Dear All,

The global shockwave initiated by the killing of George Floyd has led many organisations to take a hard and honest look at their level of progress on fighting racism and discrimination. In undertaking that assessment ourselves – and despite years of raising awareness and efforts at implementing new policies – we acknowledge that progress is nowhere fast enough. We also acknowledge that our governance, and where the positions of power sit in our movement, don't reflect the diversity of our organisation.

As the Core ExComCore ExCom: the core members of MSF's Executive Committee (ExCom) are the General Directors of the five MSF Operational Centres (Amsterdam, Barcelona, Brussels, Geneva, Paris), plus two members elected from amongst the General Directors of the MSF Partner Sections, plus the International Medical Secretary at MSF International. The core ExCom is chaired by the Secretary General of MSF International., we welcome the current debate on racism as an opportunity to accelerate change within our organisation. Pain and suffering have been expressed in recent weeks across the movement, these words reflect the reality of so many of our staff, and patients.

The strategic plans of the five Operational Centres, published just a few months ago, include strong commitments on diversity, equity and inclusion, as well as on challenging the concentration of power in Europe. We believe these are important steps in tackling racism within MSF. We are all working to transform these commitments into action and reality. We will develop clear milestones on these actions and ensure we are held accountable to the boards, staff, associative members, donors and patients on the progress we make at every step.

However, we know that these changes need to go much further to provide a more just and equitable environment to our staff. We also need to examine how the inequalities we see in our organisation influence the care we provide to patients and our transparency towards them.

We need to go further in understanding and addressing the existing biases and barriers that exist within MSF. Some are rooted in our processes; others within the cultures of the places where decisions are made and implemented, which then shapes our behaviour and ways of thinking. Many are the result of history. Founded in Europe, MSF practices and structures are not immune from the influence of the continent’s colonising past. We need to address these issues head on, however uncomfortable, and even painful, this may be for those currently making decisions.  

We are very conscious that the vast majority of the General Directors appointed by our associations are of European descent, which limits our ability to identify the extent of our own biases and provide truly diverse perspectives for leading our movement. We are also aware that racism is not the only problem we face; we see discrimination based on gender, religion, sexuality and social standing.

We must undertake changes throughout the organisation, which will include:

• Breaking the glass ceiling for locally-hired staff;  
• addressing the difference in compensation in our teams;  
• reviewing the varying level of risk taken by staff;
• continuing to tackle the broader issues of harassment, abuse and discrimination throughout the organisation, specifically focusing on the patients we treat to ensure they can truly be protected from - and report on – possible abuse perpetrated by MSF staff; and
• critical assessment of any medical double standards that may exist, for example when reduced level of quality of care becomes a norm in numerous countries where we operate.

As the Core Executive Committee, we commit to lead the way for the radical action sought after and demanded by our associations. We commit to propose and implement reforms allowing the rich diversity of the global MSF movement to be mirrored in the composition of our international governance, both associative and executive. This will lead MSF to become an ever more diverse, equitable, just and global organisation, where everyone can contribute to tomorrow’s definition of medical humanitarian action.  

Nelke Manders, General director MSF-Holland, Chair of OCA
Meinie Nicolai, General Director, MSF OCB
Marta Cañas, General Director, MSF OCBA, MSF España
Thierry Allafort-Duverger, General Director, MSF France
Liesbeth Aelbrecht, Director General, OCG
Jeremie Bodin, General Director, MSF Japan
Erwin van’t Land, General Director, MSF Norway
Christopher Lockyear, Secretary General, MSF International