As part of the ICRC Health Care in Danger Project in Karachi, the ICRC partnered with the Research Society of International Law (RSIL) to conduct a review of the legal framework within which the Karachi healthcare sector operates, in order to identify gaps in the existing legal system and posit effective recommendations to enhance the security of health-care workers, establishments and medical transport. The report examines the unique legal framework which informs the provision of health-care services in Karachi and how this framework currently protects health-care providers (HCPs) and their patrons. Within this context, the general and specific risks and threats to the health-care sector are highlighted with a view to recommending legislative and administrative reform to counter them.
This analysis allows for a focused discussion of the current legal regime for the province of Sindh. In this regard, the fundamental rights afforded by the Constitution are examined to demonstrate the limited health-care guarantees that the State of Pakistan offers to its citizens. At the provincial level, the Sindh Health-care Commission Act of 2014 is analysed to assess the potential impact this legislation will have once the Commission is operational. The extent of its powers and duties regarding the protection of health-care professionals would go a long way towards improving security and augmenting health-care service delivery throughout the province of Sindh. Furthermore, the Sindh Injured Persons (Medical Aid) Act of 2014 imposes obligations on hospital staff to treat injured persons on a priority basis over any medico-legal formalities, a provision which would extend to police officials as well. The Injured Persons Act, importantly, also bars members of the police from interfering with the treatment of a patient at a hospital. This provision provides a legal footing to the protection from pressure and harassment that medical personnel have long demanded.
The criminal legal framework in Sindh is also analysed through two federal statutes: the Pakistan Penal Code and the Anti-Terrorism Act of 1997. The Code encompasses general offences which criminalize attacks or threats against health-care professionals and also covers damage to property. In the context of terrorism, the 1997 Act provides for enhanced sentences and specifically mentions damage to ‘hospitals’ as a form of terrorism. As a result of the general nature of the 1997 Act, numerous forms of violence and threats against health-care workers and medical transport also come within its ambit. In relation to the legal provisions regarding ambulances and ‘emergency vehicles’, the report examines the Provincial Motor Vehicles Ordinance of 1965 as well as the National Highways Safety Ordinance of 2000. The report culminates in a series of recommendations aimed at enhancing the current legal framework and existing administrative protocols.