‘I could not save the rest’: Hero nurse remembers Pakistan’s nursery fire

Islamabad, Pakistan – Staff nurse Razia Noreen was at a medicine cupboard on the nursery ward of the Pakistan Institute of Medical Sciences (PIMS), Islamabad’s largest public-sector hospital. She was two doors from the babies in her care, preparing the morning’s injections.

As she shut the cupboard door, she saw through the nursery’s glass panel a light too sharp and too red to be anything ordinary. She did not wait to understand what it was.

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It was ۶:۳۸am on Wednesday, August ۲۶. Elsewhere in the ward, her colleague, Sister Nasreen, was already running out, shouting for help.

At ۵۶ seconds past ۶:۳۸am, according to security camera timestamps later logged by a government inquiry committee, Noreen rushed into the nursery.

Eight seconds later, she emerged carrying a baby. She tried to go back in. She could not. By ۶:۴۰am, the room was gone, swallowed by smoke so thick that the security cameras could no longer see through it.

Noreen was recalling this eight days later, in a plain office beside the hostel warden’s room at PIMS, dressed in a pale pink shalwar kameez, her dupatta loose over one shoulder.

“There was a proper blast,” she told Al Jazeera. “Everything turned to smoke.”

Fifteen newborns had been in that nursery. Fourteen died. The baby Noreen carried out was the only one who lived.

On Thursday, Noreen was given an award by Prime Minister Shehbaz Sharif for her courage. But for the nurse, the trauma of that Wednesday morning was still raw.

Barely two hours after meeting the prime minister, she sat down and talked, at length, about what happened inside.

‘Save the babies’

Noreen had been on duty since ۸pm the previous night, working a routine dawn medication round with Sister Nasreen, with less than two hours left before the end of her shift.

When she saw the light through the nursery glass, she says she did not stop to work out what it was.

“I just told my sister nurse, save the babies,” she told Al Jazeera. “I went in. I didn’t think about what would happen next.”

Noreen said the fire was coming out of the side of the air-conditioning unit facing her.

“The AC was right in front of me, and the fire was coming out of its side,” she said. “We don’t know what was happening behind it. That’s just what I saw.”

The government’s interim inquiry, submitted on August ۲۸, states that the precise cause of the fire “is not yet conclusively established”, with evidence pointing variously to the air conditioner, an incubator or an electrical short circuit.

Inside the nursery, Noreen reached the nearest baby. There was no time to choose between ۱۵. She carried the infant out and handed her to Dr Abdul Rehman, a doctor who had been inserting a feeding tube in the next room and emerged into the corridor moments after her. Then she turned back.

“I thought I’d get five, six, seven, eight more of them out,” she said. “But the fire was moving faster than I was.”

A second doctor, Dr Rimsha, who had been doing rounds nearby and saw the same light Noreen had, followed her in.

The two of them, and later Sister Nasreen, tried to crawl back through the smoke below the worst of the heat. A sudden loss of power plunged the room into darkness. They could not get through.

Noreen’s phone, left behind on the medication table when she ran in, sat inside the burned ward overnight. Hospital guards found it and returned it to her the next afternoon. Its case is still scorched and cracked.

Noreen, Dr Rimsha and Sister Nasreen instead moved to where a separate rescue team was lowering babies from an adjoining gynaecology ward. They stood there catching newborns and running them to the neonatal intensive care unit until the smoke became too thick to remain.

The government’s inquiry later found that the available evidence “does not support generalised allegations that front-line medical and nursing staff simply abandoned the newborns”.

Ask Noreen what a nurse is to a newborn separated from its mother, and she has one answer: its first mother.

“A mother who gives birth endures a pain no one else can stand in for,” she said. “But once a baby is in our hands, no one else is watching over it the way we are, checking their oxygen, their feeding, whether they’re breathing right, every two hours, whatever else is happening around us. That is why we are their first mother.”

‘I am very happy with the children’

Noreen, ۳۸, has spent ۲۱ years in government nursing, the last ۱۷ of them at PIMS. She trained in Karachi right after school, at the age of ۱۷, before a transfer brought her to PIMS in ۲۰۰۹. She has never married.

“Thank God, I am very happy with the children,” she said, when asked about it directly.

Born in Punjab’s city of Sahiwal, she was one of seven children. Her father, Victor John, was a pastor; he died when she was in the eighth grade. Two of her sisters have died; a third, also a nurse, lives in Lahore.

Her mother, ۸۳, a retired government school teacher who is hard of hearing, lives in Lahore with one of Noreen’s brothers.

Noreen herself has lived in the PIMS staff hostel, across from the ward where she works, for most of the past two decades.

With her own phone trapped inside the burning ward, Noreen could not call her family herself.

Noreen’s niece happened to be staying with her that week. It was the niece the warden found, and who got word to the family in Lahore: Noreen was safe.

‘It’s always the two of us’

On the morning of the fire, Noreen and Sister Nasreen were the only two nurses on duty in a nursery holding ۱۵ babies, backed by two doctors, one of them two rooms away. She says it was not an unusual night.

“Sometimes there are ۲۰ babies, sometimes ۲۵,” she said. “It’s always the two of us.”

Doctors on her ward work ۳۶-hour shifts, she said, arriving at ۸am and going off duty at ۲pm the following day.

Handover between nursing shifts, checking each baby’s medication, feeding and vital signs, takes roughly ۴۵ minutes given the numbers involved. The cost of drugs can also run to tens of thousands of Pakistani rupees per injection, all provided by PIMS to its patients.

“Sometimes we get a break, sometimes we don’t,” she said. “When the workload is heavy, even the water we carry with us goes back home untouched.”

No fire drill had been run in the nursery before August ۲۶, not even after an earlier fire at a nearby PIMS hostel in July.

Asked what is required after an incident like this, she does not hesitate.

“We should all have proper drills. If a fire starts, everyone needs to already know what to do.”

She lists what should follow: extinguishers within reach, cross-ventilation to clear smoke, and a rehearsed evacuation route for babies who cannot walk or call out for help.

‘Golden letters in history’

Until the fire, almost nobody outside her own ward knew her name, Noreen says.

“I have almost no presence in the main hospital,” she said. “Nobody there knows who I am. I work in the nursery, in my own department. I never imagined that saving one baby would take me this far.”

She travelled on Thursday to meet the prime minister in a car the government sent.

During the meeting, Sharif called her “the nation’s daughter” and said her act would be remembered “in golden letters” in Pakistan’s history.

He confirmed Noreen will formally receive the country’s Sitara-i-Khidmat (Star of Service) award at a ceremony on March ۲۳, and handed her a cheque for ۱۰ million Pakistani rupees ($۳۶,۰۰۰).

She used the meeting to say what she had already told her own colleagues privately.

“My fellow nurses work with just as much dedication,” she said. “This was a very heartbreaking incident.”

‘I haven’t slept since that day’

Eight days on, Noreen is unwell. She has had a fever of ۱۰۲ to ۱۰۳ degrees Fahrenheit (۳۸.۹C to ۳۹.۴C) on and off, and a cough she says came from smoke she breathed in from the fire that morning — a morning she will never forget. She takes an antibiotic and sleeping tablets at night. Neither has worked as it should.

“I haven’t slept, not since that day,” she said. “I take the tablets, I drink the cough syrup, but sleep doesn’t come. I close my eyes, and I open them again.”

Asked whether the same dawn shift keeps replaying in her mind, she did not need the question finished.

“The whole incident. The same babies. The mothers’ screams, and the babies’ screams, how they must have screamed. Those are the things that don’t let me sleep.”

She was signed off on medical rest only the day before this interview. Colleagues have been steadying her since.

“I would just start crying, sitting there,” she said. “They supported me like I was a child.”

But the nights are still hers alone.

“It comes back to the same thing,” she said. “When I’m in the hostel, when I’m alone, it all comes back.”

‘That, I regret’

The baby Noreen carried out — she hasn’t been named yet, according to the nurse — remains in the neonatal intensive care unit a week on.

Born preterm at just over a kilogramme (۲ pounds, ۳ ounces), the baby was already unwell before the fire. She remains critical.

Noreen met the baby’s parents for the first time the day before the meeting with the prime minister.

“She [the baby’s mother Asifa] hugged me and thanked me, and cried, and I cried with her,” Noreen said, “because for the rest of the children, my heart is still exactly where it was.”

She has told the mother the same thing she tells herself.

“I said, look, your child survived such a huge storm, she will survive what comes next, too. You pray, and I will pray.”

Asked what she would tell other nurses, Noreen urged them to work with honesty and without conditions.

“When you work somewhere with honesty, the reward comes eventually,” she said. “It came to me after ۲۱ years. Work with the same loyalty. That is our real strength.”

Then, unprompted, she returned to the ۱۴ babies who died.

“I do regret it,” she said. “I could not save the rest of the children. That, I regret.”