Objective: The access of seafarers to health care services ashore and proper medical care by specialist doctors has been established through an extensive legal framework, which dictates that seafarers are entitled to the same quality of medical care as other employees working onshore. However, during the COVID-19 pandemic, international travel and trade were significantly disrupted, and port restrictions and border closures imposed unprecedented barriers to medical referrals of seafarers ashore, resulting in serious consequences for their health and well-being. Objective: The objective of this study was to present the serious difficulties and complications faced by telemedical assistance services in managing medical cases on board during 2020-2021. Methods: The study analyzed all cases reported to Med Solutions International, an international telemedical assistance company, during the two years of the pandemic. It specifically focused on delays and denials of medical referrals ashore, which led to most cases being exclusively handled through telemedicine. Results: The study demonstrated that only a minority of cases had the opportunity to be referred ashore for medical examination, while many cases were repatriated for further investigation and treatment when ashore referrals were denied. The absence of diagnostic testing and treatment ashore posed significant challenges and frequently endangered the lives of seafarers. Conclusions: The overall medical care of seafarers and their access to healthcare facilities ashore were severely affected by the COVID-19 pandemic. Telemedical assistance services were tasked with the challenging responsibility of replacing shoreside medical care. The detrimental impact on seafarers' health and human rights calls for corrective measures from international institutions.