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Promoting a work environment free of harassment, exploitation and abuse
Médecins Sans Frontières/Doctors Without Borders (MSF) promotes a working environment free of harassment and abuse.
Our leadership has unequivocally committed to fight abuse and to reinforce mechanisms and procedures to prevent and address it. All staff are expected to abide by the MSF movement's Behavioural Commitments and our guiding principles as stipulated in our Charter.
Each year, MSF publishes a statement on the number of reports of responsible behaviour incidents that have been received and the actions that have been taken in response; along with an update on activities undertaken by MSF to address the wider issue. These statements can be found below.
Statements and figures by year
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 percent) 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 shown 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.
There is a range of ongoing work to address issues around responsible behaviour 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.
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.
Staff numbers: Please note that the 65,000 figure for MSF staff refers to the total number of individuals that have worked for MSF in the course of a year, as opposed to the total number of full-time equivalent positions – which will be a lower number as more than one individual can hold the same position in the course of a year. The latter figure has also been used in some previous statements.
2019 figures in detail
Total grievance complaints
In 2019, we had approximately 65,000 individual staff movement-wide, of more than 90 percent were working in the field.
We saw a total of 322 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.
Confirmed cases of abuse or inappropriate behaviour
Of those complaints, after investigation, 154 were confirmed as either situations of abuse or of inappropriate behaviour (134 in 2018).
This includes 104 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 57 staff members were dismissed for all forms of abuse in 2019 (52 dismissals in 2018).
Of the 104 cases of abuse, 63 were cases of sexual harassment, abuse, or exploitation, up from 59 in 2018. Thirty-seven 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 standards or affecting team cohesion; and the use of substances).
Complaints by under-represented groups
While the overall number of complaints is down by 10 percent 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 percent of all complaints despite making up more than 90 percent of MSF’s field-based workforce.
Complaints by MSF’s patients and carers
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 19 in 2019 (an increase of 46 percent).
In early 2018, MSF published a statement on the actions we had taken to combat abuse and harassment, the challenges we faced, and the number of cases recorded in 2017.
One year on, we have put together the following short update on progress so far, including figures from 2018, which we hope will help maintain a constructive focus on this important issue.
One of the most significant challenges we identified previously was that of underreporting – and the need to do more to ensure that our staff and patients are aware of, and trust, our reporting mechanisms.
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 underreporting and data gathering.
Our statement last year set out a number of ongoing measures to improve the detection and prevention of unacceptable behaviour. These included training, workshops, field visits, and the production and distribution of leaflets and audio-visual materials.
2018 saw continued activity in all these areas, as well as the allocation of increased staffing to MSF’s responsible behaviour teams; the development of new tools for improving awareness, prevention and detection of unacceptable behaviour; and the improvement of data-gathering and sharing across the MSF movement.
It is worth acknowledging that an increased public focus on this issue will very likely have contributed to increased awareness and reporting.
2018 figures in detail
In 2018, MSF had 43,000 staff working in the field (the following figures relate to complaints from the field and do not include the additional 4,000 staff working in MSF HQs).
2018 saw a significant increase in the number of complaints from the field recorded about all types of behaviour, a total of 356, up from 182 in 2017.
Confirmed cases of abuse or inappropriate behaviour
Of those complaints, after investigation 134 were confirmed as either situations of abuse or of inappropriate behaviour (83 in 2017).
This includes 78 cases qualified as abuse of all forms, compared to 61 in 2017 (this category includes sexual abuse, harassment and exploitation; abuse of power; psychological harassment; discrimination; and physical violence).
A total of 52 members of staff were dismissed for all forms of abuse (58 in 2017).
Of the total 78 cases of all forms of abuse in 2018, 59 were confirmed after internal investigation as cases of sexual abuse, harassment or exploitation, up from 32 in 2017. Thirty-six staff were dismissed as a result of those cases, up from 20 in 2017.
There 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 standards or affecting team cohesion; the use of substances).
It is worth stressing again that this is still not the complete picture that we would like to have – while we have improved data-gathering since last year, we still have more work to do to address both this issue and the challenge of under-reporting.
However, we hope that these figures are an indication that an increased focus on the issue has encouraged more people to come forward.
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.
Changes to the 2017 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 estimated: 182 as opposed to 146; the number of confirmed cases has also risen slightly. The above comparisons use the updated 2017 figures; but for the purposes of comparison, the original figures remain available in last year’s statement.
Please note that some cases from 2018 are still being investigated and have not yet been qualified, so the figures may change slightly.
MSF UK is part of an international movement of legal entities, commonly referred to as MSF, which are bound by a shared name and identity, and shared commitment to the MSF Charter and principles.
The figures in these statements relate to the international movement’s global field projects and not to the MSF UK office.