Medical Assistance for Seafarers: Standards, Obligations, and Practical Challenges

Medical Assistance for Seafarers: Standards, Obligations, and Practical Challenges

Life at sea involves unique health risks — long voyages, isolation from shore, limited medical access, and demanding physical conditions. For this reason, the right to medical care is a cornerstone of maritime labor protection and an essential part of seafarers’ welfare.

International Legal Framework

The primary international instrument governing seafarers’ health protection is the Maritime Labour Convention (MLC 2006), adopted by the International Labour Organization (ILO).
Title 4 of the Convention establishes standards for health protection, medical care, welfare, and social security of all seafarers.Its key principles include:

• Every seafarer has the right to timely and adequate medical care, both on board and ashore.

• Such care must be provided free of charge to the seafarer.

• The quality of medical services on board should be comparable to that available on land.

• Shipowners are financially responsible for the treatment, repatriation, and compensation if a seafarer’s illness or injury arises from service on board.

Earlier ILO instruments — such as the Health Protection and Medical Care (Seafarers) Convention, 1987 (No. 164) — laid similar foundations, later unified and expanded by MLC 2006 into one comprehensive framework.

Shipowners’ and Employers’ Obligations

Based on the MLC and international practice, a shipowner’s core duties include:

1. Providing Medical Care — ensuring treatment of a sick or injured seafarer at no cost to the individual.

2. Covering All Expenses — paying for medication, hospital stays, examinations, medical transport, and repatriation when necessary.

3. Ensuring Access — medical care must be available both on board and at shore-based facilities whenever possible.

4. On-board Medical Readiness — ships must be equipped with a medical chest, first-aid supplies, and medical guidebooks. Larger vessels with over 100 persons or long international voyages must carry a qualified doctor.

5. Insurance and Financial Protection — shipowners must provide insurance or equivalent financial guarantees covering medical costs, temporary or permanent disability, and death benefits.

6. Cooperation with Trade Unions — maritime unions monitor compliance, support crew members in disputes, and promote collective bargaining to improve health coverage conditions.

Common Practice and Disputed Situations

Despite the clarity of international rules, implementation often reveals serious discrepancies between standards and reality.

1. Medical Care in Remote Areas

Ships operating far from major ports or in regions with poor healthcare often struggle to ensure care “comparable to that on shore.” Evacuations may be delayed, and medical supplies or qualified personnel limited.

2. Extent of Liability

Shipowners sometimes attempt to limit their responsibility by claiming that an illness is unrelated to service or that obligations cease once repatriation is completed. Such interpretations often become subjects of legal disputes.

3. Chronic or Pre-existing Conditions

If a seafarer concealed a chronic illness during the pre-employment medical examination, the company may refuse to cover treatment costs. Yet, in many cases, the condition worsens due to on-board work, creating ethical and legal controversy.

4. Access to a Doctor in Port

MLC requires that a seafarer must be able to see a doctor or dentist “without delay” when the ship is in port. In practice, administrative approval from the company or insurer may cause delays, reducing the standard’s effectiveness.

5. Duration of Financial Coverage

Another frequent dispute concerns how long the company must continue to pay medical costs — until full recovery or only until repatriation. Some collective agreements extend this period, while others limit coverage strictly to the time of service.

6. Flag State Control

Not all flag states enforce MLC provisions equally. Ships under so-called “flags of convenience” are more likely to have outdated medical kits, missing records, or insufficient oversight of seafarers’ health and welfare.

Role of Trade Unions

Organizations such as the International Transport Workers’ Federation (ITF) play a vital role in enforcing medical rights under MLC 2006.
Unions inspect vessels, assist seafarers in obtaining compensation, and represent them in disputes with employers or insurers.
Through collective agreements, unions often secure additional benefits — extended medical coverage after repatriation, enhanced evacuation procedures, and guaranteed payment of wages during medical leave.

Practical Guidance for Seafarers

• Before signing a contract, verify that your ship flies the flag of an MLC-compliant state.

• Keep copies of all medical reports, invoices, and receipts — they are essential for reimbursement or legal claims.

• Immediately inform the master of any illness or injury and ensure it is recorded in the ship’s medical log.

• If medical attention is delayed or refused, document the situation and notify your union or crew representative.

• After repatriation, check whether the company continues to cover medical costs related to shipboard illness or injury.

Conclusion

The right to medical care is not a privilege but a legal guarantee under international maritime law.
Shipowners must provide timely treatment, hospitalization, and repatriation to every seafarer, regardless of nationality, rank, or route.
Nevertheless, practical obstacles — distance, cost-cutting, insurance restrictions, and weak enforcement — continue to undermine this right.For effective protection, seafarers must remain informed, organized, and proactive. Only then can the MLC 2006 principle truly function in practice:“No seafarer shall be left without medical care — at sea or ashore.”