Pakistan International Report: Unstabilized Approach, Poor Communication

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The preliminary report on the PIA Airbus A320 that crashed in Karachi in May reveals a crew that started its approach to landing late, failed to re-extend the landing gear and performed a go-around after dragging the engine nacelles along the runway. The Pakistan aviation board (AAIB) also reveals a series of communication breakdowns between approach and local tower controllers. 

The report, released on Wednesday, confirmed that the A320’s gear was retracted and the flight crew refused two opportunities to maneuver for the purpose of bleeding excess altitude. Flight data released in the interim report confirms the Airbus was excessively high and fast throughout the initial approach. The crew had received a clearance to cross MAKLI intersection at 3000 feet MSL but was, in fact, still at nearly 9800 feet, still traveling at 245 knots indicated airspeed (KIAS). 

Karachi Approach offered the crew the chance to maneuver or orbit to lose altitude, but they declined. Instead, the crew continued the rapid descent and then extended the landing gear at 7221 feet MSL while just 10.5 NM from the airport. They continued the rapid descent, at points exceeding 250 KIAS. 

Airspeed, altitude, and configuration data traces from the PIA’s final moments.

Once reaching glideslope and localizer intercept, the crew raised the gear, retracted the speedbrakes and put out the first increment of flaps, which caused warnings in the cockpit to go off. At 500 feet AGL, the Airbus was traveling at 220 knots indicated airspeed and descending 2,000 feet per minute. The crew continued the approach to landing, eventually touching down on the engine nacelles halfway down the runway. The crew initiated braking and reverse-thrust sequences before initiating a go-around. “Both engines scrubbed the runway at various locations causing damage to both of them,” according to the report. CCTV cameras caught the “aircraft[’s] engines touching the runway and showing sparks due to scrubbing, along with marks on the runway.“

During the first part of the go-around, the report says the flight data recorder noted “a brief action of selection of landing gear lever to down position, which was immediately followed by its movement to up position.” Nevertheless, the Airbus dutifully began its climbout until “both engines failed one by one. Ram Air Turbine (RAT) was deployed to power the essential systems. FDR data recording stopped during this timeframe (as per the designed limitation),” per the report. The aircraft crashed trying to return to the airport with both engines inoperative, killing 97 of the 99 aboard.

Complicating matters was a lack of communication throughout the landing sequence. The flight was still communicating with Karachi Approach, which was coordinating with the tower via telephone. The landing clearance was given from the tower and conveyed to the flight through approach. When the tower controllers noticed the Airbus scraping the runway, they did not attempt to alert the aircraft but instead told Karachi Approach, which did not tell the crew.

In a separate report, the Pakistani minister for civil aviation, Ghulam Sarwar Khan, reported that the crew was discussing the coronavirus situation during the descent and landing. “The pilots and the air traffic controllers both did not follow the protocol,” he said. “The pilot ignored the instructions of the air traffic controllers and the ATC, on the other hand, did not inform the pilot about the engines’ collision. The fault was at both ends. The ATC was at fault as well when it saw the plane doing the touchdown on the engines and saw a fire erupting, it should have informed [the pilot] but the control tower did not. And when the pilot took off, both the engines were damaged by that time,” the minister said.

The report ends with a “way forward” section that indicates “… further course of investigation process may include (but not limited to) advance analysis of FDR and CVR, related advanced technical analysis of aircraft / engine components, exploration for reasons and causes of the anomalies discovered so far, and also of any further shortcomings that may be revealed during later part of the investigation. This may encompass conduct of various activities at AAIB, and deep interaction / visits to relevant organizations to ascertain possible causes and identify proportionate safety recommendations.”

Finally, as Sarwar was addressing the Pakistani National Assembly, he claimed that nearly 40 percent of the country’s pilots have “fake” licenses. “Pakistan has 860 active pilots, which includes PIA, Serene Air, Air Blue. The inquiry which was initiated in February 2019 showed that 262 pilots did not give the exam themselves and asked someone else to give it on their behalf,” the minister said. ”Pilots are also appointed on political basis, unfortunately. Whilst appointing pilots, merit is ignored.”

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24 COMMENTS

  1. How anyone at ATC can be blamed for this is incompressible, particularly when the crew had written ATC off and communications between tower and approach were being relayed. If the data in this report is correct, this approach was so extremely unstable as to be a totally unrecognizable maneuver. The most damning statement in the above report and which says all that ultimately needs to be known is this: “Pilots are also appointed on political basis, unfortunately. Whilst appointing pilots, merit is ignored.”

  2. Wow. I would say that the primary blame for this fiasco is the govermnet that apparently has tolerated a system so screwed up that it almost defies description. Blaming the pilots is easy, but almost like blaming a toddler for getting into medicines that the parent left lying around within its reach.

    • Exactly. And despite what plenty of people might think, that is not letting the pilots off the hook. Our current levels of airline transport safety exist because we learned that errors and intentional violations exist within a bigger picture. This crash and loss of life was the result of many bad decisions, only some of them made in the cockpit that day.

  3. This accident chain of events is beyond unbelievable! You put the gear down and deploy the boards because you are high and fast, then intercept the glide-slope and retract the gear and speed brakes but lower the flaps? Then actually touch down on the engine nacelles, apply brakes, and thrust reversers…drop the gear handle then flip it back up, apply the coals, and take off again!!!!

    What in the world could have the tower operators done other than notify the crew on short final that the gear was up ( assuming they were looking at the aircraft at all) and then what???? Alert them that there was a massive shower of sparks half way down the runway as if that notification was going to affect the crews decision not to power back up???? You can see in the pictures the nose of the airplane almost touch the pavement as the engines hit the ground and the airplane was decelerating. The crew was quite aware they had landed gear up. The tower did alert approach…as if the shower of sparks and sudden deceleration event was not known to the crew…but approach didn’t say a word…as if their notification was going to change the bizarre decision making of this rogue crew either.

    If there are any remains of the pilots, they need to do a toxicology investigation. They had to be on some drug binge to do what they did. I am sure the CVR tapes are quite revealing recording all the bells and whistles going off plus the conversation of the crew. We don’t know a half of all the data that is available.

    “Pakistan has 860 active pilots, which includes PIA, Serene Air, Air Blue. The inquiry which was initiated in February 2019 showed that 262 pilots did not give the exam themselves and asked someone else to give it on their behalf,” the minister said. ”Pilots are also appointed on political basis, unfortunately. Whilst appointing pilots, merit is ignored.” I am assuming his statement was saying there are few if any check-rides. And if there are, they are doing them themselves??? Pilots are appointed on a political basis??? Am I living in the 21st century or is this a bad aeronautical dream??? This is absolutely mind blowing!

    The junkyard dog lawyers have had a huge piece of rotted meat thrown at them.

  4. Gentlemen commenting: welcome to aviation in a large portion of the world that does not include the US, Canada, Europe, and Japan. You have little concept of how bad it can be out there. There are a myriad of stories that would curl your hair and more get added every day. Using substitute “test takers” is not uncommon at all and that includes check rides.
    As to the “junkyard dog lawyers”… in the developed world, true, in that little corner of legal limbo… not so much. Common practice is to pay families a little blood money and it all goes away.

  5. The Third World culture that encourages this…no permits this…actually…requires this…never changing, never will. It’s not their job, but the manufacturers need a flight crew evaluation staff to approve pilot training standards before a sale of one of their aircraft to these countries.

    • Manufacturers tend to prioritize sales over everything else. Authorities are there to certify compliance and keep all parties in check, including foreign entities. Unfortunately authorities prefer the easy life of accepting lies. If you don’t cultivate third world, the third world cultivates you.

  6. This is criminal negligence on many levels. It makes me wonder if the 737 Max deserves the reputation it got, considering both crashes occurred with mid-East airlines. What training deficits did those crews have? Just saying.

  7. As a retired senior 747-4 Captain and Check Pilot, the cause of this accident clearly indicates a culture reflecting total lack of professional overview not only related to PIA but to a non-existent safety board like the FAA. Riding in cockpits worldwide for over 35 yrs, I witnessed first hand many instances of poor cockpit leadership resource management however this one trumps all in abandonment of every pilot skill one expects on a commercial flight. The myriad red flags seen in this approach and landing are terrifying in scope to ANY pilot. Hopefully Pakistan learns from this totally avoidable accident and revamps procedures, training, qualifications and overview from ground up. Till then, you’ll not see me risking life or limb with PIA.