Investigation Summary
The flight was operating in a complex post-conflict environment following the Kosovo War. Air traffic control at Pristina was managed by the British Royal Air Force (RAF) under a KFOR mandate. The investigation by the BEA revealed a breakdown in both cockpit discipline and air traffic management. The crew, particularly the captain, was severely fatigued, having flown a 14 hour duty period two days prior followed by five flights the day before the accident. This fatigue led to a sense of routine that resulted in the omission of safety altitude briefings and the selection of a decision height of 200 feet, which was significantly lower than the airport's 600 foot minimum. Simultaneously, the military controller providing radar services failed to maintain situational awareness and 'forgot' the aircraft while it was on a track leading toward high terrain. The aircraft was also flying with an unserviceable GPWS, a condition the operator had postponed rectifying, which deprived the crew of a final warning before the impact with the mountain.
Final Conclusions
The BEA concluded the collision was due to a lack of procedural discipline during maneuvers in mountainous terrain with poor visibility, combined with a military controller who failed to prevent the terrain collision while providing radar services. Contributing factors included crew fatigue, the operator's failure to respect procedures due to its critical situation as a new company, and the operation of the aircraft with a disconnected or unserviceable GPWS. The investigation also noted that the airport had been opened to civil traffic without a proper evaluation of operating conditions or aeronautical information distribution.
Video Analysis
They Forgot About This Plane, It Crashed Into A Mountain ... — The story of Si Fly Flight 3275, an ATR 42 that crashed into a mountain near Pristina, Kosovo, while operating for the United Nations.
If playback is blocked, the owner has disabled embedding — use the link above.
Airframe & Maintenance
Crew Experience
Captain
59-year-old Andrea Maccaferro, former Italian Air Force pilot. Acted as Pilot Monitoring (PM).
First Officer
49-year-old Antonio Canzolino, former Italian Air Force pilot and Pilot Flying (PF).
Systems & Failure Modes
GPWS
The Ground Proximity Warning System was unserviceable or disconnected; the airline had postponed the rectification of the device, preventing a terrain warning.
Radar Vectoring
The military controller provided radar services but failed to monitor the aircraft's proximity to high ground.
ILS
The crew attempted an ILS approach without a glidepath, which was prohibited by the airline's operating procedures.
Interesting Facts
- 01The accident is the deadliest aviation disaster in Kosovo's history.
- 02The captain had 18,000 total flight hours, with 5,000 hours on the ATR 42.
- 03The Ground Proximity Warning System (GPWS) was known to be unserviceable prior to the flight.
- 04Most passengers were UN officials, aid workers, and journalists.
- 05The first officer was the pilot flying (PF) at the time of the accident.
Safety Actions & Advisories
Airport Infrastructure Evaluation
Immediate evaluation of Pristina Airport infrastructure and operations was conducted by ICAO experts.
GPWS Maintenance Mandates
Implementation of mandatory pre-flight checks on GPWS systems and modifications to improve vital aircraft equipment.
WFP Safety Standards
The crash led to a significant overhaul of flight safety standards for World Food Programme (WFP) and UN aid flights.