Crossing Borders for Care: Afghan Patients and the Crisis of Pakistan’s Healthcare System

By Asmaa Hayat

For decades, Afghan patients have traveled to Pakistan seeking better medical treatment. Cities like Peshawar, Quetta, and Islamabad became key destinations for those who could not find adequate care at home. However, stricter border controls, tough visa policies, and the rising cost of healthcare have made this journey much harder. 

Thousands of Afghans continue to travel to Pakistan because the healthcare system in Afghanistan remains extremely weak. Yet even in Pakistan, the healthcare system is now under enormous pressure and on the brink of collapse due to economic challenges, political instability, and high demand. Hospitals are overcrowded, medical supplies are often limited, and the cost of treatment has soared. Still, for many Afghans, seeking care in Pakistan remains their only hope, as conditions at home are even worse. 

In the corridors of hospitals across Pakistan, the echoes of a collapsing public health system grow louder each day. The country’s healthcare infrastructure, once envisioned as a means to ensure equitable access to health for all, now stands as a symbol of systemic neglect, mismanagement, and a retreating state. From urban centers to rural outposts, patients find themselves navigating a labyrinth of underfunded facilities, apathetic governance, and a growing dependence on privatized care that leaves the poorest behind.

At the heart of the crisis lies the government’s increasing inclination to relinquish its role in providing essential services. Once a key participant in delivering healthcare through a three-tiered model—primary, secondary, and tertiary care—the state has gradually shifted responsibility onto the private sector. What was originally designed to complement public provision has now overtaken it. Presently, nearly 70% of patients rely on private healthcare providers, a stark indicator of the public sector’s failure to deliver even the most basic services.

This abandonment is felt most acutely by healthcare workers, particularly those in the public sector. Nurses, paramedics, and doctors often operate in facilities that lack electricity, running water, or even essential medical supplies. Meanwhile, their counterparts in privatized or semi-autonomous setups enjoy comparatively better resources and compensation. The inequity is not just financial—it’s systemic. Healthcare professionals in public institutions are shackled by bureaucratic red tape, inadequate training opportunities, and nonexistent protections. Strikes, burnout, and mass resignations have become frequent, signaling a deep-seated rot that policy makers seem unwilling or unable to address.

Yet, the state’s chosen path of privatization is not a cure-all. It often substitutes public inefficiency with market exploitation. The commodification of healthcare means life-saving treatments are increasingly accessible only to those who can afford them. Patients are left vulnerable to extortionate pricing, misleading diagnoses, and an absence of regulatory oversight. This unchecked expansion of private health services reflects a governance model where profit trumps public welfare.

The tragedy runs even deeper in rural areas, where the healthcare vacuum is absolute. Basic Health Units (BHUs) and Rural Health Centers (RHCs), once hailed as pivotal steps toward decentralizing healthcare, now suffer from chronic underfunding, lack of staff, and dilapidated infrastructure. In remote regions, women in labor, children with high fevers, and elderly individuals with chronic conditions must travel hours, sometimes days, to reach functional healthcare facilities—only to be turned away due to overcrowding or lack of resources.

While Pakistan has undertaken several initiatives, such as the Lady Health Worker program and public-private partnerships in immunization and maternal health, their impact has been limited. These efforts are often ad hoc, heavily reliant on foreign aid or NGOs, and fail to address the structural issues that plague the system: corruption, poor leadership, and insufficient health budgeting. Despite commitments under the Millennium Development Goals (MDGs) and later the Sustainable Development Goals (SDGs), the country’s healthcare indicators remain dismal, particularly in maternal and child health, nutrition, and infectious disease control.

The governance crisis is not confined to operational inefficiencies—it extends to policy formulation itself. Health policy decisions in Pakistan are frequently made without the input of healthcare professionals, local communities, or civil society. Many decision-makers lack medical or public health backgrounds, resulting in disjointed and impractical strategies. Furthermore, the decentralization of health governance following the 18th Amendment has added layers of complexity without clear mechanisms for accountability or coordination between federal and provincial bodies.

There have been moments of innovation. Institutions like the Sindh Institute of Urology and Transplantation (SIUT) and the National Institute of Cardiovascular Diseases (NICVD) in Karachi showcase what is possible when public entities are granted autonomy and shielded from political interference. However, these remain isolated examples, unable to offset the widespread dysfunction elsewhere.

The core issue is not a lack of resources, but rather how they are allocated and managed. Health consistently receives one of the lowest shares in the national budget—often under 1% of GDP. Comparatively, defense spending and infrastructure projects receive disproportionate attention. Until healthcare becomes a political priority, meaningful reform will remain elusive.

For the average Pakistani, this crisis is not just an abstract policy failure—it is a lived experience of suffering and indignity. A mother watching her child die from a preventable infection, a daily-wage worker unable to afford medication, or a cancer patient turned away for lack of beds—these stories are tragically common.

Asmaa Hayat is healthcare professional in Islamabad. 

Note: The contents of the article are of sole responsibility of the author. Afghan Diaspora Network will not be responsible for any inaccurate or incorrect statement in the articles.