An average of 400,000 infants die before their first birthday in Pakistan every year.


10 percent of Pakistani children die before the age of five, and the lack of doctors trained in Pediatric Emergency Medicine (PEM) is a big contributor to the country’s high under five mortality rate.

These were some of the conclusions local and international experts reached at the “Third Annual Emergency Medicine Conference on Emergency Care for Children” held at Aga Khan University in Karachi last Saturday.

Pakistan has long suffered from astonishing high infant and under-five mortality rates. A report published last year by the Pakistan Medical Association (PMA) found that in 2011, one child died every minute from EPI (expanded program on immunization diseases), diarrhea and acute respiratory infection (ARI). The same report said that an average of 400,000 infants die before their first birthday in Pakistan every year, and one in thirty die immediately after birth.

According to the PMA report, the most common and lethal diseases in the country as a whole are ARI, viral hepatitis, malaria, diarrhea, dysentery, scabies, goiter, hepatitis and tuberculosis. Children suffer from all of these in Pakistan, although some more than others. For example, it is estimated that 20 percent of all diarrhea patients are children.

Poor social conditions and lack of government services push the rate of these diseases up. For example, diarrhea is often caused by drinking contaminated water. On the other hand, malaria is carried by mosquitoes who are attracted to rural villages and lower-income slums in the cities by contaminated and stagnant water bodies.

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Still the lack of access to health care, particularly in rural areas, is a large reason why so many children perish from these diseases. Conference participants on Saturday said that emergency medicine is particularly crucial for saving children’s lives, especially because they make up an estimated 20 to 30 percent of all emergency patients in the country.

One of the doctors at the conference was quoted by the Pakistani daily Dawn as saying that, “There is a global recognition that the first hour of emergency care belongs to emergency medicine especially in cases of trauma, shock and where resuscitation is required.” The doctor added that this hour is crucial in determining likelihood of survival.

This bodes poorly for Pakistanis given that emergency medicine is a relatively new medical field in the country. It was only in 2010 that the Pakistan’s College of Physicians and Surgeons recognized emergency medicine as a field in its own right. PEM has thus far not been given separate recognition in the country, explaining in part why there is a shortage of doctors with specialized PEM degrees in Pakistan. Instead they receive special on-the-job training, according to participants at the conference cited by the Dawn.


The lack of pediatric emergency doctors is a critical shortcoming in Pakistan’s medical system given its importance in saving sick or injured children’s lives.

Still, overall the situation is improving, gradually. According to the UN Development Program, Pakistan’s under-five mortality rate dropped from 140 deaths per 1,000 live births in 1990-1991, to around 100 by 2004-2005. The decline appears to have stalled then, however, placing the UNDP’s initial target of 52 deaths per 1,000 live births almost certainly out of reach.

Zachary Keck is assistant editor of The Diplomat. He is on Twitter: @ZacharyKeck.