Gulf Air Flight 072

Gulf Air Flight 072

A Gulf Air Airbus A320-212, similar to the one involved.
Accident
Date	23 August 2000 (2000-08-23)
Summary	Controlled flight into terrain due to pilot error, spatial disorientation
Site	Persian Gulf, Bahrain
Aircraft
Aircraft type	Airbus A320-212
Operator	Gulf Air
Registration	A4O-EK
Flight origin	Cairo International Airport
Destination	Bahrain International Airport
Passengers	135
Crew	8
Fatalities	143 (all)
Survivors	0

Gulf Air Flight 072 was a regularly-scheduled flight from Cairo to Bahrain . On 23 August 2000, the Airbus A320 serving the flight crashed into the shallow waters of the Persian Gulf 5 kilometers from the airport. All 143 on board the aircraft were killed.

Accident

The A320 with 143 passengers and crew on board approached the landing at higher speeds than normal and carried out an unusual low altitude orbit in an attempt to correct the approach. The orbit was unsuccessful and a go around was attempted. While carrying out a turning climb, the aircraft entered a descent at 15 degrees nose down. The aircrew did not respond to repeated GPWS warnings and approximately one minute after starting the go-around the aircraft disappeared from radar screens. There were no survivors. There were 36 children on the aircraft. The accident investigation concluded that the primary cause of the crash was pilot error (including spatial disorientation), with a secondary factor being systemic organizational and oversight issues.

Flight 072 was the highest death toll of any accident involving an Airbus A320 at that time. It was subsequently surpassed by TAM Airlines Flight 3054, which crashed on 17 July 2007 with 199 fatalities.

After the accident Hamad bin Issa al-Khalifa, the Emir of Bahrain, declared three days of national mourning.

After the crash, the flight designator has been changed from GF072 to GF070.

Investigation

The investigation showed that no single factor was responsible for the accident to GF-072. The accident was the result of a fatal combination of many contributory factors, both at the individual and systemic levels.

1. The individual factors particularly during the approach and final phases of the flight were:
   1. The captain did not adhere to a number of SOPs, such as:
      1. significantly higher than standard aircraft speeds during the descent and the first approach
      2. not stabilising the approach on the correct approach path; performing an orbit, a non-standard manoeuvre, close to the runway at low altitude
      3. not performing the correct go-around procedure
      4. other related items
   2. In spite of a number of deviations from the standard flight parameters and profile, the first officer (PNF) did not call them out, or draw the attention of the captain to them, as required by SOPs.
   3. A perceptual study indicated that during the go-around after the orbit, it appears that the flight crew experienced spatial disorientation, which could have caused the captain to perceive (falsely) that the aircraft was ‘pitching up’. He responded by making a ‘nose-down’ input, and as a result, the aircraft descended and flew into the shallow sea.
   4. Neither the captain nor the first officer perceived, or effectively responded to, the threat of increasing proximity to the ground, in spite of repeated hard GPWS warnings.
2. The systemic factors, identified at the time of the above accident, which could have led to the above individual factors, were:
   1. Organisational factors (Gulf Air):
      1. A lack of training in CRM contributing to the flight crew not performing as an effective team in operating the aircraft.
      2. Inadequacy in the airline's A320 training programmes, such as: adherence to SOPs, CFIT, and GPWS responses.
      3. The airline’s flight data analysis system was not functioning satisfactorily, and the flight safety department had a number of deficiencies.
      4. Cases of non-compliance, and inadequate or slow responses in taking corrective actions to rectify them, on the part of the airline in some critical regulatory areas, were identified during three years preceding the accident.
   2. Safety oversight factors:

A review of about three years preceding the accident indicated that despite intensive efforts, the DGCAM as a regulatory authority could not make the operator comply with some critical regulatory requirements.

The chairperson of the accident investigation board adopted the report on 10 July 2002.

Nationalities of passengers

An official from the United States State Department said a diplomatic courier was among the passengers. One Egyptian man who was supposed to board the flight did not board because the immigration officials in Cairo found that his Bahrain work permit was not in order.

Nationality	Passengers	Crew	Total
Australia	1	0	1
Bahrain	34	2	36
Canada	1	0	1
People's Republic of China	3	0	3
Egypt	63	1	64
Germany	1	0	1
Kuwait	0	1	1
Morocco	0	1	1
Oman	1	1	2
Palestine	9	0	9
Philippines	0	1	1
Poland	0	1	1
Saudi Arabia	12	0	12
Sudan	1	0	1
United Arab Emirates	6	0	6
United Kingdom	2	0	2
United States	1	0	1
Total	135	8	143

See also

• Adam Air Flight 574
• Afriqiyah Airways Flight 771
• Kenya Airways Flight 507
• Flash Airlines Flight 604
• List of accidents and incidents involving airliners by airline
• List of aircraft accidents and incidents resulting in at least 50 fatalities

External links

• Accident Investigation Report – Civil Aviation Affairs – Hosted by the Bureau d'Enquêtes et d'Analyses pour la Sécurité de l'Aviation Civile (BEA)
• Cockpit Voice Recorder transcript and accident summary
• GULF AIR STATEMENT ON THE PUBLICATION OF THE ACCIDENT (Archive) 15 July 2002.
• OPEN LETTER FROM IBRAHIM ABDULLA AL-HAMER 23 August 2001. (Archive)
• Accident description at the Aviation Safety Network
• Crash in the Gulf, CBS News
• Gulf Air Crash Probe Spotlights Disorientation, Training Issues