“Things that have never happened before happen all the time in history” — Scot D Sagan, ‘The Limits of Safety‘
On Mar 9, 2022, an unarmed BrahMos missile left its launcher from an Indian Air Force base in northern region. The supersonic missile’s journey lasted about seven minutes through few waypoints in India before crossing the border and ending on the boundary wall of a small house in Mian Channu in neighbouring Pakistan’s Punjab province.
Missile firings, even in the most developed countries wielding cutting-edge technologies, are not without failures. For instance, six out of the first 21 launches of USA’s Pershing-II medium range ballistic missile encountered technical failures and misfires as per Pentagon reports. There have been many documented cases when the world teetered on the brink of nuclear war and ‘mutually assured destruction’ due to accidental launches, or false detection of such launches from an adversary.
A serious debacle
The BrahMos launch in question is however far more serious. It is the first recorded case in history where a cruise missile was accidentally launched from inside one country into a rival’s territory — in this case, both hostile neighbours with a history of wars and unsettled borders. It is the acme of incompetence and human fallibility. The resultant crisis was defused with nuanced handling devoid of knee-jerk reactions from either side. Pakistan bristled and fumed with understandable angst but did not retaliate. Perhaps they found solace in Hanlon’s Razor — “never attribute to malice that which is adequately explained by stupidity.”
Either way, the incident was too serious to be passed off as ‘technical malfunction’ during ‘routine maintenance’, which the Indian MoD did try to, pending a high-level Court of Inquiry (CoI). The inquiry and administrative process culminated this month — in just over 5 months — with dismissal of three officers from service (one Group Captain, presumably the CO of the missile unit, a Wing Cdr and one Sqn Ldr).
Legality of CoI to recommend punishment?
The speed of inquiry and the gravity of sentence may seem appropriate but it raises questions of law and mandate of military inquiry committees. What the navy calls ‘Board of Inquiry (BoI), air force knows as Court of Inquiry(CoI). To the best of my knowledge, CoI is a fact-finding exercise. There are only witnesses, evidence, appendices and exhibits in a CoI — no ‘accused’ or ‘convicts’. The CoI or BoI may attribute blame but it has no power to sentence; that power rests with a General Court Martial (GCM). The CoI report is reviewed, vetted and approved at several levels, including the command and service headquarters.
If the CoI finds culpability, administrative / disciplinary action is the next step. Those found culpable are chargesheeted based on evidence collected by a separate entity. After this, a summary trial or court martial may be convened, following due process of law — giving the accused access to a defence counsel and every opportunity to defend themselves.
Government dismissing personnel named by the CoI is exceptional, to my mind. One hopes the terminated officers were given a chance to defend themselves. All commissioned officers serve with the pleasure of the President of India. Such privilege can be withdrawn in the case of grave misconduct, but only after due process of law. This clause has likely been invoked to dismiss the three officers. For an incident this serious, should culpability stop at the rank of Group Captain or higher in the rung is for the IAF to introspect.
Cruise missiles have several layers of mechanical and electronic interlocks that preclude accidental launches. The launch event cannot be activated by a single person — SOPs simply preclude that. The BrahMos missile did not misfire; it was accidentally fired. That means it cleared the entire sequence of interlocks and safeguards, involving more than one operator.
In the navy, every missile launch is preceded by a Crew Inspection Test (CIT) where every aspect of chain of command, man and material readiness is audited by an external board before the ship is given a green signal to embark the ‘article’ and proceed with the launch. How the far more capable and technologically advanced BrahMos managed to slip through the cracks defies simple explanation. In the least, the investigation report should provide invaluable insights to all three services and BrahMos Aerospace. One hopes that organisational pathology doesn’t stifle osmosis of ‘lessons learnt’; neither should the matter end with dismissal of three officers.
Deviation from SOP? Technical malfunction? Or both?
Deeper questions must also be asked of the delay and manner of reporting the accidental launch and the confusing statements that followed. The press release of Mar 11, 2022 read “in the course of a routine maintenance, a technical malfunction led to the accidental firing of a missile“. If ‘deviation from standard operating procedures’ was the cause, why did the initial report mention technical malfunction? Or are the two interconnected? As per sources, the accidental launch happened during a operational readiness inspection. Every squadron, unit and department in the station is on ‘high alert’ during such inspections meant to test the unit’s readiness for action and detect gaps in safety management of critical systems. In this case, it seems to have had the exact opposite outcome — critical failure of a system, designed with multiple interlocks, under the highest level of scrutiny. It doesn’t get any worse than this.
Managing HR in a fighter-heavy air force
One also hopes that the dreaded ‘HR’ angle doesn’t find a place in this debacle. In the hierarchy of a fighter pilot-centric air force, missile units and their officers tend to sediment towards the bottom. IAF’s personnel branch would know how many missile units are safe haven for pilots grounded due medical, competency or other reasons. There may be some areas of overlap, but for the most part, these are different paradigms requiring different skill sets and, most importantly, different attitude. With the focus shifting from manned to unmanned, manned-unmanned teaming, stand-off weapons, and nuclear-tipped missiles, the old playbook of assigning ‘broken wings’ and second-rung officers to such strategic forces merits a serious relook.
Simple answers to complex chains
History informs us that sometimes complex sequence of events can be safely managed by a simple ‘aide memoire’. I leave the readers to ponder over the understated power of the humble ‘checklist‘ with a simple anecdote.
On Oct 30, 1935, Boeing’s Model 299 prototype took off for an evaluation flight by the US Army Air Corps from Wright Field, Dayton, Ohio. At the controls was Major Ployer Hill, test pilot and Chief of Flying at Material Division, Wright Field. Others onboard were co-pilot Lieutenant Donald Leander Putt, Boeing’s Chief Test Pilot Leslie R. Tower and two others.
At stake was a competition to build the military’s next generation long range bomber. Soon after takeoff, the aircraft pitched up, stalled and crashed in a huge fireball. Major Ployer and Leslie Tower died of their injuries.
Investigation revealed that the aircraft crashed because crew had forgotten to remove the flight controls gust locks, thereby locking the elevators at 12.5° that went unnoticed till it was too late. Boeing lost that competition and their Chief Test Pilot. The army would’ve recommended more training to handle complex aircraft but for Maj Ployer who never fit the description of someone who would be found wanting in preparation.
It was a simple error of omission every human is susceptible to. US Army’s test crew assigned to investigate the crash came up with a simple solution to overcome what was then famously dubbed ‘too much airplane for one man to fly’. Out of the flaming debris of Model 299, the checklist was ushered into aviation. Model 299 went on to become the B-17 ‘Flying Fortress’ that allowed US forces to carry out their devastating bombing campaign across Nazi Germany which helped turn the tide of World War II.
Over the next half a century, innumerable checklists were developed to grapple with galloping technology that saw introduction of supersonic passenger planes, Flight Management Systems, fly-by-wire, glass cockpits etc. Aeroplanes became complicated amalgamations of massive number of systems and subsystems that was impossible to manage through memory. Nobody can say definitively how many accidents were prevented by checklists. But aviation – arguably the safest mode of transport today – owes it in no small measure to the humble checklist. BrahMos may be rocket science, but it is not infallible to human error. If a simple approved checklist was followed diligently, chances are, the debacle may have never happened.
The first-ever BrahMos launch across the border claimed three of our own. The next one may not be as forgiving.
(A lightly edited version of this story was first published by The Quint as an op-ed. You can access it here)
©KP Sanjeev Kumar, 2022. All rights reserved. Cover image of BRAHMOS supersonic cruise missile from Wikimedia Commons. (Image credits Ministry of Defence, GODL-India; https://commons.wikimedia.org/w/index.php?curid=82760701)