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MH17 About the Investigation MH17 MH17 About the investigation 1 van 99 MH17 About the investigation The Hague, October 2015 The reports issued by the Dutch Safety Board are open to the public. All reports are available on the Safety Board’s website www.safetyboard.nl. Source photo cover: Dutch Safety Board 2 van 99 Dutch Safety Board The aim in the Netherlands is to limit the risk of accidents and incidents as much as possible. If accidents or near accidents nevertheless occur, a thorough investigation into the causes, irrespective of who are to blame, may help to prevent similar problems from occurring in the future. It is important to ensure that the investigation is carried out independently from the parties involved. This is why the Dutch Safety Board itself selects the issues it wishes to investigate, mindful of citizens’ position of dependence with respect to authorities and businesses. In some cases the Dutch Safety Board is required by law to conduct an investigation. Dutch Safety Board Chairman: T.H.J. Joustra E.R. Muller M.B.A. van Asselt Associate members of the Board: B.J.A.M. Welten A.P.J.M. Rutten General Secretary: M. Visser Visiting address: Anna van Saksenlaan 50 Postal address: PO Box 95404 2593 HT The Hague 2509 CK The Hague The Netherlands The Netherlands Telephone: +31 (0)70 333 7000 Fax: +31 (0)70 333 7077 Website: www.safetyboard.nl NB: This report is published in the English and Dutch languages. If there is a difference in interpretation between the English and Dutch versions, the English text will prevail. 3 van 99 CONTENTS Foreword ��������������������������������������������������������������������������������������������������������������� 6 List of Abbreviations��������������������������������������������������������������������������������������������� 8 1 The Dutch Safety Board’s Working Method �������������������������������������������������������10 1.1 Why this report about the investigation? ............................................................. 10 1.2 Which subjects did the investigation look into? ....................................................11 1.3 Legal framework ................................................................................................... 12 1.4 Conducting the investigation ............................................................................... 17 2 Preliminary Report���������������������������������������������������������������������������������������������� 28 2.1 Introduction .......................................................................................................... 28 2.2 Provisions of Annex 13 ......................................................................................... 28 2.3 Publication of the preliminary report ................................................................... 28 2.4 Erratum ................................................................................................................. 29 3 Crash: Causes ������������������������������������������������������������������������������������������������������ 30 3.1 Design of the investigation ��������������������������������������������������������������������������������� 30 3.2 Data collection ..................................................................................................... 30 3.3 Analysis and assessment ...................................................................................... 32 4 Crash: Flight Route ��������������������������������������������������������������������������������������������� 38 4.1 Design of the investigation ���������������������������������������������������������������������������������� 38 4.2 Data collection ..................................................................................................... 39 4.3 Analysis and assessment ...................................................................................... 42 5 Crash: The Occupants ����������������������������������������������������������������������������������������� 44 5.1 Design of the investigation ��������������������������������������������������������������������������������� 44 5.2 Data collection ..................................................................................................... 45 5.3 Analysis and assessment ...................................................................................... 46 6 Passenger Information ���������������������������������������������������������������������������������������� 48 6.1 Design of the investigation ��������������������������������������������������������������������������������� 48 6.2 Data collection ..................................................................................................... 49 6.3 Analysis and assessment ...................................................................................... 51 7 Exceptional Circumstances ����������������������������������������������������������������������������������52 7.1 Visiting the wreckage area and recovery of the wreckage ................................... 52 7.2 Reconstruction of the aeroplane ......................................................................... 58 7.3 International data collection ................................................................................. 59 7.4 Concurrence with the criminal investigation ........................................................ 63 7.5 Classified information .......................................................................................... 65 4 van 99 Statement by the Board ������������������������������������������������������������������������������������������� 68 APPENDICES �������������������������������������������������������������������������������������������������������������69 Appendix A� Project team ���������������������������������������������������������������������������������������70 Appendix B� Notification to the Dutch Safety Board ���������������������������������������������71 Appendix C� Memorandum of Understanding Ukraine-the Netherlands with regard to the delegation of the investigation ���������������������������72 Appendix D� Agreement NBAAI - Dutch Safety Board with regard to the delegation of the investigation �����������������������������������������������74 Appendix E� Confirmation of participation in the investigation by Australia�����������������������������������������������������������������������������������������78 Appendix F� Invitation to the Russian Federation to participate in the investigation ���������������������������������������������������������������������������� 79 Appendix G� Agreements about the recovery of the wreckage ���������������������������� 80 Appendix H� Request with regard to recovery of the wreckage ����������������������������82 Appendix I� Priority list of wreckage pieces ...........................................................83 Appendix J� Request with regard to the removal of the remaining pieces of wreckage ����������������������������������������������������������������������������91 Appendix K� Analysis techniques used������������������������������������������������������������������� 93 Appendix L� Response to the comments of the Russian Federation ����������������������94 5 van 99 FOREWORD Aviation disasters shock the world. In today’s society an incredible amount of information regarding the circumstances, the possible causes and who could be responsible is shared immediately after a crash. This instantly reveals the extent and the impact of the crash to the world, but brings uncertainties with it as well. A thorough investigation determines exactly the causes of a crash, presents the facts and removes the distress of speculations. This can contribute to aviation safety and also provides clarity to the relatives of the victims. The Dutch Safety Board is appointed by law to investigate aviation accidents. Because of the large number of victims with Dutch nationality, the Dutch Safety Board was ready to contribute to the investigation into the crash of flight MH17. Therefore, when Ukraine requested that the Netherlands take over the investigation into the causes of the crash, the answer could only be positive. Right from the start, the investigation applied four principles: maintaining independence; aiming for high quality; focusing on determining the causes as accurately as possible in order to exclude other scenarios; aiming to achieve as much international acknowledgment as possible for the investigation. The investigation was carried out under exceptional circumstances. The Dutch Safety Board was not blind to the geopolitical implications of the crash but in the investigation deliberately kept its distance from international politics. The facts were leading in the investigation and the views of parties were evaluated against those facts, a proven protocol that is used worldwide for aircraft accident investigations under the guidelines of the International Civil Aviation Organization (ICAO). The Dutch Safety Board has endeavoured to complete the investigation in the shortest possible time, without compromising on content quality. Within fifteen months, it has completed the investigation into four different subjects regarding the crash of flight MH17. Immediately after the crash of flight MH17, initiatives were taken at international level to further improve aviation safety, which is a complicated diplomatic process. Now that the recommendations of the Dutch Safety Board are available, they can be included in the initiatives for improvement. The relatives
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