Promoting a work environment free of harassment, exploitation and abuse

Médecins Sans Frontières (MSF) promotes a working environment free of harassment and abuse. Our leadership has unequivocally committed to reinforce mechanisms and procedures to prevent and address abuse and harassment. All staff are expected to abide by the MSF movement's Behavioural Commitments and our guiding principles as stipulated in our Charter
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. 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.
Grievance and whistle-blowing mechanisms

Procedures, including grievance mechanisms, are 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 outside any hierarchical lines, using dedicated email addresses. Victims or witnesses in the communities where MSF works are likewise encouraged to report misconduct to us so that allegations can be properly addressed. 

Broad awareness activities are carried out 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. Moreover, e-briefings and learning modules related to behaviour and management of abuse are regularly updated and improved. 

There is a range of ongoing work in this area that has been taking place across the MSF movement in recent years. Examples include: 

  • Creating new positions and/or increasing staff support to provide training, field visits and investigation on these issues. 
  • Undertaking workshops and other forms of consultation with staff to assess the problem and the steps needed to address it. 
  • Revising, promoting and strengthening guidance provided to staff on how to report harassment, abuse or exploitation. 
  • Reinforcing awareness at the patient and community level where we have operations. 
  • Improving data-gathering and sharing across the MSF movement. 
Managing cases confidentially
MSF aims to ensure that these situations are addressed with the utmost confidentiality, to create an environment where people feel they can safely file complaints, without fearing for their safety, their job, or their confidentiality. 
Our first priority when misbehaviour is reported is the safety and health of the potential victims. Immediate attention is given to provide support, which can include psychological and medical care, and securing legal assistance.
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.

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.


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. 

Update and figures in 2017-2021


Last update on 9 October 2023