We fight abuse, exploitation and harassment in our work environment - 2020 figures

Médecins Sans Frontières/Doctors Without Borders (MSF) promotes a work environment free from harassment and abuse. The organisation's management has unequivocally committed to combating abuse and strengthening mechanisms and procedures to prevent and manage it.

All staff must comply with MSF's Behavioural Commitments and the guiding principles stipulated in the MSF Charter.

The integrity of our organisation is based on the good conduct of each of our staff members, wherever they are, and their full respect for the communities we serve. For our organisation, this means not tolerating any behaviour by our staff that exploits the vulnerability of others, nor that members of our teams take advantage of their position for personal gain.

Complaint mechanisms 
Mechanisms, including grievance procedures, are in place to promote the prevention, detection, reporting and management of any type of misconduct, harassment or abuse. Through these mechanisms, all those who work for MSF are encouraged to report inappropriate behaviour or abuse, either through their managers or through specific reporting channels, with e-mail addresses enabled for this purpose that work outside any line of authority. MSF also encourages people who have experienced inadequate behaviour or witnessed misconduct in the communities where they work to speak up, so that complaints can be addressed appropriately.

Wide-ranging awareness-raising activities are carried out at MSF to inform all our staff of the mechanisms available to report inappropriate behaviour. This information is distributed through specific communications, including printed staff manuals, and shared in briefings, field visits and trainings. In addition, online informative sessions and training modules related to behaviour and abuse management are regularly updated and improved.

In recent years, a series of measures have been taken in this area, such as: 
 

• Creation of new positions and increased support for staff to provide training, field visits and research on this subject.
• Workshops and other forms of consultation with staff to assess the problem and the steps needed to address it.
• Review, promotion and strengthening of the guidance provided to staff on how to report harassment, abuse or exploitation.
• Strengthening of awareness among patients and communities where we have operations.
• Improved data collection and sharing within MSF.

Confidential case management

MSF's goal is to ensure that these situations are handled with the utmost confidentiality, since this is crucial for creating an environment in which people feel they can file complaints safely, without fearing for their job, their safety or the confidentiality of their complaint.

MSF's priority when a case of misconduct is reported is the health and safety of those people who have potentially suffered from inappropriate behaviour. They are therefore given immediate attention and support. This support can range from psychological and medical care to legal assistance.

MSF always respects the decision made by the person exposed to abuse, whether they wish to bring the matter to justice or not. If informed of sexual abuse against minors, MSF's policy is to report the case to the judicial authorities, whenever it is considered that this measure is the most appropriate for the interests of the child, and depending on the availability of legal proceedings.

The main challenge: to reduce difficulties in reporting 

 
2020 update: 
 
Published on 12 July 2021 
 
The total 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 behavioural incidents. It indicates that whistleblowers and witnesses feel increasingly confident to speak out, and that there is greater awareness of the various reporting mechanisms and channels strengthened and put in place.

However, despite this progress, under-reporting remains a problem. Of particular concern is the limited (although increasing) number of complaints from patients, caregivers and community members. This indicates the need to focus on prevention and develop tailored community complaint mechanisms for these groups.

The pandemic has led to a reduction in face-to-face activities to prevent unacceptable behaviours. As expected, the number of prevention field visits in 2020 decreased, as well as the number of attendees at awareness-raising events. However, significant effort has been made to move towards virtual training, which has led to the number of staff trained to deal with behavioural problems actually increasing compared to 2019.

In 2020, MSF had more than 63,000 employees throughout the movement. We saw a total of 444 complaints among our staff: 389 from those working in the field and 55 from those at the headquarters. Please note that in the additional details below, the field and headquarters cases are listed separately, as they are not necessarily comparable in terms of terminology and reporting processes.

Complaints from our projects in the field:

• In 2020, 90% of MSF staff (57,429 people in total) worked in the field. A total of 389 complaints related to this category of staff were filed, compared to 318 in 2019.

• After being investigated, 150 of these complaints were confirmed as situations of abuse or inappropriate behaviour (156 in 2019). (It should be noted that 15 complaints reported in 2020 remained open at the time these figures were compiled.)

• This includes 82 cases classified 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 and physical violence.) A total of 37 staff members were fired for abuse in all its forms in 2020 (55 in 2019). Depending on the severity of the case, other punishments were issued, such as suspension, demotion or a formal written warning.

• Of the 82 confirmed cases of abuse, 55 were cases of harassment, abuse or sexual exploitation, compared to 63 in 2019. A total of 28 employees were fired due to these 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, compared to 50 in 2019 (appropriate behaviour includes: poor management of people, inappropriate relationships, inappropriate behaviour that does not conform to social standards or affects the team's cohesion, and the use of substances).

We have continued to see small but encouraging increases in the number of complaints filed by previously under-represented groups, although much work remains to be done:

• The total number of complaints filed by locally hired staff increased again in 2020, to 172 (up from 144 in 2019). While this may represent marginal success in improving staff awareness and confidence to make complaints, there is still a long way to go, considering that locally hired staff make up 80% of the MSF workforce.

• The total number of complaints filed by patients, caregivers, community members and other external parties increased very slightly in 2020, to 23 (compared to 20 in 2019). Considering that MSF carries out many medical consultations each year across all its projects, as well as many other forms of contact with the communities we help, it is likely that this low figure is due to significant under-reporting. The existing reporting 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 MSF assists.

Complaints from our offices around the world

2020 was the first year in which MSF collected data on complaints from our offices around the world, as well as our projects in the field. As mentioned in previous years, the absence of these figures led to a significant gap in our data, although only about 10% of the workforce of MSF has their headquarters in these offices. Therefore, there is no previous year to compare this data. It is also worth noting that, while efforts have been made to standardise them, this data relates to many legal and human resources processes, so they might not be completely harmonised yet.

• Of the 37 central offices (non-operational entities), which had 5,596 employees (10% of MSF's workforce) in 2020, 55 cases were reported through management lines or mechanisms for reporting specific behaviour in the office.

• After being investigated, 38 cases were confirmed as abuse (20) or inappropriate behaviour (18).

• Of these cases, 20 people were fired or received some other punishment, such as a formal warning, depending on the severity of the misconduct. 
 
Achieving and maintaining a work environment free of abuse and harassment is an ongoing effort that all of us who work at MSF have to make and for which we are all responsible, just as we have the obligation to uphold our commitment not to harm the vulnerable people that we strive to help every day.

We continue to urge our staff, patients and anyone else in contact with MSF to report any incidents of unacceptable behaviour of which they become aware.