Fighting abuse, exploitation, and harassment in the countries where we work

February 18, 2018

Doctors Without Borders/Médecins Sans Frontières (MSF) promotes a working environment free of harassment and abuse in countries where we operate. Our leadership has unequivocally committed to fight abuse and to reinforce mechanisms and procedures to prevent and address it. This includes enhancing grievance channels at all levels of the organization and supporting victims and complainants.

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.

We expect all staff to abide by our guiding principles as stipulated in our charter—where our role is to provide assistance to populations in distress and to respect our professional code of ethics.

For us, this means not tolerating any behavior from our staff that exploits the vulnerability of others, or of employees taking advantage of their position for personal gain. We do not tolerate any physical or psychological abuse against individuals, sexual harassment, unlawful sexual conduct with minors, or any behavior that does not respect human dignity.

Grievances mechanisms

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

First step: awareness

A broad awareness campaign has been carried out at MSF for several years 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. Specific awareness sessions are also regularly organized at field level. Moreover, e-briefings and learning modules related to behavior and management of abuse are regularly updated and improved. 

MSF places specific importance in protecting victims and complainants. Our aim is to create an environment where they feel they can safely file complaints, without fearing for their safety, their job, or their confidentiality. This requires consistent attention and dedicated resources, and always remains a work in progress. 

An act of misconduct is one that has an immediate or potential impact on the health or well-being of those involved, on the security of our beneficiaries (patients and their caretakers), or our staff.

Managing cases confidentially

MSF’s first priority when misconduct is reported is the safety and health of the potential victims and of the complainant. Immediate attention is given to support victims, which can include providing psychological and medical care, and, if and when appropriate, advising victims of the availability of—and their rights to—relevant legal services.

MSF aims to ensure that these situations are addressed with the utmost confidentiality, which is crucial for the victims and/or witnesses who consent to the actions MSF will take to investigate allegations. In some cases, inquiries are triggered to establish the facts, take appropriate action, apply sanctions, and identify preventive measures. Consequences for implicated MSF staff can range from official warnings and mandatory trainings to temporary or definitive termination.

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. In some of the places where we work, such as conflict areas and countries or regions where impunity prevails or criminal justice or social service systems have collapsed, legal reporting mechanisms simply don’t exist or cannot be relied upon. In some places, reporting a crime could even put a person at risk.   

Key challenge: reducing barriers to reporting

Though reports of abuse through our grievance mechanisms are steadily increasing, MSF believes misconduct remains underreported today.

In 2017, there were more than 40,000 staff members working for MSF in the field, and 146* grievance complaints or alerts from the field were registered at headquarters. This includes a large variety of alerts concerning abuse of power, discrimination, harassment, and other forms of misconduct. This figure does not include cases dealt with directly by field teams and not reported to headquarters. Of these alerts and complaints, 40 cases of abuse and/or harassment at the field level were identified after internal investigations and documented at MSF headquarters. Of these 40 cases, 24 were cases of sexual harassment or abuse. Two of these were situations of sexual abuse or harassment by MSF staff against non-MSF staff (patients or members of the community). In total, out of the 24 cases of sexual harassment or abuse, 19 people were dismissed. The remaining staff members were sanctioned in other ways, such as through warnings or suspensions.

MSF is acutely concerned about any possible barriers people might face in reporting abuses, and this remains one of our key challenges today. We are continuously stepping up efforts to increase awareness of reporting mechanisms across MSF and to improve these protocols and procedures.

The reasons for underreporting are probably 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. 

Our key priority is to reinforce our reporting mechanisms and work to ensure that everyone—from headquarters visitors to community members and patients—is aware of these processes and how to access them, and to protect victims and complainants at all times.

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.

*Update as of June 17, 2019: Due to improved data collection and compilation, MSF has revised the figures reported above for 2017. As a result, the total number of complaints for 2017 is found to have been higher than previously estimated: 182 as opposed to 146; the number of confirmed cases has also risen slightly. Reporting for 2018 is available here.