Annual Behaviour Accountability Report, 2025

In 2025, 65,708 individuals¹ worked for MSF worldwide. During the year, we saw a total of 1,122 complaints about abuse or inappropriate behaviour made across the MSF movement. Of these, 1,021 were related to our medical and humanitarian projects, and 101 related to our international headquarter offices. Of those complaints, after review and investigation, 299 were confirmed to be cases of abuse or inappropriate behaviour, with some complaints still being investigated at the end of 2025 (other complaints were not found to be related to abuse after assessment and thus were referred to other channels to be addressed, and some complaints were withdrawn). The paragraphs below break down data from project and headquarters cases separately, as they are not necessarily comparable in terms of legal and reporting processes.

The overall number of complaints received related to our medical and humanitarian projects increased by 18 per cent in 2025 (1,021 complaints) compared to 2024 (864 complaints). Complaints received in our international headquarter offices in 2025 (101 complaints) increased almost 25 per cent compared to 2024 (81 complaints). Given the breadth of our activities, our number of staff, and the reach of our operational footprint, we remain concerned about underreporting of abuse and inappropriate behaviour, especially from patients, their caregivers, and from community members in the areas where we work.

Around 88 per cent of MSF staff (58,771 people in total) in 2025 were working in MSF projects. A total of 1,021 complaints were made about the behaviour of staff in these projects, up from 864 in 2024.

Of those complaints, after investigation (554 reports were investigated), 257 were confirmed to be cases of abuse or of inappropriate behaviour, with some reports still being investigated at the end of the year.²

Of those 257 confirmed cases, 220 cases were confirmed as abuse, compared to 256 confirmed cases of abuse in 2024. This includes different forms of abuse: sexual exploitation, abuse and harassment (SEAH); abuse of power; harassment and bullying; discrimination; exploitation; aggression; and abuse of the case management process (including retaliation, false reporting, interference in a case, and breach of confidentiality).

A total of 96 staff members were dismissed for different types of abuse in 2025 (84 dismissals in 2024). Depending on the severity of the case, other types of sanctions were also issued, including, but not limited to, suspension, demotion, formal written warning, or mandatory training.

Of the 220 confirmed cases of abuse, 127 were cases of sexual exploitation, abuse, and harassment (SEAH), compared to 126 in 2024. Seventy-one (71) staff were dismissed based on the findings of investigations related to those SEAH cases in 2025 (58 in 2024), noting that sexual harassment covers a wide range of behaviour.

The other confirmed cases of abuse included cases of harassment or bullying (38 confirmed cases); abuse of power (23 confirmed cases); aggression (6 confirmed cases); exploitation (10 confirmed cases); discrimination (12 confirmed cases); and abuse of the case management process (4 confirmed cases).

There were also 37 cases of inappropriate behaviour confirmed (52 in 2024). Inappropriate behaviour means behaviour which does not amount to the forms of abuse outlined above, but which are not in line with MSF’s behavioural standards. This includes, but is not limited to, mismanagement of people; inappropriate relationships; inappropriate behaviour not in line with societal standards or affecting team cohesion; inappropriate communication; and substance (mis)use.

We have continued to see some increases in the number of complaints submitted by previously underrepresented groups, such as locally hired staff, and patients and community members. However, there is still, and will always be, room for improvement to encourage reporting and increase trust in systems.

The total number of complaints submitted by patients and their caregivers was 80 in 2025, and 60 from community members (which may also include patients and others in the community whom MSF staff encounter) for a total of 140 (80 total in 2024). There were also 79 complaints submitted by “other” external parties – a category which includes suppliers, media, other organisations, partners, ex-MSF staff, and non-MSF contracted staff. We also received anonymous complaints.

Although complaints from patients and communities are increasing, more efforts are needed to reach out to patients and community members to make them aware of their rights and of the expected standards of behaviour by MSF staff, and to encourage reporting. Efforts must also be improved to ensure there are accessible, appropriate, trusted complaints mechanisms available to patients and community members, so that they can, and are confident to, hold MSF accountable for any abuse or inappropriate behaviour. Concurrently work on prevention of abuse will continue as a focus.

The total number of complaints submitted by locally hired staff increased slightly from 414 in 2024 to 467 in 2025. Efforts to encourage and support these staff to report will be continued.

In reviewing all complaints from both MSF staff and individuals outside of the organisation, there has been a very small increase in complaints made about discrimination. A total of 79 complaints relating to discrimination were received in 2025, up from 75 in 2024. While more people are coming forward to raise complaints about discrimination, there is still a need for continued and sustained efforts on diversity and inclusion, and to ensure people affected by acts of discrimination in any form report it, feel safe, and trust systems.

Since 2020, MSF has also compiled complaints from our offices around the world, in addition to the data gathered from our medical projects. Twelve (12) per cent of the total MSF workforce is based in these international offices (8,000 people).

While efforts continue to be made to standardise reporting, this data relates to many different legal and human resource processes around the world, and so may not yet be fully harmonised.

From all of the headquarter offices, 101 complaints were received in 2025 (up almost 25 per cent from 81 in 2024).

Of these, 42 cases were confirmed to be abuse or inappropriate behaviour (with 15 complaints still under investigation at the end of the year, noting that some complaints made were not about abuse and addressed by other means).

There were 35 confirmed cases of abuse and 19 of inappropriate behaviour. (Note: some cases were found to have elements of both abuse and inappropriate behaviour, so totals may not match.) This compares to 34 confirmed cases of abuse and 21 of inappropriate behaviour in 2024.

Overall, 26 staff members were sanctioned (ranging from coaching to verbal or written warnings), and 11 staff members were dismissed for abuse in 2025.

Achieving and maintaining work and care spaces free from abuse and harassment is an ongoing endeavour, for which we are all responsible. We also commit ourselves to do no harm to 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 abuse or inappropriate behaviour which they come across.