Promoting a work environment free of harassment, exploitation and abuse

The overall number of complaints received increased by 22% in 2020 compared to 2019. This increase can be seen as a sign that MSF is addressing a long-term problem of under-reporting of behaviour incidents. 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.

However, despite this progress, 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 needs to focus on prevention and to develop adapted community complaints mechanisms for these groups.

The pandemic has led to a reduction in face-to-face activities to prevent unacceptable behaviour: unsurprisingly, the number of prevention field visits in 2020 has fallen, as have the number of attendees at awareness-raising events. However, significant effort has been put into a move towards virtual training, resulting in the total number of staff being trained to deal with behaviour issues actually increasing compared to 2019.

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 the field (389 complaints) and in HQ offices (55 complaints). Please note that further details below break down field and HQ cases separately, as they are not necessarily comparable in terms of terminology and reporting processes.

Complaints from our projects in the field

• 90% of MSF’s 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 will also have been 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 SEA 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 standard or affecting team cohesion; and the use of substances).

We have continued to see small but encouraging 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% 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 huge numbers of medical consultations each year in all its 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 that MSF assists.

Complaints from our offices worldwide

2020 is the first year for which MSF has compiled complaints from our offices around the world, as well as from our projects in the field. As we have noted in previous years, the absence of these figures has led to a significant gap in our data, although only around 10% of MSF’s total workforce is based in these offices. There is therefore no previous year to compare this data to; it is also worth noting that, while efforts have been made to standardise it, 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% 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.

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 behaviour made across the MSF movement. Of these, 490 were related to our medical and humanitarian projects, and 49 related to our international headquarter 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 behaviour 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 per cent 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 behaviour (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. 33 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 behaviour, down from 67 in 2020 (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 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% 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% 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%, 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 behaviour.

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

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 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 behaviour.¹  This compares to 20 confirmed cases of abuse and 18 of inappropriate behaviour in 2020.
• 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 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. 

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 behaviour made across the MSF movement. Of these, 606 were related to our medical and humanitarian projects, and 89 related to our international headquarter offices. Of those complaints, after investigation, 248 were confirmed to be cases of abuse or of inappropriate behaviour, with some cases continuing to be investigated. 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 per cent in 2022, compared to 2021. MSF continues to face a challenge to ensure reporting of abuse and inappropriate behaviour, especially from patients, their carers, and the communities we assist. However, the increase in complaints can be seen as a sign that we continue to make progress in addressing this long-term challenge – and that awareness of and confidence in our reporting mechanisms and channels is continuing to grow.

In 2022, we began also to include complaints about ‘exploitation’ (1) and violations of the ‘case management process’(2) 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’ (3).  

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

• Around 90 per cent 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 behaviour of staff in these projects, up from 490 in 2021.  
• Of those complaints, after investigation, 204 were confirmed to be cases of abuse or of inappropriate behaviour (158 in 2021), with some cases continuing to be investigated.
• This includes 121 cases which 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 behaviour confirmed or found, up from 56 in 2021 (inappropriate behaviour includes: mismanagement of people; inappropriate relationships; inappropriate behaviour 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 programmes decreased in 2022 to 232 (down from 262 in 2021). More still needs to be done to encourage locally hired staff in our programmes to come forward with complaints, as they make up nearly 80 per cent 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). In the context of the millions of patients MSF sees each year, it is concerning that the number of complaints from patients and their carers continues to remain low. This is a clear indicator that, although efforts to inform patients and carers of expected staff behaviour standards and complaint mechanisms are ongoing, more needs to be done to advise patients of their rights and ensure access to reporting mechanisms to hold MSF accountable for any abuse or inappropriate behaviour.

The number of complaints submitted by “other” external parties – a category which includes suppliers, members of the media, members of other organisations, 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 on the total of 32 in 2021. Existing efforts on highlighting diversity and inclusion in behaviour 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 per cent of the total MSF workforce is based in these international offices.

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

Out of 38 headquarter 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 behaviour (4). This compares to 19 confirmed cases of abuse and 11 of inappropriate behaviour 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 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 abuse or inappropriate behaviour which they come across.  

(1) Exploitation (separate from sexual exploitation) relates to someone using their authority, influence, or control over resources to pressure, coerce or manipulate a person to do something in exchange for resources or offer of resources. 
(2) Case management process relates to abuse around retaliation, interference in a case, false reporting, and breach of confidentiality. 
(3) Inappropriate communication relates to any spoken, written, or non-verbal language that is not respectful of others or their environment, even if it does not constitute abuse, which includes using an aggressive, annoying, or insulting tone. 
(4) Note: one “case” can be qualified as several offences, so totals may not match. 

In 2023, over 69,000 individuals worked for the MSF movement worldwide. During that year, we saw a total of 823 complaints about abuse or inappropriate behaviour made across the MSF movement. Of these, 714 were related to our medical and humanitarian projects, and 109 related to our international headquarter offices. Of those complaints, after investigation, 300 were confirmed to be cases of abuse or inappropriate behaviour, with some complaints still being investigated at the end of 2023. The paragraphs below break down data from 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 18 per cent in 2023 (714 complaints), compared to 2022 (606 complaints). Complaints received in our international headquarter offices in 2023 (109 complaints) increased by 22 per cent compared to 2022 (89 complaints). MSF remains concerned about under-reporting of abuse and inappropriate behaviour given the breadth of our activities and the reach of our operational footprint – especially from patients, their caregivers, and from community members in the areas where we work.

Complaints received related to our medical and humanitarian projects in 2023:

• Around 89 per cent of MSF staff (69,100 people in total) in 2023 were working in MSF’s projects. A total of 714 complaints were made about the behaviour of staff in these projects, up from 606 in 2022.  
• Of those complaints, after investigation, 264 were confirmed to be cases of abuse or of inappropriate behaviour (204 in 2022), with some cases still being investigated at the end of the year.
• This includes 187 cases which were confirmed as abuse, compared to 121 confirmed cases of abuse in 2022 (this includes different forms of abuse: sexual exploitation, abuse and harassment [SEAH]; abuse of power; harassment and bullying; discrimination; exploitation; aggression; abuse of the case management process – including retaliation, false reporting, interference in a case, and breach of confidentiality). 
• A total of 85 staff members were dismissed for different types of abuse in 2023 (52 dismissals in 2022). Depending on the severity of the case, other types of sanctions were also issued, including but not limited to suspension, demotion, formal written warning, or mandatory training.
• Of the 187 confirmed cases of abuse, 85 were cases of SEAH, compared to 67 in 2022. Forty-five (45) staff were dismissed based on the findings of investigations related to those SEAH cases in 2023 (35 in 2022), noting that behaviour like sexual harassment covers a range of behaviour.
• The other confirmed cases of abuse included cases of harassment or bullying (31 confirmed cases); abuse of power (30 confirmed cases); aggression (23 confirmed cases); exploitation (13 confirmed cases); discrimination (9 confirmed cases); and abuse of the case management process (4 confirmed cases). 
• There were also 77 cases of inappropriate behaviour found (83 in 2022). Inappropriate behaviour means behaviour which does not amount to the forms of abuse outlined above, but which are not in line with MSF’s behavioural standards. This includes, but is not limited to, mismanagement of people; inappropriate relationships; inappropriate behaviour not in line with societal standards or affecting team cohesion; inappropriate communication; and substance (mis)use.

We have continued to see some increases in the number of complaints submitted by previously under-represented groups, like locally hired staff, though there is still much room for improvement, especially with patients and community members. 

The total number of complaints submitted by patients and their caregivers was 33 in 2023, and 36 from community members (which may also include patients and others in the community whom MSF staff encounter) for a total of 69 (67 in 2022).  There were also 24 complaints submitted by “other” external parties – a category which includes suppliers, media, other organisations, partners, ex-MSF staff, non-MSF contracted staff.

It remains concerning that the number of complaints from patients, their caregivers, and community members has remained so low. Increased efforts are needed to reach out to patients and community members by making them aware of their rights and MSF expected standards of behaviour, and to ensure there are accessible, appropriate complaints mechanisms available to them to hold MSF accountable for any abuse or inappropriate behaviour. 

The total number of complaints submitted by locally hired staff increased from 232 in 2022 to 328 in 2023. Efforts to encourage and support these staff to report need to be continued, as locally hired staff account for around 78 per cent of the global workforce, but are responsible for only 58 per cent of complaints made by MSF staff.  

In reviewing all complaints from both MSF staff and individuals outside of the organisation, there have been a relatively low number of complaints made about discrimination – despite ongoing movement-wide efforts to address it. A total of 45 complaints relating to discrimination were received in 2023, up slightly on the total of 40 in 2022. This suggests that continued and sustained efforts are needed on diversity and inclusion, to ensure people affected by acts of discrimination in any form, report it.

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. Eleven per cent of the total MSF workforce is based in these international offices.

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

From all of the headquarter offices, 109 complaints were received in 2023 (up from 89 in 2022).

Of these, 36 cases were confirmed to be abuse or inappropriate behaviour (with 11 complaints still under investigation at the end of the year, noting that some complaints made were not about abuse). There were 34 cases related to abuse and 21 to inappropriate behaviour.(1) This compares to 38 confirmed cases of abuse and 30 of inappropriate behaviour in 2022. 

Overall, 13 staff members were sanctioned (ranging from coaching to verbal or written warnings) and 15 staff members were dismissed for abuse in 2023.  

***

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 people with whom we work and to be accountable to them.

We continue to urge staff, patients, or anyone else who comes into contact with MSF, to report any incidents of abuse or inappropriate behaviour.  

(1) Note: some cases were found to have elements of both different types of abuse and inappropriate behaviour, so totals may not match.