The true test of a healthcare system isn’t found in the quiet, sterile halls of a metropolitan hospital, but in the chaotic, smoke-filled air of the unexpected. Between April and May 2025, the province of Sindh faced a crucible that would redefine its understanding of resilience. This period, known as Marka-e-Haq, was more than a military engagement; it was a profound human struggle where the boundary between the frontline and the home front dissolved into a single, urgent mission: the preservation of life.
While the thunder of defence operations echoed at the borders, a different kind of hero emerged on the local streets. As the skies hummed with the sound of loitering munitions and the ground shook from the impact of regional strikes, Sindh Integrated Emergency & Health Services (SIEHS) stood as the silent, unbreakable shield for the civilian population. In the face of a 72-hour high-intensity conflict that targeted the very spirit of the region, SIEHS 1122 proved that a healthcare system built on readiness does not just respond to emergencies—it withstands them.
The origins of Marka-e-Haq trace back to late April 2025, following the Pahalgam incident, which acted as a catalyst for a rapid military escalation. By the first week of May, the situation had transitioned from diplomatic tension to active hostility. The night of 6th and 7th May 2025 saw the start of a multi-domain conflict. While the nation’s armed forces executed Operation Bunyanum Marsoos to neutralise external threats, the domestic infrastructure was placed under immense strain.
Civilian areas, particularly those near strategic hubs and hospitals, were not immune to the spillover. Panic is often the first casualty of war, and in the early hours of 7th May, the fear of drone strikes and missile impacts threatened to paralyse the province. It was a “Day of Truth”—a moment where the “always on” promise of public services was put to its most extreme test.
At the centre of this domestic defence was Sindh Integrated Emergency & Health Services (SIEHS). For SIEHS, the conflict was not a reason to retreat, but a mandate to accelerate. From the first report of an impact at midnight on 7th May until the final ceasefire was finalised on 10th May 2025, the organisation’s command centre became the heartbeat of the province’s civilian response.
SIEHS 1122 demonstrated that it is far more than a free emergency ambulance service in Sindh. It is a sophisticated, integrated network of high-tech “ICUs on wheels.” During Marka-e-Haq, these vehicles became mobile sanctuaries. Staffed by ISO-certified Emergency Medical Technicians (EMTs), each ambulance was a testament to the fact that rapid pre-hospital medical care is the most critical link in the chain of survival during a conflict.
The deployment data from the 72-hour peak of Marka-e-Haq paints a picture of surgical precision and unwavering bravery. While many fled the sounds of explosions, the blue and white ambulances of SIEHS 1122 moved toward them.
In Hyderabad, the conflict felt immediate and heavy. A confirmed blast in a high-impact zone resulted in multiple fatalities and severe trauma injuries. Within minutes, five HOPE Units (High-Occupancy Patient Emergency Services) were on the scene. Despite the chaos, the crews worked with a level of calm that only comes from rigorous training, stabilising the wounded and ensuring they were shifted to secondary care facilities before the golden hour had passed.
In the provincial capital of Karachi, the challenge was different. The city’s dense population meant that any rumour of an incoming strike could lead to mass panic and gridlock. SIEHS units remained stationed at strategic takeoff points, ensuring that ambulance service in Karachi remained uninterrupted. The goal was simple: visibility equals security. By keeping the sirens moving and the units visible, SIEHS provided a psychological buffer for a city on edge.
The pressure was perhaps most acute in the northern districts. In Jacobabad, two blasts occurred in close proximity to the Civil Hospital—a location that should have been a sanctuary but became a target zone. Our crews navigated the debris to transport victims directly to the hospital gates, proving that even when the destination is under threat, the journey to save a life does not stop.
In Ghotki and Shikarpur, verified drone attacks created a landscape of uncertainty. In Shikarpur, a confirmed injury required immediate intervention. The local SIEHS ambulance arrived to find a community in shock, successfully stabilising the patient and managing the transport through volatile territory. In Ghotki, where victims had already been shifted by the time ambulances arrived, the teams stayed to secure the area and provide medical screening for those suffering from the secondary effects of the blasts, such as respiratory distress and shock.
One of the greatest challenges during Marka-e-Haq was the “fog of war”—misinformation and false alarms that could easily divert life-saving resources. In Badin and Mirpurkhas, reports of drone crashes and explosions sparked immediate responses. In many of these cases, such as in Badin, the reports were false alarms. In Mirpurkhas, a drone had indeed crashed in an open field, but there were no victims.
While some might see these as “wasted” trips, for SIEHS, they were vital operations. Every time an ambulance arrived at a scene and confirmed the absence of danger, it shut down a cycle of panic. The presence of the 24/7 emergency ambulance response in these remote districts acted as a fact-checking mechanism on the ground, ensuring that resources remained focused on where the real blood was being shed.
The conflict of 2025 reinforced a fundamental truth: Emergency Ambulance Coverage Across Sindh must be absolute. Whether it was the narrow, congested lanes of urban centres or the vast, dusty stretches of Sukkur, Larkana, and Nawabshah, the geography of Sindh did not dictate the quality of mercy.
SIEHS currently operates a fleet of over 627 state-of-the-art ambulances across 30 districts. During the war, this network allowed for a “staggered” response. If an ambulance in one district was overwhelmed, the integrated nature of the service allowed for a seamless handoff. This interoperability is what separates a standard transport service from a Sindh Integrated Emergency & Health Services (SIEHS) operation. We are not a collection of independent ambulances; we are a single, unified entity responding to a single, unified province.
Behind the statistics of “victims shifted” and “ambulances dispatched” are the individual stories of the SIEHS workforce. These are the men and women who, during Marka-e-Haq, kissed their families goodbye not knowing if the next dispatch would be their last. They handled cases of heart attack symptoms exacerbated by the stress of the war, they managed stroke symptoms in the elderly who were trapped by fear, and they treated severe bleeding from shrapnel while the ground beneath them was still warm.
The value of this service during such a time cannot be quantified in rupees. It is measured in the lives of the fathers, mothers, and children who reached the hospital when the odds were stacked against them. It is measured in the silence that follows a siren—the silence of a life that has been saved.
By the time the ceasefire was signed on 10th May 2025, the landscape of Sindh had changed, but the mission of SIEHS remained the same. Marka-e-Haq was a “Day of Truth” for our organisation. It was the moment we proved that our systems, our training, and our hearts are built to withstand the worst of days.
We don’t just respond to severe road accidents or trauma injuries in times of peace. We are the guardians of the frontline when the peace is broken. The commitment of SIEHS is a constant in an unpredictable world. From Tharparkar to Dadu, we ensure that no citizen is left without preliminary diagnosis and transport when they need it most.
When the history books look back at the 72 hours of May 2025, they will rightfully speak of the military manoeuvres and the strategic victories. But for the people of Sindh, the story will also include the sight of a blue-and-white ambulance emerging from the smoke—a symbol that even in the darkest hour, help was only four digits away.
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