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The COVID-19 pandemic has exposed additional weaknesses of the already troubling “flag of convenience” practices under international law; the passenger cruise industry was especially impacted. Most cruise ships under distress from the pandemic received little aid from their flag states, and many vessels were denied entry into ports of non-flag states (regardless of whether an outbreak had been documented onboard). States and vessels lacked clear guidance around their rights and responsibilities under the extraordinary circumstances. This paper reviews the current status of international law concerning port and flag state duties to distressed vessels, and suggests the creation of flag state medical liability to help clarify decision-making during future health crises.