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ILO/IMO Framework on Medical Examination for Seafarer
Th e MLC, 2006, and the STCW Convention, 1978, as amended, require a medical certifi cate for seafarers for the safe operation of the ship as well as to safeguard their personal health and safety. The author enunciates disseminating these guidelines and ensuring their implementation should contribute towards harmonising the standards for medical examinations of seafarers and improving the quality and effectiveness of the medical care provided to seafarers.

Seafarers are required to undergo medical examinations to reduce risks to other crew members and for the safe operation of the ship, as well as to safeguard their personal health and safety.

Purpose and Scope of the Guidelines
The MLC, 2006, and the STCW Convention, 1978, as amended, require a seafarer to hold a medical certificate, detail the information to be recorded and indicate certain specific aspects of fitness that need to be assessed.

These Guidelines apply to seafarers in accordance with the requirements of the MLC, 2006, and the STCW Convention, 1978, as amended. They revise and replace the Guidelines for Conducting Pre-sea and Periodic Medical Fitness Examinations for Seafarers, published by the ILO and WHO in 1997.

When implementing and utilising these guidelines, it is essential to ensure that:

(i) The fundamental rights, protections, principles, and employment and social rights outlined in Articles III and IV of the MLC, 2006, are respected;
(ii) From the point of view of safety of life and property at sea and the protection of the marine environment, seafarers on board ships are qualifi ed and fi t for their duties; and
(iii) Medical certifi cates genuinely refl ect seafarers’ state of health, in light of the duties they are to perform, the competent authority shall, after consultation with the ship owners’ and seafarers' organisations concerned, in giving due consideration to applicable international guidelines referred to in Guideline B.1.2 of the MLC, 2006, prescribe the nature of the medical examination and certifi cate, as outlined in Standard A.1.2.2 of the MLC, 2006.

These Guidelines are intended to provide maritime administrations with an internationally recognised set of criteria for use by competent authorities either directly or as the basis for framing national medical examination standards that will be compatible with international requirements. Valid and consistent guidelines should assist medical practitioners, ship owners, seafarers’ representatives, seafarers and other relevant persons with the conduct of medical fitness examinations of serving seafarers and seafarer candidates. Their purpose is to help administrations establish criteria that will lead to equitable decisions about who can safely and effectively perform their routine and emergency duties at sea, provided these are compatible with their individual health-related capabilities.

These guidelines have been developed in order to reduce the differences in the application of medical requirements and examination procedures and to ensure that the medical certificates, which are issued to seafarers are a valid indicator of their medical fitness for the duties they will perform. Ultimately, the aim of the Guidelines is to contribute to health and safety at sea.

A medical certificate issued in accordance with the requirements of the STCW Convention, 1978, as amended, also meets the requirements of the MLC, 2006.

Contents and Use of the Guidelines

The guidelines are arranged in the following manner:
Part 1 summarises the purpose and scope of the guidelines, their contents and the background to their preparation, and identifies the main features of a framework for medical examinations and the issue of a medical certificate to a seafarer.

Part 2 provides information relevant to competent authorities to assist with the framing of national regulations that will be compatible with relevant international instruments on the health and fitness of seafarers.

Part 3 provides information relevant to those who are carrying out seafarer medical assessments. This may be used directly or may form the basis for national guidelines for medical practitioners.

Part 4 includes a series of appendices on standards for different types of impairing conditions, recordkeeping and the contents of the medical certificate.

Some parts of the guidelines are more appropriate for competent authorities than for individual medical practitioners, and vice versa. Nevertheless, it is suggested that the whole of the guidelines be taken into consideration to ensure that all topics and information are taken into account. The guidelines are designed as a tool to enhance medical examinations and make them more consistent; they cannot and are not intended to replace the professional skill and judgment of recognised medical practitioners.

Background to the Preparation of the Guidelines
In 1997, the ILO and WHO published the first international guidelines concerning the medical examinations of seafarers. This has been an invaluable document for maritime authorities, the social partners in the shipping industry and the medical practitioners who conduct medical examinations of seafarers. Since 1997 there have been important changes in the diagnosis, treatment and prognosis of many of the medical conditions that need to be taken into account. The 1997 guidelines provided detailed information on the conduct of seafarer medical examinations but they did not, with the exception of vision, assist by proposing the appropriate criteria to be used when deciding whether a medical certificate could be issued for other conditions.

The need for revision was recognised by a number of maritime authorities, by the social partners and by doctors undertaking seafarer medical examinations. This led to a resolution being adopted by the 94th (Maritime) session of the International Labour Conference in 2006 recommending that the need for revision should be considered. The IMO, in its comprehensive review of the 1978 STCW Convention and Code, also recognised the need to include medical fitness criteria that were relevant to maritime safety, and concluded that the present Guidelines required revision.

The ILO and the IMO subsequently agreed to create a joint working group to develop revised guidelines.

Seafarer Medical Fitness Examinations
The aim of the medical examination is to ensure that the seafarer being examined is medically fit to perform his or her routine and emergency duties at sea and is not suffering from any medical condition likely to be aggravated by service at sea, to render him or her unfit for service or to endanger the health of other persons on board. Wherever possible, any conditions found should be treated prior to returning to work at sea so that the full range of routine and emergency duties can be undertaken. If this is not possible, the abilities of the seafarer should be assessed in relation to his or her routine and emergency duties and recommendations made on what the seafarer is able to do and whether any reasonable adjustment could enable him or her to work effectively. In some cases, problems will be identified that are incompatible with duties at sea and cannot be remedied. Appendices A-E provide information on the disabilities and medical conditions which are not likely to prevent all routine and emergency duties being performed, those which require adaptation or limitation to routine and emergency duties, and those which result in either short-term or longer term unfitness to work at sea.

Medical examination findings are used to decide whether to issue a medical certificate to a seafarer. Consistent decision-making needs to be based on the application of criteria for fitness that are applied in a uniform way, both nationally and, because of the global nature of seafaring and marine transport, internationally. These Guidelines provide the basis for establishing national arrangements which are complaint with the relevant international Conventions.

The medical certificate is neither a certificate of general health nor a certification of the absence of illness. It is a confirmation that the seafarer is expected to be able to meet the minimum requirement s for performing the routine and emergency duties specific to their post at sea safely and effectively during the period of validity of the medical certificate. Hence, the routine and emergency duties must be known to the examining medical practitioner, who will have to establish, using clinical skill, whether the seafarer meets the standards for all anticipated routine and emergency duties specific to their individual post and whether any routine or emergency duties need to be modified to enable them to be performed safely and effectively.

The ability to safely and effectively perform routine and emergency duties depends on both a person’s current degree of fitness and on the likelihood that they will develop an impairing condition during the validity period of the medical certificate. Criteria for performing routine and emergency duties safely will be higher where the person has critical safety consequences also need to be considered, for instance whether a seafarer is suffering from medical condition likely to be aggravated by service at sea, to render the seafarer unfit for such service, or to endanger the health and safety of other persons on board. The examining medical practitioner, should base the decision to issue a medical certificate on whether criteria for minimum performance requirements, as listed in the appendices to this document, are met in the following areas:

(i) Vision (Appendix A), hearing (Appendix B) and physical capabilities (Appendix C);
(ii) Impairment from the use of medication (Appendix D);
(iii) Presence or recent history of an illness or condition (Appendix E).

The consequences of impairment or illness will depend on the routine and emergency duties and, in some cases, on the distance from shore- based medical facilities.

Thus, the examining medical practitioner needs the skills to assess individual fitness in all these areas and the knowledge to relate their findings to the requirements of the individual’s routine and emergency duties at sea whenever any limitations in fitness are identified.

Competent authorities may, without prejudice to the safety of the seafarers or the ship, differentiate between those persons seeking to start a career at sea and those seafarers already serving at sea and between different functions on board, bearing in mind the different duties of seafarers.