Selective compliance: How Imran Khan’s medical controversy exposed the cracks in Pak system

ISLAMABAD

In Pakistan’s perennial contest between formal institutions and informal power, the recent episode surrounding former prime minister Imran Khan’s court-ordered medical examination and treatment offers a useful case study in selective compliance, competing narratives and the limits of judicial intervention. For an Indian audience, it illustrates yet again how Pakistan’s contemporary hybrid system prioritises control and optics over consistent adherence to the rule of law.

On August 18, a three-judge supreme court bench headed by Justice Shahid Waheed and comprising Justices Naeem Akhter Afghan and Ishtiaq Ibrahim issued an interim order directing the federal government to transfer Imran from the Adiala jail in Rawalpindi to the Shifa International Hospital, a private facility in Islamabad, within 48 hours. The court mandated the constitution of a medical board comprising a physician, general surgeon, internal medicine specialist, ophthalmologist and cardiologist. Imran’s personal physician, Dr Faisal Sultan, and his sister, Dr Uzma Khan, were also permitted to “remain associated” with the examination and treatment.

Imran was to remain at the hospital until the next hearing, scheduled for September 16. The order also instructed the government to facilitate weekly family meetings as well as twice-weekly telephone calls between Imran and his sons in the United Kingdom. It barred family members, Imran’s PTI (Pakistan Tehreek-e-Insaf) workers and lawyers from publicly disclosing Imran’s health condition or medical reports.

However, in the intervening night of August 20 and 21, Imran was moved not to Shifa but to the government-run Pakistan Institute of Medical Sciences (PIMS). A medical team, including an ophthalmologist, cardiologist and physician, examined him. Authorities stated that doctors from Shifa were present and that his sister, Dr Uzma, also attended. He was declared medically fit and returned to Adiala at approximately 5am. Dr Sultan waited for hours at Shifa but never saw him that night. Government spokesmen cited security risks arising from PTI gatherings near the private hospital as the reason for the change of venue.

Imran’s family and the PTI leadership initially treated the supreme court order as meaningful relief after prolonged restrictions on access and documented health concerns, including earlier reports of vision impairment caused by central retinal vein occlusion and more recent reports of anxiety and blood-pressure fluctuations linked to prolonged isolation.

Dr Uzma was present in court on August 18. Responding to inquisitive journalists after the hearing, Dr Uzma and Imran’s other sisters said they were simply grateful that Imran would get the medical attention he needed. The more detailed public response came after the PIMS episode. On August 21, Dr Uzma and Dr Sultan held a press conference describing a night of contradictory instructions, an incomplete examination in their view and Imran’s alleged complaints of sustained isolation amounting to mental torture. The PTI framed the episode as deliberate non-compliance and an insult to the entire justice system.

The government’s early reaction was cautious and legalistic but soon turned adversarial. Law Minister Azam Nazeer Tarar said the directive to transfer Imran to a private hospital sat uneasily with the Pakistan Prison Rules, particularly Rule 197, and that convicted prisoners normally received treatment in jail hospitals or at public facilities. Information Minister Attaullah Tarar and Minister of State for Interior Talal Chaudhry defended the decision to seek a review, challenging the order on legal and equality grounds and asking whether every prisoner would be entitled to private facilities. Officials insisted that the examination at PIMS fulfilled the spirit of the court order and met its substantive requirement for examination under controlled conditions and that the decision to go to PIMS rather than Shifa was operational, not political.

Meanwhile, the Islamabad chief commissioner filed a review petition under Article 188, characterising the order as discriminatory and beyond the court’s jurisdiction. The petition was returned for procedural defects. It was later refiled in amended form.

Both sides have since levelled contempt accusations. Dr Uzma filed a petition seeking proceedings against Prime Minister Shehbaz Sharif, ministers and officials for failing to implement the court order. The government countered that the family and the PTI had breached the non-disclosure clause through public statements about Imran’s health and that unauthorised gatherings had created the very security problems that necessitated the change of venue. The supreme court has not ruled on either set of claims and the interim order of August 18 remains in force pending any review outcome.

The clearest divergence from the text of the supreme court order lies in the failure to transfer Imran to the specifically named private hospital and to keep him there under the stipulated medical board until September 16. The government’s security rationale and partial examination at PIMS may constitute substantial compliance in its view, even though they do not conform to the directives contained in the order. On the family side, the non-disclosure restriction was binding, and public statements after the PIMS visit invited the government’s counter-accusation. Liability for contempt ultimately rests with the court, which alone can determine whether any breach was wilful and contumacious. What is evident is that neither side fully escaped the shadow of the order’s constraints, and the only thing that emerged unfiltered from this entire episode is the selective character of institutional compliance when high-stakes political actors are involved.

Beyond the legal contest lies a more speculative political reading, which interprets the limited judicial relief and subsequent constrained implementation as a signal within Pakistan’s current power configurations. The incumbent coalition’s working relationship with the military establishment has always been transactional, characterised by mutual dependence. Controlled humanitarian optics around Imran can function as a reminder of the residual popular support that still revolves around him, potentially pressuring the civilian leadership on difficult political issues or legislative agendas, such as getting national security bills rapidly approved by parliament, ‘convincing’ them on longer-running discussions about governance structures and the creation of smaller and more manageable administrative units from existing provinces, or increasing federal oversight of and control over certain urban centres and provincial capitals. Whether such signalling is intentional or incidental, the episode underscores once again that civilian governments in Pakistan rarely operate free from the broader institutional calculations of the establishment.

Pakistan remains trapped in a conundrum: institutional incoherence, elite bargains that systematically exclude the broader public interest, chronic economic fragility and underperformance and, most dangerously, an entire generation represented by a fast-growing, increasingly disillusioned cohort of young citizens who see little evidence that the state prioritises service delivery, opportunity, predictable justice or even basic dignity.

Sustainable progress requires synchronised public policies that treat human security in tandem with socioeconomic development as core rather than residual concerns, rational economic policies that prioritise broad-based growth for all, credible accountability processes that apply across institutional lines and beyond formal or informal immunities and, most importantly, a political settlement that not only reduces the zero-sum character of elite competition but also ensures genuine civilian supremacy under a constitutional framework that all major players accept and abide by. Only when the incentives of power begin to align with the needs of ordinary Pakistanis, rather than the perpetual management of internal rivals, can the country hope to restore political stability, societal harmony and a development path that benefits more than a narrow circle of elites.

Pakistan’s current hybrid system is more capable of managing conflict than resolving the underlying deficits of governance and development. The Imran hospital episode is a symptom, not the disease. The deeper illness remains the unresolved contest over who truly governs and for whose benefit.

The author is senior associate at the UK-based Midstone Centre for
International Affairs.