Garuda Indonesia Flight 152
A Garuda Indonesia Airbus A300 similar to the aircraft involved in the accident.
|Date||September 26, 1997|
|Summary||Controlled flight into terrain caused by ATC error|
|Site||Near Pancur Batu, Deli Serdang, North Sumatra, Indonesia
|Aircraft type||Airbus A300B4-220|
|Flight origin||Soekarno-Hatta Int'l Airport, Jakarta, Indonesia|
|Destination||Polonia International Airport, Medan, North Sumatra, Indonesia|
Garuda Indonesia Flight 152 was a scheduled domestic Indonesian passenger flight from Soekarno-Hatta International Airport in Jakarta to Polonia International Airport in Medan, North Sumatra, flown using an Airbus A300B4 registered PK-GAI and operated Garuda Indonesia.
On September 26, 1997, Flight 152, piloted by Hance Rahmowiyogo, 42, a pilot with over 20 years of flying experience at Garuda Indonesia and more than 12,000 flying hours, crashed into mountainous woodlands 30 miles (48 km) from Medan during low visibility caused by the 1997 Southeast Asian haze. All 234 passengers and crew were killed in the disaster. The crash site was in a ravine near the village of Buah Nabar in the Sibolangit district south of Medan.
Flight 152 remains the deadliest single-plane crash in Indonesia, and the deadliest aviation accident in 1997.
At approximately 1pm, air traffic controllers in Medan cleared flight 152 for an ILS approach into Runway 5 from its current 316 degree heading, and the crew was instructed to turn left heading 240 degrees to intercept the ILS beacon. 120 seconds prior to impact, the crew was asked to turn left further, to 215 degrees, and descend to 1500 feet, 500 feet below the approved altitude for the procedure. At 1.30pm, ATC directed the flight to turn right heading 045 to line up for arrival into runway 5, and asked the crew to report which direction the plane was travelling. Air traffic controllers then became confused as to which plane they were talking to, as Merpati Flight 152 was also in the area at the time. This confusion led to the controllers' failure to notice that the Garuda plane was flying dangerously low in a hilly area, and the pilots could not see the hills due to the 1997 Southeast Asian Haze.
The crew confirmed they had initiated the right turn towards Runway 5 after they were asked to. Shortly after this, the pilots screamed "Allahu Akbar!" (translation: God is great) as the mountain in front came into view. Seconds later, the plane slammed into the mountainous woodlands about 1,150 feet high, near the village of Pancur Batu, broke apart and burst into flames, killing all 234 passengers and crew on board instantly. According to eyewitnesses, flight 152 hit the mountain on a heading of approximately 220 degrees, with its left wing low, supporting the theory that the pilots had in fact not deviated from their assigned route.
About four minutes before the crash, the Medan ATC briefly confused the Garuda flight with a Merpati flight in the same area (Merpati Flight 241), addressing an instruction intended for the Garuda flight to "Merpati Flight 152." A transcript of the radio communications between the aircraft and Medan ATC shows this confusion. Then, after Garuda 152 was in radar range, air traffic control pulled it off what Garuda Indonesia pilots say is the normal landing approach, and told it to turn left at 2,000 feet, about 14 miles away. The directions brought the plane to a mountainous area requiring an altitude of at least 7,500 feet, the pilots say. Normally, the plane would descend to 2,000 feet at 6.6 miles. According to the transcript, the pilot asked for confirmation of the instructions and was told to go on.
The passengers were mostly Indonesian, but included two British, one French, four Germans, two Americans, two Quebec Canadians, one Italian, one Dutch, six Japanese, three Taiwanese, one Australian and one Malaysian.
Nationalities of the passengers and crew
Forty-eight of the bodies recovered from the crash were too mutilated to be identified and were buried in a mass grave in a cemetery outside Medan's Polonia Airport, where 61 victims of a 1979 Garuda Fokker F28 crash were also buried. The remaining 186 bodies were identified and returned to their families for private burial.
The cause of the crash, according to the official report of the National Transportation Safety Board (NTSB), were:
- The aircraft turned left instead of right as instructed by the ATC due to miscommunication.(See Transcript below)
- The aircraft descended below the assigned altitude of 2,000 feet (610 m) and thereafter struck treetops at 1,550 feet (472 m) above mean sea level.
Transcript of final communication
The following transcript is an unofficial extract of the air traffic control (ATC) communications as appeared in the press.
- MNA 241 is Merpati Flight 241 (approaching)
- BOU 683 is Bouraq Flight 683 (departing)
- GIA 152 is Garuda Flight 152 (approaching)
- MEDAN is the Medan air traffic controller
Exchange between MEDAN and GIA 152 are in bold.
|ATC tower communications|
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The first lawsuit was filed by Nolan Law Group in Chicago, Illinois on September 24, 1998 on behalf of American passengers Fritz and Djoeminah Baden. Additional lawsuits were filed in state and federal courts in Chicago related to many more victims from Indonesia, Germany, England, Italy, and Australia. The sole defendant in the lawsuits was Sundstrand Corporation (later Hamilton Sundstrand Corporation), the company that designed and manufactured the Mark-II ground proximity warning system ("GPWS") installed on the Airbus 300. The plaintiffs alleged that the GPWS was defectively designed, that the manufacturer was aware of its deficiencies in mountainous terrain for over a decade, and had the system worked as designed the accident could have been avoided.
The Indonesian authorities never released the results of their investigation of the crash, forcing the lawyers of the crash victims to file actions in the United Kingdom and France in order to obtain the flight record data from Flight 152's black boxes. The flight data recorder revealed that the warning from the GPWS sounded only five seconds before the airplane made contact with the treetops. Since the pilots immediately pulled the jet into a climb once the alarm sounded and just barely clipped the treetops, had the alarm met international design standards and sounded between 18 and 23 seconds before impact, the accident would have been avoided.
The victims' lawyers produced several internal memos from Hamilton-Sundstrand showing that the system had been inadequately tested for mountainous terrain, having been mostly tested on flat ground with gentle slopes. Perhaps the most critical memo was one written by Hamilton-Sundstrand engineer Donald Bateman, who wrote: "Based on recent flight demonstrations ... of the MK II GPWS, I have become very concerned about the Excessive Rate Detector Circuits in the MK II computers. I believe we have a much more potentially serious problem than was first envisioned in 1982. GPWS warnings can be short or non-existent in some circumstances." Bateman's memo went on to say that "the warning time for flight into mountainous terrain and steep descent rates from altitudes above the range of the radio altimeter can be very short and erratic at times ... From our studies, the average escape margin is only three-and-one-half seconds for the typical mountainous-terrain accident scenario." Sundstrand's in-house experts conducted their own after-crash simulations and confirmed that a properly functioning warning system should have sounded alarms about 14 seconds before impact and that the accident would have been avoided if that had occurred.
Nearly six years after the crash the lawsuit was settled out of court.
In Coyle v. P.T. Garuda Indonesia, Joyce Coyle filed a suit in the U.S. District Court for the District of Oregon against the Indonesian government subsidiary that operates Garuda Indonesia Airlines. Coyle alleged in her complaint that Garuda was liable for wrongful death under the Warsaw Convention. She also claimed that Garuda, which is wholly owned by the Indonesian government, could be held liable under two exceptions to the Foreign Sovereign Immunities Act. She contended that because Garuda was authorized to operate in the United States at the time, the immunity had been explicitly waived under the rules of the Department of Transportation, which requires foreign air carriers to open themselves to suit in the United States as a condition of being allowed to fly to, from, or within this country. The waiver is limited to actions arising under treaties. Coyle also claimed that by selling tickets in the United States, Garuda waived immunity under the "commercial activity" exception to the FSIA. U.S. District Judge Robert E. Jones denied Garuda’s motion to dismiss, adopting a magistrate judge’s conclusion that the trip to Medan was "one leg of an international journey" and thus subject to the Warsaw Convention and the explicit waiver of immunity.
On appeal to the U.S. Court of Appeals for the Ninth Circuit, Circuit Judge Diarmuid F. O’Scannlain, writing for a unanimous three-judge panel, rejected Garuda’s claim that a flight between two points in the same country will always fall outside the scope of the waiver. The Ninth Circuit still agreed with the defendant that under the circumstances, the Badens’ trip to Medan did not constitute "international air transportation" within the meaning of the Warsaw Convention. The facts that the tickets did not reference any international travel, were purchased in Indonesia from a source independent of the travel agent who sold them the U.S.-Indonesia tickets, and were labeled "DOMESTIK" unambiguously established that the flight was not part of their international journey as contemplated by the treaty, O’Scannlain said.
The court explained: "[T]he crux of this litigation is whether Flight 152 was a part of [the] larger international trip for purposes of the Warsaw Convention...whether it was a component of 'one undivided transportation...regarded by the parties as a single operation'...or just a late-added, purely domestic side trip apart from their international itinerary with its own final destination. The Badens' tickets for Flight 152 are powerful, unambiguous evidence of the latter."
Nor was the court persuaded by the "commercial activity" argument. For the exception to apply, O’Scannlain noted, the statute requires that the action arise from “a commercial activity carried on in the United States by the foreign state...or upon an act outside the territory of the United States in connection with a commercial activity of the foreign state elsewhere [when such] act causes a direct effect in the United States.” The fact that Garuda sold tickets in the United States did not furnish a sufficient nexus to subject its domestic flights to the exception, the judge wrote. Senior Judge Ferdinand F. Fernandez and Judge Raymond C. Fisher joined in the opinion.
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