Ask a family in interior Sindh where they go when a child burns with fever at midnight, and the answer is rarely the nearest hospital. It is Karachi, hours away, paid for by borrowing money.
I began this two-part series with a simple question: how many Sindh towns have no hospital at all? I could not find an official count, as there are many, and I refuse to invent one. The honest answer is more uncomfortable. Most of the buildings exist. What is missing is a hospital that actually works inside them.
Sindh’s population is 55.69 million, and 20,382,881 of those people live in Karachi. That is more than a third of the province, served by six government district and teaching hospitals with around 7,750 beds between them. Civil, JPMC and NICVD have not added regular inpatient beds in ten years. Civil Hospital alone handles 6,000 to 7,000 outpatients and 800 to 1,000 emergency cases daily. A system built for fewer people is being asked to carry far more.
When the city runs out of room, where does everyone else go? Hospitals across Sindh are straining under patients from within the province and from neighbouring regions, and children feel it first. Sindh has just over 450 paediatric emergency beds for more than 9.5 million children under five. Hyderabad has 30, Larkana 60, Sukkur 35, Khairpur 35 and Nawabshah 40. Even in Karachi, the National Institute of Child Health has 68 beds but sees over 400 children each day.
Express Tribune, 9 August 2026 · paediatric emergency beds at the hospitals it lists
Illness moves into the gaps. Ratodero became notorious in 2019 when hundreds of children tested HIV positive, and in the first quarter of 2026 Sindh recorded 894 new HIV cases, including 329 children. Rabies is another warning. Dog bite cases have crossed 200,000 this year; at least 35 people have died, and Karachi has logged more than 40,000 cases. The government has upgraded 278 anti-rabies centres, and that deserves credit. But Hyderabad is still waiting for a campaign to neuter and vaccinate stray dogs, and planned facilities in several districts have not been built.
Karachi is no paradise either. Doctors say two or even three children sometimes share one bed, and patients who cannot find one often turn to private hospitals. This is a city of more than 20 million people, absorbing a province’s failure on top of its own.
Then there is the department that runs the system. Dawn reported that 53 of 70 senior posts in the health management cadre are vacant, even though 2,000 doctors were recently inducted. The 2026/27 health budget is Rs393.16 billion, and more than Rs148 billion goes to hospitals and specialised institutions, including Rs26.25 billion for SIUT. Those institutions do real work. But the health development allocation fell from Rs45.4 billion to Rs38.9 billion, and the Pakistan Medical Association says basic health units and rural health centres are being sidelined. Big buildings in one city cannot replace working clinics in every district.
The numbers behind this piece
| Indicator | Figure | Period | Source |
| Sindh population | 55.69 million | 2023 census | Pakistan Bureau of Statistics |
| Karachi Division population | 20,382,881 | 2023 census | Pakistan Bureau of Statistics |
| Beds in Karachi’s six government district and teaching hospitals | About 7,750 | 2026 | Express Tribune |
| Paediatric emergency beds in Sindh | Just over 450, for 9.5 million children under five | 2026 | Express Tribune |
| New HIV cases | 894, including 329 children | First quarter 2026 | Shafaqna, citing the Pakistan Medical Association |
| Dog bite cases and deaths | Over 200,000 cases, at least 35 deaths | January to September 2026 | Express Tribune |
| Health budget | Rs393.16 billion | 2026/27 | Dawn |
| Health development allocation | Rs45.4 billion, down to Rs38.9 billion | 2025/26 to 2026/27 | Voice PK |
So here is what I keep coming back to. Families do not travel to Karachi because Sindh lacks buildings. They travel because they have stopped trusting what is inside them, and honestly, who could blame them? Parts two and three will ask why that trust broke, and what it would cost to rebuild it. (Part 1)
