Pakistan lost a third paceman on the eve of the first Test against England starting at Lord's on Thursday when Mohammad Asif was ruled out with an elbow injury.
Asif, who took 17 wickets on the recent two-Test tour of Sri Lanka, joins Shoaib Akhtar (ankle injury) and Rana Naved-ul-Hasan (groin) on the sidelines after a cortisone injection failed to ease the complaint.
"He hasn't reacted properly to an injection so he will be out," coach Bob Woolmer told reporters.
Woolmer said opening batsman Shoaib Malik, who also had a cortisone injection for a similar injury, was doubtful for the first match in the four-Test series.
England will wait until the last minute before deciding whether swing bowler Matthew Hoggard is fit after a freak injury last Saturday required six stitches in his bowling hand.
The hosts have already lost half of the pace attack who were instrumental in the Ashes win over Australia last year.
Simon Jones is out for the season with a knee operation and all-rounder Andy Flintoff will miss the first Test because of a heel problem. Their first reserve James Anderson is also out of action with a back injury.
England captain Andrew Strauss told a news conference on Wednesday the management team would give Hoggard as long as possible to recover from the injury sustained when a team mate trod on his hand during warmup exercises.
CONFIDENT INZAMAM
"At this stage we are giving him as long as possible to prove his fitness," Strauss said. "He had a useful workout in the nets today."
If Hoggard's run of 32 consecutive Tests comes to an end England will field an attack in which only Steve Harmison, who is himself returning from injury after missing the Sri Lanka series with sore shins, will have more than 15 Test wickets.
Pakistan have moved ahead of England into second place in the world rankings after winning their last three series in a row, including a 2-0 victory over England late last year.
"The one thing about them in the winter was their unpredictability," said Strauss.
"They can turn the match around in one session. We can't afford to relax, we have got to be on top of our game at all times.
Inzamam told a news conference his team has the belief and confidence to beat England.