Pakistani men watch a televised addresses to the nation by Prime Minister Nawaz Sharif in Karachi on April 22, 2016. Pakistani Prime Minister Nawaz Sharif on April 22 announced to request the supreme court to form a comission for investigation into the allegations made in the Panama papers that linked his family to a series of offshore companies. / AFP / RIZWAN TABASSUM (Photo credit should read RIZWAN TABASSUM/AFP/Getty Images)
Prime Minister Nawaz Sharif during a televised address to the nation in April © AFP

Pakistan’s Prime Minister Nawaz Sharif will undergo open heart surgery in a London hospital on Tuesday, at a time when he faces growing demands for his resignation over the alleged offshore wealth accumulated by three of his four children.

Mr Sharif has been struggling to quell rising public anger against him since last month, when the Panama Papers revealed his children had significant overseas assets, including apartments near London’s Hyde Park. His public explanations that his family had merely profited from the sale of its steel business in Saudi Arabia have failed to convince the public or his political rivals.

Mr Sharif’s heart surgery, only three days before the presentation of Pakistan’s annual budget, risks further undermining the leader, with rivals questioning his arrangements for ruling the country during his surgery and recuperation.

Government officials said Ishaq Dar, finance minister and a close ally of the premier, will oversee governmental affairs in Mr Sharif’s absence. But Mr Dar will have no formal authority to make decisions beyond the powers granted to him as finance minister.

“Pakistan’s constitution has no provisions for an acting prime minister to step in if the prime minister suffers from a medical condition,” said Hasan Askari Rizvi, a commentator on security and political affairs.

Mr Sharif’s surgery has also fuelled anxiety within his own party over the sensitive question of his political successor. For three decades Mr Sharif has built his political base from the populous Punjab province where Shehbaz Sharif, his younger brother, is chief minister. As the two brothers have aged, questions have emerged over younger members of their families remaining as united as the two elders.

“The question of succession comes into play whenever you have power going from one generation to another,” said one western diplomat. “Rivalries can very well emerge between Nawaz Sharif’s children and Shehbaz Sharif’s children.”

The government gave no details of the planned operation but Mr Sharif’s daughter, Maryam, tweeted on Friday that the procedure will fix a “perforation in the heart” left by previous heart surgery in 2011.

A Pakistani diplomat based in London said his understanding was that Mr Sharif could receive a “triple bypass involving three cardiac arteries”.

In an apparent effort to demonstrate he remains in control, Mr Sharif was due to preside over a meeting of his cabinet via Skype from London on Monday to consider and approve the budget, which will be presented to parliament on Friday. In the past, the budget was approved the day before it was announced.

“Because the prime minister will be on a ventilator after Tuesday’s operation and still recovering on Friday, he was advised to have the meeting earlier,” said a senior government official.

Arif Nizami, a Lahore-based newspaper editor, said even after Mr Sharif recovers from the procedure, questions about his political future will linger.

Pakistan’s campaign for the next elections in 2018 “will begin from 2017 onwards”, Mr Nizami said. “You will have to ask how much will Nawaz Sharif be up to the stress of leading his party through a hectic political campaign.”

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