PAHALGAM: Routine care at a quiet medical outpost evaporated with a single phone call on April 22 last year. By dusk, the floor was slick with blood. Staff had processed 26 bodies and 17 wounded survivors. The one-storey facility was the thin line between life and death following the terrorist attack in Baisaran valley near Pahalgam.One year later, the line remains dangerously thin.Little has moved at Pahalgam civil hospital. Medical care still functions within five cramped rooms. Doctors consult outpatients while paramedics squeeze X-rays and ECGs into the same narrow footprint. Outside, three ambulances — an increase of exactly one vehicle since the massacre — sit on a patchy lawn. When rain falls, the ground turns to muck, choking the path to the entrance.The tragedy forced a grim improvisation. As reinforcements arrived from across south Kashmir, staff dragged beds into a hollow, unfinished three-storey building next door. They used the shell of a hall to stack the dead. Today, that building remains a concrete skeleton, stalled by bureaucratic gridlock while the primary clinic struggles to breathe.The facility’s limitations defy the scale of its responsibility. Pahalgam is no sleepy village. It is a global destination and a spiritual gateway. In 2024, Pahalgam hosted 11.9 lakh tourists and more than 5 lakh Amarnath pilgrims — many requiring treatment for high-altitude ailments. The hospital also serves 2 lakh residents of the area.A 2021 plan to upgrade the site to a 50-bed sub-district hospital exists only on paper. Sanctioned staff positions remain empty. The skeleton crew — one surgeon, one anaesthetist, one gynaecologist, and seven paramedics — routinely refers the critically ill to Govt Medical College in Anantnag, miles away.The delay is a game of finger-pointing. Health officials blame roads and buildings (R&B) department for the crawl of construction. R&B officials claim they are being starved of roughly Rs 4.3 crore. “We have added another storey,” an R&B official said. “Construction of a lift and interior work are pending. If health department releases funds, we can make the building operational within six months.”As another tourist season peaks and Amarnath Yatra looms, Pahalgam’s primary defence against tragedy remains five rooms and a promise. The hall that once held 26 bodies remains empty, waiting for the paint and power that never arrived. For now, the urgency of that April evening has been replaced by the slow rot of neglect.