The maritime industry has spent decades building safety cultures around preventing operational accidents - falls, machinery injuries, man overboard incidents. Britannia P&I Club's analysis of nearly 3,000 crew-related claims suggests the industry may be concentrating its attention on the wrong risk.
Eighty-one percent of crew fatalities reported to Britannia during the 2023/24 and 2024/25 policy years were caused by illness rather than accidents. Cardiovascular conditions alone accounted for 58% of illness-related deaths - making them the single largest cause of crew fatalities in the dataset, and one with no direct connection to onboard operational practice.
The Club's Crew Claims Report was developed with maritime medical specialist Katherine Sinclaire of MedSea.
Britannia's findings are not an outlier. Gard's own 2024 Crew Claims Report found 74% of registered fatalities were due to illness, a proportion Gard noted correlates closely with World Health Organization data showing that non-communicable diseases - led by cardiovascular disease - cause 74% of all deaths globally. Market-wide analysis of the P&I sector has separately noted that suicide remains the leading single cause of death at sea across the wider International Group, reinforcing that illness and mental health dominate the crew fatality picture across the sector, not just at any single club.
Britannia's report identified a distinct and concerning pattern among younger crew. Suicides and incidents of seafarers missing at sea disproportionately affected this group during the claims period.
The Club was careful to note that the absolute number of cases involved remains relatively small. But it also noted that a similar pattern has emerged across a broader four-year dataset, which means the concentration of mental health risk among younger seafarers is not a single-year fluctuation. It reinforces the case for targeted intervention aimed specifically at this cohort rather than age-blind mental health provision applied uniformly across a vessel's crew.
The report draws a clear distinction between what drives claims volume overall and what drives fatalities specifically.
Illness accounted for 60% of all crew claims, compared with 36% for injuries and 4% for fatalities - meaning the vast majority of illness claims involve non-fatal conditions that never escalate to a life-threatening outcome. Hand and finger injuries remained the most common onboard injury type at 27% of injury claims, illustrating that the most frequent operational risk is not the most dangerous one.
Among injury-related fatalities specifically, more than a third involved man overboard incidents - a comparatively rare event type that nonetheless carries a disproportionately high fatality rate once it occurs. On the illness side, abdominal conditions were the largest category of illness claims overall, with dehydration-linked kidney stones flagged as a notable preventable concern for seafarers working in hot environments.
Jacob Damgaard, head of loss prevention at Britannia P&I Club, said maritime safety is often viewed through the lens of accidents and operational incidents, but the Club's claims analysis reveals a different reality. With the majority of crew fatalities linked to illness - particularly cardiovascular disease - he said the findings point to the need for a broader approach to crew welfare centred on long-term health and prevention.
Damgaard said the findings on younger seafarers and mental wellbeing are a reminder that protecting crews requires attention to psychological and personal challenges, not just physical safety. He said Britannia's focus is on helping members move beyond compliance toward a proactive safety culture where prevention is embedded into everyday operations, and that sharing lessons from claims data is intended to help shipowners and crews reduce risk and prevent avoidable harm.
Practical recommendations in the report address both dimensions: effective risk assessment, safe manual handling, consistent personal protective equipment use and strong communication for the operational injury risks the data does identify, alongside cardiovascular screening, hydration protocols and mental health support programmes for the illness and wellbeing risks that the data shows are responsible for the majority of fatalities.
A seafarer's cardiovascular health is built up or eroded over months and years at sea. A younger crew member's psychological state requires sustained monitoring and support rather than a one-off briefing or a poster on the mess room wall. Neither responds to the kind of safety intervention that decades of onboard safety culture has been designed to deliver.
Britannia's analysis, echoed by Gard's comparable findings, does not argue that operational safety culture has been wasted effort. Falls, machinery injuries and man overboard incidents are real, they carry a high fatality rate when they occur, and effective risk management reduces them. What the data argues is that the same rigour applied to operational safety needs to be applied to the slower, less visible risks that account for eight in ten of the deaths a P&I club is actually registering.
