Responsible behaviour report 2019

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.