Promoting a work environment free of harassment, exploitation and abuse

2018 update

Published 17 June 2019; updated 22 July 2019

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 almost 65,000 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 situations of 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. Thirty-six staff were dismissed as a result of those cases in 2018 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 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.   

Note on changes to the figures

Update 22 July 2019

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 update

First published 22 June 2020; updated with new figures 12 July 2021

MSF continues to face a challenge of under-reporting when it comes to issues related to 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 per cent) 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 nearly 65,000 individual staff movement-wide, of whom 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. Forty (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 per cent 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 per cent of all complaints despite making up more than 90 per cent 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 per cent). Under-reporting 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 update

Published 12 July 2021; updated with new figures 28 July 2022.

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, caregivers 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

• Over 90 per cent of MSF 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, 149 were confirmed as either situations of abuse or of inappropriate behaviour (156 in 2019).
   
• 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 40 staff members were dismissed for all forms of abuse in 2020 (55 dismissals in 2019). Depending on the severity of the case, other sanctions were also 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. Twenty-eight (28) staff were dismissed as a result of those SEAH 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 67 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 standards or affecting team cohesion; and substance use).

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 per cent of the MSF work force.
   
• The total number of complaints submitted by patients, caregivers, community members and other external parties showed no increase, at 23 in 2020 (also 20 in 2019). Considering that MSF undertakes millions of medical consultations each year in all our 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 per cent of the total MSF 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 per cent 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.  

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 unacceptable behaviour which they come across.  

2021 update

Published 28 July 2022; updated with a corrected figure 9 October 2023

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 per cent 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 training.
   
• 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 per cent 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 per cent 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 organisations, community members, partners, ex-MSF staff, non-MSF contracted staff and MSF association members – saw an increase of nearly 150 per cent, 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. 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.  

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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 unacceptable behaviour which they come across. 

2022 UPDATE

In 2022, MSF employed nearly 68,000 staff globally and recorded 695 complaints of abuse or inappropriate behaviour (606 project-level, 89 office-level), representing a 24% overall increase in project complaints compared to 2021. Following investigations, 248 total cases were confirmed. The organization expanded its reporting categories in 2022 to include exploitation, case management process violations, and inappropriate communication.

Complaints Received Related to Our Medical and Humanitarian Projects in 2022 (~62,000 Staff)

• Complaints: 606 received (up from 490 in 2021).

• Confirmed Cases: 204 total (121 abuse, 83 inappropriate behaviour).

• Breakdown of Abuse: 60 SEAH, 22 psychological harassment, 17 abuse of power, 12 physical violence, 7 exploitation, and 3 discrimination.

• Sanctions & Dismissals: 52 staff members were dismissed for abuse (35 specifically for SEAH cases), alongside administrative sanctions like demotions and warnings.

• Complainant Breakdown:

  • Locally Hired Staff: 232 complaints (down from 262 in 2021), representing a key area for improved reporting given they make up nearly 80% of the workforce.

  • Patients & Caregivers: 67 complaints (up from 53 in 2021), remaining disproportionately low.

  • External Parties & Others: 107 complaints (up from 37 in 2021).

  • Discrimination: 40 total complaints received (up from 32 in 2021).

Complaints From Our Offices Worldwide (~6,800 Staff)

• Complaints: 89 received across 38 international offices (up from 49 in 2021).

• Confirmed Cases: 44 total (38 abuse, 30 inappropriate behaviour, with overlap across categories).

• Sanctions & Dismissals: 17 staff members received sanctions or were dismissed (up from 13 in 2021).

2023 UPDATES

In 2023, MSF employed over 69,000 staff worldwide and recorded 823 complaints of abuse or inappropriate behaviour (714 project-level, 109 office-level), alongside parallel initiatives to overhaul abuse prevention systems following the DRC Ebola response. After investigations, 300 total cases were confirmed across the movement in 2023.

Complaints Received Related to Our Medical and Humanitarian Projects in 2023 (69,100 Staff)

• Complaints: 714 received (an 18% increase from 2022).

• Confirmed Cases: 264 total (187 abuse, 77 inappropriate behaviour).

• Breakdown of Abuse: 85 SEAH (Sexual Exploitation, Abuse, and Harassment), 31 harassment/bullying, 30 abuse of power, 23 aggression, 13 exploitation, 9 discrimination, and 4 case management violations.

• Sanctions & Dismissals: 85 staff were dismissed for abuse (45 specifically for SEAH).

• Complainant Demographics: 328 complaints came from locally hired staff (up from 232), 69 from patients and community members, and 24 from other external parties. Total discrimination complaints across all sources rose slightly to 45.

Complaints From Our Offices Worldwide (~7,600 Staff)

• Complaints: 109 received (a 22% increase from 2022).

• Confirmed Cases: 36 total (34 abuse, 21 inappropriate behaviour, accounting for categorical overlap).

• Sanctions & Dismissals: 15 staff members were dismissed for abuse; 13 received other administrative sanctions.

Proactive Anti-Abuse Efforts in DRC (2021-2022)

• Context: Following 2020 media revelations of widespread abuse during the 10th Ebola outbreak in North Kivu, MSF launched an internal investigation and an extensive ethical review involving 628 staff members.

• Findings: The review uncovered 24 reports of personal abuse, including 13 cases of sexual abuse (primarily sex-for-jobs). Of the 15 cases fully investigated at the time of publication, three resulted in direct sanctions.

• Structural Reforms: The investigation highlighted the need to better protect vulnerable, low-skilled workers, improve gender and diversity balance in management, and enforce stricter emergency recruitment protocols.

• Implementation: These procedural updates and specific behavioural commitments were formally integrated into MSF's subsequent Ebola response in Equateur Province in mid-2022.

2024 update

Published 6 August 2025

In 2024, 67,077 individuals worked for MSF worldwide. During the year, we saw a total of 945 complaints about abuse or inappropriate behaviour made across the MSF movement. Of these, 864 were related to our medical and humanitarian projects, and 81 related to our international headquarter offices. Of those complaints, after investigation, 345 were confirmed to be cases of abuse or inappropriate behaviour, with some complaints still being investigated at the end of 2024. The paragraphs below break down data from 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 21 per cent in 2024 (864 complaints), compared to 2023 (714 complaints). Complaints received in our international headquarter offices in 2024 (81 complaints) decreased 9 per cent compared to 2023 (109 complaints). Given the breadth of our activities and the reach of our operational footprint, we remain concerned about underreporting of abuse and inappropriate behaviour, especially from patients, their caregivers, and from community members in the areas where we work.

Complaints received related to our medical and humanitarian projects in 2024:

• Around 89 per cent of MSF staff (60,580 people in total) in 2024 were working in MSF projects. A total of 864 complaints were made about the behaviour of staff in these projects, up from 714 in 2023.  
• Of those complaints, after investigation, 308 were confirmed to be cases of abuse or of inappropriate behaviour (264 in 2023), with some cases still being investigated at the end of the year.
• Of those 308 confirmed cases, 256 cases were confirmed as abuse, compared to 187 confirmed cases of abuse in 2023 (this includes different forms of abuse: sexual exploitation, abuse and harassment [SEAH]; abuse of power; harassment and bullying; discrimination; exploitation; aggression; and abuse of the case management process – including retaliation, false reporting, interference in a case, and breach of confidentiality).
• A total of 84 staff members were dismissed for different types of abuse in 2024 (85 dismissals in 2023). Depending on the severity of the case, other types of sanctions were also issued, including, but not limited to, suspension, demotion, formal written warning, or mandatory training.
• Of the 256 confirmed cases of abuse, 126 were cases of SEAH, compared to 85 in 2023. Fifty-eight (58) staff were dismissed based on the findings of investigations related to those SEAH cases in 2024 (45 in 2023), noting that behaviour like sexual harassment covers a range of behaviour.
• The other confirmed cases of abuse included cases of harassment or bullying (35 confirmed cases); abuse of power (30 confirmed cases); aggression (17 confirmed cases); exploitation (14 confirmed cases); discrimination (22 confirmed cases); and abuse of the case management process (12 confirmed cases).
• There were also 52 cases of inappropriate behaviour confirmed (77 in 2023). Inappropriate behaviour means behaviour which does not amount to the forms of abuse outlined above, but which are not in line with MSF’s behavioural standards. This includes, but is not limited to, mismanagement of people; inappropriate relationships; inappropriate behaviour not in line with societal standards or affecting team cohesion; inappropriate communication; and substance (mis)use.

We have continued to see some increases in the number of complaints submitted by previously underrepresented groups, such as locally hired staff. However, there is still much room for improvement, especially with patients and community members.

The total number of complaints submitted by patients and their caregivers was 45 in 2024, and 35 from community members (which may also include patients and others in the community whom MSF staff encounter) for a total of 80 (69 in 2023). There were also 40 complaints submitted by “other” external parties – a category which includes suppliers, media, other organisations, partners, ex-MSF staff, and non-MSF contracted staff.

Although patient complaints are increasing, more efforts are needed to reach out to patients and community members to make them aware of their rights and expected standards of behaviour by MSF staff. Efforts must also be improved to ensure there are accessible, appropriate complaints mechanisms available to patients and community members so that they hold MSF accountable for any abuse or inappropriate behaviour.

The total number of complaints submitted by locally hired staff increased from 328 in 2023 to 414 in 2024. Efforts to encourage and support these staff to report need to be continued, as locally hired staff account for around 87 per cent of the workforce in our medical and humanitarian projects, but are responsible for only 58 per cent of complaints made by MSF staff in these projects.

In reviewing all complaints from both MSF staff and individuals outside of the organisation, there has been an increase in complaints made about discrimination. A total of 75 complaints relating to discrimination were received in 2024, up  from 45 in 2023. While more people are coming forward to raise complaints about discrimination, there is still a need for continued and sustained efforts on diversity and inclusion, and to ensure people affected by acts of discrimination in any form report it.

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. Eleven per cent of the total MSF workforce is based in these international offices (7,505 people).

While efforts have been made to standardise reporting, this data relates to many different legal and human resource processes around the world, and so may not yet be fully harmonised.

From all of the headquarter offices, 81 complaints were received in 2024 (down 9 per cent from 109 in 2023).

Of these, 37 cases were confirmed to be abuse or inappropriate behaviour (with 11 complaints still under investigation at the end of the year, noting that some complaints made were not about abuse). There were 35 cases related to abuse and 19 to inappropriate behaviour. (Note: some cases were found to have elements of both abuse and inappropriate behaviour, so totals may not match). This compares to 34 confirmed cases of abuse and 21 of inappropriate behaviour in 2023.

Overall, 16 staff members were sanctioned (ranging from coaching to verbal or written warnings), and 12 staff members were dismissed for abuse in 2024. 

What is MSF’s position on abuse?

MSF prohibits abuse and misconduct, including exploitation, and harassment. MSF is committed to ensuring that our programmes and offices are safe for our patients, communities and colleagues. However, we recognise that abuse can and does occur. When it does, it is a profound breach of trust and of the standards we expect from everyone working with MSF, and we deeply regret the harm caused to patients, community members, and colleagues. MSF has taken steps to strengthen safeguarding in recent years, but we recognise we need to make faster and more substantial progress. 

There are heightened risks given the complexities of the places where we work, which make strong safeguarding systems even more important. While it is not possible to eliminate the risk of abuse entirely, our responsibility is to be as effective as possible at reducing those risks. We are determined to act on every alert, learn from every case, create environments where people feel safe to report concerns, and support those affected when they do come forward, ensuring their voices and experiences shape our work. This work requires constant vigilance and sustained efforts. 

What is MSF doing to prevent and respond to abuse?

MSF works to prevent, detect and respond to abuse and misconduct across our programmes and offices. Measures include safer recruitment and staff management, staff training and induction, ensuring diverse reporting mechanisms, investigations, survivor support, and working with patients, communities and staff to identify and reduce risks. We know there is more to do, and we will continue strengthening our systems based on lessons from previous cases and investigations.

We recognise that strengthened safeguarding policies and systems alone are not evidence of success. What matters is whether they lead to safer environments, greater trust in reporting mechanisms, and better support for survivors. We will continue to assess what is working, identify gaps, and publicly report on abuse and misconduct across MSF as part of our annual behaviour accountability reporting.  

Examples of recent steps MSF has taken include:  

• Working to improve the support we can offer to survivors, and ensuring it is adapted to their needs. This includes ensuring we can offer support beyond the care MSF directly provides. 
• Integrating safeguarding into our everyday practice and work as an organisation. This includes recognising safeguarding as a responsibility of all colleagues to create an environment where abuse is never tolerated and where people feel safe to raise concerns.
• Briefing staff and others we hire on our behavioural commitments, and strengthening induction, supervision and oversight throughout their ongoing employment.
• Conducting safeguarding risk assessments to ensure we can identify the people and places at heightened risk and take preventive actions before abuse occurs. This includes redesigning services or doing specific awareness raising with people most at risk, or those least likely to raise concerns.  
• Increasing the number of investigators to follow up reports of abuse.
• Increasing the number of safeguarding specialists available to support country teams to prevent, detect, and respond to emerging risks.  
• Working to ensure patients and communities play a greater role in shaping how safeguarding works in practice, including helping to design reporting systems, raising awareness of abuse and misconduct, and improving the confidentiality of our reporting systems.  
• We have strengthened our global screening processes to prevent people found to have committed abuse or serious misconduct from moving between MSF projects and being rehired elsewhere in the organisation.
• Working to increase the representation of women across our programmes, particularly in maternal and child healthcare, recognising that patients and staff may feel more comfortable raising concerns with women.

What support does MSF provide to survivors?
 

Medical and psychological care is systematically offered to survivors, and MSF can also provide legal support.  

We acknowledge that our response to survivors has limitations and that greater efforts are needed to proactively engage with survivors, understand their individual needs and preferences, and identify appropriate forms of assistance.  

Barriers to accessing support can be particularly acute in some of the places where we work. Concerns about confidentiality, judgement or retaliation can affect whether survivors feel safe to access these services. Appropriate survivor-centred services may be limited or difficult to access, while survivors may face stigma, practical barriers, or fear consequences for coming forward. This makes prevention efforts, before abuse occurs, even more important, alongside active detection of cases. 

We continue to work with patients, communities, and colleagues to better understand these barriers and improve the support available. 

Does MSF publicly identify people found to have committed abuse?

MSF does not publicly identify people found to have committed abuse in our programmes. This could undermine the confidentiality and safety of survivors and witnesses. Protecting confidentiality is also important for ensuring confidence in our reporting systems and helping people to feel safe to raise concerns. 

What checks does MSF carry out before hiring someone?

MSF checks references from previous employers as part of our recruitment processes, where this is possible within the relevant national and legal framework. However, reference checks cannot always provide complete information about a person's previous employment or conduct. Securing references has also proven particularly challenging during periods of rapid operational expansion, including during an acute phase of an emergency. 

Does MSF report cases to the authorities or support survivors seeking legal action?
 

MSF respects and supports the wishes of survivors on whether cases should be reported to the authorities. Concerning specific cases involving minors, we may report this to the local authorities depending on the best interests of the child, and various other considerations including the existence of trustworthy judicial mechanisms.

When survivors are also MSF patients, MSF may hold medical information that could be relevant to legal proceedings. Where appropriate and in accordance with the survivor’s wishes, MSF can make this information available to them for judicial purposes.