Crash of a Let L-410UVP in Butembo

Date & Time: Oct 30, 2012 at 1500 LT
Type of aircraft:
Operator:
Registration:
9Q-CAZ
Survivors:
Yes
Schedule:
Goma - Butembo
MSN:
79 02 05
YOM:
1979
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
15
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Following an uneventful flight from Goma, the twin engine airplane landed on runway 14/32 which is 770 metres long. After touchdown, the aircraft was unable to stop within the remaining distance. It overran, lost its left main gear and came to rest down an embankment with its left wing damaged. All 18 occupants escaped uninjured while the aircraft was damaged beyond repair.

Crash of a Beechcraft 1900D in Bir Kalait

Date & Time: Oct 28, 2012
Type of aircraft:
Registration:
TT-ABB
Flight Type:
Survivors:
Yes
Schedule:
N'Djamena - Bir Kalait
MSN:
UE-406
YOM:
2000
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
15
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The twin engine aircraft departed N'Djamena on a flight to Bir Kalait, carrying 15 passengers and two pilots, among them a delegation of the Presidency. On short final, the aircraft named 'Am Djerass' was too low and struck the ground short of runway threshold. Upon impact, the undercarriage were torn off. The aircraft slid on its belly for about 200 metres before coming to rest in a sandy area with all propeller blades separated. The aircraft was damaged beyond repair but all 17 occupants escaped uninjured, among the Idriss Déby, President of the Tchad Republic who was flying to Bir Kalait to take part to the Peace and Development Forum for the Borku-Ennedi-Tibesti Region.

Crash of a Cessna 208B Grand Caravan in Yola

Date & Time: Oct 25, 2012 at 1830 LT
Type of aircraft:
Operator:
Registration:
5N-BMJ
Flight Type:
Survivors:
Yes
Schedule:
Jalingo – Yola
MSN:
208B-2098
YOM:
2009
Location:
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
3
Pax fatalities:
Other fatalities:
Total fatalities:
0
Aircraft flight hours:
999
Circumstances:
On the 25th of October, 2012 at 17: 48 h, a Cessna Caravan 208B, 5N-BMJ, departed Jalingo for Yola on a Visual Flight Rules (VFR) flight plan with four Persons-On-Board (one crew and three passengers). At 18:00 h, the Airport Manager stationed at Jalingo by Taraba State Government, called Yola Control Tower (CT) by phone to advise that the aircraft had departed Jalingo for Yola. At 18:25 h the pilot reported field in sight. CT then advised him to “continue approach and report final, wind calm” and the pilot acknowledged “will continue approach, to report final”. At 18:27 h CT had the aircraft in sight and advised the pilot to report “final, wind calm”, the pilot acknowledged. At 18:30 h, CT lost visual contact with 5N-BMJ and tried to raise her on radio but there was no response. At 18:37 h, information was received from witnesses, regarding a possible plane crash at Yola-Numan road close to Nigerian National Petroleum Corporation (NNPC) depot. This information was subsequently passed to the fire watch room. Rescue team and other security personnel were mobilized to the location of the crash. However, before the arrival of the rescue team from the airport, the locals had rescued the occupants from the wreckage. The occupants were subsequently taken to Federal Medical Centre (FMC), Yola for medical treatment. The accident occurred at dusk. The aircraft was destroyed.
Probable cause:
The Bureau could not conclusively determine the cause of this accident; however, the investigation identified the following factors:
- The pilot was not certified, qualified and not competent to fly the aircraft.
- The decision of the pilot to operate a VFR flight after sunset.
- Inadequate oversight by the Regulatory Authority.
Final Report:

Crash of an Antonov AN-12BP near Khartoum: 15 killed

Date & Time: Oct 7, 2012 at 1200 LT
Type of aircraft:
Operator:
Registration:
ST-ARV
Flight Phase:
Survivors:
Yes
Site:
Schedule:
Khartoum - Al Fashir
MSN:
7 34 53 10
YOM:
1967
Country:
Region:
Crew on board:
6
Crew fatalities:
Pax on board:
16
Pax fatalities:
Other fatalities:
Total fatalities:
15
Circumstances:
The four engine aircraft was performing a flight from Khartoum to Al Fashir with 16 passengers and a crew of six on behalf of the Sudanese National Army. Few minutes after he departed Khartoum-Haj Yusuf Airport, the crew informed ATC about an engine failure and was cleared to return. Few seconds later, a second engine failed on the same side and the crew attempted to make an emergency landing. The aircraft crashed in a desert area located about 22 km from Khartoum Airport. The aircraft disintegrated on impact. 13 occupants were killed while nine other were seriously injured. Few days later, two passengers died from their injuries.
Probable cause:
Double engine failure for unknown reasons.

Crash of a Let L-410UVP-E9 in Ngerende: 4 killed

Date & Time: Aug 22, 2012 at 1220 LT
Type of aircraft:
Operator:
Registration:
5Y-UVP
Flight Phase:
Survivors:
Yes
Schedule:
Amboseli – Ngerende – Mara North – Ukunda – Mombasa
MSN:
91 26 27
YOM:
1991
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
11
Pax fatalities:
Other fatalities:
Total fatalities:
4
Captain / Total flying hours:
7480
Captain / Total hours on type:
1150.00
Copilot / Total flying hours:
312
Circumstances:
This was a commercial non scheduled flight which was being operated for air transport for local flights. The operator is based in Mombasa and mostly executes passenger flights to the Masai Mara and other game parks and reserves within the Republic of Kenya. On 22nd Aug 2012, the aircraft was scheduled to carry out a flight to the Masai Mara, do several sectors to pick and drop passengers and return to Moi international Airport via Ukunda Airport. The call sign was 5Y-UVP. The last point of departure was Ngerende Airstrip in the Masai Mara at 0917 with intention of onward flight to Mara North airstrip in the Masai Mara. The flight had earlier left Amboseli Airstrip with two crew, and 17 passengers for Ngerende Airstrip. 6 passengers had disembarked at Ngerende and the remaining 11 passengers were continuing to other destinations. No additional passengers or cargo was picked up from Ngerende airstrip. No refueling was done at the airstrip. The airfield is an unmanned airfield, with crew executing unmanned airfield communication procedures to execute approach and landings and also during takeoff. There is however a ground time keeper and a fueling bay at the airfield. Due to terrain and prevailing winds at the time of the flight, Runway 28 was in use. The crew was using unmanned airfield procedures and after the drop-off of 6 passengers, the aircraft lined up runway 28 and proceeded with the take off run. Ground staff at the airstrip reported a normal takeoff run and rotation. During the initial climb, the ground staff still had the aircraft in sight and reported to have seen the aircraft veer sharply to the left and then disappear behind terrain. Shortly afterwards, a loud sound was heard followed by dust in the air. Emergency SAR was initiated with the airport and hotel staff rushing to the accident site. The location of the accident was about 310 meters from the threshold of Runway 10, offset 30° to the left of the extended center line Runway 28. GPS coordinates (figure 1.2) 01.084189° S, 35.1781127° E, Ngerende airstrip. The accident occurred at 0917 UTC on 22nd Aug 2012, during daytime.
Probable cause:
The following findings were identified:
- The left engine was most probably not developing power at the time of impact,
- The left engine propeller was most probably in feather at the time of impact,
- Both CVR and FDR were unserviceable at the time of the accident,
- AAID was unable to determine origin of contaminant found in the left engine Fuel Control Unit,
- Sufficient oversight was not exercised over the Operator,
- High turnover of the Operator’s staff.
Final Report:

Crash of an Antonov AN-26-100 in Talodi: 32 killed

Date & Time: Aug 19, 2012 at 0800 LT
Type of aircraft:
Operator:
Registration:
ST-ARL
Flight Type:
Survivors:
No
Site:
Schedule:
Khartoum - Talodi
MSN:
26 06
YOM:
1975
Country:
Region:
Crew on board:
6
Crew fatalities:
Pax on board:
26
Pax fatalities:
Other fatalities:
Total fatalities:
32
Circumstances:
The aircraft was performing a flight from Khartoum to Talodi with a delegation of 26 members of the Sudanese Government, among them several Ministers, Generals and politicians. On approach to Talodi Airport in poor weather conditions due to a sand storm, the crew initiated a go-around procedure when the aircraft impacted the slope of Mt Hagar al Nar (244 metres high) located 1,500 metres south of the airport. The aircraft was destroyed by impact forces and a post crash fire and all 32 occupants were killed.
The official list of the passengers and crew, all of whom died in the crash, is as follows:
Guidance and Religious Endowments Minister Ghazi al-Sadiq Abdel Rahim,
Justice Party chairman Makki Ali Balayil,
State minister at the Youth and Sports Ministry Mahjub Abdel Rahim Tutu,
State minister at the Ministry of Tourism, Antiquities and Wildlife Issa Daifallah,
Maj. Gen. Salah Ismail – Air Forces
Maj. Gen. Ahmed Musa Ahmed – the Police Forces
Maj. Gen. Ahmed Al-Tayeb Abu-Guroon – Security and Intelligence Organ
Brigadier Lugman Omer – Second Commander of the People's Defence Forces
Al-Saddiq Abdul-Majid Al-Makkawi – the People's Defence Forces
Awadal-Karim Siral-Khatim – Deputy Coordinator of the People's Defence Forces
Waeez Salaha Omer – Headquarters of the People's Defence Forces
Omer Mahjoub Ahmed – Deputy Coordinator of the People's Defence Forces
Salah-Eddin Mustafa – People's Defence Forces – Jabal Aulia Locality
Several officials from Khartoum (including Hamid Al-Aghbash – the National Assembly)
Five media representatives
Six crew members.
Probable cause:
Despite the fact that rebels announced officially two days later they shot down the aircraft, the Sudanese Government confirmed that visibility was low at the time of the accident with clouds at low height and poor weather conditions. As a result, officials said the accident was the consequence of a controlled flight into terrain (CFIT) after the crew descended too low on final.

Crash of a Harbin Yunsunji Y-12-II in Nouakchott: 7 killed

Date & Time: Jul 12, 2012 at 0745 LT
Type of aircraft:
Operator:
Registration:
5T-MAE
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Nouakchott - Tasiast
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
5
Pax fatalities:
Other fatalities:
Total fatalities:
7
Circumstances:
The twin engine aircraft was engaged in a special flight to the Tasiast Airstrip deserving the Gold Mine of Tasiast on behalf of the Kinross Gold Corporation. Shortly after take off from Nouakchott, while in initial climb, the aircraft stalled and crashed in a desert area located past the runway end, bursting into flames. All seven occupants were killed and aircraft was destroyed by impact forces and a post crash fire. Both pilots were Mauritanian Customs Officers while among the passengers were three Security Officers of the Kinross Gold Corporation who were in charge to transfer a load of gold back to Nouakchott.

Crash of a Grumman G-159 Gulfstream GI in Pweto

Date & Time: Jun 20, 2012
Type of aircraft:
Registration:
9Q-CIT
Survivors:
Yes
Schedule:
Lubumbashi - Pweto
MSN:
193
YOM:
1968
Location:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
3
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Following an uneventful charter flight from Lubumbashi-Lueno Airport, the crew made a steep approach followed by a hard landing. The aircraft bounced and climbed to a height of about 20 feet, landed again and went out of control. It veered off runway to the left, collided with a rocky embankment, lost its undercarriage and came to rest, broken in several pieces. All five occupants escaped uninjured while the airplane was destroyed.
Probable cause:
Wrong approach configuration after the crew made a sharp turn late on final to join the glide. The rate of descent was excessive during the last segment, causing the aircraft to land hard and to bounce. Due to excessive g-loads and aerodynamic forces, the airplane went out of control.

Crash of a McDonnell Douglas MD-83 in Lagos: 159 killed

Date & Time: Jun 3, 2012 at 1545 LT
Type of aircraft:
Operator:
Registration:
5N-RAM
Survivors:
No
Site:
Schedule:
Abuja - Lagos
MSN:
53019/1783
YOM:
1990
Flight number:
DAV992
Country:
Region:
Crew on board:
6
Crew fatalities:
Pax on board:
147
Pax fatalities:
Other fatalities:
Total fatalities:
159
Captain / Total flying hours:
18116
Captain / Total hours on type:
7466.00
Copilot / Total flying hours:
1143
Copilot / Total hours on type:
808
Aircraft flight hours:
60850
Aircraft flight cycles:
35220
Circumstances:
On 3rd June, 2012 at about 1545:00hrs, 5N-RAM, a Boeing MD-83, a domestic scheduled commercial flight, operated by Dana Airlines (Nig.) Limited as flight 0992 (DANACO 0992), crashed into a densely populated area of Iju-Ishaga, a suburb of Lagos, following engine number 1 loss of power seventeen minutes into the flight and engine number 2 loss of power while on final approach to Murtala Muhammed Airport Lagos, Nigeria. Visual Meteorological Conditions prevailed at the time and the airplane was on an instrument flight plan. All 153 persons onboard the airplane, including the six crew were fatally injured. There were also six confirmed ground fatalities. The airplane was destroyed. There was post impact fire. The flight originated at Abuja (ABV) and the destination was Lagos (LOS). The airplane was on the fourth flight segment of the day, consisting of two round-trips between Lagos and Abuja. The accident occurred during the return leg of the second trip. DANACO 0992 was on final approach to runway 18R at LOS when the crew declared a Mayday call “Dual Engine Failure – negative response from the throttles.” According to records, the flight arrived ABV as Dana Air flight 0993 at about 1350:00hrs and routine turn-around activities were carried out. DANACO 0992 initiated engine start up at 1436:00hrs. Abuja Control Tower cleared the aircraft to taxi to the holding point of runway 04. En-route ATC clearance was passed on to DANACO 0992 on approaching holding point of runway 04. According to the ATC ground recorder transcript, the aircraft was cleared to line-up on runway 04 and wait, but the crew requested for some time before lining-up. DANACO 0992 was airborne at 1458:00hrs after reporting a fuel endurance of 3 hours 30 minutes. The aircraft made contact with Lagos Area Control Centre at 1518:00hrs and reported 1545:00hrs as the estimated time of arrival at LOS at cruising altitude of 26,000 ft. The Cockpit Voice Recorder (CVR) retained about 30 minutes 53 seconds of the flight and started recording at 1513:44hrs by which time the Captain and First Officer (F/O) were in a discussion of a non-normal condition regarding the correlation between the engine throttle setting and an engine power indication. However, they did not voice concerns then that the condition would affect the continuation of the flight. The flight crew continued to monitor the condition and became increasingly concerned as the flight transitioned through the initial descent from cruise altitude at 1522:00hrs and the subsequent approach phase. DANACO 0992 reported passing 18,100ft and 7,700ft, at 1530:00hrs and 1540:00hrs respectively. After receiving radar vectors in heading and altitude from the Controller, the aircraft was issued the final heading to intercept the final approach course for runway 18R. According to CVR transcript, at 1527:30hrs the F/O advised the Captain to use runway 18R for landing and the request was made at 1531:49hrs and subsequently approved by the Radar Controller. The crew accordingly changed the decision height to correspond with runway 18R. At 1531:12hrs, the crew confirmed that there was no throttle response on the left engine and subsequently the Captain took over control as Pilot Flying (PF) at 1531:27hrs. The flight was however continued towards Lagos with no declaration of any distress message. With the confirmation of throttle response on the right engine, the engine anti-ice, ignition and bleed-air were all switched off. At 1532:05hrs, the crew observed the loss of thrust in No.1 Engine of the aircraft. During the period between 1537:00hrs and 1541:00hrs, the flight crew engaged in prelanding tasks including deployment of the slats, and extension of the flaps and landing gears. At 1541:46hrs the First Officer inquired, "both engines coming up?" and the Captain replied “negative” at 1541:48hrs. The flight crew subsequently discussed and agreed to declare an emergency. At 1542:10hrs, DANACO 0992 radioed an emergency distress call indicating "dual engine failure . . . negative response from throttle." At 1542:35hrs, the flight crew lowered the flaps further and continued with the approach and discussed landing alternatively on runway 18L. At 1542:45hrs, the Captain reported the runway in sight and instructed the F/O to retract the flaps and four seconds later to retract the landing gears. At 1543:27hrs, the Captain informed the F/O, "we just lost everything, we lost an engine. I lost both engines". During the next 25 seconds until the end of the CVR recording, the flight crew attempted to recover engine power without reference to any Checklist. The airplane crashed into a densely populated residential area about 5.8 miles north of LOS. The airplane wreckage was approximately on the extended centreline of runway 18R, with the main wreckage concentrated at N 06o 40.310’ E 003o 18.837' coordinates, with elevation of 177ft. During the impact sequence, the airplane struck an uncompleted building, two trees and three other buildings. The wreckage was confined in a small area, with the separated tail section and engines located at the beginning of the debris trail. The airplane was mostly consumed by post crash fire. The tail section, both engines and portions of both wings representing only about 15% of the airplane, were recovered from the accident site for further examination.
Probable cause:
Probable Causal Factors:
1. Engine number 1 lost power seventeen minutes into the flight, and thereafter on final approach, Engine number 2 lost power and failed to respond to throttle movement on demand for increased power to sustain the aircraft in its flight configuration.
2. The inappropriate omission of the use of the Checklist, and the crew’s inability to appreciate the severity of the power-related problem, and their subsequent failure to land at the nearest suitable airfield.
3. Lack of situation awareness, inappropriate decision making, and poor airmanship.

Tear down of the engines showed that the no.1 engine was overhauled in the U.S in August 2011 and was not in compliance with Service Bulletin SB 6452. Both engines had primary and secondary fuel manifold assemblies fractured, cracked, bent, twisted or pinched which led to fuel leaks, fuel discharge to bypass duct, loss of engine thrust and obvious failure of engine responding to
throttle movement. This condition was similar to the no.1 engine of a different Dana Air MD-80, 5N-SAI, that was involved in an incident in October 2013 when the aircraft returned to the departure airport with the engine not responding th throttle movements. This engine also was not in compliance with Service Bulletin SB 6452. This bulletin was issued in 2003 and called for the installation of new secondary fuel manifold assemblies, incorporating tubes fabricated from new material which has a fatigue life that was approximately 2 times greater than the previous tube material.
Final Report:

Crash of a Boeing 727-221F in Accra: 10 killed

Date & Time: Jun 2, 2012 at 1910 LT
Type of aircraft:
Operator:
Registration:
5N-BJN
Flight Type:
Survivors:
Yes
Schedule:
Lagos - Accra
MSN:
22540/1796
YOM:
1982
Flight number:
DHC111
Country:
Region:
Crew on board:
4
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
10
Captain / Total flying hours:
14000
Captain / Total hours on type:
1464.00
Copilot / Total flying hours:
22463
Copilot / Total hours on type:
4180
Aircraft flight hours:
40251
Aircraft flight cycles:
25380
Circumstances:
On 2nd June, 2012 at 1828hrs Allied Air Ltd Flight DHV 111, a Boeing 727-221 Cargo aircraft, Registration: 5N-BJN, departed Murtala Muhammed International Airport, Ikeja, Lagos-Nigeria to Kotoka International Airport, estimating Accra, Ghana at 1904hrs, en-route to Abidjan. While taxiing for take-off, the Flight Engineer observed that the CSD amber light (caution) had illuminated on the panel. With the Captain’s permission, it was disconnected. The flight was cleared Flight Level 240 and to maintain by Accra Area Control on 130.9MHz. The Flight was operating under Instrument Flight Rules (IFR) conditions and the flight was turbulent, the aircraft was cruising at a speed of 280kts which is the recommended turbulence speed. On the descent into Accra, the aircraft was cleared by Accra Approach on 119.5MHz initially to Flight Level 50 and later cleared to 2000ft. It was again instructed to climb to 3000ft due to high ground. On arrival at Accra, the Captain flew an Instrument Landing System (ILS) coupled approach, until he saw the runway. He then disconnected the autopilot at 500ft and manually flew the aircraft. After disconnecting the auto-pilot, he came into heavy IMC conditions in rain. The aircraft experienced an unstable approach at a high speed of 167kts and landed with a wind of 050/15kts at 154 kts and about 5807 ft from Runway 21 in nil visibility. The crew deployed thrust reversers and applied the normal brakes as well as the emergency pneumatic brakes but these actions were ineffective to stop the aircraft. Normally deploying the thrust reversers or applying the brakes would bring the nose wheel down. However, the nose gear was kept up. The speed brakes were not deployed. The crew reported seeing red lights rushing towards them soon after the main wheels touched the ground for the landing run. The aircraft nose gear never touched the ground until the aircraft went over the fence wall. A Lufthansa Flight DLH 566 operated on behalf of Lufthansa (LH) by Private Air which had landed earlier at 1902hrs reported a wind of 050/15kts and visibility of 3800m in rain. From the 2nd intersection where DLH 566 had stopped, ready to backtrack Runway 21, the crew observed Allied Air appeared to have landed at very high speed when the aircraft went past and could not determine whether the aircraft was taking off. A Lufthansa ground engineer who was waiting at the intersection to receive DLH 566 indicated the approximate touchdown point of DHV 111. Both the controller at the Tower and the Marshaller in the “follow me” vehicle waiting at the 1st Intersection saw Allied Air land between the 1st and 2nd intersections. The FDR indicated that the aircraft landed 4000 ft to the end of Runway 21. The full length of Runway 21 is 3403 m (11,162ft for take-off) but available for landing is 2990 m (9,807 ft). The FDR readout showed that the aircraft landed at 150 kts, and at 1.6 G, 5807 ft from the beginning of Runway 21 and 4000ft from the threshold of the Runway 03. The runway surface condition for braking as described by DLH crew was good. Shortly after Turkish Airline (THY 629) had landed, DLH 566 also landed followed by DHV 111. The aircraft over-run the runway and destroyed the Threshold Lights and the Approach lights on Runway 03. It knocked out the ILS Localizer transmitter structure and mounts, broke through the airport perimeter wall. The aircraft crossed Giffard Road, collided with a passenger mini bus killing all ten (10) persons on board. It uprooted a tree by the road side before finally coming to a stop at an open space near El-Wak Sport Stadium. The Emergency Locator Transmitter (ELT) was triggered by the impact. The right side of a taxi cab on the road was grazed by flying debris from the localizer transmitter structures carried along by the right wing of the aircraft. The leading edge of the wing was extensively damaged. The aircraft came to a rest outside the airport perimeter wall 1171 ft (350m) from the Threshold of Runway 03, heading 215° southwest, coordinates 05 35 13.67N 000o 10 29.20W. The four (4) crew members sustained minor injuries. The aircraft and the mini bus were all destroyed. At 1910hrs, RFFS was alerted by the Tower Controller through the crash alarm bell. It took 9 minutes for the firemen to get to the crash site. The Airport was closed for 45minutes during which runway inspection was carried out. No pool of water was found anywhere on the runway. Approximately one hour after the aircraft had over-run the runway, the Airport was re-opened to traffic. Other airlines including KLM and British Airways, landed. Even though the Technical Log Book had no records of deferred defect, the Captain in an interview said the windshield wipers where switched on during the landing phase but were unable to clear the rain. It was observed during the investigation that the windshield wipers were rather ¾ switched on.
Probable cause:
The probable causes of the accident were:
The decision of the Captain to continue with the landing instead of aborting at the missed approach point especially when he could hardly see through the windshield and when he did not know how far he had gone down the runway because of the rain and the tail wind components.
Contributory factors:
a. The Captain disconnected the auto-pilot and flew the aircraft manually in an unstable approach.
b. The Captain landed the aircraft at 4000ft to the threshold of Runway 03, 6060ft from Runway 21. He could not stop within the available distance.
c. The Captain chose to land with a tailwind of 050/15Kts in excess of maximum allowable tailwind of 10Kts.
d. The crew concentrated on tracking the Localizer rather than watching for threshold and runway edge lights. They suffered from fixation.
e. The Captain did not deploy speed brakes on landing.
Final Report: