The removal of federal health secretary immediately after the tragic fire at the Pakistan Institute of Medical Sciences (PIMS) Children's ICU, which claimed the lives of 14 children, was prompted by his alleged failure to comply with repeated directions from Prime Minister Shehbaz Sharif to personally inspect Islamabad's hospitals, particularly PIMS, according to a source familiar with the matter.

The prime minister had, on more than one occasion, directed the health secretary to visit the hospitals himself and assess the situation on the ground, including the standard of treatment, facilities and overall arrangements for patients, the source said. "He was specifically asked to ensure latest equipment and electromedical devices," disclosed the source. The secretary, however, could not undertake the required visits. According to the source, the prime minister had issued the same direction to the secretary just four days before the PIMS tragedy, but the visit could not take place.

Following the deaths of children in the ICU fire, the prime minister immediately removed the secretary from his position. The immediate action, however, does not necessarily indicate that responsibility for the tragedy has been fully determined. An inquiry committee constituted to investigate the incident is expected to submit its findings to the prime minister, with the report still awaited as of Friday evening.

The committee is expected to identify lapses and fix responsibility at different levels, after which further action could be taken. Questions are now being raised over whether more heads will roll and whether Health Minister Mustafa Kamal will also face action following the inquiry. A source said no decision regarding the minister had so far been confirmed.

The government's immediate response was to remove the health secretary, but the scope of accountability will become clearer once the inquiry committee submits its findings to the prime minister.