ hospital, even the cooks and cleaning staff are often seen administering injections themselves.
Other staff members are forced to shoulder various responsibilities—issues that will be discussed in a future column.
Written by - Shah Nawaz Ali Sher, Advocate, Nakyal - Member, Joint Public Action Committee; Former Secretary‑General, Bar Association Nakyal
