B.7.1 Introduction 

Common interest groups in the maritime sector find benefits in collaborating across international boundaries. Representative organisations usually bring such interests together and participate in discussions with international agencies and with maritime authorities. The most clearly formalised of these arrangements is the tripartite basis for the International Labour Organisation ILO, where, alongside governmental agencies, employers and employees are represented by their respective international organisations (see below) and are commonly termed ‘the social partners’.

The social partners are just one example of a wide range of interest groups who are in contact with their constituents, around the world and who play an important part in improving the standards and efficiency of maritime businesses and in safeguarding the health, safety and welfare of those who work in them. There are hundreds of maritime organisations of this sort. Those directly relevant to maritime health are described here. Others, which have an interface with maritime health, are listed.

In most cases, international collaborative bodies are federations of national organisations that represent their members’ interests at the national level. A few exist solely as international associations with direct membership rather than a federated approach.

B.7.2 Employers - The International Chamber of Shipping (ICS)

The ICS, that also operates as the International Shipping Federation when acting on seafarer employment related topics, is a federation of the national shipping employers’ associations worldwide.[1] Its members also include organisations that represent specific sectors of the industry, such as cruise liners and tankers. It has a formal role at ILO as one of the social partners and is active in discussions at the International Maritime Organisation (IMO) and other international forums. It lobbies on behalf of its members’ but does so with a view to ensuring that their reasonable concerns are met, without compromising and, where possible, by improving standards of shipping for the benefits of users, employees and the environment. It also, as the Federation, negotiates on behalf of employers about the wages of seafarers.

 Specialist employer organisations that play an active role on health matters include:

  • Intermanager – ship management companies on the provision of medical care and medical aspects of crewing in managed ships[2]
  • Intertanko – independent tanker operators[3]
  • OCIMF – Oil Companies International Marine Forum.[4] Intertanko and OCIMF are both active on safety and health aspects of bulk liquid cargo transport.
  • CLIA – Cruise Lines Industry Association[5] on health and medical care for passengers and crew on board cruise ships.

B.7.3 Seafarers – The International Transport Federation (ITF) 

ITF is a federation of affiliated national trade unions.[6] Its representative role extends beyond seafarers to include dockworkers and those employed in other modes of transport such as road, rail and air. For seafarers it acts as their representative as a social partner at ILO and is active at IMO and in other international forums. It also plays a major role in giving advice to member unions and runs international inspection and advisory services to ensure that employers, port authorities and others do not compromise the rights or employment contracts of seafarers. It has campaigned over the years on subjects such as the abuse to seafarers and lack of union recognition on ships flagged to open registries, the so called flags of convenience. It has also been running campaigns on health and welfare issues, such as HIV/AIDs. In this particular case it has campaigned for  both prevention and about minimising the stigma attached to the condition.

ITF is also host to and provides the funding for the independent charity ITF Seafarers’ Trust.[7] This charity provides funding and other forms of support for initiatives aimed at improving the health and welfare of seafarers worldwide.

B.7.4 Insurers 

In past centuries the shipping industry has played a major role in the development of modern insurance as a way of pooling risk across a number of ship owners. This in turn led to the industry developing methods for classifying the risks of particular ship types, cargoes and liabilities. Marine insurance still has three main branches:

  • Hull and machinery insurance, for the ship itself and risks of loss or damage
  • Cargo insurance, for the cargo on board
  • Liability for crew and other third party risks. This insurance covers the health care cost of seafarers and so is directly relevant to maritime health.

B.7.5 P&I (Protection and Indemnity) Clubs 


A P&I Club is an independent, non-profit making, mutual insurance association, providing cover for its ship owner and charterer members against third party liabilities. The fundamental difference between mutual and other types of insurance company is that a mutual is not trying to make a profit, has no shareholders and exists purely for the benefit of the insured ship owner. Mutual insurance is a collective self-insurance that operates at cost.

Under the idea of mutualism, various ship owners pool their resources together in order to meet losses suffered by each individual ship owner who is a member of the same mutual insurance.

The basic principle is that the contributions/mutual premium paid by the ship owners in relation to any one year should be sufficient to meet all the claims, reinsurance and administrative expenses of the P&I-Club for that year. Policy years run from 20 February to 20 February, rather than the calendar year, as that was the traditional date for the opening of the commercial shipping lanes in the Baltic Sea.

A ship owner / shipping company insured with a P&I-Club is called a ‘Member’ and the premium paid by a Member is a ‘Call’.  If there is a shortfall because claims are high, the Members may pay a pro rata ‘additional call’,  also called ‘back call’. If there is a surplus, a return may be made to the Membership, or the surplus transferred to reserve to meet losses on other years. The funds of the mutual are invested and the investment return is used to benefit the Members. The Members are both the insurer and the insured. Note that seafarers are ‘third parties’ in this relationship and any costs that arise from their medical care are liabilities that the members of the club are obliged to pay for.

The term ‘Club’ is used because ship owners decided to join forces and form a well-defined group that would pool liability costs. Each club is controlled by its members through a board of directors or a committee, elected from the membership.  A management company, often originating from a law firm, carries out the day to day management of the Club, handling of the claims, investment and administration etc.


History of P&I Clubs

In the mid-18th century, ship-owners could insure their vessels with two hull insurance companies or Lloyds.  At that time, there was no perceived need for liability insurance as ship-owners' exposure to third party claims was negligible. However, legal developments during the latter half of the 19th century resulted in a significant increase in ship-owners liabilities and the need for additional and specific insurance was generally acknowledged. The first liability insurance club was founded in 1855 as an offshoot of a mutual hull insurance club, and others quickly followed. The clubs started their activities by insuring against liability for collisions and damage to fixed objects, such as docks, which were excluded from the hull cover. This cover was called ‘protection’ insurance. The introduction of statutory liability for loss of life and injury to passengers gave rise to a new liability that was covered by the establishment of mutual ‘indemnity’ arrangements. At that time, liability for cargo could still be avoided by appropriate exemption clauses in contracts of carriage. However, further legal developments in the late 19th century resulted in ship-owners facing cargo claims, notwithstanding the terms of the contracts of carriage, and in 1874 the ‘Indemnity Clubs’ started to insure liabilities for loss of or damage to cargo. Fusion of the functions of the ‘Protection’ and ‘Indemnity’ mutual associations gave rise to the ‘Protection & Indemnity Clubs’, which have continued to adapt their cover to the developing requirements of the shipping industry. 

The P&I Clubs today

P&I Clubs cover a wide range of liabilities including:

  • Personal injury to, illness or death of crew, passengers and others on board,
  • Cargo loss and damage,
  • Oil pollution,
  • Wreck removal
  • Collision damage
  • Dock damage.

Ship owners usually have to pay out first and then reclaim from their Club. There is normally an agreed ‘deductible’, that is the ship operator agrees to pay a fixed sum themselves, with the Club meeting costs in excess of this.

Cover is available only for those risks that are regularly and commonly encountered by the majority of the membership since these are the risks that each Member has agreed to share. Liability in respect of these risks is normally unavoidable under the provisions of international or national laws or commercial risks that Members are unable to avoid contractually. Members are also expected and required to make full use of whatever legal rights they may have to exclude or limit their liability in order to protect the common funds of the Club. In other words, there is a duty to mitigate loss, including medical costs and expenses for crew, passengers and others. With regard to people, the cover responds to a complicated web of legislative, contractual and tort-based liabilities in which the Member requires the assistance of the Club to manage events that are unfolding at sea, in ports, clinics and hospitals around the world. Further information on liability is available in Ch xxx.

Clubs also provide a wide range of services to their members on claims, legal issues and loss prevention, and often play a leading role in the management of casualties. The Clubs impose standards of seaworthiness on the vessels insured and require that they fully comply with the requirements of their flag state. Many specify their own standards for medical fitness to work at sea, with the aim of reducing the crew liabilities arising from illness on board. Further information is available in Ch xxx. The Clubs have their own inspectors to confirm compliance with these requirements. They also have worldwide networks of correspondents who deal with local aspects of claim handling.

The International Group of P&I Clubs

Approximately 90% of the world's ocean-going merchant tonnage is covered by the 13 P&I Clubs and their affiliates who make up the International Group of P&I Clubs.[8]

These 13 Clubs are based variously in the United Kingdom, Scandinavia, Bermuda, Luxembourg, the United States and Japan. There are, in addition, a number of small independent Clubs, as well as some P&I facilities in the commercial market. The International Group of P&I Clubs is a ‘Club of Clubs’ which exists to

·      provide a forum for discussion of legal and technical issues affecting the member Clubs

·      provide a mutual reinsurance scheme for the member Clubs through the International Group Pool and its associated Excess Loss Reinsurance contracts,

·      monitor the transfer of business between member Clubs under the terms of the International Group Agreement.

It also acts from time to time as a lobbying organization in relation to the development of maritime law and practice internationally.

The 13 members of the International Group of P&I Clubs are:

1.     American Club

2.     Assuranceforeningen Gard  with its subsidiary Gard P&I (Bermuda) Ltd.

3.     Assuranceforeningen Skuld with its subsidiary Skuld Mutual Protection and Indemnity Association (Bermuda) Ltd.

4.     The Britannia Steam Ship Insurance Association Limited

5.     The Japan Ship Owners' Mutual Protection & Indemnity Association

6.     The London Steam-Ship Owners' Mutual Insurance Association Limited

7.     The North of England Protecting & Indemnity Association Limited

8.     The Shipowners' Mutual Protection & Indemnity Association (Luxembourg)

9.     The Standard Steamship Owners’ Protection & Indemnity Association (Bermuda) Limited with its subsidiaries :

a.     The Standard Steamship Owners’ Protection and Indemnity Association (Europe) Ltd.,

b.     The Standard Steamship Owners’ Protection and Indemnity Association (London) Ltd.

c.     The Standard Steamship Owners’ Protection and Indemnity Association (Asia) Ltd. A reinsured subsidiary association

10.  The Steamship Mutual Underwriting Association (Bermuda) Limited with its subsidiary The Steamship Mutual Underwriting Association Ltd.

11.  The Swedish Club

12.  United Kingdom Mutual Steam Ship Assurance Association (Bermuda) Limited with its subsidiary  United Kingdom Mutual Steam Ship Assurance Association (Europe) Ltd.

13. West P&I Club


What is covered?

A P&I Club will compensate a Member for the costs the insured has incurred, such as:

  • Medical costs, hospitalization, incidental expenses such as food and accommodation and other costs related to injury to or illness of a seafarer.
  • Costs and expenses for the repatriation of a seafarer and his personal belongings.
  • Costs for a funeral and other costs related to the death of a seafarer or the costs and expenses of the repatriation of the remains (coffin/urn) and personal effects.
  • Costs and expenses for sending a substitute to replace the repatriated or dead seafarer or a seafarer who has to be left behind for ongoing care.
  • The payment of compensation or damages related to the injury, illness or death of a seafarer.
  • The payment of wages of an injured, ill seafaerer.
  • Costs related to the loss or damage to personal effects of a seafarer.

Settlement of such claims can sometimes be slow and involve legal disputes. This can have adverse effects on the rehabilitation and return to work of the seafarer, leading to hardship for the crewmember and their dependents.

B.7.6 Professional Bodies

A wide range of professionals work with the maritime sector and many of these have their own organisations to represent them in international forums, as well as often playing a part in training, professional development and networking. Among those professions specific to the sector examples include:

  • International Federation of Ship Masters Association[9]
  • International Maritime Pilots Association[10]
  • The Institute of Marine Engineering, Science and Technology[11]
  • The Nautical Institute[12]

Other organisations represent professions, some of whose members work in the maritime sector, for example, the International Maritime Health Association (IMHA).

International Maritime Health Association (IMHA)

IMHA is a membership organisation for health professionals, mainly medical doctors.[13] It actively works with other international organisations to improve the standards and consistency of maritime health practice. Like most other professional associations it also plays an important role in providing support for its members and opportunities to network and exchange information on best practice.  Again, like most other professional groups it represents a diversity of interests, from academics and government, industry and trade union advisers to commercial maritime health clinic managers and staff.

International Maritime Health Foundation (IMHF)

The IMHF is a non-profit scientific foundation that was registered in Poland in 2018 (see https://www.imhf.pl ). Its primary purpose is to disseminate scientific knowledge on maritime health and related fields. The principle means for doing so is by supporting the scientific journal International Maritime Health in collaboration with partner organisations. The Foundation provides oversight and financing for the journal and it also hosts an Expert Panel of maritime health professionals. With the help of the panel the Foundation organises expert workshops on current issues in maritime health. It also seeks to raise awareness about good practice and to encourage scientific investigations on maritime health risk and their prevention.

B.7.7 Seafarer Welfare Organisations 

The International Seafarers’ Welfare and Assistance Network (ISWAN) acts as a forum for a range of bodies concerned with the welfare of seafarers: spiritual, mental, physical, mental and economic.[14] Members include ship owner and trade union federations, those providing seafarer centres in ports and the various mission bodies that have been the pioneers of welfare provision since the early 19th century. The latter also have their own representative body, the International Maritime Christian Association (ICMA).[15]

ISWAN undertakes regional welfare development projects, assists with sporting and fitness related activities for seafarers and runs a 24 hour multilingual helpline that can advise distressed seafarers on how best to seek help for their problems. In recent years it has played an active part in managing programmes to help seafarers and others  with the humanitarian aspects of piracy. Funding for the work of ISWAN comes from several charitable trusts and to a smaller extent from subscriptions and donations from other maritime organisations. Further information on seafarer welfare and organisations active in this area can be found in Ch xxx.

[1] International Chamber of Shipping www.ics-shipping.org

[2] Intermanager www.intermanager.org

[3] Intertanko www.intertanko.com

[4] Oil Companies International Marine Forum www.ocimf.com

[5] Cruise Line Industries Association www.cruising.org

[6] International Transport Federation www.itfglobal.org

[7] ITF Seafarers Trust http://www.seafarerstrust.org

[8] International Group of P&I Clubs, IGP&I.   http://www.igpandi.org

[9] International Federation of Ship Masters Association www.ifsma.org

[10] International Maritime Pilots Association www.impahq.org

[11] The Institute of Marine Engineering, Science and Technology www.imarest.org

[12] The Nautical Institute www.nautinst.org

[13] International Maritime Health Association www.imha.net

[14] International Seafarers Welfare and Assistance Network http://seafarerswelfare.org

[15] International Christian Maritime Association www.icma.as