Alleged pilot errors occurring too often with deadly results

July 07, 2021
cockpit automation
Air India Express 737. Credit: Aviation Herald

No aircraft manufacturer can design an aircraft that will survive pilot errors of ignoring air traffic control instructions and multiple warnings or just making bad decisions. Last year there were three deadly accidents all of which appear to have involved one of these three fatal elements – or all three.

On Feb 3, 2020, Pegasus Airlines Flt 2193, a Boeing 737-800, had a runway overrun after landing on runway 06 at Istanbul-Sabiha Gökçen International Airport, Turkey. Incredibly only 3 of the 183 occupants lost their lives.

According to at the time the flight arrived in the vicinity of the airport, a thunderstorm was passing. The tower controller cleared Flt 2193, to land with conditions that translated into a 19-knot tailwind.

Pegasus Airlines Flt 2193.

According to Mode-S data transmitted by the aircraft, it landed very long and fast. It touched down 1,950 m past the threshold and just 1,000 m before the runway end and overran the end of the runway at about 116 km/hr, crossed an airport road and a cliff, and impacted the airport perimeter wall.

The crew was warned that other aircraft were performing go-arounds and weather conditions were very difficult yet they proceeded with a landing that was marginal at best with tragic results.

In May, 2020 a Pakistan International Airlines crew ignored ATC instructions and multiple warnings causing the loss of their aircraft and 97 of the 99 aboard according to the preliminary report.

PIA Flt 8303, an Airbus A320, crashed on approach to Karachi-Jinnah International Airport, Pakistan. According to official reports during the flight from Lahore, the pilots did not follow standard callouts and did not observe Crew Resource Management aspects during most parts of the flight but discussed the coronavirus.

PIA Flt 8303.

The crew was too high on approach but ignored an ATC command to circle to lose height. According to the crash report Karachi Approach advised repeatedly about the excessive height but the pilots continued the approach. It also advised repeatedly to discontinue the approach.

The crew lowered then retracted the undercarriage which is still not explained. Over-speed, Enhanced Ground Proximity Warnings System (EPGWS) and undercarriage warnings were then triggered. The A320 touched the runway on its engines and the pilots then initiated a go-around but both engines were severely damaged and subsequently failed, causing the loss of the aircraft.

On August 7, 2020, an Air India Express 737 crashed at Calicut after landing long on a tabletop, water-soaked runway, and then sliding down an embankment.

After one missed approach in heavy rain and low visibility, the pilots elected to perform a landing with a 22 km/hr tailwind but touched down about 900 m down the 2,850 m long runway and overran. It went down a 34 m dropoff and broke in two killing 18 including the two pilots.

According to renowned former US crash investigator Greg Feith, the issue of runway overruns is nothing new especially in that part of the world. “The major manufacturers, including Boeing, have provided operators with safety information that includes training aids, pilot procedures, and other educational materials. Unfortunately, these types of accidents are still occurring for the same reasons, including a lack of operational discipline!”

Air India Express 737 crash at Calicut

All of these accidents involved a lack of crew and procedural discipline with tragic results and no amount of instruction or system automation by Airbus or Boeing will prevent such tragedies.

Both of the 737 MAX tragedies in 2018 and 2019 involve a significant amount of crew failure to follow well-drilled and known procedures. In November 2019, Mr. Feith told that the Lion Air co-pilot who was flying the 737MAX when it crashed “had significant training deficiencies and lacked basic flying skills.

“These same deficiencies occurred during the accident flight. These two pilots had no business being in the cockpit and the airplane should not have been operated because of all the maintenance issues that began at the beginning of October, and were not corrected, making the airplane unairworthy.”

In the Indonesian report, the training record for the First Officer’s training states: “Application exercise for stall recovery is difficult due to the wrong concept of the basic principle for stall recovery at a high level and low level.”

According to one former Airbus training captain, the “first officer not only should have failed his training but should never have held a license.”

Mr. Feith and another former NTSB investigator, John Goglia, deliver sobering insight into what really happened in the Lion Air 737 MAX crash here at Also, listen to episodes 14 & 15.

In the aftermath of the PIA, A320 disaster it was revealed that 262 pilots in Pakistan had fake pilot licenses, with other pilots sitting the exams. The revelation came from the country’s Aviation Minister Ghulam Sarwar according to Gulf News.

Sarwar revealed the disturbing news about the “fake” pilots while presenting a provisional inquiry report in the National Assembly of Pakistan about the PIA crash.

Sarwar told the National Assembly that Pakistan has 860 active pilots, which includes PIA, Serene Air and Air Blue pilots as well. He said that “the inquiry which was initiated in February 2019 showed that 262 pilots did not take the exam themselves and asked someone else to sit for the exam on their behalf.”

He further revealed that “pilots were also appointed on a political basis and merit was ignored while appointing pilots.”

This revelation comes after a similar scandal in India and accusations of bribery in Indonesia in 2016 by its aviation Director-General. This accusation was made in this Foreign Correspondent story – False Economy.

In the wake of the 737 MAX disasters and subsequent pilot errors, all manufacturers are reassessing cockpit design and systems/reaction assumptions to try and counter the level of pilot competency and training.