Pakistan is confronting a serious but largely overlooked public health challenge, with thousands of children born every year with cleft lips and palates. Although the condition is treatable, many patients remain without timely care due to gaps in the healthcare system.
Experts estimate that nearly 300,000 children are affected nationwide, placing Pakistan among the highest-burden countries globally after China, India, and Indonesia. From Karachi to Lahore and Peshawar, parents, surgeons, and healthcare workers describe the same struggle — expensive treatment, shortage of specialized facilities, and heavy dependence on charitable organizations.
Medical experts describe cleft lip and palate as a “mixed etiology” disorder caused by both genetic and environmental factors. Marriages between close relatives, folic acid deficiency, maternal malnutrition, smoking, diabetes, infections, and the use of certain medications during pregnancy are among the major causes. Treatment requires coordinated care involving plastic surgeons, speech therapists, orthodontists, psychologists, and ENT specialists.
In Sindh, families complain that treatment options in government hospitals are almost non-existent. Kashif, a father from Hyderabad, sought treatment for his four-year-old daughter born with a cleft palate.
“The situation caused severe stress and anxiety for my family. I worry about my daughter’s future and social acceptance. While cleft lip surgery is possible, children born with cleft palates often struggle with speech development,” said Kashif.
Another local from Karachi, Khan Bahadur revealed that his son was born with a cleft upper lip. After visiting Jinnah Hospital, he discovered there was no plastic surgery department capable of handling the case. Eventually, an NGO arranged two free surgeries for his child.
“Cleft lip surgery usually involves skin grafting and improves over time, while palate surgery requires longer recovery and speech therapy,” said Bahadur, who urged the government to provide treatment facilities in Karachi’s public hospitals.
Plastic surgeon Dr Muhammad Ashraf Ganatra told the Express Tribune that around 18,000 children are born daily in Pakistan, with approximately one in every 400 born with a cleft lip or palate while an estimated 20,000 to 30,000 untreated patients live in Sindh alone.
According to Dr Ganatra, Karachi’s government hospitals employ only three to four plastic surgeons despite the growing need for specialized care. “Treatment for cleft conditions can continue from birth until 18 to 20 years of age and requires a multidisciplinary “one-window” approach that is largely absent in the public healthcare system,” said Dr Ganatra.
“Because the condition is not considered life-threatening, it does not receive adequate government attention despite the severe physical and psychological impact on children. NGOs have stepped in to fill the gap, while only a few institutions in Lahore, Gujrat, and Karachi currently offer free multidisciplinary cleft treatment,” noted Dr Ganatra.
Punjab presents a somewhat better picture, though challenges remain significant. Doctors estimate that 4,000 to 5,000 new cleft cases emerge in the province every year. Government hospitals in Lahore, including Mayo Hospital, Children’s Hospital, Jinnah Hospital, and Services Hospital, have established plastic surgery units for cleft treatment.
However, families still report delays and significant out-of-pocket expenses for medicines and follow-up care. In private hospitals, a single surgery can cost between Rs150,000 and Rs500,000.
Medical sources claim surgeries in government hospitals are sometimes free, though patients still spend between Rs20,000 and Rs50,000 on medicines, tests, and follow-up treatment. Parents, however, complain of delays in surgeries despite doctors recommending urgent procedures.
Muhammad Aslam, a resident from Lahore, recalled the shock his family experienced when his newborn daughter was born with a cleft lip. “A private hospital demanded Rs300,000 for surgery, an amount the family could not afford. A charitable organization later arranged free treatment, and today my daughter is living a normal life and attending school,” shared Aslam.
Similarly, Nadia Bibi from Kasur shared that her son’s cleft palate made it difficult for him to drink milk properly. “Due to financial hardship, the family relied on a Lahore-based charitable organization that provided free surgery and treatment. Now, he has started speaking normally,” said Nazia.
Renowned plastic surgeon Professor Dr Afzal Bashir Bajwa explained that poor maternal nutrition, cousin marriages, folic acid deficiency, smoking, and genetic factors remain major contributors to the condition in Punjab. “Timely surgery and speech therapy can allow affected children to lead normal lives however, poverty and limited healthcare access in rural areas continue to prevent timely treatment,” noted Dr Bajwa.
The challenges are equally severe in Khyber-Pakhtunkhwa (K-P), where doctors estimate that 10 to 12 out of every 1,000 children are born with cleft lips or palates. Mursaleen Khan, whose two-year-old son was born with a cleft lip, was told by doctors that treatment could cost as much as Rs500,000.
Dr Hidayatullah Khan, a retired surgeon from Peshawar Burn Center who now runs a private clinic, revealed that many cleft cases are reported from Chitral, Swat, Timergara, Dir, and merged tribal districts. “Khyber-Pakhtunkhwa still lacks a specialized cleft surgery hospital, forcing families to rely heavily on NGOs for help,” said Dr Khan.
Across Pakistan, the stories from Karachi, Lahore, and Peshawar point to the same reality: cleft lip and palate is a treatable condition, yet timely care remains out of reach for many families. While NGOs continue to fill critical gaps, experts stress that lasting change will require stronger public healthcare systems, expanded surgical capacity, and early maternal health interventions.
Without coordinated action, thousands more children risk growing up with a condition that could have been corrected at the start of life.
Article Published in Express Tribune on June 21st, 2026.
