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Promoting a work environment free of harassment, exploitation and abuse

Médecins Sans Frontières/Doctors Without Borders (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 organisation 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 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 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.

Tackling institutional discrimination and racism within MSF

In 2020, the deep inequities exposed by the COVID-19 pandemic converged with powerful movements for racial equality around the world. In parallel, a multitude of grassroots voices denounced MSF’s own struggle to tackle racism and discrimination. 

Despite years of raising awareness and efforts to address these issues, we acknowledged that progress had not been fast enough. In July 2020, recognising the pain and anguish expressed by many of our staff and patients, MSF made a public commitment to tackle discrimination and racism.  Almost 18 months into the process, it is time to provide an honest update of where we are and how much more we need to do.

Key challenge: reducing barriers to reporting

Published 28 July 2022

In 2021, nearly 63,000 individuals worked for the MSF movement worldwide. During that year, we saw a total of 539 complaints relating to either abuse or inappropriate behaviour made across the MSF movement. Of these, 490 were related to our medical and humanitarian projects, and 49 related to our international headquarter offices. Further details below break down project and headquarters cases separately, as they are not necessarily comparable in terms of legal and reporting processes. 

The overall number of complaints received increased by 21 percent in 2021 compared to 2020. While MSF continues to face a challenge of under-reporting of behaviour incidents, especially from patients, their carers, and the communities we assist, this increase can be seen as a sign that MSF has made further progress in addressing this long-term problem – and that awareness and confidence in our reporting mechanisms and channels is continuing to grow. 

Complaints from our projects: 

  • Around 90 per cent of MSF staff (around 57,000 individuals in total) in 2021 were working in MSF’s projects. A total of 490 complaints were made relating to this category of staff, up from 389 in 2020.   
  • Of those complaints, after investigation, 158 were confirmed as either situations of abuse or of inappropriate behaviour (149 in 2020). 
  • This includes 102 cases which were qualified as abuse, compared to 82 confirmed cases of abuse in 2020 (this covers different forms of abuse: sexual exploitation, abuse and harassment (SEAH); abuse of power; psychological harassment; discrimination; and physical violence).  
  • A total of 54 staff members were dismissed for all forms of abuse in 2021 (40 dismissals in 2020). Depending on the severity of the case, other sanctions were also issued, such as suspension, demotion, formal written warnings or mandatory trainings. 
  • Of the 102 confirmed cases of abuse, 67 were cases of SEAH, compared to 55 in 2020. 33 staff were dismissed as a result of those SEAH cases in 2021 (28 in 2020). 
  • The other confirmed cases of abuse consisted of: psychological harassment (9 confirmed cases); abuse of power (16 confirmed cases); physical violence (4 confirmed cases); and discrimination (6 confirmed cases). 
  • There were also 56 confirmed cases of inappropriate behaviour, down from 67 in 2020 (inappropriate behaviour includes: mismanagement of people; inappropriate relationships; inappropriate behaviour not in line with societal standards or affecting team cohesion; and substance use). 

We have continued to see some increases in the number of complaints submitted by previously under-represented groups, though there remains a lot of work to be done: The total number of complaints submitted by locally-hired staff increased again in 2021 to 262 (up from 172 in 2020). This represents an increase of 52% year-on-year, and may be seen as an encouraging trend. However, more still needs to be done as locally-hired colleagues account for around 90% of the global workforce, but are responsible for only around half of complaints made. 

The total number of complaints submitted by patients and their carers showed a very slight increase, to 23 in 2021 (up from 20 in 2020). The number submitted by “other” external parties – a category which includes suppliers, media, other actors, community members, partners, ex-MSF staff, non-MSF contracted staff and MSF association members – saw an increase of nearly 150%, to 67 (from 27 in 2020). It is concerning that the number of complaints from patients and their carers has remained so low. This is a clear indicator that more needs to be done to reach out to and empower patients and community members, by making them aware of their rights to hold MSF accountable for any abusive and inappropriate behaviour. 

Another notable point is that, across all complaints from both MSF staff and people outside the organisation, there have been a relatively low number relating to discrimination and racism – despite ongoing movement-wide efforts to address these issues. A total of 32 complaints relating to discrimination were received in 2021, down slightly on the total of 41 in 2020. This suggests that more efforts on diversity and inclusion need to be integrated into mainstream channels of awareness raising on behaviour issues. 

Complaints from our offices worldwide 

Since 2020, MSF has also compiled complaints from our offices around the world, in addition to the data gathered from our medical projects. Around 11 per cent of the total MSF workforce is based in these international offices. 

While efforts have been made to standardise reporting, this data relates to a large number of different legal and HR processes, and so may not yet be fully harmonised. 

Out of 38 headquarter offices, 49 complaints were received in 2021 (down slightly from 55 in 2020, across 37 offices). 

Of these, 25 were confirmed, with 19 cases related to abuse and 11 to inappropriate behaviour. This compares to 20 confirmed cases of abuse and 18 of inappropriate behaviour in 2020. 

Overall, 13 sanctions or dismissals were given in 2021, compared to 20 in 2020.   

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Achieving and maintaining a work environment free from abuse and harassment is an ongoing endeavour, 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 behaviour which they come across.   

Read updates from 2018 and 2019  | 2020 

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