At a time when Pakistan is facing deep political polarisation, economic fragility and grave security challenges, the country is neither emotionally nor institutionally prepared to absorb the shock of another political shahadat. The execution of Zulfikar Ali Bhutto and the assassination of Benazir Bhutto remain painful reminders of how the state has, in the past, allowed politics to collide with life and death, with consequences that still haunt the nation.
In these circumstances, continued incarceration of former Prime Minister Imran Khan in solitary confinement, amid emerging health concerns, is no longer just a legal or political matter. It is a national concern that demands mature decisions.
The decision to bring the former prime minister out of Adiala Jail late at night last week for specialised eye treatment should have set off alarm bells far beyond the immediate medical issue it addressed. His diagnosis of central retinal vein occlusion (CRVO) is not a routine eye complaint. It is a red flag.
CRVO is widely recognised by physicians as a condition strongly associated with uncontrolled hypertension, diabetes, dyslipidaemia and underlying cardiovascular disease. In a 74-year-old man, it is often interpreted as evidence of worsening systemic vascular health. The eye, as doctors frequently note, offers a window into the body’s blood vessels. When a major retinal vein clots, it raises legitimate concern about what may be happening in the heart and brain.
Imran Khan may still be physically active and disciplined in his personal routine, but age, disease biology and reported dietary patterns do not bend to political narratives. CRVO suggests that his vascular risk profile is deteriorating. In such circumstances, the probability of a major adverse cardiovascular event such as an acute myocardial infarction or an ischaemic stroke rises significantly. This is not speculation; it is basic internal medicine.
What makes this situation more troubling is the setting in which Khan is being held. If he were to suffer chest pain, a heart rhythm disturbance or a stroke inside his jail cell, his survival would depend on how quickly he could be moved to a specialised facility. In cardiology, the first 90 minutes after a heart attack are considered the golden period for restoring blood flow. In neurology, the window for diagnosing and treating an ischaemic stroke is typically four to six hours. Delays of even minutes can mean the difference between recovery and irreversible damage.
A jail environment, by its very nature, is incompatible with this level of emergency responsiveness. Any transfer would require administrative clearances, security arrangements and transport coordination. Each layer adds delay.
Even more concerning is the fact that Khan was taken to the Pakistan Institute of Medical Sciences. PIMS is a heavily burdened public sector hospital that struggles with shortages, overcrowding and limited high-end cardiac and neurological capacity. It is not a centre most Pakistanis would choose for managing a complex heart attack or acute stroke if alternatives were available. The uncomfortable truth is that those who go there in emergencies often do so because they have no other option.
If something were to happen to a former prime minister with a mass political following while in custody, during transfer or while receiving delayed treatment, the consequences would extend far beyond medicine. Public perception would matter, and perception in Pakistan is shaped as much by history as by facts. Any serious harm to Imran Khan in these circumstances would be widely viewed as preventable and, fairly or unfairly, as a failure of the state.
Pakistan has already paid a heavy price for allowing political conflicts to intersect with life and death. The execution of Zulfikar Ali Bhutto and the assassination of Benazir Bhutto are scars that have never fully healed. No institution should wish to add another chapter to that tragic ledger.
Precedent also exists for restraint. Nawaz Sharif was allowed to leave the country for medical treatment. Asif Ali Zardari was repeatedly granted medical relief and hospitalisation. These decisions were taken not as acts of political favour, but in recognition that the state bears responsibility for the lives of those it detains.
In Imran Khan’s case, reasonable options exist. He could be placed under house arrest at Bani Gala or Zaman Park. He could be shifted to the Shaukat Khanum Memorial Cancer Hospital and Research Centre, where he would remain under continuous supervision by a medical team he trusts. Or, if the state truly wishes to defuse risk and tension, he could be permitted to seek specialised care abroad, most plausibly in the United Kingdom.
None of these options negate accountability, legal process or the authority of the courts. They simply recognise a basic principle: incarceration should not quietly turn into a life-threatening medical gamble.
States are judged not only by how they punish, but by how they protect life, even when the individual involved is politically inconvenient. Imran Khan’s CRVO diagnosis is a warning. Ignoring it would not be strength. It would be recklessness.