Promoting a work environment free of harassment, exploitation, and abuse

In 2022, nearly 68,000 individuals worked for the MSF movement worldwide. During that year, we saw a total of 695 complaints relating to either abuse or inappropriate behavior made across the MSF movement. Of these, 606 were related to our medical and humanitarian projects, and 89 were related to our international headquarters 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 related to our medical and humanitarian projects increased by 24 percent in 2022, compared to 2021. MSF continues to face a challenge to ensure reporting of abuse and inappropriate behavior, especially from patients, their careers, and the communities we assist. 

In 2022, we began also to include complaints about ‘exploitation’ and violations of the ‘case management process’ in our reporting. The latter was introduced to protect complainants while ensuring that reporting mechanisms are not misused. Data was also collected about complaints related to ‘inappropriate communication.'

Complaints received related to our medical and humanitarian projects in 2022:

• Around 90 percent of MSF staff (just under 62,000 individuals in total) in 2022 were working in MSF’s projects. A total of 606 complaints were made concerning the behavior of staff in these projects, up from 490 in 2021.
• Of those complaints, after investigation, 204 were confirmed to be cases of abuse or inappropriate behavior (158 in 2021), with some cases continuing to be investigated.
• This includes 121 cases that were confirmed as abuse, compared to 102 confirmed cases of abuse in 2021 (this covers different forms of abuse: sexual exploitation, abuse, and harassment [SEAH]; abuse of power; psychological harassment; discrimination; exploitation; case management – including retaliation and breach of confidentiality; and physical violence). 
• A total of 52 staff members were dismissed for all forms of abuse in 2022 (54 dismissals in 2021). Depending on the severity of the case, other sanctions were also issued, such as suspension, demotion, formal written warning, or mandatory training.
• Of the 121 confirmed cases of abuse, 60 were cases of SEAH, compared to 67 in 2021. 35 staff were dismissed based on the findings of investigations related to those SEAH cases in 2022 (33 in 2021).
• The other confirmed cases of abuse included cases of psychological harassment (22 confirmed cases); abuse of power (17 confirmed cases); physical violence (12 confirmed cases); discrimination (3 confirmed cases); and exploitation (7 confirmed cases).
• There were also 83 cases of inappropriate behavior confirmed or found, up from 56 in 2021 (inappropriate behavior includes: mismanagement of people; inappropriate relationships; inappropriate behavior not in line with societal standards or affecting team cohesion; inappropriate communication; and substance [mis]use).

For the first time since we started reporting these figures, the total number of complaints submitted by locally hired staff in our programs decreased in 2022 to 232 (down from 262 in 2021). More still needs to be done to encourage locally hired staff in our programs to come forward with complaints, as they make up nearly 80 percent of the global workforce but only represent just over one-third of complainants.

The total number of complaints submitted by patients and their carers increased slightly in 2022, to 67 (up from 53 in 2021). 

The number of complaints submitted by “other” external parties – a category which includes suppliers, members of the media, members of other organizations, community members, partners, ex-MSF staff, non-MSF contracted staff, MSF association members, and anonymous complainants –increased to 107 (from 37 in 2021). 

There remains a relatively low number of complaints made relating to discrimination and racism, despite ongoing movement-wide efforts to address these issues. A total of 40 complaints relating to discrimination were received in 2022, up slightly from the total of 32 in 2021. Existing efforts on highlighting diversity and inclusion in behavior issues need to be scaled up, as does encouraging people to speak up.

Complaints from our offices worldwide

MSF continues to compile complaints from our offices around the world, in addition to the data gathered from our medical projects. Ten percent of the total MSF workforce is based in these international offices.

While efforts have been made to standardize reporting, this data relates to many different legal and human resource processes, and so may not yet be fully harmonized.

Out of 38 headquarters offices providing data, 89 complaints were received in 2022 (up from 49 in 2021, across 38 offices).

Of these, 44 cases were confirmed, with 38 cases related to abuse and 30 to inappropriate behavior. This compares to 19 confirmed cases of abuse and 11 of inappropriate behavior in 2021.

Overall, 17 sanctions or dismissals were given in 2022, compared to 13 in 2021.

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 the 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 abuse or inappropriate behavior which they come across.

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 behavior made across the MSF movement. Of these, 490 were related to our medical and humanitarian projects, and 49 related to our international headquarters 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 behavior 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 percent 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 behavior (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. Thirty-three 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 behavior, down from 67 in 2020 (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 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 percent 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 percent 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 percent, 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 behavior. 

Another notable point is that, across all complaints from both MSF staff and people outside the organization, 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 from 41 in 2020. This suggests that more efforts on diversity and inclusion need to be integrated into mainstream channels of awareness raising on behavior 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 percent of the total MSF workforce is based in these international offices. 

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 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 behavior. This compares to 20 confirmed cases of abuse and 18 of inappropriate behavior in 2020. (A single “case” can sometimes include multiple offenses, so there may be discrepancies in the total figures.) 

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

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 that they come across.   

(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.

*These figures were updated on July 28, 2022, to reflect the final data collected by the MSF Intersectional Platform on Behavior.

(Updated on June 22, 2020)

MSF continues to face a challenge of under-reporting when it comes to responsible behavior. Since 2017, we have seen an increase in the number of complaints being reported, which is an encouraging sign that MSF’s reporting mechanisms are being more widely used. While the total number of reports has dipped slightly (by 10 percent) between 2018 and 2019, we believe this is primarily due to a large number of historical cases having been reported in 2018—likely a result of the increased levels of communication on this issue, both internally and externally.  We need to continue working to improve levels of reporting, especially among groups which have tended to be under-represented when it comes to making complaints—including locally-hired MSF staff, patients in MSF projects, and their careers. 2019’s figures have showed increases in the number of reports received from these groups, which is encouraging, though we acknowledge that there is still a long way to go.

• In 2019, we had approximately 65,000 individual staff movement-wide, of more than 90 percent were working in the field. We saw a total of 318 grievance complaints made, down from 356 in 2018. This figure relates to alerts and complaints made in the field but does not cover headquarter offices.
• Of those complaints, after investigation, 156 were confirmed as either situations of abuse or of inappropriate behavior (134 in 2018). This includes 106 cases which were qualified as abuse, compared to 78 confirmed cases of abuse in 2018  (This covers many forms of abuse: sexual abuse, harassment, and exploitation; abuse of power; psychological harassment; discrimination; physical violence.) A total of 55 staff members were dismissed for all forms of abuse in 2019 (52 dismissals in 2018). 
• Of the 104 cases of abuse, 63 were cases of sexual harassment, abuse, or exploitation, up from 59 in 2018. 40 staff were dismissed as a result of those cases in 2019 up from 36 in 2018.
• There were also 50 confirmed cases of inappropriate behavior, down from 56 in 2018 (inappropriate behavior includes: mismanagement of people; inappropriate relationships; inappropriate behavior not in line with societal standard or affecting team cohesion; and the use of substances).

While the overall number of complaints is down by 10 percent compared to 2018, it is encouraging to see an increase in the number of complaints being made by groups that have been particularly under-represented:

• The number of complaints made by national staff increased from 128 in 2018 to 144 in 2019. This is a step in the right direction, although national staff continues to be under-represented, accounting for only 45 percent of all complaints despite making up more than 90 percent of MSF’s field-based workforce. 
• The number of complaints made by MSF’s patients and their carers has also increased, although it must be noted that this was from a very low base: from 13 in 2018 to 20 in 2019 (an increase of 46 percent).  Underreporting from patients and their carers clearly remains an area where we must continue to focus, to ensure that mechanisms are accessible and understood. During 2019, a number of measures were taken to address this, including the development of staff training modules and workshops to get input from patients and carers.

The reasons for under-reporting are similar to those found in society at large, including the fear of not being believed, prevailing stigma, and possible reprisals. This is all the more acute in many crisis settings where MSF operates, such as conflict areas, where there is often a general lack of protection mechanisms for victims, a high level of generalized violence and impunity, and where populations may be highly dependent on external assistance. The size, turn-over, and diversity of our staff require a continued effort to inform and create awareness about MSF’s policies on harassment and abuse, as well as all mechanisms available for reporting any abuse or harassment.

Achieving and maintaining a work environment free from abuse and harassment is an on-going 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.   

*These figures were updated on July 12, 2021, to reflect the final data collected by the MSF Intersectional Platform on Behavior. 

(Updated on June 17, 2019)

Doctors Without Borders/Médecins Sans Frontières (MSF) promotes a working environment free of harassment and abuse. Our leadership is unequivocally committed to fight abuse and to reinforce mechanisms and procedures to prevent and address it. All staff are expected to abide by the MSF movement's behavioral commitments and our guiding principles as stipulated in our charter.

In early 2018, MSF published a statement on the actions we had taken to combat abuse and harassment, the challenges we faced, and the number of cases recorded in 2017. One year on, we have compiled a short update on progress so far, including figures from 2018. We hope that this reporting will help maintain a constructive focus on this important issue.

One of the most significant challenges we identified is of underreporting—and the need to do more to ensure that our staff and patients are aware of, and trust, our reporting mechanisms. 

While the 2018 figures show an increase in the reporting of incidents of unacceptable behavior compared to 2017, we still believe this picture to be a significant underestimate—this is likely due to a combination of challenges around both under-reporting and data gathering. 

In 2018, MSF had almost 65,000 staff working in field. We saw a significant increase in the number of alerts and complaints recorded in 2018, with a total of 356 grievance complaints made, up from 182 in 2017. This figure relates to alerts and complaints made on the field but does not cover headquarter offices. We hope that these figures are an indication that an increased focus on the issue has encouraged more people to come forward.

Of those complaints, after investigation, 134 were confirmed as either situations of abuse or of inappropriate behavior (83 in 2017). This includes 78 cases which were qualified as abuse, compared to 61 cases of abuse in 2017.  (This covers many forms of abuse: sexual abuse, harassment, and exploitation; abuse of power; psychological harassment; discrimination; physical violence.) A total of 52 staff members were dismissed for all forms of abuse in 2018 (58 dismissals in 2017).  

Of the 78 cases of abuse, 59 were cases of sexual abuse, harassment or exploitation, up from 32 in 2017. Thirty-six staff were dismissed as a result of those cases in 2018 up from 20 in 2017.

There were also 56 confirmed cases of inappropriate behavior, up from 22 in 2017 (inappropriate behavior includes: mismanagement of people; inappropriate relationships; inappropriate behavior not in line with societal standard or affecting team cohesion; and the use of substances).

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.  

Note on changes to the figures: Due to improved data collection and compilation, MSF has updated its figures for 2017. As a result, the total number of complaints for 2017 is found to have been higher than previously reported: 182 as opposed to 146; the number of confirmed cases in 2017 has also risen slightly. Please note that some cases in 2018 are still being investigated, so the overall figures may change slightly.