Two Mumbai-based Parsi doctors, physician Dr Jal Ratanji Patel and radiologist Dr Jal Dhaybho-Koo, have been nominated posthumously for Nishan-e-Imtiaz, Pakistan’s highest civilian honour, for keeping the terminal tuberculosis of Muhammad Ali Jinnah confidential in the years before Partition. The nomination was announced by Pakistan’s Minister for Planning, Development and Special Initiatives Ahsan Iqbal, who chairs the country’s Awards Committee, on the eve of Pakistan’s 79th Independence Day on 14 August 2026. The award will be formally conferred in March 2027 at Aiwan-e-Sadr in Islamabad, nearly 78 years after the secret that historians say helped shape the creation of Pakistan.
What Is Nishan-e-Imtiaz and How Does Pakistan Honour Civilians?
Nishan-e-Imtiaz, which means Order of Excellence in Urdu, is the highest honour within the Order of Imtiaz and is widely regarded as Pakistan’s highest civilian award for a Pakistani or foreign national. The still higher Nishan-e-Pakistan is reserved almost exclusively for foreign heads of state for service to Pakistan’s national interest. Nishan-e-Imtiaz therefore functions as the apex award that ordinary citizens, professionals, scientists, artists and senior military officers can receive.
The civil awards system was created on 19 March 1957 after Pakistan became a parliamentary republic under the Constitution of 1956. It is now governed by Article 259(2) of the Constitution of Pakistan, 1973 read with the Decorations Act, 1975. The President of Pakistan confers the awards on the recommendation of the Prime Minister after scrutiny by the Cabinet Division’s Awards Committee.
In Urdu, the four levels translate as Nishan (Order), Hilal (Crescent), Sitara (Star) and Tamgha (Medal). Within the Order of Imtiaz they descend in prestige as:
| Award | Urdu Meaning | Rank in Order of Imtiaz |
|---|---|---|
| Nishan-e-Imtiaz | Order of Excellence | 1st, highest civilian class |
| Hilal-e-Imtiaz | Crescent of Excellence | 2nd |
| Sitara-e-Imtiaz | Star of Excellence | 3rd |
| Tamgha-e-Imtiaz | Medal of Excellence | 4th |
The Nishan-e-Imtiaz is given for distinguished merit or outstanding service that brings world recognition to Pakistan or renders exceptional service to the country in fields such as medicine, science, literature, arts, sports, engineering and public service. For the military it is the highest award that can be given to officers of the rank of General, Air Chief Marshal and Admiral for distinguished service, and it has a separate military insignia worn on uniform while civilians receive a sash or necklet. The award is highly restricted, can be conferred posthumously, and can be given to non-citizens. It is roughly comparable to the Presidential Medal of Freedom in the United States and the Order of the British Empire in the United Kingdom.
Each year the government announces the civil awards on 14 August, Independence Day, and holds the formal investiture on 23 March, Pakistan Day. Other well-known recipients include Nobel Prize winning physicist Abdus Salam (1979) and philanthropist Abdul Sattar Edhi (1989). Indian recipients of Pakistan’s highest honours have been rare. Former Prime Minister Morarji Desai received the Nishan-e-Pakistan in 1990, and actor Dilip Kumar received the Nishan-e-Imtiaz in 1998, making the nomination of the two Mumbai doctors an unusual cross-border recognition.
Who Are the Two Mumbai Doctors Being Honoured?
Both honourees belonged to the Parsi community of Bombay, now Mumbai. Parsis are followers of Zoroastrianism, a minority that migrated from Persia to western India between the 8th and 10th centuries and has played a prominent role in medicine, business and philanthropy in Mumbai.
Dr Jal Ratanji Patel was a physician, surgeon-commander, professor of pharmacology and therapeutics, and later dean of Grant Medical College and Sir J.J. Group of Hospitals in Bombay. Grant Medical College, founded in 1845, is one of India’s oldest medical institutions. Patel served as chief medical officer at Tata Sons for several years and later became Honorary Physician to the President of India. The Government of India honoured him with the Padma Bhushan in 1962, the country’s third-highest civilian award, listed as Physician, Bombay. He was a close friend of Jinnah and treated several prominent leaders. He died in 1976. A Dr Jal Patel Memorial Oration is held in his memory at Grant Medical College.
Dr Jal Dhaybho-Koo, also rendered as Jal Daeboo or Deboo, was a radiologist based in Bombay. Far less is publicly documented about him, but reports note that he was the specialist who examined Jinnah’s chest X-rays alongside Patel and interpreted the advanced pulmonary cavities. He passed away before authors Larry Collins and Dominique Lapierre began research for their book Freedom at Midnight in the early 1970s, so his account survives only through Patel’s records and family recollections.
Pakistan’s Planning Minister Ahsan Iqbal described them as two remarkable doctors who faithfully guarded the secret of the Quaid-e-Azam, the title meaning Great Leader conferred on Jinnah in Pakistan. He wrote that by maintaining absolute professional confidentiality at a critical moment, they performed a quiet but extraordinary service, and their fidelity to their oath inadvertently became a significant contribution to the circumstances that made the creation of Pakistan possible.
What Was Jinnah’s Secret Illness and Why Was It Kept Hidden?
Muhammad Ali Jinnah, born on 25 December 1876 in Wazir Mansion, Karachi, was the founder of the All-India Muslim League’s Pakistan demand and became Pakistan’s first Governor-General on 14 August 1947. He died of pulmonary tuberculosis on 11 September 1948 in Karachi, just 13 months after independence, and is buried at the Mazar-e-Quaid in Karachi.
His tuberculosis had a long history. Historian Akbar Ahmed in his book Jinnah, Pakistan and Islamic Identity: The Search for Saladin, notes that Jinnah had suffered from lung weakness since the 1930s and had been treated for pleurisy in Berlin. Since 1938 he complained of tremendous strain on his nerves and physical strength and fell ill regularly, but the seriousness was kept within a tiny circle that included his sister Fatima Jinnah.
In the 1940s there was no effective antibiotic treatment. Streptomycin, the first antibiotic against tuberculosis, only became available around 1946 and was not widely accessible. Tuberculosis, caused by Mycobacterium tuberculosis, was highly lethal, spread through air-borne droplets and often produced cavities in the lungs visible on X-ray.
In September 1944, after the Gandhi-Jinnah talks in Bombay, Patel treated Jinnah for unresolved pneumonia at the base of the lungs, with chest pain, cough, low blood pressure and a history of dysentery. He advised rest and treatment with calcium injections, tonics and short-wave diathermy, after which Jinnah recuperated in the hills and gained weight.
The decisive diagnosis came in May-June 1946. After the Second Simla Conference at the Viceregal Lodge in Simla, where Jinnah ran a fever for ten days while meeting Viceroy Lord Wavell, Mahatma Gandhi, Jawaharlal Nehru, Sardar Patel and Maulana Azad, his health deteriorated sharply on the train back to Bombay. Fatima Jinnah sent word for Dr Patel to meet them outside Bombay. Patel advised Jinnah to avoid the large reception awaiting him at Bombay Central and instead get off at a suburban station for immediate hospital admission. After discharge, Patel examined the X-rays with radiologist Dr Dhaybho-Koo and found extensive damage, cavities and hardening of lung tissue indicating far advanced pulmonary tuberculosis. According to Freedom at Midnight, they concluded he might live only one to two years if he continued heavy smoking of up to 50 cigarettes and Cuban cigars a day, alcohol use and an 18-hour work schedule.
Patel privately informed Jinnah of the prognosis and warned that without lifestyle change he would not survive long. Jinnah asked that the diagnosis remain absolutely confidential and continued intense political activity. Patel stored the X-rays and file labelled simply M A Jinnah in an unmarked envelope in his office safe. British intelligence, Viceroy Lord Wavell and later Lord Mountbatten remained unaware of the terminal prognosis.
Keeping the secret was an act of strict medical confidentiality. Jinnah feared that disclosure would weaken his bargaining position in negotiations for a separate homeland and give opponents reason to delay decisions. Only Fatima Jinnah, a few close aides and the two doctors knew the full extent.
Could Disclosure Have Changed Partition? The Historical Debate
The possible impact of the secret became famous through Freedom at Midnight by Larry Collins and Dominique Lapierre, first published in 1975. The authors interviewed Patel, who shared the X-ray records, and also spoke to Lord Louis Mountbatten, the last Viceroy of British India who oversaw the transfer of power from March to August 1947.
Mountbatten told them with astonishment that had he known Jinnah was dying, he would have handled negotiations differently. He said he would have delayed the grant of independence for several months. In that scenario, he believed, there would have been no Pakistan as conceived, because the Muslim League’s demand depended entirely on Jinnah’s personal authority, and without another leader of similar stature the movement could have fragmented. The book quotes him as saying, if I had known all this at the time, history would have taken a different course. There would have been no Partition and India would have remained united.
Other historians add context. Lord Wavell noted in his diary in January and February 1947 that Jinnah looked a sick man, but British officials had no knowledge of terminal tuberculosis. Jinnah’s daughter Dina Wadia, mother of industrialist Nusli Wadia, told interviewers in 1973 that she learned of her father’s tuberculosis only after his death. Pakistani and Indian scholars still debate whether knowledge of Jinnah’s illness would truly have averted Partition or merely delayed it, given the deep communal mobilisation by 1946-47, the Direct Action Day violence of August 1946 and the Cabinet Mission Plan’s failure.
What is not disputed is that the two doctors’ silence preserved patient confidentiality at a moment when medical ethics and political history intersected directly. The recently released Nikkhil Advani OTT series adaptation of Freedom at Midnight has renewed public interest in this episode.
How Is the Award Decided and What Does This Nomination Signify?
Pakistan’s civil awards are announced by the President of Pakistan on 14 August each year, on the advice of the Prime Minister and the Cabinet Division. Nominations are invited from ministries, provincial governments and individuals, scrutinised by sub-committees for authenticity and recent impact, and finalised by the Awards Committee chaired in this case by Ahsan Iqbal as Minister for Planning, Development and Special Initiatives. Investiture is held on 23 March, Pakistan Day, at Aiwan-e-Sadr.
Conferring the Nishan-e-Imtiaz posthumously on two Indian nationals, and specifically on members of the Parsi community, carries symbolic weight. It acknowledges medical ethics as a form of public service, recognises a little-known human link between Mumbai and Karachi, and highlights how professional confidentiality influenced a geopolitical outcome. It also revives discussion on Partition history, medical ethics and the rare instances of cross-border honours, joining the short list that includes Morarji Desai and Dilip Kumar.
For Pakistan, the honour reinforces the official narrative of Jinnah’s determination despite failing health. For India, it brings renewed attention to the contributions of Parsi doctors and to Grant Medical College’s legacy. The story also underscores how tuberculosis, now curable through the National Tuberculosis Elimination Programme and global DOTS therapy, was once a decisive factor in political history because no effective cure existed in the 1940s.
Key Takeaways
- Dr Jal Ratanji Patel (physician) and Dr Jal Dhaybho-Koo (radiologist), Mumbai Parsi doctors, have been nominated posthumously for Pakistan’s Nishan-e-Imtiaz, the highest class of the Order of Imtiaz.
- The nomination was announced by Ahsan Iqbal, Minister for Planning, Development and Special Initiatives and chairman of the Awards Committee, on the eve of 14 August 2026, Pakistan’s 79th Independence Day, with investiture scheduled for March 2027 at Aiwan-e-Sadr, Islamabad.
- In 1946 the two doctors examined Muhammad Ali Jinnah’s chest X-rays and diagnosed far advanced pulmonary tuberculosis with one to two years to live, but kept it strictly confidential at Jinnah’s request.
- Nishan-e-Imtiaz means Order of Excellence, instituted on 19 March 1957 under Article 259(2) of the Constitution and the Decorations Act, 1975, and ranks above Hilal-e-Imtiaz, Sitara-e-Imtiaz and Tamgha-e-Imtiaz.
- Dr Jal Ratanji Patel was dean of Grant Medical College (founded 1845) Bombay, Honorary Physician to the President of India and Padma Bhushan recipient in 1962.
- Historians cite Freedom at Midnight (1975) by Larry Collins and Dominique Lapierre, where Lord Louis Mountbatten said had he known of Jinnah’s terminal illness he would have delayed independence and Partition might have been averted.
