Following the effects of COVID-19 and the crew change crisis, seafarer health and wellbeing are increasingly in focus. While port restrictions and reduced shore leave has led to an increased use of telemedical services onboard, as well as an evolution in the quality of telemedical health services as a result of the pandemic, there remains an ongoing concern regarding access to in-person and emergency medical care.

Ismael Cobos Delgado, Deputy Director of the International Maritime Organisation (IMO) Maritime Safety Division, said, “IMO’s SCAT team received numerous requests for assistance from seafarers that were unable to disembark their ships to receive medical care ashore during the COVID-19 pandemic. Receiving such care can be a matter of life and death. While tele-medicine and shipboard publications are valuable medical resources, there is also a legal obligation under IMO and ILO conventions to render assistance to seafarers in distress, including medical assistance.”

In March 2022, the International Chamber of Shipping (ICS) called on governments around the world to ensure access to medical care for seafarers, after it emerged that crews continue to be refused urgent treatment at ports during the pandemic.

In a recent report, the International Labour Organisation’s (ILO) Special Tripartite Committee of the Maritime Labour Convention, commenting on the latest report of the Committee of Experts (made up of 20 eminent jurists) noted “…with deep regret the existence of cases of denial of access to medical care ashore for seafarers, even in situations of the utmost urgency”.

Publicly reported examples throughout the pandemic include seafarers with broken limbs being asked to remain on board and take painkillers, a chief engineer vomiting blood not allowed to disembark, and even the body of a ship’s master who suffered a fatal heart attack being refused repatriation.

In lieu of access to medical shore leave, shipowners and seafarers have had to develop strategies to become more self-sufficient. Crews have often had to act as first line responders, supported by telemedical services and information in medical guides onboard mandated by the Maritime Labour Convention (MLC) 2006. As a result, not only have there been calls to update the guides in question – provided internationally by the World Health Organisation (WHO) or regionally by the flag state – but it has also led to a greater focus on preventative actions and raising awareness of resources available for crews.

“Seafarers are currently dealing with a new normal where many of the issues that began or worsened during COVID continue today, including difficulties accessing shore leave and medical services while on contract. This is one of the reasons we’ve extended our services to now not only support seafarers who contact us directly, but also offer information that might assist with preventative measures, such as physiotherapy exercises that can help reduce the risk of musculoskeletal injuries with repetitive physical work,” said Sandra Welch, CEO of the maritime charity Seafarers Hospital Society (SHS).

Government action required

Relying on owners and crews to intervene in medical emergencies is not, however, a long-term solution. ICS’ calls in March echoed the ILO report’s recommendations, urging governments around the world to designate and treat seafarers as key workers, provide access to medical care ashore when needed, and prioritise seafarers for Covid-19 vaccinations.

The ILO’s committee also linked the denial of seafarer medical treatment as a further stressor on an already overstretched global supply chain. It said that “…the crew change situation remains critical and appears to be deteriorating, which jeopardises the safe and uninterrupted delivery of vital supplies.”

Call for updated information Seafarers, shipowners and operators, unions such as the International Transport Workers Federation (ITF) and the ILO have argued that existing medical advice available onboard, such as the WHO’s International Medical Guide for Ships (Third Edition, 2007), is impractical and outdated for contemporary circumstances. The guide is perceived as too bulky and academic in nature, making it difficult to use by seafarers onboard, particularly those who are less comfortable with the English language.

“The World Health Organisation (WHO) International Medical Guide for Ships (Third Edition, 2007) has not been reviewed by the intended audience – real seafarers – but was reviewed by doctors. While this ensures that the medical advice provided is correct, its actual practical use in the field leaves much to be desired,” said Captain Pradeep Chawla, Group Managing Director, QHSE and Training, with the Anglo Eastern Univan Group and member of the Intertanko Human Element Group.

“If you have an emergency or something like a heart attack onboard, then you do not have time to look for a fat manual and read a whole page of text,” he pointed out. “What you need is a brief list of steps to follow, ideally in a pictorial format, and these would be best if available as cards rather than a whole book.”

To address such concerns, ICS has produced a new International Medical Guide for Seafarers and Fishers (First edition), authored by Dr. Sue Stannard. Due to be published in November 2022, it is written in simple English, which avoids the use of colloquialisms, has pictorial representation and highlighted quick actions, and contains pull cards that can easily be brought to the scene of an incident. The guide is intended to be user-friendly and prescribes the most up-to-date internationally available medicines.

While any focus solely on COVID-19 would likely date the guidance involved, the information provided expands on existing risk management for pandemics. While information continues to be available for COVID-19, Ebola, SARS, etc in terms of spread and symptoms, there is further up to date general guidance on how to isolate anyone affected onboard – information that could be valuable as the industry now faces the possibility of a series of monkeypox outbreaks.

Need to focus on seafarer training

While the provision of information remains a high priority, Captain Chawla argues that existing seafarer medical training is not fit for purpose. “I would strongly advise that the training period be increased and the modelled courses lay down the minimum equipment and medicines required,” he said.

Existing seafarer training for first aid would need to be updated to include updated medical knowledge and techniques, particularly guidance in case of emergency. Chawla flags the need for a uniformity in first response training, as different regions and facilities may suggest that the seafarer use medicines or medical equipment that are dated, unavailable in that region, or available but unfamiliar to the seafarer in question.

While an international guide may be the first step to greater uniformity of seafarer medical training, updates to international regulation, such as in the ongoing review of STCW, and an end to governments blocking medical aid ashore must be achieved if seafarer healthcare is to improve.