A nurse from the Lotumbe General Reference Hospital is about to visit a suspected Ebola case who has just been admitted to the Ebola Treatment Centre (ETC). The ETC was set up by Doctors Without Borders following the appearance of a few confirmed Ebola cases at the beginning of the epidemic in this area. Lotumbe, Democratic Republic of Congo. 22 October, 2020 © Caroline Thirion/MSF
A twofold response
To address this, Doctors Without Borders initiated two complementary actions. First, a dedicated team conducted an internal investigation based on information received from other international organisations, which was completed in October 2021. Second, an in-depth ‘ethical review’ was undertaken to survey Doctors Without Borders teams on staff practices in emergency situations such as the Ebola outbreak; the effectiveness of the mechanisms for preventing and managing abuse; and, more generally, the ethical issues facing individuals and our organisation in emergency situations.
To facilitate the ethical review, 628 people employed by Doctors Without Borders during the 10th Ebola epidemic in Beni health zone in North Kivu, DRC, were invited to respond to these questions. 23 preparatory interviews were conducted, 219 anonymous questionnaires were filled in, returned and validated, and 90 in-depth interviews were held in Beni, Goma and Kinshasa.
This twofold response enabled us to identify and address 24 reports of personal abuse. 13 of them concerned sexual abuse, with most involving sex in exchange for jobs.
Fifteen reports of personal abuse – sexual or otherwise – have already been investigated. Three were found to be admissible and led to sanctions; one was well-founded, but the alleged perpetrator could not be identified with absolute certainty because the person had since left Doctors Without Borders; two were un-founded; seven were closed due to lack of information or because we were asked to do so by the complainants; and two were found to involve other organisations and have been handed over to them. The Doctors Without Borders internal investigation process is ongoing for the remaining reports of personal and property abuse, and it will take a few more months to conclude them.
Wangata Ebola Treatment Centre, Mbandaka, Democratic Republic of Congo, 05 May 2022 © MSF
Review and transform the system
Beyond identifying and managing reported cases of abuse, we wanted to conduct an in-depth examination of our field practices to reinforce the general environment for preventing and sanctioning abuse within Doctors Without Borders.
The lessons of this review are clear. Broadly speaking, the way in which Doctors Without Borders operates is deemed constructive because we are seen by our staff as assuming responsibility for the risk of abuse and, through our set of practices, attempting to mitigate it. But there are still obstacles, particularly when it comes to people deciding to report abuse. While some issues are internal to our organisation and must be dealt with one by one, others relate to the local environment and our work with communities. We need to be aware of them and take the necessary steps to address them.
We need to: better protect our most vulnerable employees, who are less likely to use reporting mechanisms (e.g. those in low-skilled jobs); set up awareness-raising initiatives adapted to the communities we assist; improve the gender mix and diversity of our teams, especially in management posts and among recruitment teams; be more vigilant with our recruitment processes when hiring large numbers of people in emergency situations; and foster open dialogue with organisations we assist or work with on the issue of abuse.
Between April 25 and June 25, 2022, these lessons guided Doctors Without Borders' response to the Ebola outbreak in Equateur Province. Although few staff – only around 30 Doctors Without Borders employees – were deployed in the province, specific awareness and prevention sessions were held for our teams as well as health workers from the facilities we support, and Doctors Without Borders Behavioural Commitments were included in the partnership agreement concluded with the Ministry of Health. The mechanisms for reporting abuse were reiterated on several occasions and it was made clear that, in the event of abuse taking place, all those aware would be required to take immediate action.
Epidemiologist Gaston Musemakweli trains Marguerite Bekayi Bonpango, supervising nurse at the "Le Temps du Soir" health centre in Mbandaka, Democratic Republic of Congo. 27 October, 2020 © Caroline Thirion/MSF
Furthermore, we continue to encourage debate and the exchange of ideas among Doctors Without Borders staff in the DRC and elsewhere in order to come up with further concrete solutions that will enable us to make structural improvements to the prevention, identification and sanction of abusive behaviours that have no place within our organisation.
The debate that has gained traction in recent years on the existence of abuses in the response to humanitarian crises across the world is one we welcome. Doctors Without Borders wishes to continue contributing to this debate in a transparent and constructive manner in order to create the conditions that will enable more people to speak out, ensure further resources are made available to prevent and sanction abuses and stamp out the perception of impunity for those responsible for such acts.
We are not infallible, but the efforts we have made for close to 20 years – and continue to make – are proof of our commitment to prevent unacceptable behaviour.