The impact of the explosion sent Muhammad Safdar flying backwards. He looked up from where he had landed and saw that the windows of his parked ambulance had shattered. As he tried to pick himself back up, fellow volunteer drivers working for the Edhi ambulance service gathered around him; it looked as if Safdar was bleeding. But he had not suffered any external injuries. “Human flesh got stuck to me,” he recalls now, as we sit in the ambulance control centre in downtown Karachi. “My friends were checking me for injuries, but it was pieces of other people. I was trembling hard and I couldn’t hear my own voice when I spoke. It sounded juddering. I could only hear whistles.”

It was 5 February 2010 and Safdar had already dealt with the fallout of one explosion that day: an hour before, a motorbike laden with explosives had slammed into a bus carrying Shia Muslims to a religious procession. Safdar had raced to the scene to load the dead and injured into his ambulance and take them to the nearby Jinnah hospital. With more than people 30 injured and 12 dead, the emergency room was in a state of chaos, filled with crying and screaming as doctors struggled to cope. He was still inside the hospital when the second bomb exploded just outside the entrance.

Safdar did not realise until later that he had suffered head injuries. At the time, he followed his first instinct, which was to get up and continue to help. A further 13 people were dead, with scores more injured. “Everything was a mess, there was blood everywhere,” he remembers.

The hospital entrance was badly damaged and there were fears of a third bomb. Ambulance drivers took those with the worst wounds to other nearby hospitals for treatment. Three ambulances were destroyed in the explosion, so they worked with what they had.

Across the crowds of casualties, Safdar kept his eyes on his boss, Abdul Sattar Edhi, the founder of the service, who was sitting inside one of his own ambulances. As the head of a huge charitable organisation offering services to the poor, Edhi made a point of remaining at the frontline of rescue work. He had been collecting the dead and injured alongside his staff. Safdar ran over to him. “I came to pick him up in case of a third blast, but he said, ‘I am not going. Wherever I am, there isn’t a blast, so I am not moving.’” Safdar continued to haul bodies to ambulances parked outside. Amid the dirt and blood, he spotted something suspicious: a very clean-looking motorbike in the car park with a TV set strapped to the back. Safdar ran back to Edhi to tell him what he had seen. Edhi alerted police and stayed put as experts defused what turned out to be a third bomb.

In 13 years as an Edhi ambulance driver, Safdar has lost count of the rescue jobs he has done. He has entered burning buildings, dived into water after shipwrecks, retrieved survivors after terror attacks and industrial accidents, and navigated running gun battles.

Sporting red T-shirts emblazoned with bold white letters reading “EDHI”, these workers are a familiar sight at Pakistan’s all-too-common disaster scenes. Here in Karachi, a megalopolis of around 20 million people, there is no state ambulance service.

Karachi has suffered through decades of violence. Ethnic tensions have been simmering since the 1950s, ramping up as conflict and natural disasters elsewhere in Pakistan pushed more and more people into the city. For years, gang war raged in the slum of Lyari, and as terrorism increased in Pakistan in 2001 following the 9/11 attacks and the declaration of the war on terror, Karachi became a key militant operating ground. Since 2014, a crackdown led by the army has brought a semblance of calm, but violence still simmers below the surface.

Safdar, in his rudimentary ambulance, has been at the frontline of the shifting conflicts consuming his city, placing himself at huge personal risk for very little money.

Safdar first stumbled into the Edhi Foundation’s main office in 2003, shouting that his brother had waited too long for an ambulance. Safdar was around 22 years old (it is common in Pakistan for people to be unsure of their exact birth date), and his brother Adil was roughly 20. The ambulance driver on duty, Muhammad Liaqat, remembers, “Our reaction was not to reply in any aggressive way. He has a very good heart, but he is hot-headed.”

Adil had contracted polio as an infant, and the disease – still endemic in Pakistan – left him disabled. He needed a series of painful leg operations. With no car and limited funds, the family relied on the Edhi ambulances.

Despite Safdar’s anger, he was impressed by the operation. “I saw other people waiting at the hospital for hours for transportation,” he recalls. “Edhi Sahib [a term of respect] alone was trying to help.” Safdar had dreamed of joining the army, but needed to stay at home because of Adil’s illness. So, he got a driving licence and joined the ambulance service. “Now he creates trouble for us every day,” says Liaqat.

On his first day, Safdar went with another driver to collect one of the unclaimed bodies frequently found on the streets of Karachi. He couldn’t look. The other driver slapped him in the face. “What do you think this is?” he said. “It’s a human being. What are you? A human being. Why are you behaving like this?” Safdar picked up the corpse.

“It takes time to get used to this work,” he says. “A lot of people leave after a week or so as they can’t take it. They have fear in them.”

Safdar is a thin man with a meticulously stylish haircut, equally quick to laugh as to fly into a rage. His boss, Anwar Kazmi, ironically introduces him to newcomers as “our most polite driver”. Safdar constantly chews a betel nut derivative, which has a stimulant effect – a common habit among drivers in Pakistan. He is outspoken and talks a million miles a minute, his rapid hand movements expressing a range of emotions. He refuses to enter a government hospital where the boss was once rude to him. But he cannot stand to see suffering, sometimes getting in trouble for using his siren for non-emergency call-outs, and stopping to help if he spots anyone injured or lost on the road.

His usual base is the Edhi ambulance service’s main control centre in Kharadar in Karachi’s bustling old town. The office is open to the street, with a kiosk at the front for donations.

In a city where media companies and hospitals have armed guards, this accessibility is unusual. Inside, drivers sit and chat in between shifts, the overhead fan whirring and causing the dim electric light to flicker over their faces. Their standard work shifts are 18, 24 or 36 hours. At night, some nap on their stretchers. High up on a wall, stuck to peeling paintwork, are photographs of eight drivers killed in service. The bosses sit in this room too, behind two large desks. Kazmi, the general manager and spokesman, is always stationed at the right-hand desk, two phones and a mobile in front of him.

Facebook Twitter Pinterest Safdar lights a cigarette during a moment of downtime. Photograph: Akhtar Soomro/Reuters

Abdul Sattar Edhi came to Karachi as a poor man from an Indian village in 1947. Starting with a small pharmacy tent, his work rapidly expanded, powered by donations from ordinary citizens. With the help of his wife Bilquis, he set up a maternal health clinic and a centre for abandoned children. A large donation allowed Edhi to buy a second-hand truck, which he put to use as his first ambulance.

Pakistan can sometimes be a cruel environment, its residents caught between the dual pressures of poverty and violence. Yet it is also a place of great kindness, with a strong culture of charitable giving. Donations from what Edhi called “the common man” still power the foundation. It refuses state money, and has politely turned down donations from businessmen that it considers unethical. The organisation fills many gaps left by the state, operating a dizzying array of services, including homes for victims of domestic violence, food banks and a shelter for stray animals.

Kazmi has a persistent cough and frequently quotes Karl Marx. Despite the heat, he wears a woolly hat and a waistcoat over his salwar kameez. “I’m leftist-minded. Edhi Sahib was too,” he tells me. “Some 40 years ago, he said to me, ‘You can’t say when the revolution will come, but this is a way to serve the common man. Come and work with me.’ So I joined.”

Pakistan is a conservative, religious state. The Edhi Foundation is unusual in its ignoring of caste, creed, religion and sect. This strict stance has led to some criticism from religious groups. Edhi lived in a humble, ascetic way, even as his charity became a multimillion-pound enterprise. He refused exploit his growing celebrity for personal gain, never took a salary and even sat outside the office with a begging bowl.

When Edhi died on 8 July 2016, Pakistan entered a period of national mourning. He was hailed internationally as the “world’s greatest humanitarian”. Leadership of the organisation passed to his eldest son, Faisal. Criticism from religious conservatives about the family’s beliefs ramped up. Donations dropped. Pakistan is now watching to see if Edhi’s legacy can be continued.

Like other Edhi ambulance drivers, Safdar is technically a volunteer and works for a basic salary of 4,300 Pakistani rupees a month (£33). A private driver would earn 10,000–15,000 rupees. This basic salary covers the high-risk rescue work; the easier “patient services” jobs – moving people between hospitals and transporting corpses – incur a small fee, so drivers receive a commission of around 100 rupees (76p) per trip. Sometimes patients tip. But clearly, money is not the motivating factor.

When Safdar talks about his medical knowledge, his face lights up. Edhi drivers receive a few days of basic instruction, and those who display an aptitude later get more specialised training on an ad hoc basis. Safdar can rattle through the correct procedure in the event of a heart attack, electrocution, broken bones, fire, bombs. He has tricks for picking up heavy people, and uses the grubby cushion in his ambulance to prop up the unconscious to keep their airways open. “Doctors giving me these trainings would ask me how long I have studied for, and I would show them my thumb,” he says proudly. This signifies illiteracy: those who cannot sign their name use a thumbprint for official documents. “They’d say, ‘You seem like you’ve studied for a long time, because you know the right questions to ask.’”

Safdar and other workers care passionately about continuing Abdul Sattar Edhi’s legacy. Edhi was staunchly non-hierarchical, and had a personal relationship with even his most junior staff. Safdar keeps in his ambulance a dog-eared newspaper obituary, which quotes him saying that Edhi was “like a father”.

Between jobs, Safdar can usually be found in one of the small shops near the Kharadar base. The biryani stall dishes up heaps of steaming rice and meat to drivers on their breaks. A juice bar, with white walls and bright orange plastic seats, sells fried chicken and canned drinks. The tea shop nearby brews vats of traditional masala chai; milky, sweet, spiced tea that fuels everyone at the Kharadar office through their long shifts.

Sitting in the tea shop, Safdar pours a small amount of his tea into the saucer so it will cool quicker, slurping it up from the plate. “I am always on call even though I’m free right now,” he says. A call comes through. In an instant, Safdar is in his ambulance. There has been an explosion in the Defence Housing Authority, an upmarket suburb of Karachi.

Safdar drives at alarming speed, weaving between lanes of traffic, careering down alleyways, his siren blaring. Edhi ambulances – small Suzuki Bolan minivans equipped with a single stretcher and oxygen canister – are not set up for pre-hospital care. But their small size means they can zip through the city’s five lanes of frequently gridlocked traffic at high speed. Safdar shouts through his loudspeaker for people to move. “Hey Muslim! Go quicker!” he calls to a man with a long beard wearing a prayer hat. “Rickshaw driver, get out of the way!” “Old lady, move it!” “Son of a bitch, are you drunk?” He screeches to a halt outside the flats where the explosion has taken place.

The Edhi Foundation has around 500 ambulances in Karachi, out of a fleet of more than 1,500 across Pakistan. This makes it the world’s largest voluntary ambulance service. The Chhipa ambulance service is also run as a charity, on a similar model to Edhi. Founded in 2007, it is Karachi’s second-largest ambulance fleet.

Safdar considers Chhipa as a rival to Edhi. “I don’t consider them ambulances,” he mutters. “As far as ambulances go, we are the dons and these guys are just kids.” Once, he got into a physical fight with some Chhipa drivers. Edhi was still alive then and made sure Safdar was arrested. “He wanted to teach me a lesson,” Safdar says.

The Defence Housing Authority explosion was caused by a domestic gas cylinder, and four people were badly injured. The rate of injury and death in Karachi resulting from poor health and safety standards is particularly noticeable now that tightened security has reduced violent crime.

Pakistan’s security crackdown was triggered by two major incidents in 2014. The most shocking was a Taliban attack on a school in Peshawar, one of the country’s northern cities, on 16 December, in which more than 150 people, mostly children, were slaughtered. The other, which happened six months earlier, on 8 June, was a brazen assault on Jinnah international airport in Karachi. Around 11pm, 10 heavily armed militants entered the airport and launched an assault. Heavy fighting with the Airports Security Force ensued.

A group of Edhi workers arrived at the airport soon after the first blast and provided medical back-up to the security forces. Clad in bulletproof vests, Safdar and his colleagues were inside the airport for 16 hours as the gun battle raged. “During the active fighting, our job was to keep in a corner and watch for injuries and see if someone was shot,” says Safdar. Workers darted out with their stretchers to pick up the wounded. Of the 28 who died, 14 were security officials.

In Karachi, a number of people were killed in the crackdown that followed. Sometimes, ambulances are called to clear up the mess. On this subject, Safdar is uncharacteristically reticent. “Whether it is a big raid or a small one, back-up is needed. Sometimes we arrive and find police in masks. It is our job to check if anyone is alive, not to ask any questions.”

Edhi workers have not always had an easy relationship with the police. In April 2012, the streets of Lyari broke into a new iteration of an old gang war. The police staged a crackdown, shutting down electricity and water. Police and gangsters battled in the streets. Thousands of people were trapped inside without basic supplies, so Abdul Sattar Edhi announced that his ambulances would deliver water, rice and powdered milk door to door. This allegedly angered police, and led to widespread conspiracy theories and unsubstantiated allegations that ambulance drivers distributed arms to gangsters.

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“My job was to take groceries to homes,” says Safdar. “We couldn’t do much for the injured as the government was involved. But lots of families had other emergencies – heart attacks, going into labour. We catered for that despite the police operation.”

One day, Safdar claims, he and a colleague were apprehended by Chaudhry Aslam, who was then the police superintendent. He cut open the sacks of rice, looking for weapons, and took them into custody. The incident demonstrates the dangers of operating an ideologically independent organisation in a corrupt and unpredictable state. Safdar is sanguine: “My only regret is that I was not able to slap Chaudhry Aslam in the face as he arrested us.”

The call comes in the early afternoon. A dead body has been spotted in the sea, near the port. Siren blaring, Safdar weaves between cars. “It is not common for us to have accidents, and when we do, it is usually the public’s fault,” he says. A large truck fails to give way. “I don’t think you can even hear the horn!” he shouts, glaring at the driver.

At the port, Safdar picks up the sheet from his stretcher. Bodies are harder to lift when they are waterlogged: limbs are fragile and parts can come away. When the wooden rescue boat comes in, he and a colleague climb nimbly down the rocks and onto the boat. They roll the corpse onto the sheet, wrap it around, and carry it up to the waiting stretcher. It is fresh, a few hours old, and has not started to smell. The man was in his 60s.

When a body is found, a strict procedure follows. The ambulance takes it to a government hospital, where the death is logged and if possible, relatives contacted. If no ID is found, the body goes to a police station. From there, it is taken to the Edhi mortuary, where further efforts are made to track its identity. If this proves impossible, the body ends up in the Edhi graveyard.

The Edhi mortuary is in Sohrab Goth, an impoverished area that until recently was a hotbed of urban militancy. The mortuary is set back from the road, with a large open waiting area lined with benches, where relatives can sit. To the left are rooms where the bodies are washed. To the right is the cold storage facility. This is the only functional mortuary in Karachi, a city of more than 27.5 million people.

Facebook Twitter Pinterest Safdar chats with a colleague at the Edhi Foundation office in Karachi. Photograph: Akhtar Soomro/Reuters

Although state hospitals are equipped with cold storage facilities, most are not operational. Funds earmarked for their maintenance are frequently diverted elsewhere. The mortuary deals with unidentified bodies and the aftermath of disasters, but families can also pay for deceased relatives to be stored while they await burial, or for their bodies to be washed in the traditional Islamic way.

Ghulam Hussain, the senior clerk, has worked at the mortuary for 12 years. After his first day, he walked out. “There were so many bodies, in all conditions, fully mutilated, so there were just parts of them. When I saw that, it was like the ground was pulled from under me. It is impossible to forget. It stays with me, it never fades,” he says. Two months later, he returned, and stayed. “Slowly, I got used to it. Human beings tend to manage things.” He says that on average, between four and six unidentified bodies come in each day, rising to between 10 and 12 in the summer.

It is difficult work, and Hussain takes refuge in systems. He describes the details of procedures for treating and identifying the bodies. Until a few years ago, bodies were buried within three days, in keeping with Islamic tradition. Now that Pakistan’s ID card system is biometric, fingerprints are taken from corpses and sent to the central authority to check for a database match. This can take anything from 24 hours to several weeks.

Two men arrive, looking for a relative who went missing eight years ago. Hussain gives them the catalogue – a macabre photo album. When an unclaimed body arrives, staff take three photographs of the face: one from the front and one from each side. These are filed along with a serial number that marks the shroud and then the grave, so that even after burial relatives can find their loved ones.

The cold storage facility is a metal room with its own diesel generator to ensure that the temperature remains at zero degrees, despite Karachi’s frequent power cuts. The bodies are laid out on metal grilles, on three levels. There are two halls. Both smell overpoweringly of disinfectant, but this does not entirely cover the cloying smell of the corpses. In the first room are bodies brought in by families, entirely covered by white shrouds, with labels stating their name, age and religion. In the second are the unidentified bodies. Their faces are left uncovered, in order to ease identification. A stray hand or foot sticks out in places.

When there is a major disaster – a terror attack, a fire, a flood or heatwave – there are times when due process cannot be followed. On 11 September 2012, there was a huge fire at a textile factory in the district of Baldia Town. The fire broke out near the compound’s locked gates: there was no escape. More than 600 people were injured and more than 200 died.

Safdar and his fellow ambulance drivers worked solidly for four days to rescue survivors and retrieve the dead. “The bodies were so badly burnt that if you tried to hold them, they would crumble,” he says.

Most of the bodies went to the hospital and then, too charred to be readily identified, to the mortuary. For Hussain, the textile factory fire stands out – not because of the overwhelming volume of bodies to process, wash and identify, but because of the stress the team was placed under to work quickly. Karachi is a highly politicised environment. After major disasters, pressure is often exerted by one interested faction or another to release the bodies quickly. That is what happened in this case. “We couldn’t follow our procedures,” says Hussain. “We couldn’t test the bodies.” He is sure that some went to the wrong families, and it still distresses him.

On 12 December 2016, scores of ambulances are lined up opposite the Kharadar base. Today is a public holiday – the prophet Muhammad’s birthday – and a conservative Sunni group is holding its annual procession. Overnight, blockades have gone up around the planned route, with paramilitary forces standing guard. The Edhi Foundation’s logistical machine has kicked into action.

Safdar is late for work; he spent the morning preparing celebrations at home, ordering food and planning a Qur’an recital for the evening. Instead of his usual cargo trousers, he is wearing a blue salwar kameez. Ignoring his boss’s sarcastic comment about his excellent timekeeping, Safdar pulls his red Edhi T-shirt over the top.

Vehicles are stationed along the parade route, and Safdar drives to his spot. The rally fills up in the early afternoon. Trucks with loudspeakers blast out religious music and prayers, and distribute free snacks. Sitting in his ambulance, looking at the crowds, Safdar remembers the same event, exactly 10 years before. In the evening, a massive bomb exploded, so loud that Safdar couldn’t hear for a few minutes. His ambulance filled with the injured and he tried to drive to the nearest hospital. “When a blast happens, people leave their cars, their bikes, their bags, everything. I drove my ambulance over all this debris. I was trembling and there was a major problem with the vehicle. Only I can ever know how I was able to drive my ambulance that day.” A total of 57 people died.

Safdar’s worst memory is of the procession on the Shia holy day of Ashura in December 2009. Safdar and his colleague Farrukh were stationed near an entrance. They left their vehicles to buy a drink from a roadside stall. A man in a bulky, heavy jacket entered. He detonated his suicide vest metres away from the ambulances. Safdar, stunned by the impact but not injured, snapped into action. He realised quickly that both ambulances were badly damaged, so he lifted the injured up, away from the crowd, awaiting back-up. “Through all this, I saw the top half of Farrukh’s body lying there.” More than 30 people died and dozens were injured. Farrukh’s picture is displayed on the honour wall of dead ambulance drivers at the Kharadar office.

This year, the procession passes without incident. “I haven’t spent an Eid night at home since I started this job,” says Safdar. “Always I am driving, hoping nothing happens, wearing these fancy clothes.”

On an average day, a steady stream of people come into the Kharadar office to give small donations or to seek help. One day, a man brings in his four-year-old daughter. “She cannot walk,” he says. Staff pull out a dusty child’s wheelchair and the family leaves with it. Another day, a young woman with a black eye walks in and declares she is running away from home. Within half an hour, an ambulance driver has fetched a female case worker from the women’s shelter.

“The ambulance is the backbone of everything,” says Faisal Edhi. “Shelter homes and adoption centres run because of the ambulances. The babies are found in the bushes, ambulances go and collect them. People are lying on the street, ambulances get them.”

The final stage of the journey that a body can make is to the cemetery. The day after the procession, Safdar drives to the Edhi graveyard, a huge, flat expanse. Graves are demarcated with wooden signs bearing a number, which are stuck into the earth. This number has followed each body from the mortuary to its final resting place. It corresponds to the number of bodies buried here. On this day, the latest number is 83,390.

Facebook Twitter Pinterest A wooden marker at the Edhi Foundation graveyard on the outskirts of Karach. Photograph: Akhtar Soomro/Reuters

Each of these 83,390 bodies was given a full funeral service, with four or five Edhi staff present. In Islam, it is believed that you must join funeral prayers if you can, as it eases the person’s journey to the next world. Sometimes, other mourners join the prayers, and passersby stop their motorbikes to join in. Safdar, who has led the ceremony on many occasions, remembers times when 30 or 40 people have attended.

Some sections of the graveyard correspond to major disasters; there is a whole section for bodies still unidentified after the Baldia fire, and a long trench where victims of the 2015 heatwave lie. Some graves are no longer unmarked; families who have later tracked down a dead relative have paid to erect proper gravestones, which stand out against the endless lines of wooden sticks.

Most cemeteries in Pakistan are strictly divided along religious lines. Here, because the identity of the corpses is unknown, people of different faiths lie side by side. Safdar points to a grave marked with a wooden cross. “Edhi Sahib thought that all humans are equal,” he says. “Look at that Christian grave, whose relatives left the body here, even though it is a Muslim majority. This is a very beautiful thing to see in Pakistan.”

He gets back into his ambulance to drive back to the base. On the way, he passes the scene of an accident. An old man has been knocked off his motorbike and Safdar stops to help, administering first aid at the side of the road, expertly checking for broken bones. As the man leaves, he grips Safdar’s hand. “May you always be happy,” he says. Safdar gets back into his ambulance and drives on. “If you see someone drowning and you can be of use, why wouldn’t you help? It’s about help, not money,” he says.

Since Abdul Sattar Edhi died, many observers in Pakistan have questioned whether the organisation can continue. Safdar is adamant that things will not change. On his rare days off, he sometimes drives to Edhi’s grave in Hyderabad, where he speaks to his mentor and promises to continue his legacy. Faisal admits that donations are down 30 per cent since his father’s death, but he is determined to keep the foundation’s work going. “When my father was alive and people would criticise him, he used to say, ‘We do not need to respond, our response is our work’. So that’s what I say now. Our response is our work.”

Main photograph by Akhtar Soomro/Reuters

This is an edited version of an article that appears on Mosaic. It is republished here under a Creative Commons licence

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