Cancer patients throughout Sindh, including the bustling metropolis of Karachi, are enduring significant hardships due to the absence of a single public sector hospital that offers comprehensive cancer treatment services in one location. Currently, no government hospital in the province provides a full spectrum of care encompassing surgery, chemotherapy, radiotherapy, and palliative care, forcing patients to navigate a fragmented healthcare system. This disjointed approach compels many patients to travel between multiple facilities to receive different aspects of their treatment, often resulting in delayed care and increased physical, emotional, and financial strain on patients and their families.
The challenge of fragmented cancer care in Sindh is particularly alarming given the province’s large population and relatively advanced diagnostic capabilities, which lead to a higher detection rate of cancer cases compared to other regions of Pakistan. Each year, Pakistan records over 180,000 new cancer diagnoses, with Sindh accounting for a substantial share of these cases. Despite Karachi being the country’s largest city and a key healthcare hub, no government hospital there currently integrates all cancer treatment modalities under one roof. This gap in care infrastructure means patients frequently begin treatment at one hospital but must be referred elsewhere for other necessary therapies, complicating their treatment journey.
One poignant example illustrating this systemic failure involves a 55-year-old man from Hyderabad who was diagnosed with stomach cancer. His experience highlights the exhausting and often heartbreaking path many patients face. After his diagnosis, he was initially directed to the Sindh Institute of Urology and Transplantation (SIUT) in Karachi. However, after visiting both the Reagent Plaza facility and the main hospital near Civil Hospital Karachi, he was advised to seek further treatment at the Jinnah Postgraduate Medical Centre (JPMC). Upon examination at JPMC’s cancer ward, doctors referred him to the Karachi Institute of Radiotherapy and Nuclear Medicine (Kiran), a specialized center managed by the Pakistan Atomic Energy Commission.
At Kiran, the patient was sent back to JPMC after it was determined that his cancer had metastasized to other organs, reaching an advanced stage four, where curative treatment was no longer viable. Subsequently, oncologists at JPMC recommended that the patient’s family pursue palliative care at Aga Khan University Hospital, as no public hospital in Sindh currently offers dedicated palliative care services for terminal cancer patients. After days of being shuffled between hospitals, the patient returned home to Hyderabad, where he is now awaiting the end of his life without adequate symptom relief. This tragic case underscores the profound gaps in Sindh’s public healthcare system, where even in the largest city of Pakistan, patients with terminal cancer often suffer without proper pain management or supportive care.
The lack of palliative care services in government hospitals means that many patients with advanced or metastatic cancer endure their final days in severe pain, without access to effective symptom control. Compounding this issue is the limited availability of potent pain-relief medications such as oral and injectable morphine, which is widely recognized as the standard treatment for severe cancer pain. These essential drugs are rarely stocked in public hospitals due to stringent regulatory restrictions and supply chain challenges. Similarly, fentanyl patches, which are critical for managing chronic cancer pain, are difficult to procure. Consequently, many hospitals either do not keep these medicines in inventory or face bureaucratic obstacles in obtaining them, leaving patients to suffer from unmanaged pain.
Officials within the Sindh health department acknowledge that cancer treatment services are scattered across various institutions in Karachi. For instance, JPMC provides cancer surgeries and offers chemotherapy through financial support programs like Pakistan Bait-ul-Mal for patients unable to afford the high cost of medicines. The hospital also houses one of the country’s major radiotherapy units. However, it lacks an organized palliative care program, which is crucial for improving the quality of life for patients with terminal illnesses. Despite the growing cancer burden in the province, Sindh has yet to establish a centralized public cancer hospital that delivers comprehensive care — from diagnosis and surgery to chemotherapy, radiotherapy, and palliative services — all under one roof.
Meanwhile, the provincial government continues to invest significant funds in specialized procedures, such as bone marrow transplants, at institutions like Dow University of Health Sciences and the National Institute of Blood Diseases in Karachi. Yet, these investments have not translated into a unified cancer treatment facility capable of addressing the full continuum of care. Attempts to obtain comments from Sindh Health Minister Dr. Azra Pechuho were unsuccessful, although she has previously emphasized that Sindh boasts some of the best healthcare infrastructure in the country and that its achievements often go unrecognized.
In the meantime, cancer patients and their families bear the brunt of this fragmented system. Many are forced to sell property, take loans, or rely on charitable organizations to finance their treatment. Health experts warn that without the establishment of integrated cancer centers and accessible palliative care services in public hospitals, thousands of patients in Sindh will continue to face not only difficulties in receiving timely treatment but also agonizing pain during the advanced stages of their illness. The urgent need for a coordinated approach to cancer care in Sindh remains a critical public health challenge that demands immediate attention.
