In 1946, in the final months before Partition, Muhammad Ali Jinnah was examined in Bombay by two Parsi doctors: the physician Dr Jal Ratanji Patel and the radiologist Dr Jal Dhaybho-Koo. Reading his X-rays, they concluded that his tuberculosis had reached an advanced stage and that he had only a year or two left. Neither disclosed the finding. Jinnah went on to lead the Muslim League through the negotiations that produced Pakistan in August 1947, became its first Governor-General, and died in September 1948, roughly within the window the two doctors had privately estimated. The episode is recorded in Freedom at Midnight by Larry Collins and Dominique Lapierre, an account of the last years of British rule and the Partition of 1947. Pakistan has now nominated both doctors, posthumously, for the Nishan-e-Imtiaz.

Historians have long argued over what would have changed had Jinnah's illness been public knowledge in 1946. The Muslim League's negotiating position rested heavily on Jinnah personally, and a leadership vacuum at that moment might have altered the pace, and possibly the shape, of the transfer of power. That counterfactual is why a routine act of medical confidentiality is being treated eighty years later as a matter of state, and why the nomination is being read in both countries as a statement about history rather than about medicine.