Thursday, April 24, 2025

Study: Artificial intelligence more accurately identifies child abuse

Findings revealed at the 2025 Pediatric Academic Societies Meeting

Pediatric Academic Societies

Artificial intelligence (AI) can help better identify prevalence of physical abuse of children seen in the emergency room, a new study found. The research will be presented at the Pediatric Academic Societies (PAS) 2025 Meeting, held April 24-28 in Honolulu.

Researchers used a machine-learning model to estimate instances of child abuse seen in emergency departments based on diagnostic codes for high-risk injury and physical abuse. The researchers’ approach better predicted abuse rates than those that rely solely on diagnostic codes entered by a provider or administrative staff. Relying on abuse codes alone misdiagnosed on average 8.5% of cases.

“Our AI approach offers a clearer look at trends in child abuse, which helps providers more appropriately treat abuse and improve child safety,” said Farah Brink, MD, child abuse pediatrician at Nationwide Children's Hospital, and assistant professor at The Ohio State University. “AI-powered tools hold tremendous potential to revolutionize how researchers understand and work with data on sensitive issues, including child abuse.”

Researchers studied data from 3,317 injury and abuse-related emergency department visits at seven children’s hospitals between February 2021 and December 2022. All children were under the age of 10 and nearly three quarters were under the age of two.

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EDITOR:
Dr. Farah Brink will present “A Machine Learning Approach to Improve Estimation of Physical Abuse” on Mon., April 28 from 5:00-6:30 PM ET.
Reporters interested in an interview with Dr. Brink should contact Amber Fraley at amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting
Pediatric Academic Societies (PAS) Meeting connects thousands of leading pediatric researchers, clinicians, and medical educators worldwide united by a common mission: Connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. The PAS Meeting is produced through the partnership of four leading pediatric associations; the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). For more information, please visit www.pas-meeting.org. Follow us on X @PASMeeting and like us on Facebook PASMeeting.

Abstract: A Machine Leaming Approach to Improve Estimation of Physical Abuse

Presenting Author:
Farah Brink, MD

Organization
Nationwide Children's Hospital

Topic
Child Abuse & Neglect

Background
International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes are inaccurate for determining child physical abuse (PA) prevalence, particularly in emergency department (ED) settings. Consideration of injury codes along with abuse-specific codes may enable more accurate PA prevalence estimates.

Objective
To develop a coding schema to better estimate PA using machine learning.

Design/Methods
We performed a secondary data analysis of children < 10 years evaluated by a child abuse pediatrician (CAP) due to concerns for PA during Feb 2021-Dec 2022 at 7 children's hospitals contributing data to both CAPNET, a multicenter child abuse research network, and Pediatric Health Information System (PHIS). We excluded encounters not linked with PHIS and those not evaluated in the ED during the CAPNET encounter. True PA was defined by CAP assigned rating 5- 7 on a 7-point scale of PA likelihood within the CAPNET database. Abuse-specific codes, including suspected codes, were defined as ICD-10-CM codes for PA modified from the Centers for Disease Control and Prevention child abuse and neglect syndromic surveillance definition. All 4-digit injury ICD-10-CM codes were used. We developed LASSO logistic regression models to predict CAP¬ determined PA for encounters with and without abuse-specific codes and used the models to calculate site-specific estimates of PA prevalence. We calculated the estimation error for site estimates based on 1) abuse-specific codes alone and 2) our LASSO predictive models. Estimation error was defined as estimated PA prevalence minus CAP-determined PA prevalence (true value).

Results
3317 of 6178 CAPNET encounters were successfully linked with PHIS and seen in the ED. Median age was 8.4 months with 74% < 2 years and 59% < 1 year. CAP diagnosed PA in 35% (n=l145) of all encounters, 12.7% (n=240) of encounters without abuse-specific codes, and 63.4% (n=905) of encounters with abuse-specific codes. At least one abuse-specific code was assigned for 43% of encounters. Site-specific estimates of PA prevalence based only on assignment of abuse-specific codes overestimated prevalence with estimation errors ranging from 2.0% to 14.3% (average absolute error 8.5%). Estimates of site-specific PA prevalence based on our predictive models had reduced errors from -3.0% to 2.6% (average absolute error 1.8%) (Fig. 1). Absolute error decreased for 6 of 7 sites and increased by 0.6% for the remaining site (Fig. 2).

Conclusion(s)
Our predictive models more accurately estimated the prevalence of PA compared to abuse-specific codes alone.

Tables and Images
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Study: Opioid use disorder treatment improves pregnancy outcomes

Findings revealed at the 2025 Pediatric Academic Societies Meeting

Pediatric Academic Societies

Pregnant women living with opioid use disorder (OUD) and their infants had significantly better health outcomes when treated with buprenorphine, according to a new study at Vanderbilt University Medical Center and Emory University’s Rollins School of Public Health. The research will be presented at the Pediatric Academic Societies (PAS) 2025 Meeting, held April 24-28 in Honolulu.

Pregnant women who received buprenorphine, a medication used to treat OUD, were less likely to have a preterm birth, face serious health complications, or have their infants hospitalized in the NICU compared to those who did not receive the treatment, the study found.

“We know that treatment with medications like buprenorphine substantially reduces the risk of overdose death for pregnant women with opioid use disorder, but its benefits to newborns have not been well understood,” said Stephen Patrick, MD, MPH, senior author and chair of the Department of Health Policy and Management at Emory University’s Rollins School of Public Health. “We found a profound reduction in preterm birth among infants whose mothers were treated with buprenorphine, which can have a lifelong impact.”

Despite rates of OUD in pregnant women increasing more than fivefold from 1999 to 2017, more than half still do not receive treatment, researchers said. Previous research estimates that up to 20% of pregnant women with OUD may have a preterm birth, nearly double those without OUD. Preterm birth, a growing public health issue, increases the risk of health problems in children, including respiratory issues, infections, cerebral palsy, developmental delays, and vision and hearing problems.

Researchers also noted stark disparities in equitable care. Those receiving buprenorphine were significantly less likely to be Black.

“Disparities in access to buprenorphine significantly affect vulnerable populations, including pregnant women,” said Sunaya Krishnapura, graduating medical student at Vanderbilt University School of Medicine and presenting author. “Our findings underscore the urgent need for policies that expand treatment access in the United States to ensure a healthy pregnancy and future for mothers and infants.”

The study examined more than 14,000 pregnant women with OUD who were enrolled in Tennessee Medicaid between 2010 and 2021.

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EDITOR:
Sunaya Krishnapura will present “Association Between Buprenorphine Treatment for Maternal Opioid Use Disorder and Maternal-Infant Outcomes” on Sun., April 27 from 5:30-5:45 PM ET.
Reporters interested in an interview with Sunaya should contact Amber Fraley at amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

Abstract: Association Between Buprenorphine Treatment for Maternal Opioid Use Disorder and Maternal-Infant Outcomes

Presenting Author: Sunaya Krishnapura

Organization
Vanderbilt University School of Medicine; Rollins School of Public Health, Emory University

Topic
Public Health & Prevention

Background
Opioid use disorder (OUD) in pregnancy is associated with adverse perinatal outcomes. Treatment with methadone or buprenorphine, both opioid agonists, is recommended to improve pregnancy outcomes. Much of the existing research has evaluated the effectiveness and efficacy of methadone compared to buprenorphine, but limited evidence remains comparing buprenorphine to no treatment. As most pregnant individuals still do not receive treatment for OUD, there is a public health imperative to examine how buprenorphine treatment compared to no treatment influences maternal-infant outcomes.

Objective
To determine if treatment with buprenorphine improves maternal outcomes (severe maternal morbidity (SMM), ICU admission, maternal mortality) and infant outcomes (preterm birth, NICU admission, infant mortality) compared to no treatment.

Design/Methods
This retrospective cohort study between 2010-2021 included maternal-infant dyads with a diagnosis of OUD and enrolled in Tennessee Medicaid from 20 weeks estimated gestational age (EGA) to 6 weeks postpartum using Medicaid claims linked to vital statistics. The exposure of interest was buprenorphine treatment, defined by filled prescriptions between 20 weeks EGA to birth. We calculated descriptive statistics and created propensity scores with overlapped weighting to account for treatment bias between groups.

Results
Among 14,463 who met our inclusion criteria, 7,469 dyads received buprenorphine treatment. Compared to those who were treated, pregnant individuals who did not receive treatment were more likely to be non-Hispanic Black (10% vs. 2.1%; p< 0.001; Table 1). The crude percentage of adverse perinatal outcomes was significantly lower in dyads treated with buprenorphine compared to the untreated group (25% vs. 31%; p< 0.001); the treatment group had a lower percentage of SMM events, preterm births, and NICU admissions (Table 2). In adjusted propensity score analyses, dyads treated prenatally with buprenorphine had 5.1% (95% CI, 3.5%-6.7%) lower probability of adverse pregnancy outcomes, including a 1.2% (95% CI, 0.4%-2.1%) lower probability of SMM, 1.7% (95% CI, 0.4%-2.9%) lower probability of NICU admission, and 5.3% (95% CI, 4.0%-6.6%) lower probability of preterm birth (Figure 1).

Conclusion(s)
In a large population-based cohort, we found that receipt of buprenorphine during pregnancy improved outcomes for both mother and infant, underscoring the need to improve access to treatment nationwide.

Tables and Images
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Study: Education improves in-home gun safety

Findings revealed at the 2025 Pediatric Academic Societies Meeting

Pediatric Academic Societies

More information about gun safety has increasingly led parents to ask about firearms in the homes their kids visit, according to a new national study. The research will be presented at the Pediatric Academic Societies (PAS) 2025 Meeting, held April 24-28 in Honolulu. 

Every new source of information increased parents’ likelihood of asking by 40%. Researchers found that 16% of caregivers who had never received firearm safety information asked about firearms where their child was visiting, compared to 79% of those who had heard about firearm safety from eight different sources.

While education from other parents had the biggest impact, the study found that any additional source of information—such as a family member, a school official, or social media—made them more likely to ask about guns when their kids visited other homes. Hearing firearm safety information from a health care provider also increased the likelihood of asking, yet less than 9% of parents report discussing firearm safety with their providers.

“Robust firearm education for parents builds a safer future for children where conversations about gun safety among parents and in communities are the norm rather than the exception,” said Maya Haasz, MD, associate professor at Children’s Hospital Colorado and presenting author. “As the research shows, the more education about gun safety, the safer families can be, especially when children as young as two years old can accidentally pull a trigger.”

The findings underscore the need for ongoing, multifaceted education about gun safety, study authors say. Guns are the leading cause of death among children in the United States, research shows.

The survey consisted of nearly 1,600 caregivers of children under the age of 18.

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EDITOR:
Dr. Maya Haasz will present “Caregivers’ Asking About Firearms in Homes That Youth Visit: A Nationally Representative Cross-Sectional Survey” on Mon., April 28 from 3:30-3:45 PM ET.
Reporters interested in an interview with Dr. Haasz should contact Amber Fraley at Amber Fraley amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

Abstract: Caregivers’ Asking About Firearms in Homes That Youth Visit: A Nationally Representative Cross-Sectional Survey

Presenting Author: Maya Haasz, MD

Organization
Children's Hospital Colorado

Topic
Injury Prevention

Background
Reducing unsupervised youth firearm access is associated with lower morbidity and mortality. In addition to considering firearm safety within households with youth, efforts have been extended to consider household firearms in homes that youth visit. Little is known about whether caregivers ask others about firearm access within households their youth visit (i.e. asking behaviors).

Objective
1) Estimate the prevalence of asking behaviors; 2) Evaluate the relationship between the number of distinct firearm safety information sources (e.g., class, healthcare provider, social media) and asking behaviors.

Design/Methods
Data is from a nationally representative cross-sectional survey of US adults conducted by Gallup May-June 2023. Participants included adults living with a child < 18 years old (unweighted n=1591). We examined distinct sources where caregivers received firearm safety information. The primary exposure was the number of distinct sources of firearm safety information. The primary outcome was whether caregivers had asked other parents about the presence of household firearms. Bivariate statistics, logistic regression, and Chi-squared statistics were used to describe independent relationships between: 1) Sociodemographics 2) Sources of firearm information and the behavioral outcome of asking about firearm safety. We performed multivariable logistic regressions and predictive marginal methods to estimate the relationship between the number of information sources and asking behaviors. Analyses were weighted and account for the complex survey design. Approved by the University of Michigan IRB.

Results
Among this nationally representative sample of caregivers, 29.6% have asked other parents about the presence of household firearms. Each distinct source of firearm safety information received increased the likelihood of asking by 40% (Figure 1). Sources of firearm safety information most highly associated with increased asking behavior were other parents/guardians(OR 3.3; 95% CI 2.2, 5.0) and the child's school or childcare provider (OR 3.0; 95% CI 1.6, 5.7) (Table 1); all sources of firearm safety information were associated with increased asking behavior.

Conclusion(s)
Enhancing household firearm safety behaviors is important to pediatric firearm injury prevention. Unlike previous studies exploring the credibility of different messenger types (i.e., veterans, providers), our findings underscore the value of safety messaging from multiple distinct sources. This has important implications to increase asking about firearms at other homes, and may be useful for other forms of firearm safety education.

Tables and Images
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DEI IN STEM

We still have a representation problem for women in physics – and Canada is no exception

University of British Columbia

Fewer than one in 10 senior authors in a prestigious physics journal are women, according to a new study.

Of 15 countries, Canada has the worst record. The 33 Canadian-led papers in Nature Physics in the last 10 years had zero senior authors who were women, according to a new study published by the journal. Author Dr. Alannah Hallas, associate professor in the UBC Stewart Blusson Quantum Matter Institute and the department of physics and astrophysics, discusses the results and how they highlight the need for further support for young scientists in the field.

What did you find?

I was inspired to investigate this topic after speaking to a top scientific journal editor in 2019 who said while they didn’t collect data about representation of women authors in their journal, they were pretty sure it wasn’t a problem. I figured I’d check.

I looked at 1,804 papers published in Nature Physics from 2015 to 2024 where a senior author could be identified and assigned a gender based on the pronouns they used in their online profiles. I found that only eight per cent had a woman senior author. I was even more discouraged to find there wasn’t really any change with time—the situation is not getting better.

Canada had no women senior authors in the journal in the last decade. The U.S. had the highest number at 65, about 10 per cent of total U.S. senior authors in the journal. As of 2022, 18 per cent of physics faculty positions at U.S. universities were held by women. Canada doesn’t have comparable data, but in 2020, a self-reported census of the physics community found 29 per cent of professionals, including research staff and faculty, were women. So there’s a big gap between women physicists doing great work and women senior authors.

Why does this matter?

As I say in the paper, senior authorship is incredibly important for young researchers’ career progression. It’s a key determinant for who gets funding, awards and talk invitations. It tells your colleagues and the world, ‘This was my idea, I figured out how to solve this problem.’

The low number of senior women authors is a clear sign that there’s bias in the way we’re training young scientists. As a community, we need to tackle not just explicit bias, but the more insidious implicit bias. This can include how our community discusses young scholars’ work or suggestions of where to submit it: We all share preliminary findings at conferences or in the hallway at work, and negative or muted responses can feed into your perception of your work’s importance, so you don’t aim as high.

What can we do?

Firstly, the journal acknowledged the concerns highlighted and noted they started tracking the demographics of corresponding authors in 2023. In the paper, I highlight the need for more journals to audit their processes in order to understand why this low representation is occurring. Editorial teams could also offer networking events for young women scientists to establish relationships.

I was surprised to find Canada had no senior women authors. There is a mitigating factor in that we’re not a leading country in terms of the number of papers published overall—33 compared with 630 from the U.S. for instance—but any way you cut it, zero is a statistical outlier. Are there other factors that are making it more difficult for women physicists to thrive in Canada, such as excessive teaching or service burdens? It’s a tough nut to crack. I think some introspection is called for.

There’s no silver bullet for this. We need journals to play their part but we also need mentors, supervisors and our community at large to be conscious of the underrepresentation of women authors and to ensure these future research leaders are trained to believe in their work, and aim high.

Journal

Nature Physics

DOI

10.1038/s41567-025-02857-1

New Jersey wildfire could become state’s largest in nearly 20 years

Reuters

April 24, 2025

A view shows a burning tree during a wildfire outbreak, near Forked River, in the Ocean County region of New Jersey, US on April 23 —REUTERS

A fast-growing wildfire was burning in New Jersey’s Pinelands near its Atlantic Ocean beach towns on Wednesday and threatened to become the largest in the state in nearly 20 years, officials said on Wednesday.

The Jones Road Wildfire had spread to 13,250 acres (54 sq km) on Wednesday night and was 50 per cent contained, the New Jersey Forest Fire Service said in a statement.

It was no longer threatening populated areas but a “soaking rainfall” is needed to stop the fire, officials said. The cause of the fire was under investigation.

The blaze could become the largest in New Jersey in about 20 years, said Shawn LaTourette, the state’s commissioner of environmental protection, at a press conference. A fire in May 2007 in the same area consumed 17,000 acres.

Embers from the fire sparked several small blazes near a decommissioned Oyster Creek nuclear power plant in Waretown, according to state officials. The plant, owned by Holtec International, shut down in 2018.

Lieutenant Governor Tahesha Way declared a state of emergency beginning at 7am (4pm PKT) on Wednesday. She was filling in for Governor Phil Murphy, who was on an overseas trip.

“At this time, we have no loss of life and no homes have been harmed,” Way said on X on Wednesday morning.

So far in 2025, New Jersey has experienced nearly twice as many wildfires as in the same period last year, with 662 wildfires burning over 16,500 acres. That compares with about 310 wildfires burning 315 acres in the first four months of 2024, Bill Donnelly, the chief of the forest fire service, said at the briefing.

On average, 1,500 wildfires damage or destroy 7,000 acres of the state’s forests each year, the New Jersey Forest Fire Service said on its website.

The blaze started on Tuesday in the Greenwood Forest Wildlife Management Area near Lacey, Ocean and Barnegat townships in Ocean County, about halfway between Asbury Park and Atlantic City. The area is about 24km inland from the Atlantic Ocean shoreline.

About 1,300 homes were endangered, and between 3,000 and 5,000 people were under mandatory or voluntary evacuation orders, which were lifted on Wednesday morning. In addition, a 27km stretch of the Garden State Parkway, a major north-south highway, was closed on Tuesday but reopened on Wednesday morning

Hundreds of firefighters have been working on the blaze for almost 24 hours straight, Donnelly said.

To fully stop the fire, crews need a “soaking rainfall” which might come this weekend, said John Cecil with the state’s environmental protection department.

A wildfire burns in the Pinelands Forest northwest of Wells Mills Park in Ocean Township, New Jersey, US on April 22. — Reuters

Vehicles drive as smoke rises during a wildfire outbreak in Bayville, in the Ocean County region of New Jersey, US on April 23. — REUTERS

A firefighter works during a wildfire outbreak, in Forked River, in the Ocean County region of New Jersey, US on April 23. — REUTERS

Bilateral, brokered and broken: Overview of agreements signed between India and Pakistan

Dawn.com

Published April 24, 2025

Pakistan and India’s relations on most fronts, from diplomatic ties to cultural projects, have yo-yoed from on and off to on (then off) again since Partition. Bilateral agreements have been no exception.

Following a deadly attack in occupied Kashmir’s Pahalgam on April 22, New Delhi, while pointing the finger at Pakistan sans proof, suspended the India-Pakistan Indus Water Treaty with immediate effect along with other measures.

In retaliation, in its top security body meeting today, Pakistan decided that it would exercise the right to hold all bilateral agreements with India, including but not limited to the Simla Agreement, in abeyance. It also announced the closure of the Wagah border and suspension of all trade with New Delhi, among other measures.

The full text of the statement can be read here.

Here, Dawn.com overviews the major treaties and agreements reached between India and Pakistan since 1947 and their status.

The Nehru-Liaquat Agreement

The agreement was reached between then-Indian prime minister Jawaharlal Nehru and Pakistan’s Liaquat Ali Khan during a meeting in New Delhi in April 1950. It declared that the neighbours and their governments would protect the interests of minorities in their respective countries.

Both governments would also be accountable to each other on the issue of the protection of minority rights, the agreement stated. The pact’s provisions also included freedom of movement, non-discrimination in employment and the formation of a minorities commission to oversee its implementation.

The pact was signed in the aftermath of the Partition when communal violence was widespread in both countries.

Indus Water Treaty

Signed on September 19, 1960, the treaty was brokered by the World Bank. It fixed and delimited the rights and obligations of the neighbouring countries regarding the use of the waters of the Indus River. It was signed by Nehru and former president Ayub Khan after six years of talks.

The treaty gave the water of the western rivers — Indus, Jhelum and Chenab — to Pakistan and those of the eastern rivers — Ravi, Beas and Sutlej — to India. It also provided for the funding and construction of dams, link canals, barrages and tube wells, i.e. the Tarbela and Mangla dams. The treaty further required the creation of a Permanent Indus Commission, led by a commissioner from each country.

Numerous disputes were peacefully settled over the years through the Permanent Indus Commission. The treaty was in effect for nearly 65 years before it was suspended last night.

As highlighted by analysts, this could have far-reaching implications for Pakistan.

Simla Agreement

The agreement was signed between Pakistan and India in the aftermath of the 1970 war; the signatories being Zulfikar Ali Bhutto and Indira Gandhi. The agreement, inter alia, stipulated that neither party would take any action unilaterally, that the disputes between the two countries would be resolved bilaterally, and that the ceasefire line would become the Line of Control (LoC).

In connection with Kashmir, it stated that “the basic issues and causes of conflict which have bedevilled the relations between the two countries for the last 25 years shall be resolved by peaceful means”. It also bound both countries to discuss the modalities and arrangements for lasting peace and normalisation.

However, Pakistan argues that India violated the Simla Accord in 2019 when it unilaterally revoked Article 370, altering the status of India-occupied Jammu and Kashmir. This further enabled outsiders to obtain domicile and purchase property in Kashmir to change the Muslim-majority demography of the valley, again termed as a violation of the agreement.

“The Modi government has now gone a step further. It rejects the very idea of talks. If driven to the table, it will not discuss the part of Kashmir on its side of the line of control. This explains the cancellation of the foreign secretaries’ talks in 2014 on petty grounds. By wrecking Kashmir and thumbing its nose at the UN, it seeks to declare ‘closure’ of the dispute,” wrote Indian lawyer A.G. Noorani in a Dawn op-ed in 2019.

Protocol on visits to religious shrines

The protocol, a bilateral agreement, was signed in 1974. It is aimed at facilitating the visits of religious pilgrims from India and Pakistan to the shrines located in the respective countries. As of 2018, the agreement covers 15 such locations in Pakistan and five in India.

Shadani Darbar in Sindh’s Hyat Pitafi, Katasraj Dham in Chakwal, Gurudwaras of Nankana Sahib, and Gurudwara Panja Sahib are among the sites on this side of the fence. In India, Ajmer Sharif Dargah, Nizamuddin Dargah, and the tomb of Amir Khusro are the most-visited shrines.

Under the protocol, up to 3,000 Sikh pilgrims are permitted to visit Pakistan for any religious festival. However, the government issued a total of 6,751 visas this year, a record number. Earlier this year, India issued visas to only 100 Pakistani pilgrims for the annual Urs of Hazrat Khwaja Moinuddin Chishti in Ajmer Sharif, significantly below the allotted quota of 500.

Agreement on prohibition of attacks on nuclear installations and facilities

The agreement was signed between Pakistan and India on December 31, 1988. It, inter alia, provided that both countries should inform each other of their nuclear installations and facilities within their definitions, on January 1 of each calendar year.

The treaty also stated that both countries should refrain from undertaking, encouraging or participating in, directly or indirectly, an action aimed at causing the destruction of or damage to any nuclear installation or facility in the other country.

According to the Ministry of Foreign Affairs, the agreements went into effect on January 27, 1991, and the neighbours have been exchanging lists every year since 1992. As stipulated in the agreement, this year too India and Pakistan exchanged lists of nuclear facilities as well as civilian prisoners, including fishermen, on Jan 1 this year.

Agreement on prevention of airspace violations

The agreement was signed between Pakistan and India on April 6, 1991, in New Delhi. It aimed to reduce the risk of accidental or unintentional airspace violations between the neighbouring countries and established rules for military aircraft to avoid flying within 10 kilometres of each other’s airspace, including the Air Defence Identification Zone — a defined area of airspace where a country requires aircraft to identify themselves for national security purposes.

It also stated that no aircraft from either country was allowed to enter the other’s airspace over territorial waters without prior permission.

This agreement has been largely respected notwithstanding occasional violations. In response to India’s aggressive measures following the Pahalgam attack, Pakistan today announced that it was closing its airspace with immediate effect for all Indian owned or Indian operated airlines.

The Lahore Declaration

The declaration was signed by former Indian prime minister Vajpayee and his counterpart Nawaz Sharif during the former’s visit to Pakistan in February 1999.

In the agreement, India and Pakistan recognised that “an environment of peace and security is in the supreme national interest of both sides and that the resolution of all outstanding issues, including Jammu and Kashmir, is essential for this purpose”. They also agreed to “intensify their efforts to resolve all issues, including the issue of Jammu and Kashmir” through an accelerated process of their “composite and integrated dialogue”.

The two sides anticipated the complexity of the new responsibility that they were carrying after becoming “declared nuclear-weapon states” and decided to “engage in regular bilateral consultations on their respective security concepts and nuclear doctrines with a view to developing measures for confidence building in the nuclear and conventional fields aimed at avoidance of conflict”.

They also agreed to provide each other with advance information in respect of ballistic missile flight tests and undertook to conclude an agreement in this regard.

The process was disrupted by the Kargil crisis and resumed in 2004 when the two countries formed expert groups to discuss conventional and nuclear confidence-building measures. However, as highlighted by former foreign secretary Aizaz Ahmed Chaudhry in an op-ed for Dawn, neither Pakistan nor India created a mechanism to review the implementation of the agreement.

Agreement on pre-notification of flight testing of ballistic missiles

The pact was signed between India and Pakistan in 2005. It stated that both countries should provide the other an advance notification — not less than a time period of three days — of the flight test that they intended to undertake, of any land or sea-launched, surface-to-surface ballistic missile.

“Each party shall ensure that the test launch site(s) do not fall within 40kms, and the planned impact area does not fall within 75kms, of the International Boundary or the Line of Control on the side of the party planning to flight test the ballistic missile,” it stated.

The agreement remains operational. However, last year, Pakistan accused India of not fully complying with the accord when India conducted its first successful test flight of a domestically developed missile capable of carrying multiple warheads.
Agreement on reducing risk from accidents relating to nuclear weapons

The agreement on nuclear accidents came into effect on February 21, 2007, for an initial period of five years.

Under the pact, both countries committed to improving the security and safety of their nuclear arsenal; informing each other of any nuclear accident, and taking steps to minimise the radiological consequences of such an accident. Furthermore, each of the two countries, in the event of a nuclear accident, is bound to take steps to prevent its actions from being misinterpreted by the other.

In 2012 and 2017, the agreement was extended by five years each.

LOC ceasefire agreement

In November 2003, Pakistan and India agreed to ceasefire along the Line of Control and the Working Boundary. The LOC is a de facto border that divides the disputed Kashmir Valley between the two countries, and the Working Boundary, which separates the two neighbours.

The agreement held for a few years, but regular violations were reported since 2008. A sharp spike in the truce breaches were, meanwhile, witnessed after 2014 when Prime Minister Narendra Modi came to power in India.

In 2021, both countries recommitted themselves to the agreement. According to a statement issued by Pakistan, the two sides had concurred on reviving the existing mechanisms — hotline contact and flag meetings — for dealing with “any unforeseen situation or misunderstanding”.

What India’s Indus Waters Treaty suspension means for Pakistan

The Indus and its tributaries that have sustained civilisations for thousands of years, now test the capacity of two modern nuclear-armed nations to cooperate.

Hassaan F Khan

April 24, 2025

DAWN/PRISM

India has just announced that it will no longer abide by the Indus Waters Treaty of 1960, placing the agreement in “abeyance” until Pakistan, it claims, credibly and irrevocably renounces cross-border terrorism. This is a potentially historic moment.

For over 60 years, through wars, near-conflict, and complete diplomatic breakdowns, the treaty endured. Water, unlike so much else in the India-Pakistan relationship, had remained predictable. That predictability is now in question more than it has ever been.

The decision potentially marks a turning point in how the two countries manage the most essential shared resource between them. There will be many other discussions in the days ahead that dwell on geopolitics. The goal for this article is simpler: to understand the implications for Pakistan’s rivers, crops, people, and policymakers.

What matters most in the days and months ahead is not the threat of a sudden cutoff, but the erosion of reliability of a water system that millions depend on every single day.
How the treaty works

Before we get into what India’s suspension of the Indus Waters Treaty might mean, it’s worth recalling what the treaty actually did. Signed in 1960 after years of negotiation, with the World Bank as broker, the Indus Waters Treaty has been one of the most durable transboundary water agreements in the world.

It divided the six rivers of the Indus Basin between the two countries. India received the three eastern rivers (the Ravi, Beas, and Sutlej). Pakistan received the three western rivers (the Indus, Jhelum, and Chenab) which account for the majority (almost 80 per cent) of the shared basin’s water.

As part of the agreement, India retains the right to use the western rivers for non-consumptive purposes like hydropower, and for limited irrigation, but is not allowed to store or divert their flows in ways that harm downstream access. These constraints are deliberately specific and enforceable and include engineering design features and notification procedures. For Pakistan, this structure provides more than water. It provides the predictability needed to build an entire irrigation and water management system around.

The treaty also provides a standing mechanism for cooperation and conflict resolution. A Permanent Indus Commission exists, with one commissioner from each country, tasked with exchanging data, reviewing new projects, and meeting regularly.

Disagreements are resolved using a tiered process: technical questions go first to the commission, unresolved differences may be referred to a neutral expert, and legal disputes may be sent to an international Court of Arbitration, with the World Bank playing a role in both forums. This process has been used before to resolve disagreements over India’s Baglihar and Kishanganga dams — it is designed to prevent unilateral action. The treaty has no expiry date, and it includes no provision for suspension. Article XII makes clear that it can only be modified by mutual agreement. That has never happened.

The hydrologic reality

One common question that arises in moments like this is whether India can simply “stop the flow” of water into Pakistan. In the immediate term, the short answer is no. Certainly not at the scale that would make a meaningful dent in flows during the high flow season.

The Indus, Jhelum, and Chenab are enormous rivers. Between May and September, as snow melts, these rivers carry tens of billions of cubic meters of water. India has some upstream infrastructure on these rivers, including the Baglihar and Kishanganga dams, but none of it is designed to hold back these kinds of volumes. These are run-of-the-river hydropower projects with very limited live storage. Even if India were to coordinate releases across all its existing dams, all it may be able to do is slightly shift the timing of flows.

The overall volumes in the western rivers during this high-flow period are far too large to meaningfully disrupt without flooding its own upstream regions. India already utilises most of the flow from the eastern rivers allocated to it under the treaty, so any new actions on those rivers would have a more limited downstream impact.

A more pressing concern is what happens in the dry season when the flows across the basin are lower, storage matters more, and timing becomes more critical. That is where the absence of treaty constraints could start to be felt more acutely.

Over the medium to longer term, the picture becomes more complicated. If India chooses to act outside the treaty framework, it opens the door to developing new infrastructure that would give it greater control over the timing and volume of flows into Pakistan. But even then, the path is far from straightforward. Any large-scale dam or diversion project would take years to build. The sites available in Indian-occupied Kashmir for significant water storage are limited and geologically challenging. The financial cost would be enormous. And the political risk would be even greater.

Pakistan has long said that any attempt by India to construct major new storage on the western rivers would be viewed as an act of war. In today’s age of satellites, these structures would not be invisible. They would be contested politically and possibly militarily.

There are also hydrological constraints. Holding back high flows on rivers like the Chenab or Jhelum risks flooding upstream regions in India itself. And the idea of diverting water out of the Indus Basin entirely, into other parts of India would require enormous infrastructure and energy costs that would be hard to justify, even in peacetime.

Beyond the basin, there are reputational and strategic risks. India is itself a downstream riparian on the Brahmaputra and other rivers that originate in China. This (often overlooked) reality has historically shaped India’s approach to respecting downstream rights. By suspending the treaty and acting unilaterally, it sets a precedent that could one day be used against it. This is not a cost-free move and could complicate its efforts to frame itself as a reliable partner in other international negotiations.
Possible Implications for Pakistan

While the physical and political limits on disruptions by India are real, the erosion of treaty protections still matters. This is not because water will stop tomorrow, but because the system it supports was never built for uncertainty. The flows of the Indus, Jhelum, and Chenab are the backbone of our agriculture, our cities, our energy system. At this moment, we simply do not have a substitute for these waters.

For Pakistan, the impact of India’s disruption (if manifested) could be far-reaching. Pakistan’s irrigation system is one of the largest in the world, and it depends almost entirely on the predictable timing of flows from the western rivers. Farmers plan their sowing around those flows. Canal schedules are designed based on assumptions that have held for decades. If that rhythm is even slightly disrupted, the water system will begin to fray.

The most immediate risk is to predictability. Even if the total volume of water coming into Pakistan does not change immediately, small changes in when that water arrives can cause real problems. A late-season delay during the wheat planting cycle, or an unexpected dip in flow during the dry winter months, can mean missed sowing windows, lower yields, and higher costs. The Indus Delta is already shrinking due to reduced freshwater outflows. Further uncertainty in upstream flows could accelerate that degradation, with consequences for coastal livelihoods and fisheries.

Any shortfall or shift in river timing will force the state to make hard choices about water allocation. This risks intensifying inter-provincial tensions, especially between Punjab and Sindh, where water-sharing debates are already politically charged.

Then there’s energy. A third of Pakistan’s electricity comes from hydropower, generated by water flowing through Tarbela, Mangla, and other reservoirs. If upstream flows are reduced or poorly timed, it could cut into generation capacity. None of this is speculative. Pakistan is already a water-scarce country, living close to the edge. A system that has long been run on thin margins now faces a new layer of uncertainty.

Historical context

This week’s announcement did not come out of nowhere. While the Indus Waters Treaty has long been praised for its durability, the last decade tells a story of mounting strain.

In 2013, a Court of Arbitration ruled in Pakistan’s favour by requiring India to release minimum environmental flows downstream of the Kishanganga project (upstream on Jhelum), and reinforced limits on reservoir drawdown. This successful resolution was a continuation of the treaty’s ability to manage complex engineering disagreements.

But that pattern began to shift after the 2016 Uri attack. India suspended routine cooperation, began fast-tracking dam projects it had long delayed, and started linking water to broader security narratives. Even then, India said it would work “within the pact.”

That too began to change in 2023, when India formally invoked Article XII(3) (the provision that allows for treaty modification only by mutual consent) and requested renegotiation, citing climate change, national development needs, and Pakistani obstruction. Pakistan refused to renegotiate.

In the months that followed, both countries doubled down on competing legal strategies. India pursued a neutral expert to review technical dam design questions; Pakistan pushed ahead with a Court of Arbitration. By early 2025, both mechanisms were active in parallel; this is something the treaty never envisioned.

This most recent announcement that India would “suspend” its obligations under the treaty marks the culmination of a long, escalating trajectory. For the first time since 1960, one country has effectively stepped outside the treaty’s procedural and cooperative framework. Whether this is a negotiating tactic or a permanent break remains to be seen. What comes next will test not just bilateral diplomacy, but the resilience of Pakistan’s water system in a world where guarantees no longer hold.

The Indus Waters Treaty is not perfect. But it does something few agreements between adversaries manage to do. It keeps the rivers flowing and gives both countries a reason to keep talking, even when everything else has broken down. That framework is now under strain. Whether the treaty is reinstated in full, renegotiated, or left to fade in practice, what follows will be harder.

Without clear rules, even small projects can provoke mistrust. Every monsoon, every reservoir, every dry spell becomes a potential source of tension. At a time when climate change is already intensifying droughts and floods, and when both countries face rising domestic water stress, the last thing the region needs is another layer of uncertainty. Yet that is where we now find ourselves.

The western rivers are not just shared rivers. They are Pakistan’s primary source of water. In the long run, there may be reforms or alternatives. But in the here and now, there is no substitute. These rivers sustain lives, livelihoods, and landscapes across the country. Pakistan can simply not afford to let it become collateral in a political fight. Thus, the flows must continue. Not out of goodwill, but because the consequences of stopping them are too great for either country to bear.

The Indus and its tributaries that have sustained civilisations for thousands of years, now test the capacity of two modern nuclear-armed nations to cooperate. The coming months and years will reveal whether wiser heads prevail, or if the subcontinent will enter a new, uncertain era of unilateralism on its most precious resource: water.

The author is an assistant professor of Urban & Environmental Policy (UEP) and Environmental Studies (ENVS) at Tufts University. He was previously an assistant professor at Habib University.

‘India’s worn-out narrative’: Full text of statement on Pakistan NSC’s decisions

Dawn.com

April 24, 2025

Full text of PMO Press Release following National Security Committee (NSC) — the top security body — meeting on Thursday following India’s aggressive measures against Pakistan in the wake of an attack in India-held Kashmir’s Pahalgam.

Prime Minister Muhammad Shehbaz Sharif chaired a meeting of the National Security Committee (NSC), today. The participants discussed the national security environment and the regional situation, particularly in the wake of Pahalgam attack in the Anantnag District of Indian Illegally Occupied Jammu and Kashmir (IIOJK) on 22 April 2025.

Expressing concern over the loss of tourists’ lives, the Committee reviewed the Indian measures announced on 23 April 2025 and termed them unilateral, unjust, politically motivated, extremely irresponsible and devoid of legal merit.

The National Security Committee made the following observations: Kashmir remains an unresolved dispute between Pakistan and India as recognized through multiple UN resolutions. Pakistan continues to support the right of self-determination of the Kashmiri people. The continued Indian state oppression, abrogation of statehood, political and demographic gerrymandering, has persistently led to an organic backlash from the people of IIOJK, which perpetuates cycles of violence. India’s systemic persecution of minorities, particularly Muslims, has become more pervasive. Attempts at forced passage of Waqf Bill is the latest effort to marginalize Muslims across India.

India must resist the temptation to exploit such tragic incidents to its advantage and take full responsibility for its failure to provide security to the people

Pakistan unequivocally condemns terrorism in all its forms and manifestations. As the world’s front-line state against terrorism, Pakistan has suffered immense human and economic losses. Indian attempts to inject volatility in the environment along Pakistan’s Eastern borders is aimed at distracting Pakistan’s counter-terrorism efforts. In the absence of any credible investigation and verifiable evidence, attempts to link the Pahalgam attack with Pakistan are frivolous, devoid of rationality and defeat logic

India’s worn-out narrative of victimhood cannot obfuscate its own culpability in fomenting terrorism on Pakistan’s soil, nor can it distract attention from its systematic and state sponsored oppression and human rights violations in IIOJK.

Contrary to Indian claims, Pakistan has in its custody incontrovertible proof of Indian-sponsored terrorism in Pakistan, including the confession of a serving Indian Navy officer, Commander Kulbhushan Jadhav, who remains a living testament to India’s state-sponsored terrorist activities.

The National Security Committee deplored the implicit threat contained in the Indian statement of 23 April 2025. The international community ought to remain mindful of India’s state sponsored extraterritorial assassinations or attempts on foreign soil. These heinous acts were carried out in blatant violation of international law as recently exposed by Pakistan along-with various other states with undeniable evidence. Pakistan will pursue all those responsible, planners and perpetrators alike and ensure that justice is served. Any threat to Pakistan’s sovereignty and to the security of its people will be met with firm reciprocal measures in all domains.

India should refrain from its reflexive blame game and cynical staged managed exploitation of incidents like Pahalgam to further its narrow political agenda. Such tactics serve only to inflame tensions and obstruct the path to peace and stability in the region.

Extremely irresponsible warmongering Indian state controlled media, fueling volatility in the regional calculus is reprehensive, which requires serious introspection.

The Committee decided the following:

Pakistan vehemently rejects the Indian announcement to hold the Indus Waters Treaty in abeyance. The Treaty is a binding international agreement brokered by the World Bank and contains no provision for unilateral suspension. Water is a Vital National Interest of Pakistan, a lifeline for its 240 million people and its availability will be safeguarded at all costs. Any attempt to stop or divert the flow of water belonging to Pakistan as per the Indus Waters Treaty, and the usurpation of the rights of lower riparian will be considered as an Act of War and responded with full force across the complete spectrum of National Power.

Noting the reckless and irresponsible behaviour of India, which disregards international conventions, UN Security Council Resolutions and international obligations at will, Pakistan shall exercise the right to hold all bilateral agreements with India including but not limited to Simla Agreement in abeyance, till India desists from its manifested behaviour of fomenting terrorism inside Pakistan; trans-national killings; and non-adherence to international law and UN Resolutions on Kashmir.

Pakistan shall close down the Wagah Border Post, with immediate effect. All cross-border transit from India through this route shall be suspended, without exception. Those who have crossed with valid endorsements may return through that route immediately but not later than 30 April 2025.

Pakistan suspends all visas under SAARC Visa Exemption Scheme (SVES) issued to Indian nationals and deems them cancelled with immediate effect, with the exception of Sikh religious pilgrims. Indian nationals currently in Pakistan under SVES are instructed to exit within 48 hours, less Sikh pilgrims.

Pakistan declares the Indian Defence, Naval and Air Advisors in Islamabad persona non grata. They are directed to leave Pakistan immediately but not later than 30 April 2025. These posts in the Indian High Commission are deemed annulled. Support staff of these Advisors are also directed to return to India.

The strength of Indian High Commission in Islamabad will be reduced to 30 diplomats and staff members, with effect from 30 April 2025.

Pakistan’s airspace will be closed with immediate effect for all Indian owned or Indian operated airlines.

All trade with India including to and from any third country through Pakistan is suspended forthwith.

The National Security Committee underscored that Pakistan and its Armed Forces remain fully capable and prepared to defend its sovereignty and territorial integrity against any misadventure, as clearly demonstrated by its measured yet resolute response to India’s reckless incursion in February 2019.

In conclusion, India’s belligerent measures have vindicated the Two- Nation Theory as well as the apprehensions of Quaid- E- Azam Muhammad Ali Jinnah, as encapsulated in the 1940 Pakistan Resolution, which continues to echo the sentiments of the complete Pakistani Nation.

The Pakistani Nation remains committed to peace, but will never allow anyone to transgress its sovereignty, security, dignity and their inalienable rights.

LA REVUE GAUCHE - Left Comment

Thursday, April 24, 2025

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