IN THE SUPREME COURT OF BRITISH COLUMBIA Citation: Providence Health Care Society v. Canada (Attorney General), 2014 BCSC 936 Date: 20140529 Docket: S-138411 Registry: Vancouver Between: Providence Health Care Society and Deborah Bartosch, Charles English, Douglas Lidstrom, Larry Love and David Murray on their own behalf and on behalf of all persons with severe opioid addiction who have previously not responded to other available treatments and on whose behalf a SAP request for diacetylmorphine is made by a medical practitioner Copy

IN THE SUPREME COURT OF BRITISH COLUMBIACitation:Providence Health Care Society v. Canada (Attorney General),2014 BCSC 936Date: 20140529Docket: S-138411Registry: VancouverBetween:Providence Health Care Society and Deborah Bartosch, Charles English, Douglas Lidstrom, Larry Love and David Murray on their own behalf and on behalf of all persons with severe opioid addiction who have previously not responded to other available treatments and on whose behalf a SAP request for diacetylmorphine is made by a medical practitioner
Plaintiffs

And

Attorney General of Canada

Defendant

And

Vancouver Coastal Health Authority

Intervenor

Before: The Honourable Chief Justice Hinkson

Reasons for Judgment

Counsel for the Plaintiffs, Providence Health Care Society, Bartosch, English, Lidstrom, Love and Murray:

J.J. Arvay, Q.C., A.M. Latimer, A. Juva

Counsel for Defendant:

L. Lachance, K. Reimer, S. Smiley

Counsel for Intervenor:

S. Tucker

Counsel for Interested party, British Columbia:

L. Greathead, K. Evans

Place and Date of Trial:

Vancouver, B.C.

March 25, 26, and 27, 2014

Place and Date of Judgment:

Vancouver, B.C.

May 29, 2014

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[1] The plaintiff Providence Health Care Society (“Providence”) is a non-profit organization incorporated in 2000 pursuant to the Society Act, R.S.B.C. 1996, c. 433. It operates a number of hospitals, residences and clinics in the City of Vancouver and provides care to vulnerable inner city residents, including those affected by addiction and infectious diseases.

[2] The plaintiffs Deborah Bartosch, Charles English, Douglas Lidstrom, Larry Love, and David Murray (who I will refer to as the “personal plaintiffs”) have each deposed that they have a severe opioid addiction and have not responded to other available treatments for their addiction. They have also deposed that each of their physicians have submitted a Special Access Program (“SAP”) request for diacetylmorphine (heroin) for their use.

[3] The personal plaintiffs apply on their own behalves, and on behalf of all persons with severe opioid addiction who have not responded to other available treatments, and whose physicians have submitted a SAP request for diacetylmorphine, for the following injunctive relief pending the trial of this action:

a) an interlocutory injunction exempting all plaintiff requests and future requests relating to the Study to Assess Longer-term Opioid Medication Effectiveness (“SALOME”) from the application of ss. J.01.001 and C.08.010 of the Food and Drug Regulations, C.R.C., c. 870 [the FDR], insofar as they apply to access to diacetylmorphine and its salts;

b) a mandatory injunction directing the Attorney General of Canada and any agents, agencies, departments, directors, officers, offices and/or Ministers of the Federal Crown to provide all necessary regulatory approvals, permits and/or exemptions required to secure access to the diacetylmorphine granted under any plaintiff requests and/or future SALOME request on an expedited basis; and

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c) a direction that the Court maintain jurisdiction to supervise all issues arising in respect of plaintiff requests and future SALOME requests.

[4] Providence seeks the same relief for the same persons.

[5] The application for injunctive relief is supported by the Attorney General of British Columbia, who appears pursuant to the Constitutional Question Act, R.S.B.C. 1996, c. 68, and by the intervenor, the Vancouver Coastal Health Authority.

The Legislative Scheme

[6] In his Application Response, the Attorney General of Canada set out the relevant parts of the legislative scheme that pertain to the plaintiffs’ application:

2. Three United Nations Conventions, to which Canada is a signatory, form the basis for the current global drug control system: the United Nations Single Convention on Narcotic Drugs, 1961 as amended by the 1972 Protocol; the United Nations Convention on Psychotropic Substances, 1971; and, the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988.

3. The Conventions establish controls on specific narcotics, psychotropic substances and precursors that are listed in the Schedules to the Conventions. The Conventions control the production, manufacture, export, import, distribution and stocks of, trade in and use and possession of the scheduled narcotics, psychotropic substances and precursors.

4. The implementation of the United Nations international drug control conventions is monitored by the International Narcotics Control Board (the “INCB”). The INCB is an independent and quasi-judicial body that was established in 1968 in accordance with the Single Convention on Narcotic Drugs, 1961.

5. The legal status of heroin in Canada is governed by both the Food and Drugs Act (the “FDA”) and the Controlled Drugs and Substances Act (the “CDSA”) as well as the regulations made under those Acts. Together these Acts and their regulations form the principle legislative and regulatory scheme for access to and control of drugs in Canada.

…

8. The FDA is rooted in the criminal law power and is concerned with the manufacture and sale of drugs in Canada. The FDA and its regulations create a comprehensive scheme for the regulation of the sale of drugs in Canada that is designed and intended to protect the health and safety of Canadians. The FDA and its regulations prohibit

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the sale of drugs where their safety, efficacy and quality have not been demonstrated.

…

10. The FDA and the Food and Drug Regulations (“FDR”) Part C restrict the sale of drugs in dosage form. Under the FDR, there are three ways in which an unauthorized drug in dosage form can be authorized for sale:

(a) upon issuance of a Drug Identification Number (“DIN”) for drugs in dosage form and upon issuance of a DIN and a Notice of Compliance (“NOC”) for new drugs in dosage form;

(b) in the context of a clinical trial, to which the Minister has not objected; or

(c) pursuant to a letter of authorization under the Special Access Programme (“SAP”).

…

20. The SAP is governed by sections C.08.010 and C.08.011 of the FDR. These provisions empower the Assistant Deputy Minister, Health Products and Food Branch, Health Canada (the “Director”) with discretionary authority to issue SAP authorizations in response to requests from individual practitioners. The Director may authorize or deny access to a drug based on the data supplied by the practitioner and other information the Director may have in his or her possession.

21. The Director exercises his or her discretion to issue SAP authorizations by considering all information provided by the practitioner, the nature of the medical emergency, and the extent to which the data submitted in support of the request or is otherwise available is credible and relevant to the specified medical emergency.

22. A practitioner is responsible for initiating a request on behalf of a patient and ensuring that the decision to prescribe the drug for a specific indication is supported by credible evidence available in the medical literature or provided by the manufacturer.

…

24. During a SAP assessment, the Director determines, based on the information before him or her if: a) the condition is a medical emergency; b) all other marketed therapies have been tried and failed, considered and deemed unsuitable or otherwise unavailable; and c) there is credible data supporting the use, safety and efficacy of the drug for the medical emergency at issue.

…

30. The FDR do not permit the Director to issue an authorization for a restricted drug as defined in Part J of the FDR (“Part J (Restricted Drug Regulations)”), which is outlined below.

…

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32. The CDSA applies to “controlled substances” and precursors listed in its schedules. Most of the controlled substances listed in the schedules to the CDSA are “drugs” as defined in the FDA. In simple terms, the CDSA prohibits all activities, including importation and distribution, involving the substances listed in the Schedules to the CDSA unless the activities are otherwise authorized under the CDSA or its regulations or an exemption is obtained under section 56 of the CDSA.

…

34. The Restricted Drug Regulations define the term “restricted drugs” and include a Schedule listing substances that are considered to be restricted drugs. The Restricted Drug Regulations also set out provisions authorizing the sale of restricted drugs for use in clinical and laboratory research, as well as provisions to sell, possess or otherwise deal in a test kit.

…

36. Section 56 of the CDSA permits the Minister to exempt any person or class of persons or any controlled substance or precursor from the application of all or any of the provisions of the CDSA or its regulations if, in the opinion of the Minister, the exemption is necessary for a medical or scientific purpose or is otherwise in the public interest.

…

38. The CDSA and the Restricted Drug Regulations impose tight restrictions on the importation of restricted drugs. These measures aim to control and limit the importation of these drugs to control the abuse and diversion of these drugs.

39. Restricted drugs may only be imported into Canada by a licensed dealer, for example, a pharmaceutical manufacturer or distributor. A licensed dealer may import only substances that are listed on its license. To initiate an import, a licensed dealer must submit an import permit application to the Office of Controlled Substances. The application must specify, among other things, the quantity of the restricted drug to be imported and the purpose for which the drug is required. A licensed dealer must obtain an import permit every time they want to import a restricted drug.

…

41. The importation of certain drugs into Canada, such as heroin, is monitored by the INCB. Canada must provide an estimate to the INCB each year of how much heroin it will require for medical and scientific research purposes that year. Canada cannot authorize the importation of certain drugs, such as heroin, over the estimated amount unless it makes a request to the INCB and the INCB approves that request. This process may take weeks or months and approval is not guaranteed.

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42. A permit is required by the licensed dealer to import a drug such as heroin into Canada and it is used by the Canada Border Services Agency to allow the entry of the shipment. Canada must provide Quarterly Statistics of Imports and Exports of Narcotic Drugs reports to the INCB, including the exact quantity of the drug that is imported.

43. Under the FDA and the FDR, heroin for the treatment of opioid addictions is a “drug” and would be considered a “new drug” for market authorization purposes. Because no manufacturer has a DIN and NOC for heroin for treatment of opioid addiction, its sale in dosage form is prohibited by the FDR C.08.002 and C.0.014. Currently, the sale of heroin through the SALOME clinical trial is ongoing, as the Minister did not object to its sale under Division 5 of the FDR. Further, because heroin is a restricted drug, the Director cannot authorize the sale of heroin under the SAP.

44. Under the CDSA, diacetylmorphine (heroin) and its salts (“heroin”) is a controlled substance listed in Schedule I. As a result, all activities related to heroin are prohibited unless otherwise specifically authorized by the Restricted Drug Regulations or an exemption is obtained under section 56 of the CDSA. It is in part because of the significant harm such substances can cause that the penalties associated with illegal activities involving the controlled substances listed in Schedule I are the highest imposed by the CDSA.

45. Heroin can only be imported into Canada by a licensed dealer who is licensed to conduct activities with heroin.

46. As noted above, the importation of heroin into Canada is monitored by the INCB. Heroin cannot be imported into Canada above the pre-established estimates of annual medical and scientific requirements unless a request is made and approved by the INCB. For 2013, the importation estimate for heroin was 16.5 kg. For 2014, that estimate is 17.3 kg.

[7] Health Canada operates the SAP pursuant to ss. C.08.010 and C.08.011 of the FDR. Those sections provide:

C.08.010. (1) The Director may issue a letter of authorization authorizing the sale of a quantity of a new drug for human or veterinary use to a practitioner named in the letter of authorization for use in the emergency treatment of a patient under the care of that practitioner, if

(a) the practitioner has supplied to the Director information concerning

(i) the medical emergency for which the drug is required,

(ii) the data in the possession of the practitioner with respect to the use, safety and efficacy of that drug,

(iii) the names of all institutions in which the drug is to be used, and

(iv) such other data as the Director may require; and

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(b) the practitioner has agreed to

(i) report to the manufacturer of the new drug and to the Director on the results of the use of the drug in the medical emergency, including information respecting any adverse reactions encountered, and

(ii) account to the Director on request for all quantities of the drug received by him.

(1.1) The Director shall not issue a letter of authorization under subsection (1) for a new drug that is or that contains a restricted drug as defined in section J.01.001.

(2) The Director shall, in any letter of authorization issued pursuant to subsection (1), state

(a) the name of the practitioner to whom the new drug may be sold;

(b) the medical emergency in respect of which the new drug may be sold; and

(c) the quantity of the new drug that may be sold to that practitioner for that emergency.

C.08.011. (1) Notwithstanding section C.08.002, a manufacturer may sell to a practitioner named in a letter of authorization issued pursuant to section C.08.010, a quantity of the new drug named in that letter that does not exceed the quantity specified in the letter.

(2) A sale of a new drug made in accordance with subsection (1) is exempt from the provisions of the Act and these Regulations.

[Emphasis added.]

[8] Prior to the enactment of the Regulations Amending Certain Regulations Relating to Access To Restricted Drugs, S.O.R./2013-172 [the Regulations], s. J.01.001 of the FDR provided that “restricted drug” means “a drug set out in the schedule to this Part”.

Background

[9] Diacetylmorphine is the active component of heroin, but it can be pharmaceutically produced without the impurities associated with street drugs. It is, however, now a restricted drug pursuant to the FDR.

[10] Severe Opioid Use Disorder is the term used in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders consulted by the medical profession for the diagnosis of mental disorders. According to Dr. Evan Wood, a

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specialist in internal medicine, epidemiology and addiction medicine, the term is used to refer to what is conventionally described as severe opioid addiction or opioid dependence. Dr. Wood describes the disorder as a serious and potentially life-threatening condition that will often require urgent medical attention.

[11] The treatment options presently available in Canada for opioid addiction include detoxification, treatment recovery, methadone maintenance therapy (“MMT”) and buprenorphine. The evidence of experts in the treatment of opioid addiction relied upon by the plaintiffs is that for those who are refractory to presently available treatment for their addiction, the treatment of choice, and perhaps the only effective treatment, is to provide them with diacetylmorphine.

[12] Between March 2005 and July 2008, researchers at Providence conducted a randomized controlled trial to study the effectiveness of injectable diacetylmorphine, as compared to oral methadone, in retention in treatment and reducing illicit drug use and illegal activities among treatment-refractory opioid-dependant individuals. The study was named the North American Opiate Medication Initiative (“NAOMI”).

[13] Participants in NAOMI were randomly selected to receive one of either oral methadone, injectable diacetylmorphine or injectable hydromorphone. The plaintiffs Ms. Bartosch and Mr. Murray participated in this trial.

[14] In 2011, researchers at the plaintiff Providence began the SALOME trial. SALOME is a single centre, double-blind, randomized controlled trial. Phase 1 of the trial compares whether injectable hydromorphone (a medication approved in Canada to treat pain) is as effective as injectable diacetylmorphine for patients with severe opioid addition who have previously not responded to MMT. The study is also testing whether oral diacetylmorphine and/or oral hydromorphone are as effective as injectable diacetylmorphine.

[15] The second phase of the SALOME trial is intended to test whether oral diacetylmorphine and/or oral hydromorphone are as effective as intravenous diacetylmorphine. Participants are randomly selected to receive one of either

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injectable diacetylmorphine or hydromorphone for six months and then randomly selected to receive either oral or continued injectable treatment of the study drug the participant was provided in phase 1.

[16] The initial study design required 322 participants in order to definitively answer the research questions. However, the SALOME Data Safety Monitoring Board (an independent data quality monitoring group) recently concluded that the study sample of 202 participants would be sufficient to answer the research questions.

[17] The SALOME trial will be unblinded in August 2014. The data results in respect of Phase 1 of SALOME will be available to Health Canada by the end of December 2014. These data results will be publically available in or around February or March 2015.

[18] Both SALOME and NAOMI were funded by the Canadian Institutes of Health Research, the major federal agency responsible for funding health research in Canada. I infer that the diacetylmorphine used in these trials thus far was provided by the Federal Government for research purposes, though I have not specifically been informed of the source of the drug by counsel. The SALOME trial will not be completed until 2016.

[19] The personal plaintiffs all participated in SALOME. Each entered the SALOME trial in 2012, and each has deposed that they experienced significant positive results in phase 1 of the trial. However, Ms. Bartosch, Mr. Lidstrom and Mr. Love did not feel that the treatment they received in Phase 2 of the trial was as effective for them.

[20] The SAP allows medical practitioners to request access to drugs that are unavailable for sale in Canada for patients with life-threatening conditions on a compassionate or emergency basis when conventional therapies have failed, are unsuitable, or are unavailable. On September 20, 2013, Providence doctors received

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SAP approvals from Health Canada for a 90 day supply of injectable diacetylmorphine for 16 of 36 applicants sponsored by Providence.

[21] On September 20, 2013, the Minister of Health issued a statement which provided in part:

Earlier today, officials at Health Canada made the decision to approve an application under the Special Access Program’s current regulations to give heroin to heroin users - not to treat an underlying medical condition, but simply to allow them to continue to have access to heroin for their addiction even though other safe treatments for heroin addiction, such as methadone, are available.

This decision is in direct opposition to the government’s anti-drug policy and violates the spirit and intent of the Special Access Program.

I am taking immediate action to protect the integrity of the Special Access Program and ensure this does not happen again.

The Special Access Program was designed to treat unusual cases and medical emergencies; it was not intended as a way to give illicit drugs to drug addicts.

Our policy is to take heroin out of the hands of addicts, not to put it into their arms.

[22] On September 27, 2013 Providence doctors received SAP approvals from Health Canada for a 90 day supply of injectable diacetylmorphine for another 5 applicants sponsored by Providence.

[23] Mr. Lidstrom and Mr. Murray each received approval from Health Canada to receive diacetylmorphine treatment at the Providence Crosstown Clinic for three months, but to date have not received any such treatment.

[24] On October 2, 2013, the Governor in Council, on the recommendation of the Minister of Health, made the Regulations pursuant to s. 55(1) of the Controlled Drugs and Substances Act, S.C. 1996, c. 19 [the CDSA], and s. 30 of the Food and Drugs Act, R.S.C. 1985, c. F-27.

[25] Sections 1, 2 and 11 of the Regulations (collectively the “impugned provisions”) are in issue here. Sections 1 and 2 of the Regulations replace the

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definition of “restricted drug” in s. J.01.001 of the FDR to include, inter alia, “diacetylmorphine (heroin) and its salts.” Section 11 of the Regulations amends s. C.08.010 of the FDR, which deals with the SAP, to provide that:

(1.1) The Director shall not issue a letter of authorization under subsection (1) for a new drug that is or that contains a restricted drug as defined in section J.01.001.

[26] Since October 4, 2013 the Manager of the SAP has denied all SAP requests for diacetylmorphine on the basis that:

Your request for emergency access to the above named product cannot be authorized. The drug requested is a “restricted drug” as defined in Part J of the Food and Drug Regulations, and is not eligible for authorization by the programme in accordance with subsection C.08.010 (1.1). For your reference, a copy of the relevant provision is inserted below and the content of the regulations is attached.

C.08.010 (1.1) The Director shall not issue a letter of authorization under subsection (1) for a new drug that is or that contains a restricted drug as defined in section J. 01.001.

[27] Applications for diacetylmorphine treatment for Ms. Bartosch, Mr. English and Mr. Love pursuant to the SAP were submitted to Health Canada by their physicians, but were denied due to the new provisions of the FDR.

The Legal Principles

[28] The Supreme Court of Canada established a three part test for determining whether to grant an interlocutory injunction in Manitoba (A.G.) v. Metropolitan Stores Ltd., [1987] 1 S.C.R. 110, [1987] 3 W.W.R. 1. The three parts are: first, whether there is a serious question to be tried; second, whether the applicant will suffer irreparable harm if the injunction is not granted; and third, an assessment of the balance of convenience between the party or parties seeking the injunctive relief, and those opposing it.

[29] Justice Beetz, writing for the Court, discussed the test as follows at 127–129:

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The first test is a preliminary and tentative assessment of the merits of the case, but there is more than one way to describe this first test. The traditional way consists in asking whether the litigant who seeks the interlocutory injunction can make out a prima facie case. The injunction will be refused unless he or she can make out such a case: Chesapeake and Ohio Railway Co. v. Ball, [1953] O.R. 843, per McRuer C.J.H.C., at pp. 854–55. The House of Lords somewhat relaxed the first test in American Cyanamid Co. v. Ethicon Ltd., [1975] 1 All E.R. 504, when it held that all that was necessary to meet this test was to satisfy the Court that there was a serious question to be tried as opposed to a frivolous or vexatious claim. Estey J. speaking for himself and five other members of the [Supreme Court of Canada] in a unanimous judgment referred to but did not comment upon this difference in Aetna Financial Services Ltd. v. Feigelman, [1985] 1 S.C.R. 2, at pp. 9–10.

American Cyanamid has been followed on this point in many Canadian and English cases, but it has also been rejected in several other instances and it does not appear to be followed in Australia: see the commentaries and cases referred to in P. Carlson, “Granting an Interlocutory Injunction: What is the Test?” (1982), 12 Man. L.J. 109; B.M. Rogers and G.W. Hately, “Getting the Pre-Trial Injunction” (1982), 60 Can. Bar Rev. 1, at pp. 9-19; R.J. Sharpe, Injunctions and Specific Performance (Toronto 1983), at pp. 66-77.

In the case at bar, it is neither necessary nor advisable to choose, for all purposes, between the traditional formulation and the American Cyanamid description of the first test: the British case law illustrates that the formulation of a rigid test for all types of cases, without considering their nature, is not to be favoured (see Hanbury and Maudsley, Modern Equity (12th ed. 1960), pp. 736-43). In my view, however, the American Cyanamid “serious question” formulation is sufficient in a constitutional case where, as indicated below in these reasons, the public interest is taken into consideration in the balance of convenience. But I refrain from expressing any view with respect to the sufficiency or adequacy of this formulation in any other type of case.

The second test consists in deciding whether the litigant who seeks the interlocutory injunction would, unless the injunction is granted, suffer irreparable harm, that is harm not susceptible or difficult to be compensated in damages. Some judges consider at the same time the situation of the other party to the litigation and ask themselves whether the granting of the interlocutory injunction would cause irreparable harm to this other party if the main action fails. Other judges take the view that this last aspect rather forms part of the balance of convenience.

The third test, called the balance of convenience and which ought perhaps to be called more appropriately the balance of inconvenience, is a determination of which of the two parties will suffer the greater harm from the granting or refusal of an interlocutory injunction, pending a decision on the merits.

[30] Here, the plaintiffs seek not only an injunction to maintain what they contend is the status quo ante, exempting them from the application of the impugned provisions, but also a mandatory injunction directing all necessary regulatory

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approvals, permits and/or exemptions required to secure access to the diacetylmorphine be issued, and on an expedited basis.

[31] In Canwest Pacific Television Inc. v. 147250 Canada Ltd. (1987), 14 B.C.L.R. (2d) 104, [1987] B.C.J. No. 1262 (C.A.), a mandatory injunction for the transfer of certain shares was sought. The action in which the application was brought sought specific performance of an alleged sale of the shares, so the injunction, if granted, would provide to the plaintiffs the very remedy they sought in the action. Madam Justice McLachlin, as she then was, writing for the Court, held at 108–109:

In Aetna Fin. Services Ltd. v. Feigelman, supra, the Supreme Court of Canada reviewed the principles governing the granting of orders prior to trial which are not confined to procedural matters, but which have the effect of altering the parties' rights over their property in the pre-trial period. At issue was a “Mareva” injunction depriving the defendant of the possession and use of his property pending trial.

Canwest contends that the principles enunciated in Aetna must be confined to Mareva or similar injunctions and have no application in the case at bar. I cannot accept that submission. The language of the passages relied on by the chambers judge below clearly extends to any order which restricts the defendant's substantive rights without a trial.

At p. 166, Estey J., for the court, distinguished between interlocutory applications of a procedural nature and those which affect the parties' substantive rights, stating:

As a general proposition, it can be fairly stated that in the scheme of litigation in this country, orders other than purely procedural ones are difficult to obtain from the court prior to trial.

After referring to the need of the applicant to show irreparable harm if the order sought does not go, he went on to state:

A second and much higher hurdle facing the litigant seeking the exceptional order is the simple proposition that in our jurisprudence, execution cannot be obtained prior to judgment and judgment cannot be recovered before trial. Execution in this sense includes judicial orders impounding assets or otherwise restricting the right of the defendant without a trial.

These passages make it plain that the essential distinction is not between Mareva orders and other types of interlocutory orders, but between interlocutory orders of a procedural nature and interlocutory orders which restrict a party's substantive rights before trial. The broad concept of execution as that word is used in Aetna extends to any order abrogating the defendant's rights prior to trial. Such orders, apart from certain exceptions, will not be granted.

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The exceptions set out by Estey J. and reviewed by the chambers judge below are the following:

1. Orders for the preservation of assets, the very subject matter in dispute, where to allow the adversarial process to proceed unguided would see their destruction before the resolution of the dispute;

2. Where generally the processes of the court must be protected even by initiatives taken by the court itself;

3. To prevent fraud both on the court and on the adversary;

4. Qua timet injunctions under extreme circumstances to prevent a real or impending threat of removal of the assets from the jurisdiction.

I conclude that the chambers judge did not err in applying the principles set out in Aetna on this application. Counsel for D.K.L. is correct when he says that the relief sought on this application should be granted only if the test for summary judgment is met, namely, that there is no arguable defence to the claim. Any other course would permit execution before judgment in circumstances where it is inappropriate.

[32] In R.J.R. — MacDonald v. Canada (A.G.), [1994] 1 S.C.R. 311 at 333, 111 D.L.R. (4th) 385, Sopinka and Cory JJ. commented on the need for courts to be sensitive to and cautious of making rulings on applications for injunctive relief whose effect would deprive legislation enacted by elected officials of its effect. However, they recognized at the same time that:

… the Charter charges the courts with the responsibility of safeguarding fundamental rights. For the courts to insist rigidly that all legislation be enforced to the letter until the moment that it is struck down as unconstitutional might in some instances be to condone the most blatant violation of Charter rights. Such a practice would undermine the spirit and purpose of the Charter and might encourage a government to prolong unduly final resolution of the dispute.

Discussion

a) Serious Question to be Tried

[33] The Attorney General of Canada has effectively conceded that the first part of the test for an injunction has been met, submitting that “[while] the respondent denies that there is merit to the applicants’ claims, it acknowledges that the issues raised by the applicants are neither frivolous nor vexatious.”

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[34] For her part, the Attorney General of British Columbia takes the position from a division of powers perspective that the impugned provisions are ultra vires the federal government.

[35] I need not resolve the division of powers issue in order to deal with the application before me. However, it bears mentioning that in Canada (Attorney General) v. PHS Community Services Society, 2011 SCC 44 at paras. 66–70, [2011] 3 S.C.R. 134, the Supreme Court of Canada determined that the delivery of health care services is not a protected core of the provincial power over health care in ss. 92(7), (13) and (16) of the Constitution Act, 1867 (U.K.), 30 & 31 Victoria, c. 3, and is therefore not immune from federal interference.

[36] The Court explained that the federal role in the domain of health makes it impossible to precisely define what falls in or out of the provincial “core”, concluding at para. 68 that “[overlapping] federal jurisdiction and the sheer size and diversity of provincial health power render daunting the task of drawing a bright line around a protected provincial core of health where federal legislation may not tread”.

[37] As the application before me is for interlocutory relief, and the evidence relied upon by the opposing parties has not been tested, I propose to say little more about the merits of the plaintiffs’ case or the Attorney General of Canada’s response to that case. I accept that the plaintiffs have raised a serious question to be tried.

b) Irreparable Harm

[38] The second test consists in deciding whether the litigant who seeks the interlocutory injunction would, unless the injunction is granted, suffer irreparable harm; that is, harm which cannot be readily quantified in monetary terms or which cannot generally be cured by an award of damages. Some judges consider, at this stage, the situation of the other party to the litigation and ask themselves whether the granting of the interlocutory injunction would cause irreparable harm to this other party if the main action fails. Other judges take the view that this last aspect rather forms part of the balance of convenience.

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[39] Prior to the introduction of the impugned provisions, the Assistant Deputy Minister, Health Products and Food Branch, Health Canada (the “Director”) was given discretion to authorize special access to diacetylmorphine. The impugned provisions take away that discretion.

[40] The plaintiffs contend that the impugned provisions deprive them of their rights to life, liberty and security of the person pursuant to s. 7 of the Canadian Charter of Rights and Freedoms, Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (U.K.), 1982, c. 11 [the Charter] and their rights not to be discriminated against based upon the enumerated ground of disability contrary to s. 15 of the Charter. The plaintiffs contend that the alleged s. 7 deprivations are not in accordance with the principals of fundamental justice because they are arbitrary, overbroad, and grossly disproportionate to the alleged objective of the legislation.

[41] Other than accepting, as I do, that the impugned provisions are alleged to breach the plaintiffs Charter rights, I consider that it is inappropriate to address these contentions on this application.

i) Refractory Dependence

[42] The Attorney General of Canada contends that the injunctive relief sought for persons other than the plaintiffs with severe opioid addiction who have not previously responded to other available treatments for their addiction should be refused, as there is an absence of evidence upon which a conclusion could be reached as to whether such persons could properly be considered refractory.

[43] There is no agreed-upon definition of the term refractory. The experts relied upon by the plaintiffs contend that the term describes opioid addicted individuals who have proved unresponsive to MMT on previous attempts.

[44] The Attorney General of Canada relies on the evidence of Dr. Meldon Kahan, a witness who has extensively researched and gained substantial experience in the treatment of individuals suffering from opioid and other addictions. Dr. Kahan

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contends that the term refractory should be used to describe: those who have undertaken MMT, but have continued to use heroin at least several times per week despite receiving a dose of at least 100 mg of methadone over a period of at least 2 months; those who have dropped out of such therapy because of intolerable side effects; or those who have received a trial at an optimal dose and duration of at least two of either buprenorphine, oral slow release morphine, or oral hydromorphone.

[45] In his affidavit of January 23, 2014, Dr. Kahan states that he is opposed to the use of diacetylmorphine to treat heroin addicts who have not responded to other available treatments for their addiction. The reasons for his opposition are set out in paragraph 16 of that affidavit:

16. My opposition to [Heroin Substitution Treatment (“HST”)] is based on my review of the evidence on its safety and effectiveness, relative to methadone and other oral opioids. I reviewed the following types of evidence:

 Evidence from controlled trials and observational studies on the impact of methadone at different doses on heroin use and treatment retention.

 Evidence on the effectiveness of buprenorphine and morphine on treatment retention and heroin use.

 Evidence from experimental studies on the potential risks of medically-administered intravenous opioids: suppression of breathing, low oxygen levels, and impaired cognitive function.

 Evidence on the impact of program factors, such as take-home doses, on heroin use and treatment retention.

[46] Professor Martin Schechter, whose affidavit was filed by the plaintiffs, is the founding Director of the School of Population and Public Health in the Faculty of Medicine at U.B.C. In his affidavit of December 4, 2013, Professor Schechter commented at paras.6–9 and 11 that:

6. Heroin is a street drug sold in the black market that is a mixture of a number of substances. One of them is [diacetylmorphine (“DAM”)], the ingredient that produces heroin’s main effects, but street heroin contains many impurities in addition to DAM. Pure DAM, on the other hand, is a pharmaceutical medication, manufactured under pharmaceutical industry standards, with precise dosage, stability and sterility. The terms “heroin-assisted therapy” and “medically prescribed heroin” are actually misnomers because it is not street heroin that is being prescribed but rather the pure

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pharmaceutical medication DAM. For this reason, I will refer to the treatment in question as diacetylmorphine-assisted therapy (“DAT”).

7. Methadone is an oral medication that blocks the craving and withdrawal symptoms experienced by people with heroin addiction. MMT usually involves the once-daily provision of methadone. MMT is a convenient and effective treatment for many people with heroin addiction and should remain the treatment of first choice; however, there is an extremely vulnerable subgroup of people with heroin addiction for whom MMT and other existing treatments have not been successful despite repeated attempts. For convenience, I will refer to this subpopulation of people with chronic heroin addiction who are refractory to existing treatments as the “target population” because it is for this group that effective treatment is being sought. It has been estimated that the target population represents approximately 15% of people with heroin addiction. Attached hereto and marked as Exhibit C to this my affidavit is true copy of an article entitled “Prediction of relapse to frequent heroin use and the role of methadone prescription: an analysis of the Amsterdam Cohort Study among drug users” dated 2005.

8. Because Canadian medical professionals have no effective treatments to offer, members of the target population remain outside the health care system, deeply affected by the illness of addiction and its many consequences. Because street heroin is of unknown and variable dose, they are at significant risk of death due to overdose. Because street heroin is often injected in unsterile conditions, they are at significant risk of acquiring HIV, hepatitis C and other life-threatening infections. Because they are deeply entrenched in the black market, most of their time is spent in search of their next dose or “fix” of street heroin. This search often involves criminal activity and sex work.

9. A physician attempting to get an individual in the target population into treatment faces the following clinical question: Should one make yet another attempt at offering an existing treatment that is very likely not to engage and retain the patient in treatment, or should one try something different that may be more likely to retain the patient and stabilize them? Responding to this conundrum as early as 1972, the Le Dain commission wrote:

[O]ur recommendation is... that heroin maintenance be permitted on a controlled, experimental basis, as a treatment adjunct to be used in exceptional cases.... “On balance, however, we believe that the availability of heroin maintenance will increase the capacity of the overall treatment process to win patients from, the illicit market and for this reason, it is a justified experience. ’’

…

11. It is understandable that one might, at first glance, ask whether DAT is simply providing an addict with the drug to which she or he is addicted. However, the premise of this is incorrect because DAT is not simply the administration of a drug. It is the application of a “bundle” of interventions that includes not only the provision of the pharmaceutical, but the opportunity for patients to benefit from up to thrice daily contact with doctors, nurses and counselors; the breaking of their cycle of criminality, sex work, jails and

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hospitalizations; and the stabilization of their previously chaotic lives which made improved health outcomes extremely unlikely. It is also worth noting that methadone is often co-prescribed as part of DAT, usually as an evening dose, to prevent overnight craving and withdrawal. For all of these reasons, DAT should not be viewed as the simple administration of DAM, but rather as an overall treatment strategy that is assisted by DAM but also by many other components.

[47] Dr. Kahan holds the view that NAOMI did not demonstrate that Heroin Substitution Treatment was superior to optimal methadone treatment. He stated that NAOMI demonstrated that patients who have previously failed methadone treatment programs often respond to a re-trial, and that many patients in the methadone group did well in the study. He concluded that these patients should be offered such a re-trial at a higher dosage.

[48] Dr. Kahan swore at paras. 26 and 87 of his affidavit that:

26. For patients who are refractory to methadone, three alternative oral medications are available: buprenorphine, oral morphine and oral hydromorphone. All three are far safer than intravenous heroin treatment. Buprenorphine is particularly useful for patients who experienced side effects with methadone, and patients who require take-home doses because of work or family commitments. Four randomized trials have demonstrated that slow morphine release morphine [sic] and methadone are of comparable efficacy.

…

87. To determine why a patient has failed at or dropped out of methadone treatment, one needs the following information: i) the dose and duration of treatment, ii) whether the patient experienced ongoing withdrawal symptoms and cravings, iii) the patient’s pattern of heroin use during treatment, iv) side effects with methadone, and v) the patient’s reasons for dropping out of treatment. With this information, one can usually determine why the patient failed at methadone treatment. There are five main reasons for treatment failure: a) Early non-response, b) partial sustained response, c) intolerable side effects with methadone and d) program factors; and e) patient factors. Once these reasons are identified, an individualized treatment plan can be formulated.

[49] Dr. Kahan swore at para. 44 of his affidavit that there is no clinical need for the use of intravenous heroin. He expressed his opinion that patients who are truly refractory to an optimal trial of methadone, buprenorphine, and morphine or oral hydromorphone should be treated with intravenous hydromorphone.

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[50] Dr. Eugenia Oviedo-Jokes, who is the principal investigator for the SALOME study, disagrees with many of Dr. Kahan’s assertions and views about the treatment of opioid dependant patients and his use of the term refractory.

[51] The differences between these experts as to what constitutes refractory are, in many respects, more semantic than substantive insofar as they impact upon my decision on this application. When distilled down, the consensus seems to be that refractory means substantially resistant to conventional treatments such that further retrials of those treatments are unlikely to prove successful. On the materials before me, it appears the major difference is to where these individual physicians and researchers draw the line in finding an individual patient to be substantially resistant and therefore refractory. However, without the benefit of further evidence and cross examination, I cannot accept Dr. Kahan’s more limited use of the term for the purposes of this application. As such, I use the term to mean the broader definition given above.

ii) Risks Associated with the Use of Heroin

[52] The plaintiffs submit that the irreparable harm faced by persons with severe opioid addiction who have not responded to other available treatments and whose physicians have submitted an SAP request for diacetylmorphine, if the relief that they seek is not granted, is set out in para. 7 of Dr. Wood’s affidavit sworn December 3, 2013 in these proceedings:

7. Opioid Use Disorder is associated with a range of health and community concerns, including compulsive drug-seeking behaviour, infectious diseases and related risk behaviors (e.g., used syringe sharing, sex-trade involvement), fatal overdose and drug acquisition crime. Through their high consumption of illicit drugs, heroin-addicted individuals also contribute to the highly profitable and often violent illegal drug market which is believed to be largely controlled by organized crime groups.

[53] In his affidavit, Dr. Wood also deposed at paras. 6, 12, 14, 21 and 43 that:

6. … This fact has been recognized by various national and international public health bodies, including Health Canada. Attached hereto and marked as Exhibit C to this my Affidavit is a true copy of a letter from Ian MacKay, Manager, Health Canada’s Special Access Programme (“SAP”), to Dr. Cheryl

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McDermid, dated May 2, 2013, which states: “SAP considers CROD (Chronic Relapsing Opioid Dependence) to be a serious and/or life-threatening condition that will often require urgent medical attention.” This fact is also supported by a large body of literature and research. For instance, a study of mortality rates among intravenous-drug-using women in Vancouver’s Downtown Eastside reported age-adjusted rates of mortality almost 50 times higher than among British Columbia’s overall female population (Spittal et al., AIDS Care. 2006 Feb; 18(2): 101-8).

…

12. While medical detoxification (i.e., weaning individuals off of drugs of abuse), counselling, residential treatment and self-help (e.g., 12-step) programs have all been studied as addiction treatments, research has shown that these treatments fail in the vast majority of patients with severe Opioid Use Disorder. For instance, the recently completed study of prescription opioid addicted persons by the US National Institute on Drug Abuse known as the Prescription Opiate Abuse Treatment (POATS) study (Archives of General Psychiatry. 2011 Dec;68(12):1238-46) found that approximately 90% of prescription opioid addicted patients with opioid use disorder relapsed to opioid use when effective opioid agonist medication was tapered. As described below, this is just one of many studies demonstrating the value of maintaining patients on opioid agonist treatment. Attached hereto and marked as Exhibit E to this my Affidavit is a true copy of this study entitled “Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence” dated December 2011.

…

14. As is the case for many medical conditions where first line therapies sometimes fail to achieve a therapeutic benefit, available opioid agonist treatments (i.e., methadone and buprenorphine) are not successful for all patients and, in particular, for some of the most severely addicted individuals who may suffer from comorbid mental illnesses, such as the consequences of severe trauma. It is important to stress that accepted opioid agonists (e.g., methadone) were once highly controversial based on the view that it was simply maintaining a heroin-addicted individual on a substitute addictive agonist medication. To some extent this controversy exists to this day, but ultimately medical science has overcome this controversy, and buprenorphine and methadone are now on the World Health Organization’s list of essential medications.

…

21. From an evidence-based medicine perspective, and certainly in my opinion, the use of injectable diacetylmorphine is a much safer option than supervised use of oral or injectable hydromorphone for patients exiting the SALOME study, for several reasons. First, there is extensive experience with diacetylmorphine for this indication, and next to zero experience with hydromorphone, as I explain below. Specifically, experience with the prescription of diacetylmorphine to opioid-dependent patients began in the 1950s, and over the last several decades there has been a great deal of clinical experience regarding the safety and effectiveness of this approach in both observational clinical settings as well as the clinical trial setting. This has

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been well described in the literature. Attached hereto and marked as Exhibit I to this my Affidavit is a true copy of an article authored by Stimson and Ogborne entitled “Survey of addicts prescribed heroin at London clinics” published in the Lancet and dated May 30, 1970. Attached hereto and marked as Exhibit J to this my Affidavit is a true copy of an article authored by Rehm, Gschwend, Steffen, Gutzwiller, Dobler-Mikola and Uchtenhagen entitled “Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: a follow-up study” published in the Lancet and dated October 27, 2001. Other studies are described below.

…

43. As indicated above, past research suggests that when diacetylmorphine treatment is abruptly discontinued in patients who have been successfully treated with this therapy, greater than 80% will experience a severe health deterioration that places them at immediate risk of serious harm (e.g., HIV, hepatitis C, endocarditis, hypoxic brain injury) or death (for example, from a fatal heroin overdose) from resumption of unsupervised and unsterile street heroin use.

[54] In her affidavit of December 4, 2013, Professor Jane Buxton, who is associated with the U.B.C. School of Population and Public Health and is the harm reduction leader at the B.C. Centre for Disease Control, identified risks to users of illicit drugs, including the potential that a drug represented as heroin may in fact have a different and potentially dangerous active substance, may contain adulterants, or will be of an unknown potency.

[55] On the other hand, Dr. Kahan asserts at paras 65, 67 and 93–95 of his affidavit that even medically prescribed heroin is not without its own risks:

65. In contrast, safety data on medically prescribed heroin is scant compared to the wealth of information on morphine and hydromorphone. NAOMI and other controlled trials have shown that iv heroin has an extremely high rate of life-threatening events. Preliminary studies indicate that intravenous heroin commonly causes marked cerebral hypoxia post-injection, and another study found that patients on medically supervised heroin performed worse on cognitive tests than patients on methadone or buprenorphine. Further research is needed to confirm these findings. But until these studies have been conducted, the safety of long-term medically supervised heroin administration remains an open question. Switching a patient from a safe and potentially effective oral agent to an unsafe intravenous treatment is unethical and in violation of the First Do No Harm principle.

…

67. Intravenous opioids should be only used as a treatment of last resort, in patients who are truly refractory to all other treatments. Intravenous opioids

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reach the brain within seconds, whereas oral opioids are absorbed slowly and must first undergo metabolism through the liver before reaching the brain. Experimental studies have demonstrated that intravenous heroin causes a more rapid rise and higher peak blood levels of heroin and its metabolites than does oral ingestion of heroin (Girardin 2003). This makes intravenous use far more likely to cause intoxication, respiratory depression and hypoxia (lack of oxygen). In a meta-analysis of controlled trials, intravenous morphine and hydromorphone were associated with a measurable incidence of respiratory depression, but oral morphine and hydromorphone were not (Felden 2010). As described below, cerebral hypoxia is a common occurrence after injection of medically prescribed heroin.

…

93. Preliminary evidence suggests that heroin injection is commonly followed by clinically significant respiratory depression. In one placebo-controlled study, sixteen patients on HST were administered their usual dose. The arterial oxygen level dropped to below 80 in eight of the subjects, with a low pulse rate, low breathing rates, and abnormal EEG patterns were also observed. Another study found low levels of oxygen in the brain after HST patients received their usual heroin injection. (Stohler, Dursteler et al. 1999; Stoermer, Drewe et al. 2003). The authors state, “The criteria for the prescription and therapeutic use of IV HAT should be critically revised. ... additional studies of the safety of IOT are required. .. long-term complications such as brain lesions induced by frequent hypoxic states ... and consequent cognitive impairment... appear to be possible not only with illicit opioid use but with therapeutic use as well.” Until this study is replicated and more is known about the safety of heroin, it should be prescribed for research purposes only. Attached as Exhibit “Q” to this my affidavit is a copy of the Stohler study. Attached as Exhibit “R” to this my affidavit is a copy of the Stoermer study.

94. In the NAOMI trial, the heroin group experienced 16 life-threatening medication-related events (overdoses and seizures), for a rate of one event per six patients per year. This is an extremely high rate for an outpatient, long-term maintenance treatment. There were no life-threatening medication-related events in the methadone group. Other HST trials had similarly high rates. The Cochrane review of HST trials (Ferri 2012) reported that the risk of an adverse event related to the study medication was 13.5 times higher in the heroin group than in the methadone group. Post-injection hypoxia can also occur when patients leave the clinic, especially if the patient goes home and fall asleep, or takes benzodiazepines or drink alcohol. Studies have shown that benzodiazepine use is extremely common in heroin addicts (Bleich, Gelkopf et al. 2002)

95. The adverse events in the NAOMI trial resolved with treatment, and hospitalizations were not required. But non-fatal overdoses can have serious sequelae, including trauma, aspiration, and cognitive damage (Warner-Smith 2002). In a survey of patient complaints about HST, some patients reported cognitive deficits, muscle twitches and temporary paralysis of the limbs. The latter two symptoms can be caused by opioid toxicity and non-fatal overdose (Dursteler- MarcFarland 2006).

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iii) The Personal Plaintiffs

[56] Each of the personal plaintiffs has returned to the use of illicit heroin after completing the second phase of the SALOME trial. They contend that this has occurred because they no longer receive treatment that is effective for them. They are supported in this view by Dr. MacDonald, a general practitioner in British Columbia with lengthy and broad experience in the treatment of opioid dependant patients.

[57] Ms. Bartosch deposed that she has been using heroin for approximately 16 years. It is her evidence that she has attempted to wean herself from the use of heroin several times, and that her single attempt at a methadone maintenance treatment was accompanied by uncomfortable side effects. She further deposed that she responded well to her treatment in the SALOME trial, but that since she no longer has access to effective treatment, she has returned to the use of illicit heroin.

[58] Mr. Love deposed that he has used illicit drugs since he was 13 years of age. His evidence is that he suffered injuries to his left knee while serving in the Canadian Armed Forces, and following his honourable discharge from the military in October of 1969, he moved to Vancouver and began using heroin to relieve the pain in his knee. He has been incarcerated for activities related to his drug use, but remains addicted to heroin. He further deposed that he has undergone alcohol and drug detoxification at least 50 times, and that he found that he was unable to function normally when on a methadone maintenance program.

[59] Mr. Love deposed that he was stabilized while in the SALOME trial until he was placed on oral hydromorphone, which he found ineffective. It is his evidence that he thus returned to the use of illicit heroin.

[60] Mr. Murray deposed that he has been injecting heroin and other opioids for approximately 42 years, despite at least ten attempts to treat his addiction to heroin by undergoing MMT. He further deposed that he participated in both the NAOMI and SALOME trials, but after each trial he relapsed into the use of illicit heroin. It is his

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evidence that the oral hydromorphone treatment he received following his participation in the SALOME trial was ineffective in treating his heroin addiction.

[61] Mr. English deposed that he began injecting heroin and cocaine in or around 1985 when he was 21 years of age and considers that he was addicted to and dependant on heroin by the time he was 24 years of age. He deposed that he engaged in criminal activities to support his addiction. He also deposed that he entered a methadone maintenance program in 1993, but was unable to cope with the side effects of the treatment. A second treatment attempt in 1994 was similarly unsuccessful for him, but from 2010 until 2012 when he entered the SALOME trial he was able to stay on a methadone maintenance program. Since completing the SALOME trial, Mr. English has deposed that he has been prescribed hydromorphone which he uses once or twice per day, but that while he finds it better than methadone, it has proven ineffective in eliminating his need to use illicit heroin.

[62] Mr. Lidstrom has deposed that he began using heroin and other drugs some 40 years ago, when he was 16 or 17 years of age. He has enjoyed some periods of abstinence from the use of heroin, for as long as 10 years, but returned to its use in 1990. He has participated in 6 methadone maintenance programs, but found that they were ineffective in preventing his return to illicit street heroin or other opioids. He has experienced a number of health related difficulties which he associates with his drug use, and has a criminal record which he attributes to his need to finance his addiction.

[63] After 6 months in the SALOME trial Mr. Lidstrom was randomized onto oral treatment. He has deposed that he found this ineffective for him, and that he has since returned to the use of illicit heroin. Subsequently he was placed on oral hydromorphone, but this has not permitted him to refrain from the use of illicit heroin.

[64] Dr. Kahan disagrees that the personal plaintiffs necessarily face the risks described by Drs. Wood and Buxton. In his affidavit, Dr. Kahan challenges the assertion that the personal plaintiffs are refractory, asserting that they have not received optimal doses of methadone.

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[65] Dr. Kahan swore in his affidavit at paras. 33–37 and 100 that:

33. Mr. Love was on a high dose of methadone. The clinical record does not indicate why he discontinued methadone treatment. He is taking immediate-release hydromorphone only twice per day, which is insufficient to relieve withdrawal symptoms. Therefore he cannot be classified as refractory to hydromorphone treatment.

34. In his two previous attempts. Mr. Murray’s maintenance methadone doses were 80-100 mg, and 55 mg. These doses may have been insufficient to fully relieve withdrawal symptoms and suppress heroin use. He is only taking hydromorphone twice per day, therefore he is not necessarily refractory.

35. I do not believe Mr. English is refractory to methadone. In SALOME he did well on high doses of methadone (100-130 mg). He requested a rapid taper, not because of side effects but because he wanted to become abstinent.

36. Ms Bartosch is probably refractory to methadone treatment, because she experienced sweating and other side effects while on methadone. She is also probably refractory to buprenorphine, because she continued to use heroin while on it. She continues to experience withdrawal symptoms while on oral hydromorphone but it is only administered three times per day, which may be insufficient.

37. It is possible that Mr. Lidstrom is refractory to methadone treatment, since at one time his dose was 100 mg. I do not believe he is refractory to oral hydromorphone, because he responded well to a dose of 130 mg three times per day, with a small dose of methadone at night.

…

100. The concerns I have expressed about HST are in stark contrast to the plaintiffs’ descriptions of their lived experience with HST. The plaintiffs speak movingly of the marked improvements they have experienced in their health, mood and social life with HST. But it is important to note that the plaintiffs are comparing their lives on HST to their lives as out-of-treatment heroin addicts, or their lives while on methadone and still using heroin. If the plaintiffs had received optimal treatment with methadone or with other oral treatments, I believe there is a very good chance that they would have stopped illicit heroin use without HST, and the lives might have improved to an equal or greater degree. I have witnessed hundreds of patients who have made remarkable life transformations with methadone and other oral treatments. If they had been offered HST when they were actively addicted to heroin, they might well have accepted it, but I believe that they would have had a less productive and fulfilling work and family life.

[66] The Attorney General of Canada relies upon the evidence of Dr. Kahan and Dr. Conway, an expert in aspects of the treatment of intravenous drug users, to support its contention that for the individual plaintiffs, the available treatments for

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their addiction have not been fully or effectively explored and that as a result, they cannot properly be considered refractory to such treatments. The evidence of the treatment experts relied upon by the Attorney General includes the view that oral morphine and oral hydromorphone are available treatments for opioid addiction, even though neither is listed by the Federal Government as indicated for the treatment of opioid addiction when issuing Drug Identification Numbers nor in the Notice of Compliance for morphine.

[67] The Attorney General of Canada contends that to satisfy the second part of the test for an injunction, the plaintiffs must establish that the harm they allege to be irreparable must be real and substantial, and that the harms alleged by the plaintiffs here are only speculative, raising but the mere possibility of harm.

[68] In PHS Community Services Society, the Supreme Court of Canada considered the applications of PHS, a non-profit organization that oversaw the operation of a safe injection facility that provided medical services to intravenous drug users in the Downtown Eastside of Vancouver, VANDU, a non-profit society that advocated on behalf of drug users, and two intravenous drug users, all of whom sought an extension of the facility’s exemption from the operation of criminal laws in the CDSA.

[69] At paras. 7 and 10, the Supreme Court accepted that:

[7] The residents of the DTES [Downtown Eastside of Vancouver] who are intravenous drug users have diverse origins and personal histories, yet familiar themes emerge. Many have histories of physical and sexual abuse as children, family histories of drug abuse, early exposure to serious drug use, and mental illness. Many injection drug users in the DTES have been addicted to heroin for decades, and have been in and out of treatment programmes for years. Many use multiple substances, and suffer from alcoholism. Some engage in street-level survival sex work in order to support their addictions. It should be clear from the above that these people are not engaged in recreational drug use: they are addicted. Injection drug use is both an effect and a cause of a life that is a struggle on a day to day basis.

…

[10] For injection drug users, the nature of addiction makes for a desperate and dangerous existence. Aside from the dangers of the drugs themselves, addicts are vulnerable to a host of other life-threatening

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practices. Although many users are educated about safe practices, the need for an immediate fix or the fear of police discovering and confiscating drugs can override even ingrained safety habits. Addicts share needles, inject hurriedly in alleyways and dissolve heroin in dirty puddle water before injecting it into their veins. In these back alleyways, users who overdose are often alone and far from medical help. Shared needles transmit HIV and hepatitis C. Unsanitary conditions result in infections. Missing a vein in the rush to inject can mean the development of abscesses. Not taking adequate time to prepare can result in mistakes in measuring proper amounts of the substance being injected. It is not uncommon for injection drug users to develop dangerous infections or endocarditis. These dangers are exacerbated by the fact that injection drug users are a historically marginalized population that has been difficult to bring within the reach of health care providers.

[70] The evidence proffered by the plaintiffs is similar to that accepted in PHS Community Services Society. That evidence is that drug addiction is a chronic disease and can be progressive, relapsing, and fatal, and that there are persons in British Columbia who have opioid addictions but who are refractory to presently available treatment for their addiction. The evidence is also that the risks of opioid dependence that is maintained by the use of illicit street drugs include fatal overdoses (which can be caused by the substitution of other substances for the drugs the user believes he or she has purchased, unknown strengths of such drugs, or the adulteration of such drugs), infections such as endocarditis, HIV/AIDS, and Hepatitis C, social disintegration, violence and criminal sanctions.

[71] In PHS Community Services Society the Supreme Court found that the Minister’s failure to grant a s. 56 exemption to the safe injection facility engaged the claimants’ s. 7 rights and contravened the principles of fundamental justice. The Court concluded that the effect of denying the services of the facility to the population it served and the correlative increase in the risk of death and disease to injection drug users was grossly disproportionate to any benefit that Canada might derive from presenting a uniform stance on the possession of narcotics and ordered the Minister to forthwith grant an exemption to the facility.

[72] The plaintiff submits that the process of withdrawal involves a combination of biochemical, psychological and social stresses that typically affect habitual drug users, putting them at a high risk of relapse when they attempt abstinence.

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[73] I am not prepared, at this juncture, to accept the view of Dr. Kahan that, as the personal plaintiffs have not received what are in his view optimal doses of methadone, they are not refractory, or that they do not necessarily face the risks described by Drs. Wood and Buxton.

[74] I find that the risks identified by Dr. Woods and Buxton are risks faced by the personal plaintiffs, and by those on whose behalf they apply, which will be reduced if they receive injectable diacetylmorphine treatment from Providence physicians. These potential harms are clearly irreparable in nature.

c) The Balance of Convenience

[75] The plaintiffs contend that the injunctive relief sought is of little practical consequence to the Attorney General of Canada as the impugned provisions were made for purely political reasons or for reasons based on a misapprehension of the facts, the medical opinions and the evidence. I am not persuaded that this is the case.

[76] Ian MacKay is the Manager of the SAP. At paras. 50–51 of his affidavit of January 23, 2014, Mr. MacKay explained what transpires when a SAP request is received by his office:

50. During a SAP assessment, the Director determines, based on the information before her or him:

(a) if the condition is a medical emergency;

(b) whether all other marketed therapies have been tried and failed, considered and deemed unsuitable or otherwise unavailable; and

(c) there is credible data supporting the use, safety and efficacy of the drug for the medical emergency at issue.

51. If a SAP authorization is issued, notice of the SAP authorization is transmitted to a specified manufacturer and a copy is provided to the applicant practitioner. SAP authorization permits the specified manufacturer to sell a specific quantity of the drug to a specific practitioner for a specific patient. An authorization does not compel a manufacturer to sell a drug; authorizations simply permit the sale of a drug provided the manufacturer is willing and able to supply the drug.

[77] Mr. MacKay cautioned, however, at para. 57 that:

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57. The SAP is neither a mechanism to encourage the early use of drugs nor is it meant to circumvent clinical development of a drug or regulatory review of a submission for marketing. Access to any drug through the SAP should be limited in duration and quantity to meet emergency needs only. The SAP is intended for short term access to drugs. Long term access to any drug through SAP risks circumvention of the market authorization process.

[78] The Attorney General of British Columbia submitted that as the impugned provisions disturbed the status quo ante, and were enacted without time to consult with the Province of British Columbia, the public interest asserted by the Attorney General for Canada should carry less weight, particularly as the injunction sought is, at least in part, an exemption to allow the Director to exercise the discretion contemplated by the SAP, as opposed to the suspension of the legislation.

[79] I consider that there is public interest in both the control of illicit drugs through the criminal justice system, and in reducing the attendant social costs that will not be abated if the personal plaintiffs are refractory to the available treatments for their addiction other than diacetylmorphine, if diacetylmorphine would be effective to treat their addictions.

[80] I accept that the potential harms facing the personal plaintiffs, and those on whose behalf they apply, are grave and that an award of damages will be of little, if any, assistance to them. As such, those harms must weigh heavily in the balance, particularly given that the exemption requested by the applicants does not cause any material harm to the government pending the ultimate resolution of this matter at trial. While I must keep in mind Sopinka and Cory JJ.’s statements as to the caution required when considering whether to deprive duly enacted legislation of its effect on an interlocutory basis, I find that on the evidence before me an order to that effect is justified.

[81] SAP applications are considered and either approved or disapproved by those with expertise in both addictions and drug safety issues. In light of the seriousness of the potential harms facing the applicants, I am persuaded that the balance of convenience in this case favours those for whom such applications for injectable diacetylmorphine were approved on terms and conditions prior to the

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enactment of the impugned provisions, or those whose applications may have been so approved had such applications been made prior to that enactment.

[82] I am not, however, persuaded that I can accede to the application for a mandatory injunction directing all necessary regulatory approvals, permits and/or exemptions required to secure access to the diacetylmorphine be granted. Such an order would, in my opinion, provide to the plaintiffs the very remedy they seek in this action.

[83] Further, the mandatory injunction sought would undercut the procedural safeguards in place regarding the importation and distribution of diacetylmorphine prior to the introduction of the impugned provisions. Those safeguards were described by Jacinthe David, the Acting Manager, Licences and Permits Division, Office of Controlled Substances, Controlled Substances and Tobacco Directorate in the Healthy Environments and Consumer Safety Branch of Health Canada, in her affidavit sworn January 23, 2014. At paras. 15 and 17–20 of that affidavit, Ms. David deposed that:

15. Under the Restricted Drug Regulations, restricted drugs may be imported into Canada only by a licensed dealer who is licensed to conduct activities with that particular restricted drug.

…

17. A licensed dealer must obtain an import permit under the Restricted Drug Regulations every time that they want to import a restricted drug. The dealer may import a restricted drug only pursuant to the terms and conditions of the import permit.

18. To obtain an import permit, a licensed dealer must submit an import permit application to the Office of Controlled Substances. In the import permit application, the licensed dealer must specify:

a) the quantity/item/strength of the restricted drug to be imported;

b) the total restricted drug content of the items imported, for example, the weight of the imported item that is a restricted drug;

c) the purpose for which it is required;

d) the name of the exporter;

e) the mode of transportation; and

f) the customs point of import.

Providence Health Care Society v. Canada (Attorney General) Page 32

19. Health Canada may also request additional information with respect to the restricted drug to confirm that it will be sold only to parties authorized to possess that restricted drug under the CDSA and the Restricted Drug Regulations. Additional information may also be requested to assist Canada in meeting its international reporting obligations to the [International Narcotics Control Board (the “INCB”)].

20. The importation of heroin into Canada is monitored by the INCB. Canada must provide an estimate to the INCB each year of how much heroin it will require for medical and scientific research purposes that year. Canada cannot authorize the importation of heroin over the estimated amount unless it makes a request for an increase to the INCB and the INCB approves the request. This process may take weeks or months and approval is not guaranteed. Canada’s estimate for 2013 was 16.5kg and the estimate for 2014 is 17.3kg. These estimated amounts were increased in 2013 based on the need for heroin for the purposes of the SALOME clinical trial. Canada must also provide Quarterly Statistics of Imports and Exports of Narcotic Drugs reports to the INCB, including the exact quantity of heroin that has been imported.

[84] At para. 30, Ms. David deposed that:

30. The Office of Controlled Substances has not received any applications to date for import permits from ALMAT [the only non-governmental licensed dealer] or any other licensed dealer for the purpose of providing heroin to medical practitioners who have received SAP authorizations for heroin. Furthermore, pursuant to the Restricted Drug Regulations, a licensed dealer can provide heroin only to persons who are authorized to possess it. If those persons are not otherwise authorized to conduct activities with heroin under Part J (Restricted Drug Regulations), they would require an exemption under section 56 of the CDSA.

[85] Scott Harrison, the Director Urban Health & HIV/AIDS of Providence Health Care swore in part at paras. 3, 8, 9, 13, 15 and 16 of his affidavit dated January 30, 2014 that:

3. In summary, the reason that Health Canada has not received any applications for an importation permit is because Almat, the only non-governmental licensed dealer, after several discussions with Health Canada have resolved not to become involved until this legal case is settled.

…

8. On November 20, 2013 I received an email from Mr. Boutaleb stating that Almat was waiting on a Health Canada response and would advise of any development as soon as possible. …

9. Mr. Boutaleb contacted me again, two hours later, on November 20, 2013, asking if Providence Health Care had the capacity to hold a full case of 90 x l0gm vials of DAM. …

Providence Health Care Society v. Canada (Attorney General) Page 33

…

13. On November 29, 2013, Mr. Janmohammed and I called Mr. Boutaleb to discuss the purchase order further and find out if there was any progress. Mr. Boutaleb indicated that Almat was waiting for a response from Health Canada, that the delay was usual due to the reconciliation process that occurs at the end of the year and that by the second week of January, we would likely have some more clarity.

…

15. On January 21, 2014, Mr. Janmohammed and I called Mr. Boutaleb and left a voicemail message.

16. On January 22, 2014, Mr. Janmohammed called Mr. Boutaleb and Mr. Boutaleb stated that Almat had had several discussions with the Office of Controlled Substances Canada with respect to the importation and permits for DAM related to the SAP approvals. I joined this teleconference and Mr. Boutaleb stated that “at this time, Almat are not able to assist you with this order.” I asked for this to be emailed to me so I had it in writing. I did not receive the email I requested.

[86] While I am prepared to grant the interlocutory injunction sought by the plaintiffs on the ground that it amounts to a restoration of the status quo ante, I am not prepared to order that diacetylmorphine be delivered to individuals addicted to heroin for the purpose of treatment. This would put them in a position of advantage above where they would have stood had the impugned provisions never been introduced. Further, such an order would involve both interfering with the approval process of several expert regulatory bodies and potentially adversely affecting the allocation and distribution of the amounts of heroin that have been approved for importation by the International Narcotics Control Board. It would also likely involve provisions directly affecting individuals and entities, such as AMLAT, which are not parties to this litigation. As such, I refuse the mandatory injunction sought.

[87] As I have seized myself of the litigation between the parties, it would be redundant to provide a direction that I maintain jurisdiction to supervise all issues arising in respect of plaintiff requests and future SALOME requests.

Conclusion

[88] I grant an interlocutory injunction exempting all outstanding plaintiff requests and future SALOME requests for access to diacetylmorphine and its salts from the

Providence Health Care Society v. Canada (Attorney General) Page 34

application of ss. J.01.001 and C.08.010 of the FDR, insofar as they are for patients who are refractory to other treatments and whose physicians have made or make a SAP application.

[89] I dismiss the application for a mandatory injunction directing the Attorney General of Canada and any agents, agencies, departments, directors, officers, offices and/or Ministers of the Federal Crown to provide all necessary regulatory approvals, permits and/or exemptions required to secure access to the diacetylmorphine granted under any plaintiff requests and/or future SALOME requests on an expedited basis.

[90] I decline to make a direction that the Court maintain jurisdiction to supervise all issues arising in respect of plaintiff requests and future SALOME requests, on the basis that such a direction is unnecessary.

_______________________________ The Honourable Chief Justice Hinkson

IN THE SUPREME COURT OF BRITISH COLUMBIA Citation: Providence Health Care Society v. Canada (Attorney General), 2014 BCSC 936 Pivot Legal Society copy.

Pivot Legal Society







IN THE SUPREME COURT OF BRITISH COLUMBIA

Citation: Providence Health Care Society v. Canada

(Attorney General),

2014 BCSC 936

Malaysia Airlines Flight 370 (MH370/MAS370 2014-05-29.

Malaysia Airlines Flight 370 (MH370/MAS370)[a] was a scheduled international passenger flight from Kuala Lumpur to Beijing that lost contact with air traffic control[2] on 8 March 2014 at 01:20 MYT,[b] less than an hour after takeoff. At 07:24, Malaysia Airlines (MAS) reported the flight missing.[4] The aircraft, a Boeing 777-200ER, was carrying 12 Malaysian crew members and 227 passengers from 14 nations.[5] There has been no confirmation of any flight debris[6][7][8][9][10] and no crash site has been found.[11]

A multinational search and rescue effort, later reported as the largest in history,[12] began in the Gulf of Thailand and the South China Sea.[13][14] Within a few days, the search was extended to the Strait of Malacca andAndaman Sea.[15][16][17] On 15 March, based on military radar data and radio "pings" between the aircraft and an Inmarsat satellite, investigators concluded that the aircraft had diverted from its intended course and headed west across the Malay Peninsula, then continued on a northern or southern track for around seven hours.[18][19][20] The search in the South China Sea was abandoned.[21] Three days later, the Australian Maritime Safety Authority began searching the southern part of the Indian Ocean.

On 24 March, the Malaysian government confirmed independent analyses by the British Air Accidents Investigation Branch (AAIB) and Inmarsat, and announced that search efforts would be concentrated on the Australian-led area. In the first two weeks of April, aircraft and ships deployed equipment to listen for signals from the underwater locator beacons attached to the aircraft's "black box" flight recorders. Four unconfirmed signals were detected between 6 and 8 April but after that time the batteries of the beacons were believed to have become exhausted. The search continued in the area of the signals, using a robotic submarine.



Contents [hide]
1 Disappearance
1.1 Timeline of disappearance
1.2 Satellite pings
2 Assumed loss
3 Search
3.1 Hypothesised routes
3.2 Hypothesised locations
3.2.1 First phase
3.2.2 Second phase
3.2.3 Third phase
3.2.4 Fourth phase
3.3 International involvement
3.4 Information sharing
3.5 Analysis of satellite communication
4 Aircraft
5 Passengers and crew
5.1 Passengers
5.2 Crew
6 Investigation
6.1 International participation
6.2 Possible passenger involvement
6.3 Crew and cargo
6.4 Claims of responsibility
7 Criticism and response
8 Timeline of events
9 See also
10 Notes
11 References
12 External links


Disappearance[edit]

Route: Kuala Lumpur – Beijing. Insert: initial search areas and known path through waypointsIGARI, VAMPI, and IGREX. Small red squares: radar contacts. Small circles: claimed spotting of debris.

The flight departed from Kuala Lumpur International Airport on 8 March 2014 at 00:41 local time (16:41 UTC, 7 March) and was scheduled to land at Beijing Capital International Airport at 06:30 local time (22:30 UTC, 7 March). It climbed to its assigned cruise altitude of 35,000 feet (11,000 m) and was travelling at 471 knots (872 km/h; 542 mph)[22] true airspeed when it ceased all communications and the transponder signal was lost. The aircraft's last known position on 8 March at 01:21 local time (17:21 UTC, 7 March) was at the navigational waypoint IGARI in the Gulf of Thailand, at which the aircraft turned westwards, heading towards a waypoint called VAMPI in the Strait of Malacca,[23] primary radar tracking suggests that the aircraft descended as low as 12,000 feet (3,700 m). From there, the aircraft flew towards a waypoint called GIVAL, arriving at 2:15 local time (18:15 UTC, 7 March), thereafter to the Southern Thailand Islands (Andaman Coast) of Phuket, and was last plotted heading northwest towards another waypoint called IGREX.[24][25][26]

The crew was expected to contact air traffic control in Ho Chi Minh City as the aircraft passed into Vietnamese airspace, just north of the point where contact was lost.[27][28] The captain of another aircraft attempted to reach the crew of Flight 370 "just after 1:30 am" using the International distress frequency to relay Vietnamese air traffic control's request for the crew to contact it; the captain said he was able to establish contact, and just heard "mumbling" and static.[29]

Malaysia Airlines (MAS) issued a media statement at 07:24, one hour after the scheduled arrival of the flight at Beijing, stating that contact with the flight had been lost by Malaysian ATC at 02:40.[4] MAS stated that the government had initiated search and rescue operations.[3] It later emerged that Subang Air Traffic Control had lost contact with the aircraft at 01:22 and notified Malaysia Airlines at 02:40. Neither the crew nor the aircraft's onboard communication systems relayed a distress signal, indications of bad weather, or technical problems before the aircraft vanished from radar screens.[30][31]
Timeline of disappearance[edit]
Elapsed (HH:MM)TimeEvent
MYTUTC
00:00 8 March 7 March Take-off from KUL (Kuala Lumpur)
00:41 16:41
00:20 01:01 17:01 Crew confirms altitude of 35,000 feet (11,000 m)[32]
00:26 01:07 17:07 Last ACARS data transmission received;[33] crew confirms altitude of 35,000 feet, a second time[32]
00:38 01:19 17:19 Last Malaysian ATC voice contact[34]
00:40 01:21 17:21 Last secondary radar (transponder) contact at 6°55′15″N 103°34′43″E[35][36]
00:41 01:22 17:22 Transponder and ADS-B no longer operating.
00:49 01:30 17:30 Voice contact attempt by another aircraft, at request of Vietnam ATC; mumbling and radio static heard in reply[29]
00:56 01:37 17:37 Missed expected half-hourly ACARS data transmission[33]
01:34 02:15 18:15 Last primary radar contact by Malaysian military, 200 miles (320 km) NW of Penang, 6°49′38″N 97°43′15″E
01:41 02:22 18:22 1st of 6 roughly hourly Classic Aero[37] pings (handshakes) since last ACARS transmission, via the Inmarsat-3 F1 satellite[38][39]
05:49 06:30 22:30 Missed scheduled arrival at PEK (Beijing)
06:43 07:24 23:24 Malaysia Airlines pronounces flight missing in statement released to media[4]
07:30 08:11 8 March 6th and last successful automated hourly handshake with Inmarsat-3 F1[38][40]
00:11
07:38 08:19 00:19 Unscheduled, unexplained partial handshake transmitted by aircraft[41][42]
08:34 09:15 01:15 Scheduled hourly ping attempt by Inmarsat goes unanswered by aircraft[38]

Satellite pings[edit]

On 11 March, New Scientist reported that, prior to the aircraft's disappearance, two Aircraft Communications Addressing and Reporting System (ACARS) reports had been automatically issued to engine manufacturer Rolls-Royce's monitoring centre in the United Kingdom;[43] and The Wall Street Journal, citing sources in the US government, asserted that Rolls-Royce had received an aircraft health report every thirty minutes for five hours, implying that the aircraft had remained aloft for four hours after its transponder went offline.[44][45][46]

The following day, Hishammuddin Hussein, the acting Malaysian Minister of Transport, refuted the details of The Wall Street Journal report stating that the final engine transmission was received at 01:07 MYT, prior to the flight's disappearance from secondary radar.[46] The WSJ later amended its report and stated simply that the belief of continued flight was "based on analysis of signals sent by the Boeing 777's satellite-communication link... the link operated in a kind of standby mode and sought to establish contact with a satellite or satellites. These transmissions did not include data..."[47][48]

Inmarsat said that "routine, automated signals were registered" on its network,[49] and that analysis of "keep-alive message[s]" that continued to be sent after air traffic control first lost contact could help pinpoint the aircraft's location,[50] which led The Independent to comment on 14 March that the aircraft could not have met with a sudden catastrophic event, or all signals would have stopped simultaneously.[23] There was a call for automated transponders after the attacks of 11 September 2001; however, no changes were made as aviation experts preferred flexible control, in case of malfunctions or electrical emergencies.[51]

On 25 March, Hishammuddin revealed that Inmarsat had found evidence that the aircraft had attempted a final seventh handshake with the satellite at 00:19 UTC, eight minutes after the last hourly report. This "partial ping" initiated by the aircraft was unscheduled, not the result of any human interaction,[52][53] and is consistent with the satellite equipment aboard the aircraft requesting a logon during power-up after an electrical outage, perhaps caused by fuel exhaustion.[54]
Assumed loss[edit]

Messages of hope and prayer for MH370 at a bookstore in Malaysia

On 24 March, Malaysian Prime Minister Najib Razak said,


Using a type of analysis never before used in an investigation of this sort... Inmarsat and the AAIB have concluded that MH370 flew along the southern corridor, and that its last position was in the middle of the Indian Ocean, west of Perth. This is a remote location, far from any possible landing sites. It is therefore with deep sadness and regret that I must inform you that, according to this new data, flight MH370 ended in the southern Indian Ocean.[55][c]

Just before Najib spoke at 22:00 MYT, Malaysia Airlines announced that Flight 370 was assumed lost with no survivors. It notified most of the families in person or via telephone, and some received the following SMS:


Malaysia Airlines deeply regrets that we have to assume beyond any reasonable doubt that MH370 has been lost and that none of those on board survived. As you will hear in the next hour from Malaysia's Prime Minister, we must now accept all evidence suggests the plane went down in the Southern Indian Ocean.[58][59][60]

On 29 March, the Government of Malaysia and the AAIB stated that, in accordance with the protocols detailed in International Civil Aviation Organization (ICAO) Annex 13 concerning aircraft accident investigation, they would set up an international team to investigate the loss of the flight.[61][62] On 30 March, Australian Prime Minister Tony Abbott announced the appointment of retired Australian Air Chief Marshal Angus Houstonto head the Joint Agency Coordination Centre (JACC) to co-ordinate the search effort and closely co-operate with Malaysia, the responsible state under international law.[63][64]

If the official assumption of no survivors holds, Flight 370 would be the deadliest aviation incident in the history of Malaysia Airlines (surpassing the 1977 hijacking and crash of Malaysian Airline System Flight 653 that killed all 100 passengers and crew on board); and the deadliest to date involving a Boeing 777, surpassing Asiana Airlines Flight 214. It would also be the second-deadliest incident in the Indian Ocean, behind Iran Air Flight 655;[65] the 17th-deadliest incident of all time; and the deadliest incident since the February 2003 crash of an Iranian military aircraft.
Search[edit]
Hypothesised routes[edit]

Search for aircraft. Pink circle: Range of aircraft based on fuel (5,300 kilometres (3,300 mi)). Ping corridors: possible locations (in red) of aircraft at last ping to Inmarsat and possible last location (lighter red) based on residual fuel. Search areas: 1) 8–20 March, 2) 20–27 March, 3) 28 March.

On 11 March, it was reported that military radar indicated the aircraft turned west away from the intended flight path and continued flying for 70 minutes before disappearing from Malaysian radar near Pulau Perak.[66][67] It was also reported that it had been tracked flying at a lower altitude across Malaysia to the Malacca Strait, approximately 500 kilometres (310 mi) from its last contact with civilian radar.[68] The next day, the Royal Malaysian Air Force chief denied the report.[69][70] A few hours later however, the Vietnamese transport minister claimed that Malaysia had been informed on 8 March by Vietnamese air traffic control personnel, that they had "noticed the flight turned back west".[71][d]

Although Bloomberg News said that analysis of the last satellite "ping" received suggested a last known location approximately 1,000 miles (1,600 km) west of Perth, Western Australia,[74] the Malaysian Prime Minister Najib Razak said on 15 March that the last signal, received at 08:11 Malaysian time, might have originated from as far north as Kazakhstan.[75] Najib explained that the signals could not be more precisely located than to one of two possible loci: a northern locus stretching approximately from the border of Kazakhstan and Turkmenistan to northern Thailand, or a southern locus stretching fromIndonesia to the southern Indian Ocean.[76] Many of the countries on a possible northerly flight route – China, Thailand, Kazakhstan, Pakistan, and India – denied the aircraft could have entered their country's airspace, because military radar would have detected it.[77]

It was later confirmed that the last ACARS transmission showed nothing unusual and a normal routing all the way to Beijing,[78] The New York Times reported "senior American officials" saying on 17 March that the scheduled flight path was pre-programmed to unspecified western coordinates through the flight management system before the ACARS stopped functioning,[79] and a new waypoint "far off the path to Beijing" was added.[79] Such a reprogramming would have resulted in a banked turn at a comfortable angle of around 20 degrees that would not have caused undue concern for passengers. The sudden cessation of all on-board communication led to speculation that the aircraft's disappearance may have been due to foul play.[79]
Hypothesised locations[edit]
[show]Map of all coordinates from Google
Map of up to 200 coordinates from Bing


As the available data analyses of the flight were refined, the foci of search operations changed to different areas in several distinct phases.
First phase[edit]

A MH-60R Sea Hawk lands aboardUSS Pinckney during a crew swap before returning to the search and rescue on 10 March 2014

An admiral of the Vietnamese navy reported that radar contact with the aircraft was last made over the Gulf of Thailand.[30][80] Oil slicks detected off the coast of Vietnam on 8 and 9 March later tested negative foraviation fuel.[81][82] Alleged discovery of debris about 140 km (87 mi) south-west of Phú Quốc Island near 80 km (50 mi) south of Thổ Chu Island on 9 March was also found to be not from an aircraft.[83] Searches following a Chinese website's satellite images, taken on 9 March, showing three floating objects measuring up to 24 × 22 metres (79 × 72 ft) at 6.7°N 105.63°E also turned up blank;[84][85] Vietnamese officials said the area had been "searched thoroughly".[86][87]

The Royal Thai Navy shifted its focus in the search away from the Gulf of Thailand and the South China Sea at the request of its Malaysian counterpart, which was investigating the possibility that the aircraft had turned around and could have gone down in the Andaman Sea, near Thailand's border.[88] The chief of the Royal Malaysian Air Force, Rodzali Daud, claimed that military recordings of radar signals did not exclude the possibility of the aircraft turning back on its flight path.[89][90] The search radius was increased from the original 20 nautical miles (37 km; 23 mi) from its last known position,[91] south of Thổ Chu Island, to 100 nautical miles (190 km; 120 mi), and the area being examined then extended to the Strait of Malacca along the west coast of the Malay Peninsula, with waters both to the east of Malaysia in the Gulf of Thailand, and in the Strait of Malacca along Malaysia's west coast, being searched.[14][41][90]

On 12 March, authorities also began to search the Andaman Sea, northwest of the Strait of Malacca, and the Malaysian government requested help from India to search in the area.[92]
Second phase[edit]

Chinese PLAAF Ilyushin Il-76arriving at RAAF Base Pearce in Perth, Australia on 21 March 2014

On 13 March, White House Press Secretary Jay Carney said "an additional search area may be opened in the Indian Ocean based on some new information"[44][93] and a senior official at The Pentagon told ABC News: "We have an indication the plane went down in the Indian Ocean."[94] On 17 March, Australia agreed to lead the search in the southern locus from Sumatra to the southern Indian Ocean.[95][96] The search would be coordinated by the Australian Maritime Safety Authority (AMSA), with an area of 600,000 km2 (230,000 sq mi) between Australia and the Kerguelen Islands lying more than 3,000 kilometres (1,900 mi) Southwest of Perth, to be searched by ships and aircraft of Australia, New Zealand, and the United States.[97] This area, which Australian PM Tony Abbott described as "as close to nowhere as it's possible to be", is renowned for its strong winds, inhospitable climate, hostile seas, and deep ocean floors.[98][99] On 18 March, the search of the area began with a single Royal Australian Air Force P-3 Orion aircraft.[100] On 19 March, the search capacity was ramped up to three aircraft and three merchant ships;[101] the revised search area of 305,000 square kilometres (118,000 sq mi) was about 2,600 kilometres (1,600 mi) south-west of Perth.[102]

Search efforts intensified on 20 March, after large pieces of possible debris had been photographed in this area four days earlier by a satellite.[103][104][105][106][107] Australia, the United Kingdom, the United States, China, Japan, New Zealand, and South Korea assigned military and civilian ships and aircraft to the search.[108][109] China published images from satellite Gaofen 1 on 22 March that showed large debris about 120 km (75 mi) south west of the previous sighting.[6][7][8] On 26 March, images from French satellites indicated 122 floating objects in the southern Indian Ocean.[9][110] Thai satellite images published on 27 March showed about 300 floating objects about 200 km (120 mi) from the French satellites' target area.[111] The abundant finds, none yet confirmed to be from the flight, brought the realisation of the prior lack of surveillance over the area, and the vast amounts ofmarine debris littering the oceans.[112][113]
Third phase[edit]

Deployment of a towed pinger locator for detecting an aircraft's ULB

Revised estimates of the radar track and the aircraft's remaining fuel led to a move of the search 1,100 kilometres (680 mi) north-east of the previous area on 28 March,[10][114] to a new search area of 319,000 square kilometres (123,000 sq mi), roughly 1,850 kilometres (1,150 mi) west of Perth.[115][116][117][118] This search area had more hospitable weather conditions.[7]

On 30 March, four large orange-coloured objects found by search aircraft, described by media as "the so far most promising lead", turned out to be fishing equipment.[119] On 2 April, the centre of the search area was shifted again 456 kilometres (283 mi) east, to a position 1,504 kilometres (935 mi) west of Perth.[120] The same day, Royal Navy survey vessel HMS Echo and submarine HMS Tireless arrived in the area,[121] with HMS Echo starting immediately to search for the aircraft's underwater locator beacons (ULBs) fitted to the "black box" flight recorders,[122] whose batteries are expected to have expired around 7 April.[123][124]
Fourth phase[edit]

Ocean Shield deploys Bluefin-21, 14 April 2014

On 4 April, the search was refocused to three more northerly areas from 1,060 to 2,100 kilometres (660 to 1,300 mi) west of Learmonth, spanning over 217,000 square kilometres (84,000 sq mi).[125][126] ADV Ocean Shield, fitted with a TPL-25 towed pinger locator, together with HMS Echo – which carried a "similar device", began searching for pings along a 240 kilometres (150 mi) seabed line believed to be the Flight 370 impact area.[123][127][128]Operators considered it a shot in the dark,[129] when comparing the vast search area with the fact that TPL-25 could only search up to 50 square miles (130 km2) per day.[129]

On China's announcement of two unconfirmed acoustic events picked up by Haixun 01 through a handheld hydrophone on 4 and 5 April,[130][131][132][133][134] the Joint Agency Coordination Centre (JACC) ordered HMS Echo to the area, to attempt verification with more advanced equipment.[135]

On 6 April, JACC announced that Ocean Shield had also picked up a signal, about 300 nautical miles (560 km; 350 mi) from Haixun 01.[135][136] It was announced the next day that the TPL-25 pinger locator towed by Ocean Shield had picked up a signal twice on 6 April.[137][138] The first, in the morning of 6 April at approximately 3,000 metres (9,800 ft) depth, lasted 2 hours and 20 minutes; the second episode took place at approximately 300 metres (980 ft) depth with the TPL only in the process of being deployed, and lasted 13 minutes. During the second episode, two distinct pinger returns were audible. Both episodes of recorded signals, which took place at roughly the same position though several kilometres apart, were considered to be consistent with signals expected from an aircraft's flight recorder ULB.[139] The Ocean Shield events were recorded at the north of a newly calculated impact area, which was announced on 7 April, while the Haixun 01 events had been recorded at its southern edge.[139][140][141] Ocean Shield detected two more signals on 8 April – the first signal acquired at 16:27AWST held for 5 minutes, 32 seconds; the second signal was acquired at 22:17 AWST and held for around 7 minutes.[11][142][143] Experts had determined that the earlier signals captured by Ocean Shield were "very stable, distinct, and clear ... at 33.331 kHz and ... consistently pulsed at a 1.106-second interval". These were claimed to be consistent with the flight recorder ULB.[11] but the frequency of the detections was well outside the manufacturer's specification of 37.5 +/- 1.[144] The later signals detected, at a frequency of 27 kHz, cast further doubt that they were from a black box.[145] On 10 April, a signal recorded by one of the sonobuoys deployed with a hydrophone at 300 metres depth[146][147] was found unlikely to have originated from Flight 370.[148]

On 14 April, due to the likelihood of the ULBs' acoustic pulses ceasing after their batteries had run down, the Towed Pinger Locator search gave way to a sea-bed search using side-scan sonar installed in the Bluefin-21 Autonomous Underwater Vehicle.[149] The first day's search was aborted because the sea bed was considerably deeper than the maximum operating depth of Bluefin. Scanning resumed after the abortive initial mission.[150]

After covering 42 square miles in its first four dives, the submersible was reprogrammed to allow it to dive 604 feet lower than its limit of 14,800 feet, when the risk of damage was assessed as "acceptable". Ravikumar Madavaram, an aviation expert at Frost & SullivanAsia Pacific described the search as "definitely the biggest operation ever." The search was then believed to have cost $100 million (£72m) and had been labelled "the costliest in aviation history".[151]

Bluefin-21 required 16 missions to complete its search of the 314 square kilometre area around the detections made by the Towed Pinger Locator.[152][153] At a news conference in Canberra on 28 April, Tony Abbott said "It is now 52 days since Malaysia Airlines Fight MH370 disappeared and I'm here to inform you that the search will be entering a new phase". Abbott also explained that "a much larger" area of the ocean floor would now be searched; it was "highly unlikely" that any surface wreckage would be found; and that the aerial searches had been suspended.[154][155][156] Mission 17 of Bluefin-21, covering the new, wider search area, was on 30 April.[153]

On 12 May, it was reported that the captain of Ocean Shield said there was increasing doubt that pings #3 and #4 detected on 8 April originated with MH370's black boxes because their frequency of about 27 kHz was too far below the pinger's design frequency of 37.5 kHz. Pings #1 and #2, detected on 5 April at 33 kHz, were still being considered by the search authorities.[157] On 13 May the search was interrupted due to problems with both the transponder mounted on Ocean Shield and that mounted on Bluefin-21.[158] By 22 May those problems had been resolved and the search was resumed, with Ocean Shield being joined by the Chinese survey ship Zhu Kezhen, which was to conduct a bathymetric survey of the area.[159]

On 26 May CNN reported that after Bluefin-21 had completed searching the area centered on the four pings, search efforts would be put on hold to allow for a new operator for the search effort to be selected. Equipment envisaged to be used would include towed side-scan sonar.[160] On 29 May the Australian Deputy Prime Minister, Warren Truss, announced that no aircraft debris had been found in that part of the ocean where searchers previously had reported 'pings' from the black boxes. The announcement followed a statement, by a US Navy officer, which cast doubt on whether the signals were from an aircraft flight recorder. Truss informed parliament that, beginning in August, the search would move into a new phase "that could take twelve months".[161]
International involvement[edit]
Wikimedia Commons has media related to Search of Malaysia Airlines Flight 370.


In response to the incident, the Malaysian government mobilised its civil aviation department, air force, navy, and Maritime Enforcement Agency; and requested international assistance under Five Power Defence Arrangementsprovisions and from neighbouring states. Various nations mounted a search and rescue mission in the region's waters.[162][163] Within two days, the countries had already dispatched more than 34 aircraft and 40 ships to the area.[14][15][90] The Comprehensive Nuclear-Test-Ban Treaty Organization Preparatory Commission analysed information from its network of infrasound detection stations, but failed to find any sounds made by Flight 370.[164]

On 11 March, the China Meteorological Administration[165] activated the International Charter on Space and Major Disasters, a 15 member organisation whose purpose is to "provide a unified system of space data acquisition and delivery to those affected by natural or man-made disasters,"[166] the first time the charitable and humanitarian redeployment of the assorted corporate, national space agency, and international satellite assets under its aegis had been used to search for an airliner.[167]

Another 11 countries joined the search efforts by 17 March, after more assistance was requested by Malaysia.[18] At the peak, before the search was moved to the south Indian Ocean, 26 countries were involved in the search, contributing a total of nearly 60 ships and 50 aircraft. In addition to the above, these parties included Australia, Bangladesh, Brunei, Cambodia, China, France, India, Indonesia, Japan, Myanmar, New Zealand, Norway, Philippines, Russia, Singapore, South Korea, Taiwan, Thailand, United Arab Emirates, United Kingdom, United States, Vietnam.[168][169] While not participating in the search itself, Sri Lanka gave permission for search aircraft to use its airspace.[170] Malaysia deployed military fixed-wing aircraft and helicopters,[171] and ships.[171][172][173] A co-ordination centre at the National Disaster Control Centre (NDCC) in Pulau Meranti, Cyberjaya was established.[174]

On 16 March, three staff members of the French government agency BEA flew to Kuala Lumpur to share with Malaysian authorities their experience in the organisation of undersea searches, acquired during the search for the wreckage of Air France Flight 447.[175]

The United Kingdom provided technical assistance from the Ministry of Defence, the United Kingdom Hydrographic Office, Department for Transport and the Met Office; and personnel from the Royal Air Force.[176]

Ships and aircraft from Australia, China, Japan, Malaysia, New Zealand, South Korea, the United Kingdom and the United States were involved in the search of the southern Indian Ocean.[124][177] On 27 March, the Canadian Press reported that a Royal Canadian Air Force pilot on exchange with the Royal Australian Air Force was flying with a crew of 12 to assist in the search.
Information sharing[edit]

Although Malaysia's acting Transport Minister Hishammuddin Hussein, who is also the country's Defence Minister, denied the existence of problems between the participating countries, academics said that because of regional conflicts, there were genuine trust issues involved in co-operation and sharing intelligence, and that these were hampering the search.[178][179] International relations experts said entrenched rivalries over sovereignty, security, intelligence, and national interests made meaningful multilateral co-operation very difficult.[178][179] A Chinese academic made the observation that the parties were searching independently, thus it was not a multilateral search effort.[179] However, The Guardian noted the Vietnamese permission given for Chinese aircraft to overfly its airspace as a positive sign of co-operation.[179]

Malaysia had initially declined to release raw data from its military radar, deeming the information "too sensitive", but later acceded.[178][179] Defence experts suggested that giving others access to radar information could be sensitive on a military level. As an example: "The rate at which they can take the picture can also reveal how good the radar system is."[178] One suggested that some countries could already have had radar data on the aircraft but were reluctant to share any information that could potentially reveal their defence capabilities and compromise their own security.[178] Similarly, submarines patrolling the South China Sea might have information in the event of a water impact, and sharing such information could reveal their locations and listening capabilities.[180] This is quite plausible, given how quickly the US redirected USS Kidd to begin searching the Indian Ocean, even as other search assets were then still focused on searching previous search areas.[94]

Satellite imagery was also made available by Tomnod for the public to help with the search through crowdsourcing.[181]
Analysis of satellite communication[edit]

The datalink for Malaysia Airline's avionics communications is supplied by SITA, which contracted with Inmarsat to provide a satellite communication link using Inmarsat's Classic Aero service.[39][182] An aircraft's satellite communication (SATCOM) system is used to transmit messages from the cockpit as well as automated messages from on-board systems using the ACARS communications protocol, but may also be used to transmit FANS & ATN messages and provide voice, fax and data links[37] using other protocols.[39][182][183] The SATCOM signals from the aircraft are picked up by Inmarsat's constellation of satellites and relayed to ground stations.[38] In the absence of a signal from a terminal, the ground station transmits hourly 'log on/log off' messages – informally referred to as a 'ping' – to the terminal; an active terminal automatically responds. The entire process is referred to as a 'handshake'.[38][184] After ACARS equipment on the aircraft was disabled, the SATCOM transceiver aboard Flight 370 completed six further handshakes; the final complete handshake occurring at 00:11 UTC on 8 March (08:11 MYT).[38][184]

Although the ACARS system on Flight 370 was disabled at 01:21 MYT (17:21 UTC, 7 March), the SATCOM terminal remained operable.[39] On 8 March, Inmarsat provided basic flight data relating to Flight 370 to SITA, which relayed information to Malaysia Airlines and investigators.[185] On 9–10 March, Inmarsat engineers noted that the ground station log recorded pings from the aircraft for several hours after contact was lost with air traffic control.[185] An analysis of the time difference between the transmission of the ping and the aircraft's response allowed Inmarsat to determine the aircraft's distance from the satellite resulted in the plotting of two arcs—referred to as the "northern corridor" and "southern corridor" where the aircraft may have been located at the time of its last complete handshake at 00:11 UTC.

Inmarsat conducted further analysis on the signals received during the handshakes, focusing on the frequency shift of the signal emitted from the aircraft compared with the actual frequency received, known as the burst frequency offset,[38][184] using a baseline of earlier system data for the aircraft, satellite, and ground station.[184] The burst frequency offset, caused by the Doppler effect, varies based on the aircraft's speed and whether it is moving towards or away from the satellite. Using an "innovative technique"[184] that has "never before [been] used in an investigation of this sort",[55] the team determined it could also use the burst frequency offset to determine the aircraft's speed and position along the identified arcs. Inmarsat cross-checked its methodology to known flight data from six Boeing 777 aircraft flying in various directions on the same day, and found a good match.[38] Applying the technique to the handshake signals from Flight 370 gave results that correlated strongly with the expected and actual measurements of a southern trajectory over the Indian Ocean, but poorly with a northern trajectory.[38][184][186] Further revised calculations to account for movements of the satellite relative to the earth allowed the northern corridor to be ruled out completely. This analysis was passed on to Malaysian authorities on 23 March.[39] At 22:00 local time the next day, Prime Minister Najib cited this development to conclude that "Flight MH370 ended in the southern Indian Ocean."[39][187]

In addition to the six completed handshakes between Flight 370 and the ground station after ACARS stopped sending messages, there is "evidence of a partial handshake" at 00:19 UTC which was not immediately well understood and is subject to further investigation.[38][184] Since the aircraft did not respond to a ping at 01:15 UTC, it was concluded that at some point between 00:11 UTC and 01:15 UTC, the aircraft lost the ability to communicate with the ground station,[38][184][185] which Malaysia's Department of Civil Aviation noted was "consistent with the maximum endurance of the aircraft".[184] Of note, the SATCOM terminal on an aircraft requires power from the aircraft to operate.[185]

Malaysian investigators set up an international working group, consisting of various agencies with experience in aircraft performance and satellite communications, to further analyse the signals between Flight 370 and the ground station, especially the signal at 00:19 UTC.[184] These included representatives from the UK's Inmarsat, AAIB and Rolls-Royce; China's Civil Aviation Administration and Aircraft Accident Investigation Department; the US NTSB and FAA, and Malaysian authorities.[188] Also on 7 April, JACC announced that the Malaysian technical investigation team indicated that the partial ping from Flight 370 at 08:19 MYT was most likely when it impacted with the water. Together with further refinement of the satellite data calculation, the investigation team hypothesised a reduced search area.[139][140][141]

In an article published on 8 May several satellite experts questioned the analysis of satellite pings made by Inmarsat staff because the Doppler frequency shifts measured were apparently not properly corrected against the satellite's own drift (a periodic North-South oscillation of 3º every 24 hours). Without any additional data being released, the implication of this new analysis was that the northern portion of the Inmarsat satellite pings arc could not be ruled out.[189]

On 27 May 2014, the Malaysian government released a listing of the raw satellite data obtained from Inmarsat to the public.[190][191]
Aircraft[edit]

Flightdeck of 9M-MRO in 2004.
Wikimedia Commons has media related to aircraft 9M-MRO.


Flight 370 was operated with a Boeing 777-2H6ER,[e] serial number 28420, registration 9M-MRO. The 404th Boeing 777 produced,[193] it first flew on 14 May 2002, and was delivered new to Malaysia Airlines on 31 May 2002. The aircraft was powered by two Rolls-Royce Trent 892 engines,[193] and configured to carry 282 passengers.[194] 9M-MRO had accumulated 53,460 hours and 7,525 cycles in service,[195] and had not previously been involved in any major incidents,[196] though a minor incident while taxiing at Shanghai Pudong International Airport in August 2012 resulted in a broken wingtip.[197][198] Its last maintenance 'A' check was carried out on 23 February 2014.[195]

The Boeing 777, introduced in 1994, is generally regarded by aviation experts as having a safety record that is one of the best of any commercial aircraft.[199][200] Since its first commercial flight in June 1995, there have been only three other serious accidents involving hull-loss: British Airways Flight 38 in 2008; a cockpit fire in a parked Egyptair 777-200 at Cairo International Airport in 2011;[201][202] and Asiana Airlines Flight 214 in 2013, in which three people died.
Passengers and crew[edit]
People on board by countryCountryNo. Australia 6
Canada 2
China 152
France 4
Hong Kong [f] 1
India 5
Indonesia 7
Iran[g] 2
Malaysia[h] 50
Netherlands 1
New Zealand 2
Russia 1
Taiwan 1
Ukraine 2
United States 3
Total 239


Malaysia Airlines released the names and nationalities of the 227 passengers and 12 crew members, based on the flight manifest, later modified to include two Iranian passengers travelling on stolen passports.[205]
Passengers[edit]

152 of the 227 passengers were Chinese citizens, including a group of 19 artists with six family members and four staff returning from a calligraphy exhibition of their work in Kuala Lumpur; 38 passengers were Malaysian. The remaining passengers were from 13 different countries.[206] Of the total, 20 were employees of Freescale Semiconductor, a company based in Austin, Texas – 12 of whom were from Malaysia and 8 from China.[207][208] One passenger who worked as a flight engineer for a Swiss jet charter company was briefly suspected as potential hijacker because he was thought to have the relevant skill set.[209]

Under a 2007 agreement with Malaysia Airlines, Tzu Chi – an international Buddhist organisation – immediately sent specially trained teams to Beijing and Malaysia to give emotional support to passengers' families.[210][211] The airline also sent its own team of caregivers and volunteers[174] and agreed to bear the expenses of bringing family members of the passengers to Kuala Lumpur and providing them with accommodation, medical care, and counselling.[91]Altogether, 115 family members of the Chinese passengers flew to Kuala Lumpur.[212] Some other family members chose to remain in China, fearing they would feel too isolated in Malaysia.[213] The airline's offer of an ex gratiacondolence payment of US$5,000 to the family of each passenger was initially rejected;[214][215] the amounts were handed out to relatives on 12 March. It was also reported that Malaysian relatives only received $2,000.[216]
Crew[edit]

All 12 crew members were Malaysian citizens. The flight's captain was 53-year-old Zaharie Ahmad Shah from Penang; he joined MAS in 1981 and had 18,365 hours of flying experience.[217] Zaharie was also an examiner qualified to conduct simulator tests for pilots.[218]

The first officer was 27-year-old Fariq Abdul Hamid, an employee of MAS since 2007, with 2,763 flying hours.[219][220] This was Fariq's first flight as a fully qualified Boeing 777 first officer, following the completion of his supervised transition to that type of aircraft.[220]
Investigation[edit]
International participation[edit]

On 8 March, although a formal (ICAO-sanctioned) investigation had not yet started, Boeing announced that it was assembling a team of experts to provide technical assistance to investigators,[221] in accordance with ICAO protocols. The United States National Transportation Safety Board (NTSB) soon thereafter announced it was sending its own team of investigators with technical advisers from the Federal Aviation Administration (FAA).[222][223]

The United States Federal Bureau of Investigation (FBI) had already deployed technical experts and agents to investigate the disappearance.[224] A senior US law enforcement official clarified that FBI agents had not been sent to Malaysia.[225] By 17 March the investigation was also being assisted by Interpol and other relevant international law enforcement authorities according to the Malaysian government.[226][227]

On 6 April Malaysia announced it had set up three ministerial committees to help co-ordinate the search, and a new investigation team including members from Australia, China, the US, the UK, and France had been established,[228] being led according to the ICAO standards by "an independent investigator in charge".[229] The investigation into the aircraft's disappearance was Malaysia's responsibility and Australia was co-ordinating the ocean search. Australia, the US, UK, and China had agreed to be "accredited representatives" of the investigation.[230]
Possible passenger involvement[edit]

Two men identified on the manifest, an Austrian and an Italian, had reported their passports stolen in 2012 and 2013, respectively.[30][231] Interpol stated that both passports were listed on its database of lost and stolen passports, and that no check had been made against its database.[232][233] Malaysia's Home Minister, Ahmad Zahid Hamidi, criticised his country's immigration officials for failing to stop the passengers travelling on the stolen European passports.[233] The two one-way tickets purchased for the holders of the stolen passports were booked through China Southern Airlines.[234] It was reported that an Iranian had ordered the cheapest tickets to Europe via telephone in Bangkok, Thailand. The tickets were paid for in cash.[235][236] The two passengers were later identified as Iranian men, one aged 19 and the other 29, who had entered Malaysia on 28 February using valid Iranian passports. The head of Interpol said the organisation was "inclined to conclude that it was not a terrorist incident".[204] The two men were believed to be asylum seekers.[237][238] United States and Malaysian officials were reviewing the backgrounds of every passenger named on the manifest.[206] On 18 March the Chinese government announced that it had checked all of the Chinese citizens on the aircraft and ruled out the possibility that any were potential hijackers.[239]
Crew and cargo[edit]

Police searched the homes of the pilot and co-pilot,[240] on suspicion that those in the cockpit had been responsible for the aircraft's disappearance.[241] However, no evidence had emerged to support this theory. After the FBI reconstructed the deleted data from the pilot's home flight simulator, the Malaysian government spokesman indicated that "nothing sinister" had been found on it.[242][243]

Malaysia Airlines disclosed its cargo manifest on 1 May.[244] On 17 March, MAS chief executive, Ahmad Jauhari Yahya, indicated only that the aircraft was carrying 3 to 4 tonnes/tons of mangosteens and said that nothing it transported was dangerous.[245][246][247]Three days later, he also confirmed that potentially flammable batteries, identified as lithium-ion,[248] were on board, adding that all cargo was "packed as recommended by the ICAO", checked several times, and deemed to meet regulations.[249][250][251] The cargo manifest released on 1 May had revealed two air waybills (AWBs) for lithium-ion batteries with a total consignment weight of 221 kg. Three other AWBs weighing 2,232 kg, were declared as radio accessories and chargers, but an MAS representative said he was not permitted to provide additional information.[252]

On 2 April Khalid Abu Bakar, Malaysia's Police Inspector-General, said that as part of its ongoing criminal investigation, more than 170 interviews had been conducted, including with family members of the pilots and crew.[253][254] Khalid said that the provenance and destination of all cargo, including the mangosteens and in-flight meals, were being investigated to rule out sabotage as a cause.[255]
Claims of responsibility[edit]

On 9 March 2014, members of the Chinese news media received an open letter that claimed to be from the leader of the Chinese Martyrs Brigade, a previously unknown group. The letter claimed that the loss of flight MH370 was in retaliation for the Chinese government's response to the knife attacks at Kunming railway station on 1 March 2014 and part of the wider separatist campaign against Chinese control over Xinjiang province's Uyghur regions. The letter also listed unspecified grievances against the Malaysian government. The letter's claim was dismissed as fraudulent based on its lack of detail regarding the fate of MH370 and the fact that the name "Chinese Martyrs Brigade" appeared inconsistent with Uyghur separatist groups which describe themselves as "East Turkestan" and "Islamic" rather than "Chinese".[256][257]
Criticism and response[edit]

Public communication from Malaysian officials regarding the loss of the flight was initially beset with confusion.[i] The New York Times wrote that the Malaysian government and the airline released imprecise, incomplete, and sometimes inaccurate information, with civilian officials sometimes contradicting military leaders.[269] Malaysian officials were also criticised after the persistent release of contradictory information, most notably regarding the last point and time of contact with the aircraft.[270]

Vietnam temporarily scaled back its search operations after the country's Deputy Transport Minister cited a lack of communication from Malaysian officials despite requests for more information.[271] China, through the official Xinhua News Agency, said that the Malaysian government ought to take charge and conduct the operation with greater transparency, a point echoed by the Chinese Foreign Ministry days later.[178][272]

On 11 March, three days after the aircraft disappeared, British satellite company Inmarsat had provided officials (or its partner, SITA) with data suggesting the aircraft was nowhere near the areas in the Gulf of Thailand and the South China Sea being searched at that time; and may have diverted its course through a southern or northern corridor. This information was only publicly acknowledged and released by Najib on 15 March in a press conference.[39][273]

Questions and criticisms were raised by air force experts and the Malaysian opposition about the current state of Malaysia's air force and radar capabilities.[274][275][276] Opposition leader Anwar Ibrahim said it was impossible and unacceptable that the country's advanced British radar system and military readiness had not been triggered by such a diverted flight.[277]

On 14 March, Malaysia Airlines retired the MH370/MH371 flight number pair for the Kuala Lumpur–Beijing–Kuala Lumpur route, replacing them with MH318 and MH319 respectively.[278]

On 24 March, Chinese Deputy Foreign Minister Xie Hangsheng reacted sceptically to the conclusion by the Malaysian government that the aircraft had gone down with no survivors. Xie Hangsheng demanded "all the relevant information and evidence about the satellite data analysis", and said that the Malaysian government must "finish all the work including search and rescue."[42][279]

Criticism was also levelled at the delay of the search efforts. Explaining why information about satellite signals had not been made available earlier, Malaysia Airlines said that the raw satellite signals needed to be verified and analysed "so that their significance could be properly understood" before it could publicly confirm their existence.[280] Hishammuddin said Malaysian and US investigators had immediately discussed the Inmarsat data upon receiving them on 12 March, and on two occasions, both groups agreed that it needed further processing and sent the data to the US twice for this purpose. Data analysis was completed on 14 March: by then, the AAIB had independently arrived at the same conclusion.[281]

On 25 March, Chinese president Xi Jinping said he was sending a special envoy to Kuala Lumpur to consult with the Malaysian government over the missing aircraft.[282] The same day, around two hundred family members of the Chinese passengers protested outside the Malaysian embassy in Beijing.[283][284] Relatives who had arrived in Kuala Lumpur after the announcement continued with their protest, accusing Malaysia of hiding the truth and harbouring the murderer. They also wanted an apology for the Malaysian government's poor initial handling of the disaster and its "premature" conclusion of loss, drawn without physical evidence.[285] An op-ed for China Daily said that Malaysia was not wholly to be blamed for its poor handling of such a "bizarre and unprecedented crisis", and appealed to Chinese people not to allow emotions to prevail over evidence and rationality.[286] The Chinese ambassador to Malaysia rebuked the "radical and irresponsible opinions" of the Chinese relatives, and said that they "[did] not represent the views of Chinese people and the Chinese government".[287] The ambassador also strongly criticised Western media for having "published false news, stoked conflict and even spread rumours" to the detriment of relatives and of Sino–Malaysian relations.[255] On the other hand, an article in the The New York Times criticized China for providing apparently false leads that detracted from the search effort and wasted time and resources.[288][289]
Timeline of events[edit]

Date (UTC)CategoryEvent7 March Media Department of Civil Aviation (DCA) Malaysia and Malaysia Airlines confirm Subang Air Traffic Control outside Kuala Lumpur lost contact with Malaysia Airlines Flight 370 on 8 March 2014 at 02:40 local time (on 7 March 2014 at 18:40UTC), later corrected to 01:30 local time (17:30 UTC) located at 6°33′05″N 103°20′39″E[290]
Search Malaysian and Vietnamese authorities jointly searching in the Gulf of Thailand area; China dispatches two maritime rescue ships to the South China Sea.[291]
8 March Search An international search and rescue mission mobilised, focusing on Gulf of Thailand. Natuna Islands archipelago and South China Sea. Malaysia, Vietnam, China, Singapore and Indonesia.
Media Malaysia Airlines releases passenger manifest of Malaysia Airlines Flight 370.[292]
Two men from Austria and Italy, listed among the passengers on Flight 370, are not in fact on board. Officials in both countries say that each had his passport stolen.[293]
9 March Search The search zone expanded, to include areas in the Strait of Malacca as military radar tracking indicates aircraft might have turned west from its flight plan and flight path.[294]
Investigation INTERPOL confirms that at least two passengers are found to have been travelling on stolen passports registered in its databases.[295]
10 March Search Ten Chinese satellites deployed in the search. Oil slicks on the surface of the South China Sea test negative for jet fuel.
Media Malaysia Airlines announces it will give US$5,000 to the relatives of each passenger.
11 March Investigation INTERPOL says that two false identities are not linked to the disappearance.[204]
Media China activates the International Charter on Space and Major Disasters.
12 March Search Chinese satellite images of possible debris from Flight 370 in the South China Sea at 6.7°N 105.63°E released, but surface search finds no wreckage.[85] Malaysian government receives Inmarsat info that Flight 370 pinged for hours after ACARS went off-line.
Media Chinese government criticises Malaysia for inadequate answers regarding Flight 370.
Investigation Royal Malaysian Air Force chief says that an aircraft plotted on military radar crossed the Malay Peninsula after changing course, towards a waypoint called GIVAL at 2:15 local time (18:15 UTC, 7 March), 200 miles (320 km) northwest of Penang Island off Malaysia's west coast. It followed standard aviation corridors. Search and rescue efforts being stepped up in Andaman Sea and Bay of Bengal.[296][297]
14 March Investigation Investigation concludes that Flight 370 was still under human control after it lost ground control contact.
Media MAS retires the MH370/MH371 flight number pair.[278]
15 March Search New phase of multi-national search and rescue operations within two areas in the northern and southern "corridors". Twenty-six countries involved, among the northern corridor countries are Kazakhstan, Turkmenistan, China,Thailand, including South China Sea and Gulf of Thailand. The southern corridor covers Indonesia, Australia, and the Indian Ocean.[298][299]
India continues search for Malaysia Airlines Flight 370; Malaysia ends hunt in South China Sea.[21]
Investigation Malaysian police search the homes of both of the aircraft's pilots.
16 March Search Twenty-five countries are involved in the search. India ends its search in the Andaman Sea and Bay of Bengal.[300]
17 March Search Search area reported by Malaysian authorities to be 2,000,000 square miles (5,200,000 km2), as a belt beneath the last possible arc position stretching from Kazakhstan over Indonesia to the southern part of the Indian Ocean.[298]Australia pledges to lead a search from Sumatra to the southern Indian Ocean.[301]
18 March Search China starts a search operation in its own territory. Australia conducts an aerial search through waters West and North of Cocos Islands and Christmas Island (close to Indonesia). Australia also conducts its first aerial search of the southern Indian Ocean,[100] roughly 3,000 kilometres (1,900 mi) southwest of Perth.[99]
19 March Search Australia searches the southern Indian Ocean with three aircraft and three merchant ships,[101] transiting through a slightly revised search area of 305,000 square kilometres (118,000 sq mi) about 2,600 kilometres (1,600 mi) southwest of Perth.[102]
20 March Media Prime Minister of Australia, Tony Abbott, told parliament that the "new and credible information" had emerged from expert analysis of satellite imagery.[302]
Search Five aircraft and a fourth (merchant) ship are dispatched to 44°03′02″S 91°13′27″E.[103]
22 March Search Chinese satellite image taken on 18 March shows a possible object measuring 22.5 by 13 metres (74 by 43 ft) at 44°57′30″S 90°13′40″E, approximately 3,170 kilometres (1,970 mi) west of Perth and 120 kilometres (75 mi) from the earlier sighting, but did not confirm the object's nature.
24 March Media Prime Minister of Malaysia announces that Flight 370 is assumed to have gone down in the southern Indian Ocean; Malaysia Airlines states to families that it assumes "beyond reasonable doubt" there are no survivors.[303]
Search Search area narrowed to the southern part of the Indian Ocean west and southwest of Australia. The northern search corridor (northwest of Malaysia) and the northern half of the southern search corridor (the waters betweenIndonesia and Australia) are definitively ruled out. An Australian search aircraft spots two objects at sea, 1,550 miles (2,490 km) southwest of Perth.[304]
26 March Search French satellite images captured on 23 March show 122 possible pieces of debris[9] at 44°41′24″S 90°25′19.20″E, 44°41′38.45″S 90°29′31.20″E and 44°40′10.20″S 90°36′25.20″E.[305]
Media UK Air Accidents Investigation Branch (AAIB) heads a team of investigators from other states as part of an international effort supporting the Malaysian authorities in accordance with the International Civil Aviation Organization (ICAO) code.[306][307]
27 March Search The search area narrows to roughly 76,000 square kilometres (29,000 sq mi). Thai and Japanese[citation needed] satellite images, captured 24–26 March show floating objects 200 kilometres (120 mi) south of the French observations.[111] Five ships from Australia and China are engaged.
28 March Search Search shifts to a new 319,000-square-kilometre (123,000 sq mi) area 1,100 kilometres (680 mi) northeast of the previous search area.[115][116]
29 March Media Malaysia announces that an international panel will be formed under United Nations protocols to investigate the Flight 370 incident.[308]
30 March Media Prime Minister of Australia announces newly formed Joint Agency Coordination Centre (JACC) headed by Angus Houston.[309] Military air crew from Australia, China, Japan, Malaysia, New Zealand, South Korea, and the United States are actively engaged.[310]
5 April Search Chinese patrol ship Haixun 01 detects a pulse signal at 25°S 101°E.[131][132][133][311] Ocean Shield also picks up two longer lasting signals.[11][137]
8 April Search Ocean Shield picks up two further signals 3,500 metres deep, close to those of 5 April.[11][143]
10 April Search Another signal is acquired by a sonobuoy deployed near the Ocean Shield signal acquisitions.[312] JACC declares the contact unlikely to be related to Flight 370.[148] Hydrographic survey ship HMS Echo arrives on scene to provide advanced computer analysis of Ocean Shield collected sonar data and to measure the thermoclines in the area to predict the trajectory of the detected pings.
14 April Search An oil slick is found 5.5 km from the estimated location of the pings by Ocean Shield.[313] Ocean Shield ceases towed passive sonar operations; the AUV Bluefin-21 is deployed with side-scan sonar to search for wreckage on the ocean floor,[314] but its mission is automatically aborted on reaching its maximum operating depth.[150]
15 April Search Bluefin-21 resumes scanning after its abortive initial mission.[150]
18 April Search The oil slick discovered four days earlier is determined by an Australian laboratory analysis not to be related to Flight 370.[315]
24 April Search Debris consisting of riveted metal sheets washes up on the Western Australian coast. This is later confirmed to be unrelated to Flight 370.[316]
28 April Search PM Abbott and Angus Houston of JACC announce that a larger area of the ocean floor would now be searched and there would be a suspension of the aerial search due to the likelihood that any wreckage would have sunk.[154][155][156]
5 May Search The US Navy extends contract for Bluefin-21 by four weeks.[317]
12 May Search Searchers say two of the four 'pings' they thought were from flight recorder ULBs may not have been from the flight recorder.[318]
22 May Search Bluefin-21 resumes search after repair.[319]
27 May Search Satellite data released after long wait.[320]

See also[edit]
Malaysia Airlines Flight 370 conspiracy theories
Zenith Plateau
Notes[edit]

Jump up^ MH is the IATA designator and MAS is the ICAO designator.[1] The flight is also marketed as China Southern Airlines Flight 748 (CZ748) through a codeshare.[1]
Jump up^ Initial reports on 8 March stated that contact had been lost at 02:40. This was changed to 01:30 by the Media Statement at 02:00 on 9 March[3] and then to 01:20 by the Malaysian Director General of Civil Aviation without comment or explanation.
Jump up^ Inmarsat stated that its conclusion had been based on a further analysis of the measurements of the Doppler shift of the "ping" transmissions.[56] Although the company did not elaborate, notably, the Inmarsat-3 F1 satellite's orbit is inclined by 1.67 degrees, causing it to cross the equator twice a day.[57] This motion could cause a difference between the Doppler shifts of northbound and southbound transmitters.
Jump up^ A US radar expert analysing the radar data reported that they did indeed indicate that the aircraft had headed west across the Malay Peninsula.[72] The New York Times reported that the aircraft experienced significant changes in altitude.[48][73]
Jump up^ The aircraft is a Boeing 777-200ER (for Extended Range) model; Boeing assigns a unique customer code for each company that buys one of its aircraft, which is applied as an infix in the model number at the time the aircraft is built. The code for Malaysia Airlines is "H6", hence "777-2H6ER".[192]
Jump up^ One passenger boarded with a Hong Kong passport.[203]
Jump up^ The manifest released by Malaysia Airlines listed an Austrian and an Italian. These were subsequently identified as two Iranian nationals who boarded Flight 370 using stolen passports.[204]
Jump up^ 38 passengers and 12 crew.
Jump up^ Examples:
* Malaysia Airlines' chief executive, Ahmad Jauhari Yahya, initially said air traffic control was in contact with the aircraft two hours into the flight when in fact the last contact with air traffic control was less than an hour after takeoff.[258]
* Malaysian authorities initially reported that four passengers used stolen passports to board the aircraft before settling on two: one Italian and one Austrian.[259]
* Malaysia abruptly widened the search area to the west on 9 March, and only later explained that military radar had detected the aircraft turning back.[259] This was later formally denied by Rodzali Daud.[70]
* Malaysian authorities visited the homes of pilot Zaharie and co-pilot Fariq on 15 March, during which they took away a flight simulator belonging to Zaharie. Malaysian police chief Khalid Abu Bakar said this was the first police visit to those homes. On 17 March, the government contradicted this by saying police first visited the pilots' homes on the day following the flight's disappearance,[260] although this had been previously denied.[261]
* On 16 March, Malaysia's acting transport minister contradicted the prime minister's account on the timing of the final data and communications received. Najib Razak had said that the ACARS system was switched off at 01:07. On 17 March, Malaysian officials said that the system was switched off sometime between 01:07, time of the last ACARS transmission, and 01:37, time of the next expected transmission.[262][263]
* Three days after saying that the aircraft was not transporting anything hazardous, Malaysia Airlines' chief executive Ahmad said that potentially dangerous lithium batteries were on board.[246][248]
* MAS chief executive initially claimed that the last voice communication from the aircraft was, "all right, good night", with the lack of a call sign fuelling speculation that the flight may have been hijacked.[34][264][265] Three weeks later Malaysian authorities published the transcript that indicated the last words were "Good night Malaysian three seven zero".[32][266][267][268]
References[edit]

^ Jump up to:a b MacLeod, Calum; Winter, Michael; Gray, Allison (8 March 2014). "Beijing-bound flight from Malaysia missing". USA Today. Retrieved 3 May 2014.
Jump up^ Azharuddin Abdul Rahman (10 March 2014). "Press Conference: MH370 (10 March 2014, 12:00 Noon)" (PDF).Ministry of Transport. Retrieved 3 May 2014.
^ Jump up to:a b "Sunday, March 09, 02:00 AM MYT +0800 Malaysia Airlines MH370 Flight Incident – 6th Media Statement".Malaysia Airlines. scroll down to find "6th Media Statement". Retrieved 5 April 2014.
^ Jump up to:a b c "Saturday, March 08, 07:30 AM MYT +0800 Media Statement – MH370 Incident released at 7.24am". Malaysia Airlines. scroll to bottom of page. Retrieved 2 April 2014.
Jump up^ "Saturday, March 08, 10:30 AM MYT +0800 Malaysia Airlines MH370 Flight Incident – 3rd Media Statement". Malaysia Airlines. scroll down to find "3rd Media Statement". Retrieved 2 April 2014.
^ Jump up to:a b Murdoch, Lindsay (22 March 2014). "Missing Malaysia Airlines flight MH370: Floating debris spotted by Chinese satellite image". The Sydney Morning Herald. Retrieved 24 March 2014.
^ Jump up to:a b c McDonell, Stephen (22 March 2014). "Missing Malaysia Airlines plane: Chinese satellites spot new possible debris from MH370" (text & images). ABC News. Retrieved 7 May 2014.
^ Jump up to:a b "Malaysia plane search: China checks new 'debris' image" (text, images & video). BBC News. 22 March 2014. Retrieved 8 May 2014.
^ Jump up to:a b c Withnall, Adam (26 March 2014). "Missing Malaysia flight MH370: French satellite images show possible 'debris field' of 122 objects in search area". The Independent. Retrieved 26 March 2014.
^ Jump up to:a b "Flight MH370: 'Objects spotted' in new search area"(text & images). BBC News. 28 March 2014. Retrieved 8 May 2014.
^ Jump up to:a b c d e "Transcript of Press Conference, 9 April 2014".Joint Agency Coordination Centre. 9 April 2014. Retrieved 6 May 2014.
Jump up^ Neuman, Scott (17 March 2014). "Search For Flight MH370 Reportedly Largest in History". The Two-way. NPR. Retrieved 11 May 2014.
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Jump up^ Exclusive: Radar data suggests missing Malaysia plane deliberately flown way off course – sources. Reuters, 14 March 2014
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Jump up^ "International Panel To Look Into MH370 Incident – Hishammuddin". Bernama (29 March 2014)
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Jump up^ *"China: no evidence MH370 entered airspace". CNTV English. 20 March 2014.
*"Missing Malaysian plane MH 370 never entered Thai airspace". The Indian Express. 18 March 2014.
*G Surach (16 March 2014). "Missing MH370: No way plane flew over Indian airspace undetected – Nation". The Star. Malaysia.
*"Missing Malaysian jet LIVE updates: Kazakhstan says detected no unidentified planes when Malaysian jetliner vanished : Asia, News". India Today. Retrieved 30 March 2014.
*Haris Hussain and Farrah Naz Karim (18 March 2014)."MISSING MH370: EXCLUSIVE: Flying as low as 80 feet 'possible'". New Straits Times.
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Jump up^ New MH370 search area may be opened in Indian Ocean – White House The Daily Telegraph 13 March 2014.
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Jump up^ "Missing MH370: Australia to lead southern search for MH370". The Star. 17 March 2014.
Jump up^ "Australia agrees to lead search in Indian Ocean for missing Malaysia Airlines flight MH370". The Canberra Times. 17 March 2014.
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Jump up^ Jacobs, Frank (26 March 2014). "MH370 and the Secrets of the Deep, Dark Southern Indian Ocean". Foreign Policy
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Jump up^ Molko, David. "MH370: Transport safety chief says next phase of underwater search months away". CNN.com. Retrieved 27 May 2014.
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Jump up^ Koswanage, Niluksi (9 March 2014). "Pilot of missing Malaysian flight an aviation tech geek". Reuters. Retrieved 10 March 2014.
Jump up^ "MISSING MH370: Co-pilot family awaits for latest updates – Latest". New Straits Times. 8 March 2014.
^ Jump up to:a b Watkins, Tom (10 March 2014). "First officer on missing jet was transitioning to 777-200s". CNN. Retrieved 10 March 2014.
Jump up^ "Boeing team to offer technical help to investigators".Deccan Chronicle. Retrieved 30 March 2014.
Jump up^ "Press Release March 8, 2014: NTSB positioning team to offer assistance in investigation of Malaysia Airlines 777 event". Ntsb.gov. Retrieved 9 March 2014.
Jump up^ Govindasamy, Siva; Scott, Alwyn; Hepher, Tim (12 March 2014). "Missing Malaysia Airlines plane's legal limbo hampers probe" (text, images & video). The Sydney Morning Herald. Retrieved 7 May 2014.
Jump up^ Serrano, Richard A. "FBI to investigate disappearance of a Malaysian Airlines jet." Los Angeles Times. 8 March 2014. Retrieved 9 March 2014.
Jump up^ "FBI not in on Malaysia crash probe; other U.S. agencies to arrive Monday". Reuters. Retrieved 11 March 2014.
Jump up^ "New phase of search starts on both corridors". Free Malaysia Today. Retrieved 30 March 2014.
Jump up^ Weaver, Matthew; McCarthy, Tom. "MH370: Australia takes lead in Indian Ocean as search area expands – live". The Guardian. Retrieved 30 March 2014.
Jump up^ Childs, Nick; Westcott, Richard (6 April 2014). "Malaysia flight MH370: Search ships to verify signals" (text, images & videos). BBC News. Retrieved 9 May 2014.
Jump up^ "Malaysia Reorganizes Flight 370 Investigation, Appoints Independent Investigator". Frequent Business Traveler. 6 April 2014. Retrieved 6 April 2014.
Jump up^ Gander, Kashmira (5 April 2014). "Missing Malaysia Airlines Flight MH370: Chinese patrol ship discovers pulse signal in southern Indian Ocean as plane spots white objects". The Independent. Retrieved 6 April 2014.
Jump up^ Catherine E. Shoichet and Ray Sanchez (9 March 2014)."Plane bore painters, pilgrims, others from around the world". CNN. Retrieved 8 March 2014.
Jump up^ "INTERPOL confirms at least two stolen passports used by passengers on missing Malaysian Airlines flight 370 were registered in its databases". Interpol. Retrieved 9 March 2010.
^ Jump up to:a b Murdoch, Lindsay (10 March 2014). "Fake passports on Malaysia Airlines flight reveal flaw in airline safety" (text, images & video). The Sydney Morning Herald. Retrieved 7 May 2014.
Jump up^ Keith Bradsher; Eric Schmitt (9 March 2014). "Passport Theft Adds to Mystery of Missing Malaysia Airlines Jet". The New York Times.
Jump up^ Mezzofiore, Gianluca (10 March 2014). "Missing Malaysia Airlines Flight MH370: Iranian Middleman Asked Thai Agent to Book Tickets on Stolen Passports". International Business Times (UK). Retrieved 11 March 2014.
Jump up^ "'There are no answers': Days later, no sign of Malaysia Airlines Flight 370". CNN. Retrieved 11 March 2014.
Jump up^ "MISSING MH370: Man with stolen passport on jet is asylum seeker – Latest". New Straits Times. Retrieved 30 March 2014.
Jump up^ Dehghan, Saeed Kamali. "Iranians travelling on flight MH370 on forged passports 'not linked to terror'". The Guardian. Retrieved 30 March 2014.
Jump up^ Chris Buckley and Keith Bradsher. "China Rules Out Terror Ties Among Citizens on Jet". The New York Times. Retrieved 19 March 2014.
Jump up^ Gardner, Frank; Fisher, Jonah (15 March 2014). "Missing Malaysia Airlines plane 'deliberately diverted'" (text, images, audio & video). BBC News. Retrieved 9 May 2014.
Jump up^ Barbara Starr, Chelsea J. Carter and Jim Clancy. "U.S. officials lean toward 'those in the cockpit' behind missing flight". CNN. Retrieved 16 March 2014.
Jump up^ Thomas, Pierre; Margolin, Josh (2 April 2014). "FBI Finishes Probe into Malaysia Airlines Captain's Flight Simulator" (text, images & video). ABC News. Retrieved 7 May 2014.
Jump up^ Moore, Andy; Donnison, Jon (29 March 2014). "Flight MH370: Chinese and Australian ships draw blank". BBC News. Retrieved 9 May 2014.
Jump up^ "Malaysia reveals how long lost jetliner went unnoticed". CBS News. Retrieved 2 May 2014.
Jump up^ "Was a small BOMB hidden inside MH370's cargo hold? AND WHY HASN'T M'SIA REVEALED THE CARGO MANIFEST?". Malaysia Chronicle. 19 March 2014.
^ Jump up to:a b "Not just mangosteens on board, MH370 also carried lithium-ion batteries, says daily". The Malaysian Insider. 22 March 2014.
Jump up^ "Malaysia News | AsiaOne". News.asiaone.com. 18 March 2014.
^ Jump up to:a b Tomlinson, Simon (22 March 2014). "Missing jet WAS carrying highly flammable lithium batteries: CEO of Malaysian Airlines finally admits to dangerous cargo four days after DENYING it". Daily Mail. Retrieved 23 March 2014.
Jump up^ "Missing MH370 carried lithium ion batteries as cargo but not seen as 'dangerous'". The Straits Times. 21 March 2014.
Jump up^ "Missing MH370: Lithium ion batteries deemed non-dangerous goods". The Star Online. 22 March 2014.
Jump up^ Missing Jet was Carrying Potentially Flammable Batteries: CEO NBC News 21 March 2014. Retrieved 21 March 2014.
Jump up^ "MH370: Motorola Owns 200kg Lithium Ion Batteries, Source Claims". International Business Times. Retrieved 6 May 2014.
Jump up^ "MH370 passengers "cleared" in four probe areas: Malaysian police". Channel NewsAsia. 11 March 2014.
Jump up^ "Missing plane MH370: Malaysia mystery 'may not be solved'". BBC News. 2 April 2014. Retrieved 9 May 2014.
^ Jump up to:a b Murdoch, Lindsay (3 April 2014). "Flight MH370: Police investigate whether food on missing plane was poisoned".The Sydney Morning Herald. Retrieved 3 April 2014.
Jump up^ ""中国烈士旅领导人"发信称对马航客机失事负责". 9 March 2014. Retrieved 6 May 2014.
Jump up^ "Obscure Group From Northwestern China, Chinese Martyrs' Brigade, Claims Responsibility For Missing Malaysia Airline Flight MH370; Authorities Skeptical of Claim". 10 March 2014. Retrieved 6 May 2014.
Jump up^ Hodal, Kate (14 March 2014). "Flight MH370: a week of false leads and confusion in hunt for missing plane". The Guardian. Retrieved 25 March 2014.
^ Jump up to:a b "Missing Malaysia Airlines flight MH370 – a week of confusion". The Sydney Morning Herald. 14 March 2014. Retrieved 7 May 2014.
Jump up^ "MH370: Further confusion over timing of last words" TV3 (New Zealand). 18 March 2014
Jump up^ Jamieson, Alastair (13 March 2014). "Officials Deny Engine Data Report From Missing MH370". NBC News.
Jump up^ Calder, Simon; Withnall, Adam (17 March 2014). "Missing Malaysia Airlines Flight MH370: Confusion deepens over ‘missing 30 minutes’ at heart of mystery engulfing stricken jet ". The Independent
Jump up^ Woodrow Bellamy III (19 March 2014). "Avionics Magazine :: Malaysian PM Clarifies MH370 Avionics Disablement". Aviationtoday.com.
Jump up^ "MH370: "All right, good night" came after system shut down". The Malaysian Times. 17 March 2014. Retrieved 31 March 2014.
Jump up^ "Malaysia Airlines flight MH370 co-pilot's last message was 'all right, good night' – video". The Guardian. 17 March 2014. Retrieved 31 March 2014.
Jump up^ "Last words transmitted from missing Malaysia Airlines plane were actually 'Good night, Malaysian three seven zero'".News.com.au. 1 April 2014. Retrieved 1 April 2014.
Jump up^ "New account of MH370 pilot's final words". Al Jazeera. Retrieved 31 March 2014.
Jump up^ Donnison, Jon; Westcott, Richard (31 March 2014). "MH370: New account of cockpit last words" (text, images & video). BBC News. Retrieved 8 May 2014.
Jump up^ "Stolen Passports on Plane Not Seen as Terror Link". The New York Times. 11 March 2014. Retrieved 15 March 2014.
Jump up^ Denyer, Simon (12 March 2014). "Contradictory statements from Malaysia over missing airliner perplex, infuriate". The Washington Post. Retrieved 14 March 2014.
Jump up^ Harlan, Chico (11 March 2014). "Malaysia Airlines plane may have veered wildly off course during flight, military says". The Washington Post. Retrieved 14 March 2014.
Jump up^ "China appeals to Malaysia for search information".Associated Press. 14 March 2014. Retrieved 14 March 2014.
Jump up^ Pasztor, Andy; Ostrower, Jon; Hookway, James (19 March 2013). "Critical Data Was Delayed in Search for Missing Malaysia Airlines Flight MH 370". The Wall Street Journal.
Jump up^ Malaysia Insider (8 July 2011). "MH370 throws spotlight on Malaysia's air force and radar capabilities". The Malaysian Insider.
Jump up^ Childs, Nick (16 March 2014). "Missing Malaysia plane: MH370 and the military gaps". BBC News. Retrieved 9 May 2014.
Jump up^ "Malaysia lets slip chance to intercept MH370".malaysiakini. Malaysiakini. 17 March 2014. Retrieved 6 April 2014.
Jump up^ Henderson, Barney (3 April 2014). "MH370 Malaysia Airlines: Anwar Ibrahim says government purposefully concealing information". The Daily Telegraph. Retrieved 6 April 2014.
^ Jump up to:a b Anwar, Zafira; Nambiar, Predeep (13 March 2014)."MISSING MH370: MAS changes flight number for KL-Beijing-KL flights". New Strait Times. Retrieved 6 April 2014.
Jump up^ Hatton, Celia (25 March 2014). "Malaysia Airlines MH370: Relatives in Beijing scuffles". BBC News. Retrieved 9 May 2014.
Jump up^ "Saturday, March 15, 05:45 PM MYT +0800 Malaysia Airlines MH370 Flight Incident - 19th Media Statement". Malaysia Airlines. scroll down to find "19th Media Statement". Retrieved 15 March 2014.
Jump up^ Hishammuddin Hussein (21 March 2014). "MH370 Press Briefing by Hishammuddin Hussein on 21st March 2014". Malaysia: Department of Civil Aviation Malaysia. Retrieved 6 May 2014.
Jump up^ "China's Xi to send special envoy to Malaysia over missing plane". Yahoo! News. 25 March 2014. Retrieved 1 April 2014.
Jump up^ "MH370 passengers' relatives protest in China". Al Jazeera. 25 March 2014. Retrieved 25 March 2014.
Jump up^ "(Flight MH370) Message from Beijing: "Liars"". The Standard. 25 March 2014. Retrieved 6 April 2014.
Jump up^ Branigan, Tania (30 March 2014). "Flight MH370: Chinese relatives demand apology from Malaysia". The Guardian. Retrieved 6 April 2014.
Jump up^ Mei Xinyu, (31 March 2014). "Treat MH370 tragedy rationally". China Daily.
Jump up^ Jha, Supriya (3 April 2014). "Developments over Malaysian jet search: As it happened". Z News. Retrieved 6 April 2014.
Jump up^ "Flight MH370: Missteps by China slowed search for missing jet". The New York Times via The Economic Times. Retrieved 23 April 2014.
Jump up^ "China gets taste of world criticism in MH370 hunt". The Malay Mail. Retrieved 23 April 2014.
Jump up^ Rivera, Gloria (7 March 2014). "Malaysia Airlines Flight Vanishes, Three Americans on Board" (text, images & video).ABC News. Retrieved 7 May 2014.
Jump up^ Vast waters hide clues in hunt for missing Malaysia Airlines flight. CNN, 9 March 2014
Jump up^ Malaysia Airlines Flight MH 370: See names, faces of passengers aboard doomed plane. Daily News (New York), 8 March 2014
Jump up^ Two Europeans listed on missing Malaysia flight were not on board. Reuters, 8 March 2014
Jump up^ RMAF chief: Recordings captured from radar indicate flight deviated from original route. The Star, 9 March 2014
Jump up^ INTERPOL confirms at least two stolen passports used by passengers on missing Malaysian Airlines flight MH370 were registered in its databases. INTERPOL, 9 March 2014
Jump up^ Exclusive: Radar data suggests missing Malaysia plane deliberately flown way off course – sources. Reuters, 12 March 2014
Jump up^ MH370 Malaysia Airlines: Anwar Ibrahim says government purposefully concealing information. The Daily Telegraph, 3 April 2014
^ Jump up to:a b "Two MILLION square miles to be searched, 26 countries involved – and still not a trace of Flight MH370: hunt for the missing plane stretches from Kazakhstan to Southern Ocean". Daily Mail. 17 March 2014.
Jump up^ MH370 possibly in one of two ‘corridors’, says PM. The Malay Mail, 15 March 2014
Jump up^ India Suspends Its Search for Flight 370 Gardiner Harris,The New York Times, 16 March 2014
Jump up^ "Search operation for Malaysian airlines aircraft" (PDF). Australian Maritime Safety Authority (AMSA). 17 March 2014.
Jump up^ "Prime minister Tony Abbott announces search planes being sent based on 'new and credible information' from satellite images". The Guardian. 20 March 2014.
Jump up^ "Malaysia plane: Bad weather halts search for flight MH370". BBC News. 25 March 2014. Retrieved 9 May 2014.
Jump up^ Austin, Henry (24 March 2014). "Missing Jet: 'Orange Rectangular Object' Spotted in Sea". NBC News. Retrieved 24 March 2014.
Jump up^ Donnison, Jon (26 March 2014). "Flight MH370: 122 new objects spotted – Malaysia minister". BBC News. Retrieved 9 May 2014.
Jump up^ MH370: Malaysia Following International Procedures On Information Disclosure. BERNAMA, 31 March 2014
Jump up^ "Updated statement on Malaysian Airlines Flight MH370 issued 26/03/14". UK-AAIB. 26 March 2014. Archived fromthe original on 28 March 2014.
Jump up^ International panel to be set up . The Star, 29 March 2014
Jump up^ "About the Joint Agency Coordination Centre". Joint Agency Coordination Centre. Retrieved 6 May 2014.
Jump up^ Angus Houston to lead new Joint Agency Coordination Center in search of missing flight. Xinhua, 30 March 2014
Jump up^ Branigan, Tania (5 April 2014). "MH370: Chinese patrol ship detects ping near suspected location of plane". The Guardian. Retrieved 6 April 2014.
Jump up^ Malaysia Airlines Flight 370 searchers hear another possible black box ping from Indian Ocean . CBS, 10 April 2014
Jump up^ "Malaysia Airlines MH370: submarine to be deployed as oil slick spotted". The Daily Telegraph. Retrieved 14 April 2014.
Jump up^ "Missing flight MH370: Robotic submarine to begin search". BBC News. 14 April 2014. Retrieved 9 May 2014.
Jump up^ Withnall, Adam. "Malaysia Airlines flight MH370: Analysis of Indian Ocean oil slick shows it is not from missing jet". The Independent. Retrieved 18 April 2014.
Jump up^ Farrel, Paul; Safi, Michael. "Link to MH370 discounted after debris washes up on Western Australia coast". The Guardian. Archived from the original on 26 April 2014. Retrieved 26 April 2014.
Jump up^ "Transcript of Press Conference, 5 May 2014". JACC. Retrieved 5 May 2014.
Jump up^ "Searchers fear 'pings' they thought were from missing MH370 were not from the plane at all". Daily Mail. Retrieved 12 May 2014.
Jump up^ "Flight MH370: Hunt for missing jet resumes as search area is widened again". Mirror. 22 May 2014. Retrieved 22 May 2014.
Jump up^ "MH370: Inmarsat satellite data revealed to the public - CNN.com". Edition.cnn.com. Retrieved 2014-05-29.
External links[edit]
Wikimedia Commons has media related to Malaysia Airlines Flight 370.

Accident description at the Aviation Safety Network
Preliminary Report - Preliminary report issued by the Malaysia Ministry of Transport. Dated 9 April 2014 and released publicly on 1 May 2014.
Prime Minister of Malaysia Press Releases.
Malaysian Ministry of Transport: Press Statements and Briefings from the Prime Minister, Minister of Defence and acting Minister of Transport, Director General of the Department of Civil Aviation and Director General of Immigration. Includes transcripts of questions and answers not available on other external links.
Updates regarding MH370 from Malaysia Airlines
Australian Maritime Safety Authority MH370 Search Media Kit Original Briefings and charts etc. for the MH370 search in the Australian area. Includes MP3 and MP4 videos of Media Briefings. From 1 April 2014, communication regarding the MH370 search were issued by the Joint Agency Coordination Centre (JACC). The AMSA site does however include all charts, including those after 1 April.
JACC: Media releases, press conference transcripts.
US Department of Defense – MH370: news & photos regarding MH370 from the US Department of Defense (content is in the public domain)