Johannesburg-Oliver Reginald Tambo (Jan Smuts)

Unstable approach whereby the aircraft was flared too high with high forward speed resulting with a low sink rate in which during touch down the left landing gear
experienced excessive vibration and failed due to shimmy events.
The following findings were identified:
- According to the FDR recordings, the aircraft flare was initiated earlier at 65ft than at 20ft as recommended by aircraft manufacture, which contributed to the low sink rate.
- The shimmy damper failed the post-accident lab-test and fluid was found in the thermal relief valve, which could have contributed to the shimmy damper failure.
- According to the lab results, significant wear was found on the upper torsion link bushing and flange, which could have contributed to undamped vibration
continuation.
- The aircraft had a tailwind component during landing, which could have prolonged the landing distance.

The loss of situational awareness caused the crew to taxi straight ahead on the wrong path, crossing the intersection/junction of Bravo and Mike instead of following Bravo where it turns off to the right and leads to the Category 2 holding point. Following aircraft stand taxilane Mike; they collided with a building on the right-hand side of Mike.
Contributory Factors:
- Failure of the crew to carry out a briefing after they had received instruction from ATC that the taxi route would be taxiway Bravo.
- The lack of appropriate knowledge about the taxiway Bravo layout and relevant information (caution notes) on threats or risks to look out for while taxiing on taxiway Bravo en route to the Cat 2 holding point.
- The aerodrome infrastructure problems (i.e. ground movement navigation aids anomalies), which created a sense of confusion during the taxi.
- Loss of situation awareness inside the cockpit causing the crew not to detect critical cues of events as they were gradually unfolding in front of them.
- Failure of the other crew members to respond adequately when the Co-pilot was commenting on the cues (i.e. narrowness and proximity to the building).
- The intersection/junction of Bravo and Mike not being identified as a hotspot area on the charts.

Inappropriate decision by the captain to reverse the aircraft at night without external guidance.

A final approach carried out in common managed guidance mode should have relieved the crew of their tasks. The limited coordination and cooperation between the two crew members, especially the change into vertical selected guidance mode by the PF, probably led to a lack of a common action plan. The lack of feedback from the 28 April 2010 flight, flown by the same crew on the same aircraft, did not allow them to anticipate the potential risks associated with managing non-precision approaches. The pilots’ performance was likely impaired because of fatigue, but the extent of their impairment and the degree to which it contributed to the performance deficiencies that occurred during the flight cannot be conclusively determined. During the go-around, the crew was surprised not to acquire visual references. On one hand the crew feared exceeding the aircraft’s speed limits in relation to its configuration, and on the other hand they were feeling the effects of somatogravic illusion due to the aircraft acceleration. This probably explains the aircraft handling inputs, mainly nose-down inputs, applied during the go-around. These inputs were not consistent with what is expected in this flight phase. The degraded CRM did not make it possible for either crew member to identify and recover from the situation before the collision with the ground, even when the TAWS warnings were activated close to the ground.
Based on elements from the investigation, the accident resulted from:
- The lack of common action plan during the approach and a final approach continued below the MDA, without ground visual reference acquired.
- The inappropriate application of flight control inputs during a go- around and on the activation of TAWS warnings,
- The lack of monitoring and controlling of the flight path.
These events can be explained by the following factors:
- Limited CRM on approach that degraded during the missed approach. This degradation was probably amplified by numerous radio-communications during the final approach and the crew’s state of fatigue,
- Aircraft control inputs typical in the occurrence of somatogravic perceptual illusions,
- Inappropriate systematic analysis of flight data and feedback mechanism within the AFRIQIYAH Airways.
- Non adherence to the company operation manual, SOP and standard terminology.
In addition, the investigation committee found the following as contributing factors to the accident:
- Weather available to the crew did not reflect the actual weather situation in the final approach segment at Tripoli International Airport.
- In adequacy of training received by the crew.
- Occupancy of tower frequency by both air and ground movements control.

The accident resulted due to a loss of control (aircraft becoming uncontrollable in the pitch and roll axis), which occurred approximately 35 to 40 seconds after lift-off/rotation. It was induced and aggravated by a 16% overload condition as well as the exceedance of the certified aft CG limitation of the aircraft. The investigation revealed that the aircraft was overloaded by approximately 16% 699.6kg). The cargo was not secured, nor was there a seat or a restraining device in the aircraft for the passenger that was onboard the ill-fated flight. The last Mandatory Periodic Inspection prior to the accident was certified on 30 May 2001 at 4 353.1 airframe hours, by AMO No. 273. Since the inspection was certified a further 96.6 hours were flown. The Certificate of Airworthiness for the aircraft was invalid at the time of the accident, as both engines have exceeded their TBO (time between overhaul) by approximately 185 hours.

It was determined that the total weight of the aircraft was five tons above MTOW while the CofG was too far forward, out of the envelope. In such conditions, the aircraft was not properly configured and a takeoff was impossible.

Loss of control during initial following an engine failure for unknown reasons.

The following findings were reported:
- Poor weather conditions with heavy rain falls,
- Limited visibility,
- The runway 05 was wet and the braking action was reduced,
- The aircraft suffered aquaplaning,
- The reverse thrust systems were unserviceable on engine n°2 and 4,
- The crew completed the landing without the spoilers being armed,
- The aircraft was not airworthy,
- The crew failed to follow the approach checklist.