In late 2020, a media investigation revealed multiple accounts of abuse from employees of organisations involved in the response to the 10th outbreak of Ebola in the Democratic Republic of Congo (DRC). One of the accounts indicated a link to Médecins Sans Frontières (MSF), prompting us to conduct a full-scale investigation and take action.

Médecins Sans Frontières is not immune to abusive behaviours. For more than 20 years, one of our institutional priorities has been combatting them. Every year, we publish data on reports and investigations conducted by our abuse prevention and management units. We believe that publicly addressing such issues is important, and so we are now releasing the results of our most recent investigations in DRC.

While MSF did not wait for the late 2020 revelations to take action, the concern triggered by their scale served as the catalyst to increase and enhance our efforts. The media investigation pointed to a system of widespread abuse among the organisations deployed in the Ebola response, yet our teams had received not one report or alert; nor had MSF’s internal abuse prevention and management units (accessible to all employees) been informed of any concerns. Although considered particularly effective by the humanitarian aid sector, this raised important questions over whether there were flaws in our reporting mechanisms – and if so, what needed to be done to remedy them?

A twofold response

To address this, MSF initiated two complementary actions. First, a dedicated team conducted an internal investigation based on information received from other international organisations, which was completed in October 2021. Second, an in-depth ‘ethical review’ was undertaken to survey MSF teams on staff practices in emergency situations such as the Ebola outbreak; the effectiveness of the mechanisms for preventing and managing abuse; and, more generally, the ethical issues facing individuals and our organisation in emergency situations.

To facilitate the ethical review, 628 people employed by MSF during the 10th Ebola epidemic in Beni health zone in North Kivu, DRC, were invited to respond to these questions. There were 23 preparatory interviews were conducted; 219 anonymous questionnaires were filled in, returned and validated; and 90 in-depth interviews were held in Beni, Goma and Kinshasa.

This twofold response enabled us to identify and address 24 reports of personal abuse; 13 of them concerned sexual abuse, with most involving sex in exchange for jobs.

In addition, 15 reports of personal abuse – sexual or otherwise – have already been investigated. Three were found to be admissible and led to sanctions; one was well-founded, but the alleged perpetrator could not be identified with absolute certainty because the person had since left MSF; two were un-founded; seven were closed due to lack of information or because we were asked to do so by the complainants; and two were found to involve other organisations and have been handed over to them. MSF’s internal investigation process is ongoing for the remaining reports of personal and property abuse, and it will take a few more months to conclude them.  

Review and transform the system

Beyond identifying and managing reported cases of abuse, we wanted to conduct an in-depth examination of our field practices to reinforce the general environment for preventing and sanctioning abuse within MSF.

The lessons of this review are clear. Broadly speaking, the way in which MSF operates is deemed constructive because we are seen by our staff as assuming responsibility for the risk of abuse and, through our set of practices, attempting to mitigate it. But there are still obstacles, particularly when it comes to people deciding to report abuse. While some issues are internal to our organisation and must be dealt with one by one, others relate to the local environment and our work with communities. We need to be aware of them and take the necessary steps to address them.

We need to: better protect our most vulnerable employees, who are less likely to use reporting mechanisms (e.g. those in low-skilled jobs); set up awareness-raising initiatives adapted to the communities we assist; improve the gender mix and diversity of our teams, especially in management posts and among recruitment teams; be more vigilant with our recruitment processes when hiring large numbers of people in emergency situations; and foster open dialogue with organisations we assist or work with on the issue of abuse.

Between 25 April and 25 June 2022, these lessons guided MSF’s response to DRC’s 14th Ebola outbreak, located in Équateur province. Although few staff – only around 30 MSF employees – were deployed in the province, specific awareness and prevention sessions were held for our teams as well as health workers from the facilities we support, and MSF’s Behavioural Commitments were included in the partnership agreement concluded with the Ministry of Health. The mechanisms for reporting abuse were reiterated on several occasions and it was made clear that, in the event of abuse taking place, all those aware would be required to take immediate action.

Furthermore, we continue to encourage debate and the exchange of ideas among MSF staff in DRC and elsewhere in order to come up with further concrete solutions that will enable us to make structural improvements to the prevention, identification and sanction of abusive behaviours that have no place within our organisation.

The debate that has gained traction in recent years on the existence of abuses in the response to humanitarian crises across the world is one we welcome. MSF wishes to continue contributing to this debate in a transparent and constructive manner in order to create the conditions that will enable more people to speak out, ensure further resources are made available to prevent and sanction abuses and stamp out the perception of impunity for those responsible for such acts.

We are not infallible, but the efforts we have made for close to 20 years – and continue to make – are proof of our commitment to prevent unacceptable behaviour.