In 2022, in partnership with a major photo agency, Médecins Sans Frontières (MSF) published images of a 16-year-old girl who was the victim of rape in the Democratic Republic of Congo. Following widespread criticism, both within MSF and externally, we removed the images from all our platforms.

The controversy sparked a wider conversation about the protection and visual representation of people in the care of MSF, and the circulation of such imagery for editorial, fundraising and commercial purposes.  

Bearing witness to the plights of communities we support is fundamental to the mission and identity of our organisation, and over the years, visual stories, commissions and collaborations with media and photo agencies have played a key role in helping us to do this. Along the way, MSF has contributed to shaping norms and establishing standards in the humanitarian photography field.  Today, we must question these very same norms and standards.  

Photography is a powerful way to inform, provoke and create a sense of empathy. But as a medical organisation, our primary duty must be to protect the privacy, dignity and agency of patients in our care. The medical principle of ‘doing no harm’ cannot be sidelined when depicting people in their most vulnerable moments, in order to raise global awareness and funds.

We must acknowledge that we have not always lived up to this principle. How did images of suffering bodies become so ubiquitous and to what extent has MSF contributed to normalising the pain of others? Did we forget to ask ourselves: how would I feel if the person in this photograph was my son, my father, my sister? 

This excessive display of suffering is both unjustifiable and unnecessary. As a global NGO, and as individuals, we must reflect on how our worldview and choices are influenced by historical power dynamics, and to what extent they have created deep-rooted biases.   

MSF has been called out on images of our patients on news and photo agency websites, for which we do not hold the copyright. When photos of our patients are taken during a media visit and posted on a news agency platform, both MSF and the agency instantly lose control over their circulation and use. We must therefore acknowledge that, by prioritising high public visibility, in a context of increased marketisation of the news sector, we have contributed to the over-exposure of people in our care and facilitated the wide dissemination of sensitive, intrusive and sometimes disturbing images.  

While MSF does not profit from these images, news and photo agencies do; many images are available to buy on their websites. They can also be found on social media, and in books and internal publications. In a digital era, images can stay online for decades. Did all these photos need to be taken? No. Could we have used and disseminated them differently? Yes.  

In 2022, heads of communications across the MSF movement recognised our shortcomings and committed to do better. Dr Christos Christou, MSF’s International President, acknowledged that mistakes had been made and reaffirmed that “MSF’s ultimate responsibility is to protect the health and well-being of the people we seek to assist”.  

Pathways for change  

Our drive to implement changes in visual representation converges with our commitment to produce content in a more inclusive, respectful and accurate manner for communications and fundraising, in line with new guidance we produced in 2021. Concrete actions are being taken at different levels of the organisation; all part of a critical self-inquiry period that will help redefine how we produce stories.   

Back in 2021, we launched a project to investigate the thousands of images in the MSF archive. We started by reviewing photographs according to several ethical criteria, including stereotypes, lack of dignity, disturbing or offensive content, protection of minors, security risk, medical practices and nudity. By the end of 2022, this process had helped us identify 10,000 potentially problematic images. The most sensitive images are now hidden from the database for most users, while the remaining ones carry a specific warning in their captions.  

In 2023, this preliminary work will be refined by a panel of internal and external advisors, comprising photography and child protection experts, curators, academics, ethicists, patient activists and first-line medical workers. The panel will review a set of these problematic images and make recommendations, which we will apply to the full media database and use as a critical guideline to direct how we collect, store and use images in the future.  

Regarding images hosted outside our own media database, we have had a first round of interactions with news and photo agencies to gain an understanding of their ethical standards and content management. Initial findings indicate loose editorial control and high automation of content upload.

As a result, we are taking steps to amend our collaborations with these agencies and asking them to remove or restrict distribution of certain sensitive images. We are also reviewing our standard contracts with external photographers, especially clauses related to reselling images taken during their assignments to external media. 

These are complex issues that involve everyone who works with us. Real cultural change will require ownership at all levels of the organisation. We are therefore engaging with a wide variety of people within MSF through surveys and workshops, so that they can contribute to help define how we work with imagery, and also share their challenges, opinions and experiences.  

The notion of informed consent and agency will be at the core of these considerations. The process will involve listening to community-based staff to better understand the needs of patients being represented, including their sometimes-strong desire to speak out about the situation they are facing. These conversations will help determine whether a photo should be taken, how it might be used and for how long. 

The outcomes of these internal and external consultations will be analysed in 2023 and will serve as the basis for clear decisions on how we produce, store, commission and disseminate images. Inevitably, there will be difficult conversations and disagreements. However, there is a consensus on the fact that the dignity and integrity of our patients should prevail over all other considerations. Even if it means snapping and sharing less often.  

We owe this collective change to the people to whom we provide care.