INVESTIGATION: Human errors, dereliction of duty are major causes of plane crashes in Nigeria

Avoidable human errors and dereliction of duty by public officials working in the aviation sector have been major reasons for the loss of hundreds of lives in air crashes in Nigeria, reports by the Aviation Investigation Bureau (AIB) have shown.

The bureau which is saddled with the responsibility of investigating air accidents in the country stated these in its findings, conclusions, and recommendations’ after air crashes that occurred in 2002 and 2005 involving two airlines, Sky Executive Aviation Services (SEAS)  and Sosoliso airline.

The reports which can be found on the website of the agency shows that if airport officials, airline operators, officials of the Federal Airports Authority of Nigeria (FAAN), and the Nigeria Civil Aviation Authority (NCAA) had done their jobs diligently, at least 103 lives could have been saved in those two crashes while property, including the two airplanes involved, worth hundreds of billions of naira could also have been saved.

Some of the human errors identified by AIB as causes of the plane crashes include non-lightening of runways and airfields, poorly constructed drainage culverts, inaccurate information by the control tower, lack of proper certification of radio operators and poor supervision of aircraft imported into the country.

Lighting the runway

On Friday, June 8, an aircraft operated by Arik airline left the Port-Harcourt airport for the Nnamdi Azikiwe airport in Abuja. The flight scheduled for 6.30pm arrived Abuja about an hour later. Several minutes after circling round the Abuja airport, the pilot decided he could not land. The lights on the runway were not on so there was poor visibility of the airstrip; also, several calls to the control tower yielded no result.

The Arik air pilot promptly made a detour back to Port-Harcourt. He probably learnt from the mistake made by another pilot seven years earlier. 

The Sosoliso disaster

Going by July 20, 2006 report that was submitted to the Minister of Aviation, on Saturday, December 10, 2005, at 2.05pm, Benjamin Adebayo, the pilot of Sosoliso aircraft 5N BFD, contacted the Port-Harcourt airport tower (whom he had been communicating with for over 40mins) for final permission to land the aircraft he flew from Abuja, and which contained 110 people (103 passengers and 7 crew members).

“The controller then cleared the airplane to land on runway 21 but to exercise caution as the runway surface was slightly wet and the pilot acknowledged,” A.I. Ozoka, the Director of Accident Investigation and Prevention Bureau (AIPB), said in the agency’s final report on the reasons for the crash.

The permission given to Mr. Adebayo to land his plane was in spite of the fact that the runway lightening was not on; hence the pilot had a limited view of the airfield.

“The crew continued the descent and went well below the Decision Altitude without having visual contact with the runway,” the AIPB report stated.

Mr. Adebayo’s decision to land his plane despite limited visibility was cited as one of the reasons for the crash which led to the death of the 108 occupants of the plane.

“The probable cause of the accident was the crew’s decision to continue the approach beyond the Decision Altitude without having the runway and/or airport in sight,” Mr. Ozoka stated.

He explained that “the reducing visibility in thunderstorm and rain as at the time the aircraft came in to land was also a contributory factor to the accident.”

The AIPB director further highlighted the effect of the un-lit runway saying “the fact the airfield lightings were not on may also have impaired the pilot from sighting the runway.”

In other words, according to findings by the AIPB, if the airport runway had been properly lit, the Pilot could have landed properly and the 108 people who died on the Sosoliso aircraft could have been saved.  

Runway lightening, whose role

Seven years after the AIPB recommended that “there is the need for the provision of Uninterrupted Power Supply UPS) to the airfield lightings to ensure that all critical aids are on throughout the operational period of the airport”, planes in Nigeria, as shown by last Friday’s Arik incident, still land in unlit runways.

During its investigations, the AIPB found out that “on the day of the crash, there was power failure at the station due to electrical fault”. 

The FAAN, whose duty it is to “maintain and control airport lightening” insisted that the “fault was rectified at 1205 hours” (1.05pm). 

Eyewitnesses (the air traffic controllers and fire/rescue personnel) however told the AIPB officials that “the airfield lightings were not on,” which therefore led to the accident.

Following the recommendation of AIPB, runway lighting which was then under FAAN, was earlier this year transferred to the Nigeria Airport Management Authority (NAMA) another agency under the ministry of aviation.

NCAA: Failure of regulation 

The agency saddled with regulating activities in the aviation sector, the NCAA, was also found wanting in the discharge of its duties. After the Sosoliso crash, the AIPB recommended that “the Nigerian Civil Aviation Authority, NCAA should monitor and strictly enforce standards on airfield lightings, fire cover and aviation personnel training.”

However, Seven years after this recommendation, the NCAA still appears unable to enforce “standards on airfield lightings” as witnessed in the Arik incident.

The NCAA spokesman, Sam Adurogboye, however absolved the NCAA of any blame as he insists all airlines including international carriers were duly informed by the appropriate agency of the repairs going on the Abuja runway lights. 

Mr. Adurogboye put the blame on the Arik pilot and management.  

“Before they left Port-Harcourt to Abuja, did they find out about their destination airport? You don’t fly a plane from one airport to another without knowing the condition of the airport you are going,” he said. 

Mr. Adurogboye’s claim was however disputed by the Arik management. 

The airline’s spokesman, Ola Banji, in a telephone interview denied that the airline was aware of any repairs on the airport runway light. 

“It can’t be true. There was no NOTAM (Notices to Airmen) to that effect. You know we were not the only ones affected,” Mr. Banji said. 

In other words, something (runway light) which caused an air crash leading to the death of over a hundred people almost repeated itself seven years after the appropriate agencies were chastised for their shortcomings. 

Apart from runway lighting, another major cause of the 108 deaths that occurred as a result the Sosoliso crash, was the existence of an exposed drainage.

The exposed driainage

As the Sosoliso aircraft veered off after landing poorly due to poor view of the runway 21, on which it was to land; another human error caused the aircraft to disintegrate.

“At about 60m from the first impact, the aircraft rear fuselage impacted heavily with a concrete drainage culvert where the No 2 engine and the rear staircase of the aircraft were detached and lodged,” the investigators said.

This impact with the concrete drainage culvert which was “poorly located” led to the disintegration and explosion of the aircraft, giving a total wreckage distance of 1,120m, the investigators found. 

Premium Times could not confirm if the concrete drainage has been properly reconstructed.

Weather and human errors

Though bad weather conditions also contributed to the Sosoliso crash, the investigators found that failure to disclose the accurate weather conditions to the crew was the major factor.

At 1.30pm when the pilot asked the control tower in Port-Harcourt for the weather condition, “the controller passed the weather report for 1230hrs (1.30pm) as: 260°/20kts, visibility 12km, nil weather, BKN 420m, Few CB, (N-SE) at 690m, QNH 1008, temp 33° C.” 

“This was the weather report for 1200 hrs (1.00pm),” the AIPB report stated.

This misinformation by the control tower to the pilot also played a major role in the Pilot’s decision to land the plane the way he did.

“If the correct weather information were passed at the time, it would have placed the crew in the correct perspective on the weather situation to expect at the station,” the report stated.

The AIPB further emphasized the role the misinformation on the weather condition played in the flight crash when it stated that “At about 1305 hrs, when the aircraft was in contact with the control tower, one would have expected the controller to give the aircraft the prevailing wind conditions to the pilot but instead, he only cleared the aircraft to land.”

Few minutes before the aircraft landed, a wind shear (defined as a change in wind speed and / or direction within a short time that takes place close to the ground) occurred which also aggravated the crash.

It was not the wind shear itself that hastened the crash, but the lack of information to the pilot, the AIPB noted.

“The crew was not aware of the prevailing adverse weather conditions since they were not equipped with actual wind situation,” the report stated.

The failure of regulation and how it led to plane crashes was also seen in the Sky Executive Aviation Services (SEAS) aircraft which killed all five occupants

The sky crash

After leaving Abuja, the Sky aviation plane had a stop at the Port-Harcourt airport. The plane left Port-Harcourt en-route Calabar at 6.50pm on Tuesday, May 21, 2002.

The plane which was declared missing at about 9.30pm had 5 passengers on board. However, findings by the AIPB after the plane crashed killing all five people on board showed that the plane should not have been allowed to fly in the first place as there were several manipulations in its registration and clearance documents.

“The airline got the permit to import and operate LET-410 UVP aircraft in Nigeria on the 5th November 2001 on the condition that the NCAA conducts pre-importation inspection of the aircraft,” the AIPB report signed by Remi Faminu, its director stated.

“However, there was no pre-importation inspection by NCAA before the aircraft was brought into the country. That means no proper documentations.” The report stated.

Though the aircraft was also given demonstration flight clearance on October 30, 2001 by the NCAA ‘to enable it determine the airline’s capabilities,’ the AIPB found no record of any demonstration flight being carried out. 

On January 18, 2002, four months before the crash, the NCAA had  actually grounded the operations of SEAS, while the manufacturers of that particular aircraft had also advised SEAS to discontinue the use of the aircraft if it “so wishes.” The NCAA could however not implement its directives.

Culpability of airline management

The investigators found that SEAS management was very culpable in the crash as the aircraft was not maintained as at when due. The investigators said – “the aircraft was not properly maintained as the airframe had exceeded the prescribed annual inspection time by 248hrs as at the crash time.”

The management also refused to maintain the engine of the aircraft according to the AIPB. 

“The engines were not maintained in accordance with the standard procedure required for air safety. Both engines had exceeded the overhaul time by 242hrs as at the time of the accident.” 

Apart from the aircraft, even the pilots flying the plane were not qualified to fly in Nigeria.

“The pilots started operating without the validation of their licenses nor did they have immigration’s permit to work in the country. But they had visiting visa,” the investigation report stated.

 


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