Street food boom fuels public health crisis

Lax inspections, unhygienic surroundings of popular food hubs have driven a spike in foodborne diseases

KARACHI:

While thousands flock to Karachi's vibrant food streets, many end up in overcrowded emergency wards, as doctors increasingly link rising cases of diarrhoea, gastroenteritis, and food poisoning to appetizingly deadly street food favourites.

Food is a city's identity, and few cities in Pakistan are as widely celebrated for street food as Karachi. From samosas, chaat, and pani puri to bun kebab, falooda, khow suey, and layered biryanis, the city's culinary culture is built around affordable roadside stalls that attract hundreds of customers daily. Yet, beneath the aromas and flavours lies the bitter reality, a growing public health crisis that remains unaddressed by the authorities.

Across Karachi, unregulated and poorly monitored food streets have grown along broken roads and open sewage drains. In areas such as Lyari,

Lee Market, and Ranchhor Line, stalls selling ready-to-eat food operated beside overflowing gutters carrying untreated wastewater. Similar conditions are visible in some of the city's most popular food destinations, including Burns Road, Boat Basin, Tariq Road, and MA Jinnah Road.

While these locations are often promoted as organised food hubs, large sections continue to function in unhygienic surroundings. In several locations with street food stalls, stagnant wastewater collects near cooking areas, producing a strong stench. Despite these conditions, many of the outlets prominently display valid Sindh Food Authority licences, highlighting the disconnect between regulatory approval and actual food safety.

Under the Sindh Food Authority Act, 2016, all food business operators are legally required to obtain a licence before selling food to the public, ensuring minimum hygiene standards, safe food handling practices, and routine inspections. However, the presence of a licence displayed at a stall or eatery has done little to improve conditions on the ground.

According to this law, food business operators are required to obtain separate licences for each outlet, even when operating under the same brand. Each licence is valid for one year and must be renewed annually against a fixed fee. While the official fee is relatively small, the licensing process frequently involves additional informal costs. Several operators allege that failure to make these extra payments results in repeated objections or threats of closure.

As a result, licences are often issued without thorough inspections, and in some cases, without inspectors ever visiting the premises. Even in areas marketed as organised food streets, food is often prepared and served in the open, without protection from dust, vehicle emissions, or insects. Broken pavements and overflowing garbage bins create an environment where contamination becomes unavoidable.

In the absence of effective enforcement, it becomes clear that licences have little meaning regarding the hygiene element of street food. This is strongly linked with foodborne diseases. Former Pakistan Medical Association Secretary General Dr Qaiser Sajjad warned that food streets established alongside open sewage drains posed a serious public health hazard.

"The stench rising from these drains carries bacteria and harmful particles that settle on exposed food and enter the human body through both ingestion and inhalation.

Dust from broken and unpaved roads further contaminates food, while vehicle emissions add another layer of exposure. Pathogens commonly found in such environments include Escherichia coli, Salmonella, and Shigella, which can cause diarrhoea, gastroenteritis, dysentery, and food poisoning," said Dr Sajjad.

"Contaminated water is frequently used to wash utensils, plates, and spoons at roadside stalls, increasing the risk of disease transmission," added Dr Sajjad, who further revealed that Karachi's high levels of air pollution, combined with dust settling on food, were also contributing to respiratory problems such as asthma, bronchitis, and allergies. "In this scenario, the increased prescription of antibiotics also raises concerns about antibiotic resistance as a secondary public health challenge," noted Dr Sajjad.

Hospitals reported a steady influx of patients, particularly during the warmer months, when food spoils faster, and bacteria multiply more rapidly. The situation has placed additional pressure on already overstretched public health facilities. Dr Khalid Bukhari, Medical Superintendent at the Civil Hospital Karachi, pointed out that diarrhoea cases surged between May and October and continued to rise each year.

"Substandard food sold on unsafe food streets on the roads is causing an increase in diarrhoea. Stomach diseases in children are largely caused by colourful syrups and drinks sold at roadside stalls during summer, while adults primarily fall ill due to unhealthy food," said Dr Bukhari, who appealed to parents and the general public to prevent children from eating and drinking at unsafe food streets.

It is the emergency wards in hospitals that absorb this daily burden. For instance, at the Civil Hospital Karachi, 22 to 25 patients are brought to the department every day with diarrhoea. This translates into more than 750 cases per month and over 9,000 annually. From January to December 2025 alone, the hospital recorded 6,527 cases of diarrhoea and gastroenteritis among children.

According to the Sindh Government Liaquatabad Hospital's records, 50 to 60 patients suffering from diarrhoea and gastroenteritis arrive daily, especially from areas such as Nazimabad, Golimar, and other parts of the central district. This adds up to more than 1,800 cases a month and over 21,000 annually.

Speaking to the Express Tribune, Dr Atiq Qureshi, Medical Superintendent of the hospital, shared, "The increase in cases is directly linked to contaminated water consumed at hotels and unhygienic food sold at unsafe food streets." Similarly, at the Sindh Government Saudabad Malir Hospital, 60 to 70 diarrhoea patients are reported every day.

Dr Agha Amir, Medical Superintendent of the hospital, confirmed that the number of such patients almost doubled during the peak summer months of April, May, and June. "Diarrhoea patients are treated through drips and ORS," mentioned Dr Amir, noting that dehydration remained a major complication in such cases.

Data from the Jinnah Postgraduate Medical Centre revealed that 80 to 90 patients with gastrointestinal complaints were treated daily. Although numbers declined during colder months, doctors maintained that contaminated food and water remained year-round contributors. The New Karachi Hospital receives 20 to 28 such patients each day, while Lyari Hospital reports 30 to 32 cases of diarrhoea and gastroenteritis daily. Across hospitals, school-going children are identified as particularly vulnerable, as per The Express Tribune's investigation.

A 2023 study on the risk of foodborne diseases provides scientific evidence of how unhygienic environments and practices lead to harmful diseases. The research was conducted by the Institute of Environmental Science at the University of Karachi, in collaboration with the School of Public Health at Dow University of Health Sciences, and examined the microbiological quality of street food sold near major public hospitals.

Food samples were collected from vending stalls within a 0.5-kilometre radius of facilities, including Jinnah Hospital, Civil Hospital, and Landhi Korangi Hospital. The study focused on commonly consumed street foods such as bun kebab, chaat, samosa, chicken rolls, and pakoray. Laboratory analysis revealed widespread bacterial contamination.

Both Gram-positive and Gram-negative bacteria were isolated, including E. coli, Enterobacter, Pseudomonas, Salmonella, Bacillus subtilis, Staphylococcus aureus, and Enterococcus faecalis. E.coli was the most prevalent organism and was detected even in fried items, indicating contamination after cooking.

The study revealed that water quality played a significant role in this contamination. Street vendors rely on water for washing hands, cleaning utensils, and preparing chutneys and sauces. Due to limited access to tap water, many vendors reuse water throughout the day, redistributing microorganisms across food items. Poor handling practices further compound the risk.

The study also found that most vendors lacked basic food hygiene training. Aprons, gloves, and caps were rarely used, and food was handled with bare hands. Items were often served in polythene bags, old newspaper, or reused paper. Inadequate waste disposal was widespread, with food waste discarded near stalls, attracting flies identified as carriers of disease-causing microorganisms. Despite licensing requirements, enforcement of hygiene standards has remained weak. With food inspections infrequent and monitoring inconsistent, consumers bear the health consequences. The Express Tribune attempted to contact Sindh Food Authority's Director General Shahzad Fazal Abbasi regarding the number of licences issued in Karachi and the inspection mechanism, but received no response despite multiple reminders.