In Karachi, with a population of around 20 million people, ambulance drivers are on the front lines of this megacity’s shifting conflicts. Samira Shackle joins one of these drivers, Muhammad Safdar, on his relentless round of call-outs. As a first-responder for more than 15 years, Safdar has witnessed Karachi wracked by gang wars, political violence and terrorism. At the height of the unrest, the number of fatalities was often overwhelming. With no state ambulance service in Pakistan, the Edhi Foundation, set up by the late Abdul Sattar Edhi in 1954, stepped in to offer services to the poor. Safdar drives one of its fleet of 400 ambulances: rudimentary converted vans with basic emergency provision. His missions bring him to many of Karachi’s most deprived and troubled areas, revealing the complex social and economic problems at the heart of the country. As Samira and Safdar traverse this enormous city, their experiences reveal a remarkable story of life and death in contemporary Pakistan.