Ali Sher Hoppo Bugti enters a battle ground at the highest reaches of the Koh-e-Suleiman range in Pirkoh, Dera Bugti, having been diagnosed with cancer. Formerly a taxi driver who navigated the corners of the country, he is now tethered to a sickbed. Cancer has become an uninvited passenger in his life since 2023.
A surgery afforded him salvation, yet it rendered him reliant on expensive medical supplies – traveling expenditures that deplete his resources almost as relentlessly as the disease drains his vigour. As the sole provider for his family of eight, Ali Sher endures a monthly ordeal: striving to gather Rs 30,000 solely to finance the journey from his native village to a hospital located in Lahore. His existence has devolved into a painful cycle of desperate hope and meagre coins, perpetually hinged on the harsh demands of survival and medical necessity.
Hundreds of kilometres distant in Baghlechar, Dera Ghazi Khan, yet situated upon the same mountain chain of Koh-e-Suleiman, another family bears a strikingly similar burden. Rehmat Khan's 10-year-old son, Muhammad Abdullah Buzdar, is afflicted with cancer. At Shaukat Khanum Hospital, they discovered a shining beacon of hope – treatment provided free of charge. Nevertheless, the sanctuary is shadowed by hidden costs: travel and lodging expenses incurred in a city far from their home have already drained more than Rs 70,000. “The treatment is free,” Rehmat sighs, “but the hope itself is costing us everything.”
The cancer epidemic within the Koh-e-Suleiman range, stretching from Taunsa to Dera Bugti in Baloch areas, has escalated to an alarming severity. It affects all age groups and genders, encompassing children such as 7-year-old Zubida from Fazala (Taunsa) and the elderly, including 67-year-old Banguan Bugti from Zain Koh Loti, Dera Bugti.
Inhabitants of Koh-e-Suleiman draw a heartbreaking parallel, saying that while atomic bombs caused instant death elsewhere, their generations are being killed slowly by continuous radiation exposure from improperly dumped materials
Dera Ghazi Khan has witnessed a steady, distressing rise: from 68 deaths in 2015 to 116 in 2020, marking the highest on record, with 157 cancer patients documented as of December 2021. Current estimates suggest there are between 370 to 390 cases in total, including those deceased, recovered, or currently undergoing treatment. Breaking down case numbers in villages throughout the region starkly illustrates the scale of the crisis:
- Bador (Baghlechar): about 70-80 cases
- Ronghan: around 50-60 cases
- Kacchi Wanga: 20-25 cases
- Seminj: 15-20 cases
- Kallair, Than Gullah, Channalh, Khoriali, Phugl: each 10-15 cases
- Market towns like Jhandi, Mandraka, Bandar, Theekar: 5-10 cases each
- Smaller villages combined: 80-100 cases
In Dera Bugti alone, 12 cancer deaths occurred last year, with many more currently battling the illness, including seven patients from Zain Koh Loti village.
This grim rise in cancer cases is tightly linked with environmental degradation caused by unmonitored resource extraction and pollution. The radioactive and toxic waste disposal practices surrounding cement plants, gas companies (active since the 1950s), atomic power facilities in Dera Ghazi Khan, and rare earth mineral mining from the 1960s have been dangerously negligent. Local communities suffer from exposure to radioactive materials improperly dumped in public areas.
The Baloch Women Forum released a strong statement cautioning that radioactive waste dumping in the Koh-e-Suleiman mountains has precipitated a drastic increase in diseases including bone marrow disorders, liver, lung, kidney cancers, facial tumours, and intestinal cancers across Dera Ghazi Khan and its adjacent areas. The Bugti Progressive Students Society echoes this profound concern for Dera Bugti.
The inhabitants of Koh-e-Suleiman frequently lament that the atomic bombs dropped on Hiroshima and Nagasaki killed instantly, whereas here, generations of their people continue to suffer and perish slowly from radiation exposure. The entire Koh-e-Suleiman mountain range – from Tuman Qaisrani and Tuman Khosa to the Bugti tribe area – urgently requires healthcare infrastructure. In response to the escalating cancer crisis, local political and social organizations have amplified their voices. Baloch Raj launched an awareness campaign on the health impacts of cancer among indigenous people, drawing substantial public participation. Concurrently, Buzdar Ittihad in Taunsa Sharif organized several protests demanding immediate government action.
Healthcare authorities in Punjab and Balochistan and policymakers must urgently implement measures to prevent exposure to chemical and radiological hazards.
Immediate Relief and Patient Support
Some of the first measures will have to address the ongoing impact on those most affected, to alleviate the suffering caused by their geographic distance from centres of treatment elsewhere in the country:
- Establish a "Travel and Lodging Fund": The provincial governments of Punjab and Balochistan, in collaboration with NGOs and corporate social responsibility (CSR) funds from the very industries operating in the region, must immediately establish a dedicated fund. This fund would cover travel, accommodation, and lost wages for patients and their caregivers traveling to cities like Lahore, Multan, Karachi and Islamabad for necessary treatment.
- Mobile Cancer Care Units: Deploy mobile medical vans fully equipped for basic palliative care, chemotherapy administration, and sample collection. These units can also serve as crucial data collection points.
- Public-Private Partnerships with Hospitals: Formalize agreements with major cancer hospitals (such as Shaukat Khanum) to establish dedicated referral pathways and subsidized hostel facilities for patients arriving from specific high-risk districts like Dera Bugti and Dera Ghazi Khan.
Healthcare Infrastructure and Capacity Building
The next layer of interventions has to be to bring treatment facilities closer to those who need them.
- Establish a Regional Cancer Diagnosis and Palliative Care Centre.
- Train Local Healthcare Workers: Launch comprehensive programs to train local nurses, community health workers, and midwives in cancer symptom identification, patient navigation, and palliative care. This initiative builds essential local capacity and creates a vital first line of defence within the communities.
Environmental Remediation and Regulatory Action
From treatment of the these cancers, administrative attention will have to move towards addressing the root causes:
- Independent Environmental Audit: A transparent, independent audit of all industrial sites—especially cement plants, gas facilities, and mining operations—must be commissioned immediately. This audit, led by environmental agencies like the Pakistan Environmental Protection Agency, must meticulously test soil, water, and air for radioactive materials and heavy metals. The results must be made publicly accessible.
- Enforce "Polluter Pays" Principle and Safe Waste Disposal: Strict enforcement of regulations requiring industries to:
- Immediately cease the dumping of waste in public areas and water sources.
- Clean up existing waste sites and return toxic waste to be sealed, designated areas within mining sites.
- Implement and fund continuous, real-time environmental monitoring with public dashboards.
- Health Impact Assessment (HIA): Mandate that no new mining or industrial project can commence without a comprehensive HIA, and existing operations must undergo one retrospectively. This legally forces a critical connection between industrial activity and public health.
Data Collection, Research and Awareness
Research infrastructure will have to be established to inform and support all these efforts:
- Establish a Regional Cancer Registry: This must be formalized into a government-funded, population-based cancer registry for the entire Koh-e-Suleiman region. Accurate, official data is essential for securing funding, tracking progress, and understanding the full scope of the epidemic.
- Fund Epidemiological Studies: Universities and national health institutes must be funded to conduct long-term studies to definitively link the high cancer rates to specific environmental contaminants. This scientific evidence is crucial for litigation and policy change.
- Amplify Local Advocacy: The work of the Baloch Women Forum, Baloch Raj, and student societies like Bugti Progressive Students Society is vital. Their reports and protests should be given a national platform. Partnering with national media and human rights organizations can amplify their demands and hold authorities accountable.
Legal and Policy Framework
Measures to protect the people of Koh-e-Suleiman from such deadly health risks will have to be given formal legal and administrative backing:
- Recognize "Cancer Clusters" Officially: The government must officially recognize the areas Bador, Ronghan, Zain Koh, Pirkoh, Sui and Uch as "cancer clusters."
- This formal designation triggers specific policy responses and the requisite allocation of resources.
The mountains of Koh-e-Suleiman are not solely suffering from a disease; they are suffering from profound neglect and injustice. The solution requires not just better medicine, but also greater accountability. It demands treating this situation not merely as a health emergency, but as a direct consequence of environmental degradation and failed governance.
The resilience of Ali Sher Hoppo Bugti and the quiet despair of Rehmat Khan demand nothing less than a concerted war waged on two distinct fronts: one to save the lives of those already afflicted, and another to safeguard future generations from the poisoned legacy of unchecked industrial progress.