Pakistan, Jan. 29 -- It would not take much to understand the story of Pakistan's export economy if one listened to the grind of steel in Sialkot, where workshops supplying surgical instruments to foreign hospitals argue that the state has made survival harder than competition ever did.

Surgical exports rose from roughly $420m in 2021 to nearly $492m in 2024, then slid back to about $445m in 2025-a reversal industry leaders link less to vanishing demand than to self-inflicted friction at home.

Sialkot's cluster is dominated by small and medium enterprises, often family-run units built on apprenticeship and incremental capital. A once simple, deducted-at-source tax system has been replaced by full accounting and compliance demands that s...