Promoting a work environment free of harassment, exploitation and abuse

_{(Updates and figures in 2017-2022)}

 

2017:

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 generalized 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.

 

2018:

While the 2018 figures show an increase in the reporting of incidents of unacceptable behaviour compared to 2017, we still believe this picture to be a significant underestimate – this is likely due to a combination of challenges around both under-reporting and data gathering. 

 

In 2018, MSF had over 43,000 staff working in field.  We saw a significant increase in the number of alerts and complaints recorded in 2018, with a total of 356 grievance complaints made, up from 182 in 2017.    This figure relates to alerts and complaints made on the field, but does not cover headquarter offices.  We hope that these figures are an indication that an increased focus on the issue has encouraged more people to come forward.

 

Of those complaints, after investigation 134 were confirmed as either situation of abuse (from abuse of power, to harassment or sexual abuse) or of inappropriate behaviour (83 in 2017).  This includes 78 cases which were qualified as abuse, compared to 61 cases of abuse in 2017.  (This covers many forms of abuse: sexual abuse, harassment and exploitation; abuse of power; psychological harassment, discrimination, physical violence). A total of 52 staff members were dismissed for all forms of abuse in 2018 (58 dismissals in 2017).  

 

Of the 78 cases of abuse, 59 were cases of sexual abuse, harassment or exploitation, up from 32 in 2017. 36 staff were dismissed as a result of those cases in 2018, up from 20 in 2017. 

 

Here were also 56 confirmed cases of inappropriate behaviour, up from 22 in 2017 (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 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.   

 

The reasons for under-reporting 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.

 

Note on changes to the figures: Due to improved data collection and compilation, MSF has updated its figures for 2017. As a result, the total number of complaints for 2017 is found to have been higher than previously reported: 182 as opposed to 146; the number of confirmed cases in 2017 has also risen slightly. Please note that some cases in 2018 are still being investigated, so the overall figures may change slightly. 

 

2019:

MSF continues to face a challenge of under-reporting when it comes to responsible 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%) 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 approximately 65,000 individual staff movement-wide, of more than 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. 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% 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% of all complaints despite making up more than 90% 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%).  Underreporting 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. 

 

2020:

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

• 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 substance uses).

 

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% 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 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 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% of MSF’s total 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% 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.  

 

2021:

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 an increase, to 53 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.  

 

^{[1] Note: one “case” can be qualified as several offences, so totals may not match.}

 

2022: 

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. 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:

• 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 67 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 2021, compared to 13 in 2021. 

 

^{[1] Note: 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] Note: case management process relates to abuse around retaliation, interference in a case, false reporting, and breach of confidentiality.
[3] Note: 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.}