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Fighting abuse, exploitation and harassment in our work environment

Médecins Sans Frontières (MSF) promotes a working environment free of harassment and abuse. 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 organisation, and supporting victims and whistle-blowers.

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.

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 behaviour 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, sexual relations with minors, or any behaviour that does not respect human dignity.

Grievance mechanisms

Procedures, including grievance and whistle-blowing mechanisms, have long been 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, 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 organised at field level. Moreover, e-briefings and learning modules related to behaviour and management of abuse are regularly updated and improved.

MSF places specific importance in protecting victims and whistle-blowers. 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 inappropriate behaviour 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 misbehaviour is reported is the safety and health of the potential victims and of the whistle blower. Immediate attention is given to support the victim, which can include providing psychological and medical care, and securing legal support.

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.

Key challenge: reducing barriers to reporting

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

 

2020 update

Published 19 July 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 in terms of 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 under-reporting of behaviour 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 behaviour, however significant effort has been put towards virtual training. The total number of staff trained to deal with behaviour issues actually increased compared to 2019.

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

 

Complaints from our projects in the field

  • Over 90 per cent of MSF staff (57,429 individuals in total) in 2020 were working 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 behaviour (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. Twenty-eight (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 behaviour, up from 50 in 2019 (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 small but notable 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 2020 to 172 (up from 144 in 2019). While this may be a 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 per cent of the MSF work force.
  • 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 all our various projects, along with many other forms of contact with the communities we assist, this is very likely to be significant under-reporting. 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 per cent of the total MSF 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 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 37 headquarter offices (non-operational entities) which accounted for 5,596 staff (10 per cent of MSF workforce) in 2020, 55 cases were reported either through management lines or office-specific behaviour reporting mechanisms.
  • After investigation, 38 cases were confirmed as either abuse (20) or inappropriate behaviour (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 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.  

 

2019 update

First published 22 June 2020; updated with new figures 12 July 2021

 

MSF continues to face a challenge of under-reporting when it comes to issues related to behaviour. 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 per cent) 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 carers. 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 nearly 65,000 individual staff movement-wide, of whom 90 per cent 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 behaviour (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 106 cases of abuse, 63 were cases of sexual harassment, abuse, or exploitation, up from 59 in 2018. Forty (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 behaviour, down from 56 in 2018 (inappropriate behaviour includes: mismanagement of people; inappropriate relationships; inappropriate behaviour 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 per cent 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 continue to be under-represented, accounting for only 45 per cent of all complaints despite making up more than 90 per cent 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 per cent). Under-reporting 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 generalised 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.

 

2018 update

Published 17 June 2019, updated 22 July 2019

 

Though reports of abuse through our grievance mechanisms are steadily increasing, MSF believes misbehaviour 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 inappropriate behaviour. 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 all 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 mechanisms.

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 generalised 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.

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 whistle-blowers at all times.

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