The first sign that something was wrong in the small southern Pakistani city of Ratto Dero appeared in February.

A handful of concerned parents had taken their children to the doctor, complaining that their children could not get rid of a fever.

In a few weeks, other children came forward suffering from a similar illness.

Disoriented, Dr. Imran Aarbani has sent the children's blood for testing. What came back confirmed his worst fears. The children were infected with HIV – and nobody knows why.

"By April 24, 15 children were positive, although none of their parents was found to carry the virus," the hospital doctor told the BBC.

It was just the tip of the iceberg.

In the past month, more than 607 people – 75% of them children – were diagnosed with the virus after the rumors of an epidemic sent families to run to a special camp set up in the government's hospital city ​​from the health department of the province of Sindh.

Perhaps most surprising, however, is the fact that this is not the first outbreak to hit the region in recent years.

Rumors of a possible outbreak in the province of Sindh, Larkana, of which Ratto Dero is a sub-division, have led thousands of people to take the test in 2016.

On that occasion, 1,521 people tested positive for HIV, according to the data available with the Sindh Aids Control Program (SACP).

The vast majority of those infected were men and, at that time, the cause was related to prostitutes in the area, who were mainly transgender and 32 of whom were found carriers of the AIDS virus.

The discovery of the epidemic led to a crackdown on the traveller's inns in Larkana, where sex workers had been able to exercise their trade relatively freely, despite the ban on prostitution in Pakistan.

But could this epidemic be linked to the recent discovery of health officials?

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The dott. Asad Memon, who directs the operations of the SACP in Larkana, believes in it, though not directly.

"I think the virus (AIDS) has been carried by members of the high-risk group (transgender and sex worker) and therefore negligent practices by local charlatans have caused the infection of other patients," he told the BBC.

For "charlatan" refers to unqualified people who practice medicine, ranging from paramedics who run a private clinic posing as doctors, to medical graduates who have not been able to find work in hospitals and have no exposure to standard medical practices.

In Pakistan, especially in rural areas, people often go to "charlatans" instead of qualified doctors because they are cheaper, easily available and have more time to devote to their patients.

Dr. Fatima Mir, who works for Aga Khan University Hospital and specializes in AIDS among children, is currently doing volunteer work at Ratto Dero. He agrees that negligent medical practices are the most likely link between children and the 2016 epidemic.

"There are three ways a child can be infected," he explained. "It is through a nursing mother who carries the virus, through a blood transfusion, or through an infected surgical instrument or a syringe".

In most cases he managed, the mothers were found to be HIV-negative and few children had blood transfusions. So the only remaining explanation was the practice of using a syringe for several patients at local clinics.

Officials also appear to be in agreement. About 500 unregulated clinics have been ordered closed throughout the province, health authorities reported.

Furthermore, a local specialist child, dr. Muzaffar Ghangro, was arrested on charges of spreading Aids through syringes.

He denied the charge, saying that all the infected people were not his patients.

Meanwhile, Sindh officials – who have one of the highest rates of HIV infection in Pakistan – have started an investigation to identify the causes of the epidemic.

But this will not help those who have already found themselves with a diagnosis that will have an impact on their entire life.

The doctors of the Ratto Dero hospital camp have tested more than 18,418 people since April 25th.

At least 607 of them have been positive so far, three-quarters of them children aged between one month and 15 years.

This means that there are hundreds of parents left to count the costs, both for the health of their children and for their daily existence.

"Adult medicines are usually available (with health authorities) in Larkana, but for the child's medicines we have to go to Karachi, which means we spend several thousand rupees for each trip," a mother, of whom she is three years old her daughter was diagnosed as HIV-positive, she told the BBC.

"My husband is just a laborer, so we can't afford it for long."