copyright msf caption copyright msf caption © Christopher Rogel Blanquet/MSF
Two Doctors Without Borders social psychologists take a walk with two patients.
14 Feb 18 22 Jul 21

A work environment built on care, dignity and respect

Doctors Without Borders/Médecins Sans Frontières (MSF) promotes a working environment free of harassment and abuse.

Our leadership has unequivocally committed to reinforce mechanisms and procedures to prevent and address abuse and harassment. All staff are expected to abide by the MSF movement's Behavioural Commitments and our guiding principles as stipulated in our Charter.

The integrity of our organization is upheld by the good conduct of each individual staff member, in any location, with full respect for the communities we serve. For us, this means not tolerating any behaviour from our staff that exploits the vulnerability of others, or of employees taking advantage of their position for personal gain.

Grievance and whistle-blowing mechanisms

Procedures, including grievance mechanisms, are in place to encourage prevention, detection, reporting, and management of all types of misbehaviour, harassment and abuse. Through these mechanisms, all staff members are encouraged to report inappropriate behaviour or abuse either through their management line or through specific reporting channels outside any hierarchical lines, using dedicated email addresses. Victims or witnesses in the communities where MSF works are likewise encouraged to report misconduct to us so that allegations can be properly addressed.

Broad awareness activities are carried out to inform all staff of the mechanisms available to them to report abuse. This information is shared through specific communications, including in printed staff manuals, and is conveyed in briefings, field visits and trainings. Moreover, e-briefings and learning modules related to behaviour and management of abuse are regularly updated and improved.

There is a range of ongoing work in this area that has been taking place across the MSF movement in recent years. Examples include:

  • Creating new positions and/or increasing staff support to provide training, field visits and investigation on these issues.
  • Undertaking workshops and other forms of consultation with staff to assess the problem and the steps needed to address it.
  • Revising, promoting and strengthening guidance provided to staff on how to report harassment, abuse or exploitation.
  • Reinforcing awareness at the patient and community level where we have operations
  • Improving data-gathering and sharing across the MSF movement.

Managing misbehaviour cases confidentially

MSF aims to ensure that these situations are addressed with the utmost confidentiality, to create an environment where people feel they can safely file complaints, without fearing for their safety, their job, or their confidentiality. 

Our first priority when misbehaviour is reported is the safety and health of the potential victims. Immediate attention is given to provide support, which can include psychological and medical care, and securing legal assistance.

MSF always respects the victim’s decision to bring – or not – a matter to justice. In the event of sexual abuse against minors, MSF’s policy is to report the case to judiciary authorities depending on the child’s best interests and availability of such procedures.

2020 update: Increasing confidence to speak up against abuses

(Updated on July 12, 2021)

In 2020, MSF had more than 63,000 individual staff movement-wide. We saw a total of 444 complaints made across our staff working in medical and humanitarian projects in the field (389 complaints) and across international headquarter offices (55 complaints). Further details below break down field and headquarters cases separately, as they are not necessarily comparable with regard to terminology and reporting processes.

The overall number of complaints received increased by 22 percent in 2020 compared to 2019. While MSF continues to face a challenge of underreporting of behavior incidents, this increase can be seen as a sign that MSF is starting to address this long-term problem. It indicates that complainants and witnesses have increasing confidence to speak up, and that there is growing awareness of the various reporting mechanisms and channels that have been reinforced and put in place.

The pandemic has led to a reduction in face-to-face activities to prevent unacceptable behavior, however significant effort has been put towards virtual training. The total number of staff trained to deal with behavior issues actually increased compared to 2019.

Despite these improvements, underreporting continues to be an issue. Of particular concern is the limited (if increasing) number of complaints from patients, caregivers, and community members. This indicates the need to focus on prevention and to develop adapted community complaints mechanisms for these groups.

Complaints from our medical projects in the field

  • 90 percent of MSF’s staff (57,429 individuals in total) in 2020 were working in medical projects in the field. A total of 389 complaints were made relating to this category of staff, up from 318 in 2019. 
  • Of those complaints, after investigation, 150 were confirmed as either situations of abuse or of inappropriate behavior (156 in 2019). (Please note that 15 reported complaints for 2020 remained open at the time these figures were compiled).
  • This includes 82 cases which were qualified as abuse, compared to 106 confirmed cases of abuse in 2019 (this covers different forms of abuse: sexual abuse, harassment, and exploitation; abuse of power; psychological harassment; discrimination; physical violence). A total of 37 staff members were dismissed for all forms of abuse in 2020 (55 dismissals in 2019). Depending on the severity of the case, other sanctions were also issued, such as suspension, demotion, or formal written warnings.
  • Of the 82 confirmed cases of abuse, 55 were cases of sexual harassment, abuse, or exploitation (SEAH), compared to 63 in 2019. 28 staff were dismissed as a result of those SEAH cases in 2020 (40 in 2019).
  • The other confirmed cases of abuse consisted of: psychological harassment (14 confirmed cases); abuse of power (8 confirmed cases); physical violence (3 confirmed cases); and discrimination (2 confirmed cases).
  • There were also 68 confirmed cases of inappropriate behavior, up from 50 in 2019 (inappropriate behavior includes: mismanagement of people; inappropriate relationships; inappropriate behavior not in line with societal standards or affecting team cohesion; and substance use).

We have continued to see small but notable increases in the number of complaints submitted by previously underrepresented groups, though there remains a lot of work to be done:

  • The total number of complaints submitted by locally hired staff increased again in 2020 to 172 (up from 144 in 2019). While this may represent some marginal success in improving awareness and trust for colleagues to submit complaints, there is still more to be done considering that locally hired colleagues account for 80 percent of the MSF workforce.
  • The total number of complaints submitted by patients, caregivers, community members, and other external parties showed a very slight increase, to 23 in 2020 (up from 20 in 2019). Considering that MSF undertakes millions of medical consultations each year in its various projects, along with many other forms of contact with the communities we assist, this is very likely to be significant underreporting. Existing complaint mechanisms need to be further adapted and improved to better reach patients and communities in individual project locations, especially given the extremely vulnerable position of many of those people whom MSF assists.

Complaints from our offices worldwide

2020 is the first year for which MSF has compiled complaints from our offices around the world, in addition to the data gathered from our medical projects in the field. Around 10 percent of MSF’s total workforce is based in these international offices. As we have noted in previous years, the absence of these figures has led to a significant gap in our data. There is no prior year comparison. It is also worth noting that, while efforts have been made to standardize reporting, this data relates to a large number of different legal and HR processes, and so may not yet be fully harmonized.

  • Out of 37 headquarter offices (non-operational entities) which accounted for 5,596 staff (10 percent of MSF workforce) in 2020, 55 cases were reported either through management lines or office-specific behavior reporting mechanisms.
  • After investigation, 38 cases were confirmed as either abuse (20) or inappropriate behavior (18).
  • Out of these cases, 20 people were either dismissed or received other sanctions, such as formal warnings, depending on the severity of the facts.  

Achieving and maintaining a work environment free from abuse and harassment is an ongoing endeavor, for which we are all responsible. We also commit ourselves to do no harm to vulnerable people we are striving to help.

We continue to urge staff, patients, or anyone else who comes into contact with MSF to report any incidents of unacceptable behavior which they come across.