Patients pay nominal fees for consultations, injections, and prescriptions, making these outlets appealing in a country where public hospitals are overcrowded and under-resourced.

A silent yet deadly health crisis continues to unfold in the dusty villages and bustling urban outskirts of Pakistan. An estimated more than 600,000 unlicensed and unqualified individuals, commonly referred to as “fake doctors” or quacks, operate across the country, providing medical treatment without any formal training, licensing, or oversight. This staggering figure, repeatedly cited by the Pakistan Medical Association (PMA) and corroborated by the Sindh Healthcare Commission (SHCC) using data from the Pakistan Medical and Dental Council, underscores a national epidemic that endangers the lives of millions, particularly the poor and rural populations who have limited access to qualified healthcare.

Recent reports have brought renewed attention to this issue. In rural Sindh province – home to some of the highest concentrations of these practitioners – unlicensed clinics serve as the primary, and often only, point of medical contact. Patients pay nominal fees, sometimes as low as 300 rupees (roughly $1), for consultations, injections, and prescriptions, making these outlets appealing in a country where public hospitals are overcrowded and under-resourced.

Inside an Unlicensed Clinic: Hygiene Risks and Dangerous Practices

Abdul Waheed, a 48-year-old featured prominently in recent investigations, exemplifies the problem. By day, he works at a private hospital in Hyderabad; by evening, he runs an informal clinic in Tando Saeed Khan without any medical license. Holding only a homeopathy diploma and a nursing certificate, Waheed confidently diagnoses ailments and administers treatments. His setup is rudimentary: wooden tables serve as examination beds, rusted nails on the walls hold used infusion tubes, and syringes are often washed only with water before reuse.

During journalist visits, another nearby unqualified practitioner quickly shuttered his clinic and fled upon spotting reporters. Local residents, many uneducated, admit they cannot distinguish qualified doctors from these impostors. “People aren’t educated and can’t recognise qualified doctors,” one villager told reporters. Such practices – reusing needles and failing to sterilize equipment – directly fuel the transmission of blood-borne diseases like hepatitis and HIV/AIDS, a risk repeatedly highlighted by health experts.

An Epidemic with Devastating Health Consequences

The PMA describes this phenomenon as a “public health epidemic.” Many fake doctors begin as assistants in legitimate clinics, absorb rudimentary skills, and then launch independent operations. They lack knowledge of proper dosages, side effects, drug interactions, or evidence-based medicine. PMA Secretary-General Abdul Ghafoor Shoro has warned that these practitioners “don’t know side effects or exact dosages” and that “instruments are not sterilised… They reuse syringes, which increases the spread of hepatitis and AIDS.”

Historical outbreaks illustrate the danger. In 2019, a notorious case in Larkana, Sindh, saw over 500 people – including hundreds of children – infected with HIV due to a single quack reusing contaminated syringes. While recent statistics on exact transmission rates linked to fake doctors remain limited, experts link ongoing poor infection control in unlicensed settings to sustained high prevalence of hepatitis B and C in Pakistan, one of the countries with the highest burdens globally.

Public hospitals bear the brunt. Dr. Khalid Bukhari, head of Civil Hospital Karachi, reports that his facility is “overloaded” with complications from misdiagnoses, wrong treatments, and infections acquired elsewhere. “Most of the cases we receive are those ruined by them,” he said. Families often face catastrophic expenses when patients require advanced care after initial mishandling, leading to disabilities, prolonged suffering, or death.

Regulatory Struggles and Enforcement Challenges

Authorities acknowledge the crisis but face severe limitations. The SHCC, responsible for regulating healthcare in Sindh, has sealed thousands of illegal outlets over the years – over 11,000 in Sindh alone in the past seven years up to late 2025, according to some reports. Yet the problem persists. “If we shut down 25 outlets, 25 new ones open the very next day,” said Ahson Qavi Siddiqi, head of the SHCC.

A recent example involved sealing an unregistered bungalow in Karachi operating as a full-fledged hospital with pediatric and adult intensive care units. Enforcement remains weak: many offenses are bailable, allowing quick releases, and inspection teams face threats, including being held hostage or attacked by influential local quacks backed by community or political support.

Nationwide, the issue is compounded by broader systemic failures. Pakistan produces around 22,000 new doctors annually and has roughly 370,000 registered medical professionals, but brain drain is severe – nearly 3,800–4,000 doctors left in 2025 alone, the highest recorded. With a population exceeding 250 million, the country falls short of WHO-recommended doctor-to-population ratios, leaving rural areas underserved and vulnerable to quackery.

Root Causes: Poverty, Illiteracy, and Healthcare Gaps

The persistence of fake doctors stems from deep structural issues. Poverty forces millions to seek cheap, immediate care rather than traveling to distant government facilities with long waits. Illiteracy prevents patients from verifying credentials. Weak rural infrastructure and doctor shortages – many qualified professionals prefer urban private practice – create a vacuum that unlicensed operators fill.

In villages like those in Sindh, these clinics offer convenience and perceived confidence, even if dangerous. Patients with fevers, infections, or chronic pain receive quick injections or pills, often providing temporary relief that masks underlying problems.

Urgent Calls for Reform and Long-Term Solutions

Health advocates and regulators demand comprehensive action: stricter legislation with non-bailable penalties, increased funding for enforcement teams, nationwide registration drives, public awareness campaigns on recognizing qualified providers, and massive investment in primary healthcare infrastructure, especially in rural areas.

Without these reforms, the cycle will continue – cheap but risky care for the vulnerable, overwhelmed hospitals, preventable deaths, and a persistent threat to public health. As one expert noted, eliminating unlicensed practice requires not just crackdowns but addressing the root causes of access inequality.

The crisis of Pakistan’s fake doctors is more than a regulatory failure; it is a stark reflection of healthcare inequities in one of the world’s most populous nations.