As the details of the devastating injuries sustained onboard flight SQ321 emerge, attention is turning to what happens to these passengers and crew now and what can be done to make all the hours spent in an aircraft cabin safer.
Aviation experts believe this incident is a glimpse into a future where there is an increased risk of deadly turbulence, but also where the in-cabin experience will need to be vastly different.
Innovation in aircraft safety is a perpetual quest, and the world does not see as many plane crashes as it once did.
But the Singapore Airlines incident this week suggests the next frontier is avoiding in-cabin injuries and the unfortunate loss of life that can happen when a plane hits unexpected turbulence at 37,000 feet.
A few days ago, the director of Bangkok's Samitivej Srinakarin Hospital read out details of the injuries among the 41 passengers and crew being treated there.
Twenty two people sustained spinal and spinal cord injuries.
Six sustained skull and brain injuries.
Thirteen have injuries to their bones, muscles and other organs.
The patients have been grouped according to their most severe injuries, but some do fall into multiple categories.
These are injuries that have the potential to impact them for the rest of their lives.
Australian man Keith Davis and his wife Kerry Jordan are among them.
"Kerry is not in a great space at all. She's had severe spinal trauma," he told the ABC.
"She had emergency surgery as soon as we were admitted and it remains that she has no sensation from the waist down.
"It is pretty life changing."
The likelihood of in-cabin injuries
The Singapore Airlines incident has been described as happening in an "absolute instant" and as being of extreme in nature.
Whether a sudden movement in an aircraft is caused by turbulence or something else, it is the level of unpredictability combined with the severity of the injuries that is most alarming for an industry built on understanding and reducing risk.
Head of aviation at Central Queensland University and pilot of 40 years Professor Doug Drury told ABC News the future of aviation must consider the likely increase in turbulence.
"The good news is we don't have these major events that frequently that create this kind of damage and unfortunate loss of life," he said.
"But we can expect more and more events to occur in the future with our global climate change."
Turbulence is yet another natural phenomenon affected as global temperatures increase.
A 2017 study predicted that severe turbulence will become two to three times more common over the north Atlantic by 2050-2080 because of climate change.
At the same time, there are bold predictions for how the aviation industry will expand.
Pre-COVID levels saw airlines carry 4 billion people across the world every year and the industry predicts that number to double by 2036.
That means a lot more planes in the sky, and that's happening while cargo and private flights are expected to increase too.
It could get a little crowded and become even harder to find a calm path clear of any turbulence.
"If we've got all this hot air rising, and we're flying through other people's wakes, then it's just going to be potentially continuous," Dr Drury said.
That look to the future is forcing the aviation industry to grapple with the in-cabin injury problem.
Being able to better predict turbulence is one major factor, but measures that protect passengers and crew in the event of it would also help when something else was to blame.
Because there is also a history of equipment errors and technical faults that have led to unrestrained passengers and crew being hospitalised.
And airlines have been forced to compensate them for their suffering.
The Montreal Convention
It was only in March that 50 people were treated on the tarmac of Auckland Airport after a LATAM Airlines flight from Sydney experienced a "sudden drop".
There were reports of passengers and crew members being "thrown into the roof of the plane".
That incident was not caused by turbulence, but by a "technical fault" that investigators have now indicated was likely to do with a cockpit seat unexpectedly moving forward.
Some of the injured passengers have now engaged legal representation to start compensation claims against LATAM.
And it's an interesting treaty called the Montreal Convention that establishes liability in cases like this.
Former president of the Aviation Law Association and specialist aviation lawyer Peter Carter told the ABC "most countries are signatories" and would likely apply to flight SQ321 in some way.
"It applies to all flights between countries [when] one of the countries is a signatory to the Montreal Convention, and Singapore and United Kingdom are, so there's no difficulty about that," he said.
The Montreal Convention has two tiers, placing a $260,000 cap on compensation for passengers where the airline is deemed not to be at fault.
If an airline has a level of fault, passengers may be able to claim tier two compensation, which has no cap.
Mr Carter said, "legally there's not a lot of difference" between injuries caused by a technical fault or by turbulence.
"Passengers are still entitled to compensation for their proven injuries, subject to the $260,000 first tier cap," he said.
That means the type of turbulence that shook flight SQ321 becomes very important.
"If the airline can show [the incident] was nothing to do with them, then the limit will apply. They've got the onus of showing it's nothing to do with them," Mr Carter said.
"[With] clear air turbulence, they might have a shot at doing it, but I think ... if it's to do with developing thunderstorm turbulence, it's a different kettle of fish."
It's worth noting specific ticket terms and conditions can be a factor too because some airlines waive liability limits.
And if a manufacturer fault is to blame, they can be sued too.
Airlines are insured for this kind of thing, of course, but these cases of in-cabin injuries are not uncommon.
"Lufthansa, Air Canada and Hawaiian Airlines have all had planes that encountered unexpected turbulence over the past few years with a combined injury count well above 100 passengers and crew," Mr Carter said.
Incidents have led to changes in the past, to reduce the risk to passengers and crew and the potential for airlines and manufacturers to be liable for injuries and death.
It's expected the Singapore Airlines incident will be widely studied.
Sensors on seatbelts, padding on ceilings
Singapore's Transport Safety Investigative Bureau has sent its people to Bangkok to learn more about how this incident happened.
The investigation may reveal what type of turbulence flight SQ321 flew into as passengers were being served breakfast and why it wasn't detected.
Dr Drury said the risk of in-cabin injuries from sudden drops or turbulence "is not going to go away".
"Something is going to have to change and it will have to come down from regulatory [bodies]," he said.
"Can we build in padding or put flexible bottoms on the overhead bins? They were hitting the overhead bins so hard that they were opening up ... and the baggage was falling out. So do we lock the bins to prevent that?
"There will have to be some modifications."
But no matter the type of turbulence, or if in the case of the LATAM incident in March, a technical fault caused the aircraft to suddenly move, Dr Drury said "there was one common denominator" when it came to the risk to passengers and crew.
"They were not wearing seatbelts," he said.
"I understand how people feel about that sometimes, but it is for our own protection. I never take my seatbelt off, if I need to I'll loosen it up a little bit, but I'll never take it off."
He believes this incident will likely force regulators to look at whether the seatbelt sign should be on more often or as a default setting.
"Can it be something as simple as having a sensor in the buckle itself? It says, 'seat 32B is showing red', so then the cabin crew will have to go back there and say, 'Excuse me, sir, you need to put your seatbelt on'," he said.
"I do think regulators ... will all begin to look at events like this a little bit differently and what kind of rule making changes need to be put in place.
"And so if they write the rules that say that the seatbelt sign has to stay on at all times, then the airlines are going to have to adapt the way they do business.
"It's going to present some really interesting challenges."
