Promoting a work environment free of harassment, exploitation and abuse (Update 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.