A British passenger has died during a cruise around Africa after a medical emergency at sea was followed by delays in securing appropriate treatment on land.

The incident raises renewed questions about the adequacy of travel insurance and medical infrastructure on certain cruise itineraries.

Lorraine Russell, 62, from North Lanarkshire in Scotland, suffered a heart attack while travelling with her husband aboard Norwegian Cruise Line from Cape Town in January 2024. She received initial emergency care on board before medical staff advised that she required a stent procedure to stabilise her condition.

Her family contacted their travel insurance provider, arranged through the Royal Bank of Scotland and administered by Direct Line, but say efforts to identify a suitable hospital were delayed.

According to her daughter, Ashley Hassan, the couple were directed to seek treatment in Nosy Be, a journey of approximately 17 hours.

“My mum had suffered a heart attack and the stress of having to search for the right hospital, scared and in pain, put her in a state of absolute terror,” Ashley Hassan, Daughter of Lorraine Russell, told The Express.

“She was first told to go to the next port at Nosy Be in Madagascar, which was 17-and-a-half hours away.

“They told them to head to the nearest hospital and reassured them there was a plan for when she got to the facility. They said that everything would be okay.”

On arrival, the family found that the facility lacked the equipment required to treat her condition. “We trusted the insurance, but when mum and dad got there the next day they discovered there was no equipment and no way she could be treated there,” said Hassan.

“It wasn’t even a proper hospital, it was a sexual health clinic and people were lying in cardboard boxes on the floor.”

The couple then travelled onward within Madagascar in search of adequate care, including a flight to the capital, Antananarivo. However, similar conditions were encountered, with no capacity to perform the required procedure.

A third facility, Polyclinique d’Ilafy, was eventually identified, but by the time Lorraine Russell arrived, she was critically ill. “By then, my dad was screaming ‘My wife is dying, please help us’,” said Hassan.

“The doctors then said she was stable and that a stent would be put in place, but she went into cardiac arrest the next day and died.”

A subsequent investigation by the Financial Ombudsman Service in the UK concluded in November 2025 that there was no medical evidence to show that the insurer’s actions caused or contributed to her death.

However, it found that failures in identifying an appropriate medical facility left her in “significant discomfort and distress” and that errors “needlessly and significantly exacerbated an already very distressing and worrying situation”.

UK Insurance Limited, acting on behalf of Direct Line, was ordered to pay £2,500 in compensation.

Despite the ruling, the family maintains that earlier intervention could have changed the outcome. “Instead of the insurance company acting quickly to find the right care, everything was delayed,” said Hassan.

“Mum had already suffered a heart attack, then she was put under all this extra stress. We didn’t get to be with her or hold her hand or even say goodbye.”

The case is now the subject of legal proceedings, with Direct Line declining to comment.

The incident highlights a broader issue for cruise passengers travelling on long-haul or expedition-style itineraries, particularly in regions where advanced medical infrastructure may be limited or unevenly distributed.

While modern cruise ships are equipped to provide stabilisation and initial emergency care, they are not substitutes for specialist interventions such as cardiac procedures, which depend on rapid access to appropriately equipped hospitals.

For international passengers, particularly those embarking on itineraries along parts of the African coastline, the case underscores the importance of scrutinising travel insurance policies beyond headline coverage limits.

Medical evacuation provisions, including the ability to transfer patients to countries with more advanced healthcare systems such as South Africa, can be decisive in time-critical situations.

It also raises questions about coordination between cruise operators, insurers, and local healthcare networks, particularly where ports of call may lack the facilities required to handle acute medical cases.

As cruise lines continue to expand itineraries into emerging destinations, the alignment between destination infrastructure and passenger risk management is likely to come under increased scrutiny.