The two conditions for carrying a doctor and the free reach of radio medical advice (MLC Regulation 4.1)

Whether a ship has to carry a doctor, and who fills that position if it does not. MLC, 2006 Standard A4.1 answers with conditions. Two of them have to apply together before a doctor is required; where they do not, substitute requirements open. And either way there is one more layer underneath, coming from outside the ship.

The cost, as a rule, does not fall on the seafarer

(d) ensure that, to the extent consistent with the Member’s national law and practice, medical care and health protection services while a seafarer is on board ship or landed in a foreign port are provided free of charge to seafarers; and

Free of charge reaches two places: while on board, and while landed in a foreign port. What falls inside is treatment received in a foreign port during the voyage, not general treatment after signing off.

The benchmark is in the provision too. A level as comparable as possible to what is generally available to workers ashore. Paragraph 1 writes essential dental care into that scope. And it is not limited to treating the sick or injured: preventive measures such as health promotion and health education programmes are inside it.

There is also a right to visit a qualified medical doctor or dentist without delay in ports of call. That one carries where practicable.

A doctor becomes mandatory where two conditions overlap

(b) ships carrying 100 or more persons and ordinarily engaged on international voyages of more than three days’ duration shall carry a qualified medical doctor who is responsible for providing medical care;

The two conditions are joined by and: 100 or more persons on board, and ordinarily engaged on international voyages of more than three days’ duration. One alone does not trigger the subparagraph.

That is not the end of it. The same subparagraph hands to flag State law the question of which other ships have to carry a doctor, listing the duration, nature and conditions of the voyage and the number of seafarers on board among the factors. The figure of 100 is a floor, not the whole of the judgement.

Ships without a doctor have two substitute routes

Who is on board	Training required
At least one seafarer in charge of medical care and administering medicine as part of regular duties	Satisfactorily completed training in medical care meeting STCW requirements
At least one seafarer competent to provide medical first aid	Satisfactorily completed training in medical first aid meeting STCW requirements

Which level is required is set by flag State law. The factors here are the same: the duration, nature and conditions of the voyage, and the number of seafarers on board.

All ships carry a medicine chest, medical equipment and a medical guide. The specifics are prescribed by the competent authority and are subject to regular inspection.

Radio medical advice is free regardless of flag

(d) the competent authority shall ensure by a prearranged system that medical advice by radio or satellite communication to ships at sea, including specialist advice, is available 24 hours a day; medical advice, including the onward transmission of medical messages by radio or satellite communication between a ship and those ashore giving the advice, shall be available free of charge to all ships irrespective of the flag that they fly.

This subparagraph points the other way. Where the preceding ones make demands of that flag State’s ships, this one reads all ships irrespective of the flag that they fly. A ship of any flag has to be able to get it free of charge.

Two more things attach. It has to be available 24 hours a day, and specialist advice is included. What is free covers not only the advice itself but the onward transmission of medical messages between the ship and those ashore giving it.

A confidentiality condition attaches to the medical record

2. The competent authority shall adopt a standard medical report form for use by the ships’ masters and relevant onshore and on-board medical personnel. The form, when completed, and its contents shall be kept confidential and shall only be used to facilitate the treatment of seafarers.

The competent authority adopts the form; masters and relevant onshore and on-board medical personnel use it. The completed form and its contents are kept confidential and are used only to facilitate the treatment of seafarers. The purpose is limited inside the provision.

Death during a voyage puts the repatriation of remains on a named State

6. Where a seafarer has died during a ship’s voyage, the Member in whose territory the death has occurred or, where the death has occurred on the high seas, into whose territorial waters the ship next enters, shall facilitate the repatriation of the body or ashes by the shipowner, in accordance with the wishes of the seafarer or their next of kin, as appropriate.

The responsible State is identified two ways: the Member in whose territory the death occurred, or, for a death on the high seas, the Member into whose territorial waters the ship next enters. The repatriation is carried out by the shipowner and that State facilitates it. Body or ashes follows the wishes of the seafarer or their next of kin.

Worth confirming

The passages above come from printed pages 58 to 60 of the consolidated MLC, 2006 (including the 2022 amendments). The contents of the medicine chest, the level of training, and which other ships have to carry a doctor are set by flag State law. Whether the number on board and the voyage duration bring that ship inside the two conditions, whether the training certificate of the seafarer in charge of medical care is live, and whether the contact route for radio medical advice is posted on board are where the actual judgement starts.