We are pleased to be able to share the findings from a study carried out in 2024 examining the health of seafarers and their access to healthcare in the cruise and cargo sectors. The research was conducted by Helen Sampson, Iris Acejo, Neil Ellis, and Nelson Turgo from Cardiff University, UK, and supported by Stiftelsen Sveriges Sjömanshus and the Sjöbefälsföreningen. It draws from a mixed-methods approach involving surveys and interviews with seafarers, maritime health professionals, and employer representatives. The study underscores critical differences between the cruise and cargo sectors and identifies systemic barriers to healthcare access.

1.Introduction

Seafaring is an inherently challenging profession, with long periods away from home, confined living conditions, and high physical and psychological demands. The COVID-19 pandemic brought international attention to the vulnerabilities of seafarers, especially regarding access to medical care. This report builds on those concerns to investigate the current state of seafarers’ health, the adequacy of medical support onboard, and the nature of shore-based healthcare access.

2.Key Findings

Health Conditions and Well-being

• Cargo Sector: Seafarers in the cargo sector frequently reported stress, fatigue, and poor mental health. Loneliness, isolation, long working hours, and limited recreational activities contributed significantly to mental strain. Chronic conditions such as hypertension and musculoskeletal disorders were also common.
• Cruise Sector: Cruise sector seafarers had better access to medical staff and onboard facilities but still faced challenges such as overwork, pressure to avoid sick leave, and mental fatigue due to long contracts and lack of privacy.
• Lifestyle Factors: Across both sectors, poor diet, lack of exercise, and sleep disturbances were prevalent. Restrictions due to work schedules and limited port leave often prevented seafarers from maintaining healthy lifestyles.

Onboard Medical Provision

• Cargo Ships: These typically had minimal medical provisions. The responsibility for health care often fell to officers with limited medical training. This led to underreporting of symptoms and self-medication due to lack of confidence in receiving proper treatment.
• Cruise Ships: Cruise vessels were better equipped with medical teams including doctors and nurses. However, high workloads and the perception of medical care as a performance issue often discouraged workers from seeking help.
• Telemedicine: Though available, telemedicine was not universally trusted or used, particularly in the cargo sector. Concerns included data privacy, language barriers, and doubts about effectiveness.

Access to Shore-Based Healthcare

• Shore Leave: Access to shore-based healthcare was inconsistent and often limited by bureaucratic hurdles, costs, and time constraints. In some cases, crew were denied disembarkation for medical treatment due to local regulations or shipping company policies.
• Insurance and Costs: The cost of shore-based medical treatment was a significant barrier, especially for seafarers from lower-income countries. Some reported incurring personal expenses or being denied reimbursement.
• Pandemic Legacy: The pandemic entrenched stricter port controls, which have persisted, further limiting seafarers’ ability to seek treatment ashore.

Cultural and Structural Issues

• Company Culture: Many seafarers feared reporting illness due to potential job loss or contract termination. There was a prevailing belief that medical issues would be interpreted as weakness or incompetence.
• Hierarchies and Discrimination: Rank and nationality played roles in healthcare access. Senior officers and Western nationals reportedly received better treatment and more leniency in accessing medical support.
• Gender: Female seafarers faced additional barriers, including lack of gynaecological care and fears of stigma when seeking medical help. Harassment and isolation further impacted mental well-being.

3.Stakeholder Perspectives

Interviews with employers and healthcare providers revealed gaps in understanding and provision. Employers emphasized operational demands and cost management, while medical professionals pointed to underutilization of services and lack of follow-through on treatments. There was general acknowledgment that seafarers’ health was critical to ship safety and efficiency, but this recognition often failed to translate into improved practices.

4.Recommendations

The report offers several actionable recommendations to improve healthcare access and outcomes for seafarers:

1. Policy and Regulation

• Enforce international standards on medical care at sea.
• Require transparency in how healthcare costs are covered and reimbursed.

2. Medical Staffing

• Mandate qualified medical personnel on all vessels or ensure enhanced telemedical support with standardized protocols.
• Improve training for officers in basic medical care.

3. Mental Health Support

• Integrate psychological support into routine medical assessments.
• Provide confidential mental health services via telemedicine.

4. Equitable Access

• Ensure all crew, regardless of rank, gender, or nationality, receive equal treatment and access to healthcare.
• Develop anti-discrimination policies and ensure enforcement.

5. Onshore Healthcare

• Negotiate port agreements to secure shore access for urgent medical needs.
• Simplify processes for medical disembarkation and treatment.

6. Health Promotion

• Encourage better nutrition, exercise, and sleep habits.
• Provide educational materials and resources to improve health literacy.

5.Conclusion

This report highlights a significant disparity in seafarers’ health experiences between the cruise and cargo sectors. While cruise ships typically offer better onboard medical facilities, structural, cultural, and psychological barriers persist across both sectors. Access to medical treatment—onboard and ashore—is frequently compromised by cost concerns, corporate pressures, and inadequate infrastructure.

Improving seafarers’ health requires a multifaceted approach that includes better training, stronger regulation, cultural change, and investment in health infrastructure. As international trade and tourism continue to depend heavily on maritime labour, ensuring the health and well-being of seafarers is not only a human rights imperative but also an operational necessity.

Cardiff University are hosting a webinar which you can register for here.

Should you wish to find out more about the research. You can also download the report here.