A system that lets people down is a system that needs fixing.

What happened on June 12th in Ahmedabad is heartbreaking? A Boeing 787 took off like any normal flight. But within seconds, both engines lost power. The aircraft did not make it. It crashed just outside the airport. Many lives were lost, both on board as well as on the ground.

This was not some old or outdated plane. It was a modern jet, flown by trained crew. So how could this happen?

Early findings show that after takeoff, the fuel control switches, which keep fuel flowing to the engines, somehow flipped to the ‘cutoff’ position. With no fuel, the engines shut down.

The strange part? The pilots did not do it.

One pilot asked, “Why did you cut off?” The other said, “I didn’t.”

So What went Wrong?

The answer may lie deep inside the aircraft’s engine control system. Each engine has a small computer, called Electronic Engine Control (EEC) that controls how it runs. Inside that computer is a microchip, called MN4, which is vital for controlling the fuel.

Years ago, the engine maker and the US FAA warned airlines that this chip could fail over time. The tiny metal balls connecting it, called solder balls, can crack due to heat and age. If that happens, the chip may stop working, even for a split second and the engines could shut down by mistake.

A Service Bulletin, which is a strong recommendation was issued in 2020/21 saying this chip should be replaced. Another Boeing bulletin from 2018 said fuel switches should be upgraded to prevent them from moving by accident.

Neither of these safety steps had been done on this plane. And, on June 12th, what had been warned about, happened.

When People Make Things Go Right

In the past, we used to think that accidents happen because people make mistakes. That is called the Safety I way of thinking, stop people from doing the wrong thing.

But experts like Professor Sidney Dekker came along and said: ‘People are not the problem. People are the reason things usually go right’.

That is the Safety II approach.

Most of the time, pilots, engineers, and staff are the ones keeping flights safe, even when systems are not perfect. They adapt, they fix things on the go and they make it work.

But when a system quietly fails, like a chip deep inside a box, even the best-trained pilot might not be able to save the day.

In this case, the crew did everything right. Thrust levers were in takeoff position. They tried restarting the engines. They called MAYDAY. They followed procedures. But the engines did not respond, because the system had already failed them.

Was It Incompetence, Negligence, or Just Complacency?

That is the tough part.

• Was it incompetence – not knowing what needed to be done?
• Was it negligence – knowing, but not doing?
• Or just complacency – thinking “it won’t happen to us”?

This was not bad luck. It was a missed opportunity to act earlier, when warnings were first given.

And that is why this is a wake-up call. Not just to find out what failed, but to ask why we did not fix it when we had the chance.

Final Thought

We often think safety is about stopping people from making mistakes.

But real safety is giving people the tools and systems they can rely on, and acting quickly when we know something is not right. A warning ignored is not just a memo. It can become a life lost.

Let us not forget this tragedy. But more importantly, let us learn from it.

Because safety is not a checklist. It is a mindset.

This article is based on information contained in the interim report released by the national aircraft accident investigation authorities.