MSF UK response to the International Development Committee, regarding their submission from Decolonising MSF – March 2022
We are grateful for the opportunity to engage with the issues raised in the submission to the IDC’s inquiry into racism in the aid sector. As MSF has previously acknowledged, this is a crucial issue deserving of scrutiny, and of action by the MSF movement.
Before providing further information, it may help to briefly explain the set-up of the MSF movement. This submission is being provided by MSF UK, a ‘partner section’ which carries out a number of functions in support of the MSF movement’s medical humanitarian operations. However, MSF UK does not direct those operations itself – this role is undertaken by the Operational Directorates, of which there are presently six – five headquartered in Europe and one in West Africa. These directorates, together with entities around the world similar to MSF UK, together comprise the ’MSF Movement.’ This multi-centric structure, together with the varied legal, regulatory, linguistic and cultural contexts across the many countries in which we work, means it can be challenging to provide single, one-size-fits-all answers to questions regarding MSF activities, but this submission will seek to provide a broad picture while highlighting specific details or differences as appropriate. We will also provide some points on actions being taken by MSF UK specifically, but it is important to remember that, while other MSF entities may be undertaking similar measures, these cannot necessarily be applied to the MSF movement as a whole.
MSF activities around racism, discrimination and other forms of abuse
Acknowledgement and assessment of the problem
MSF’s senior leadership has long recognised that there is work to do to deal with racism and other prejudices within the movement. The current strategic plans of the five Operational Centres, published in early 2020, include commitments on diversity, equity and inclusion, as well as on challenging the concentration of power in Europe. MSF’s Core Executive Committee (Core ExCom), comprising the General Directors of the five OCs, stated in July 2020 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.”
Beyond the statement of the Core ExCom, many MSF entities have also produced their own analyses of the issue, and commitments to deal with it, which are available publicly. In June 2020 the Management Team of MSF’s Operational Centre Amsterdam (OCA), of which MSF UK is a partner, sent a message to all its staff and Association members in which it acknowledged “our failure to date to act decisively on institutional racism and other forms of discrimination,” noting that “Decision‐making authority in MSF remains almost entirely in Europe, and our cultural structures (including policies), actions and beliefs perpetuate an unequal distribution of privileges and resources between people of different origin, skin colour and contractual status. We are deeply sorry to those who have experienced this, and other forms of discrimination, over the years.” The statement also specifically welcomed the open letter to which the Decolonising MSF submission refers, making clear that “We appreciate the clear actions and steps that the open letter contains” and “We openly recognise and acknowledge that institutional racism and discrimination is present within MSF in many forms.”
Earlier this year, MSF published an update on progress against the commitments made by the Core Excom in 2020. A publicly-accessible summary of this has been provided here https://www.msf.org/tackling-institutional-discrimination-and-racism-within-msf - with the full document also publicly available, here: https://www.msf.org/tackling-institutional-discrimination-and-racism-msf-core-excom-action-plan
For reasons of space we will not seek to comprehensively replicate that progress report here, or the many initiatives taking place elsewhere in the movement. The following however aims to give an indication of progress and planned activities in a selection of key areas:
Reporting and detection of abuse
MSF continues to strengthen its systems for detecting all forms of abuse – including racism and other forms of discrimination. We publish annual updates on this work, the most recent of which is available here: https://www.msf.org/fighting-abuse-exploitation-and-harassment-our-work-environment We remain aware, despite some improvement, that under-reporting of cases continues to be an issue. Examples of ongoing work to improve the reporting and detection of abuse include:
As the examples above show, we try to ensure that internal analyses of our shortcomings in this area, as well as relevant data and the steps we are taking to address issues of racism are made publicly available (within the limitations of the confidentiality our colleagues and the people we assist would expect). We believe that we owe this level of transparency to the people we assist, our colleagues, and the supporters that make our work possible. Among the information we have published are not only action plans and progress updates, but also data, for example on the number and typology of cases of abuse and other unacceptable behaviour reported through MSF’s grievance mechanisms (available here: https://www.msf.org/fighting-abuse-exploitation-and-harassment-our-work-environment )
Training and awareness
At international level, a number of initiatives are underway to provide training and awareness raising among staff regarding racism and discrimination, including:
However, a large number of initiatives are also being pursued at the level of individual MSF entities. For example, at MSF UK, we have undertaken an audit of HR policies to check for statements that undermine workforce inclusion, fairness and diversity, and are rolling out revised HR policies in response to this. We will shortly be publishing an EDI action plan, following a programme of surveying, consulting and discussing these issues among our office staff, UK-contracted project staff, and members of our Association. We would of course be happy to share this plan with the Committee once it is available.
Treatment of staff 
MSF’s International President, Dr Christos Christou, has noted that “In conversations with MSF staff members from across the globe, we are challenged frequently on rewards policies and on the different treatment experienced by different staff groups. People are right to challenge us – and to challenge MSF leadership – because we have much more to deliver.”
MSF’s existing staffing model has also led to unequal access to recruitment and career development opportunities. This has restricted access to coordination positions for locally hired staff, and resulted in over-representation of staff of European and Western origin in senior headquarters leadership roles.
Despite these challenges, there has been progress in the right direction. Our Dakar office is now the third largest recruiter in the MSF movement, after Paris and Brussels. We are certain that finding qualified staff from a broader range of regions will contribute to a better mix in our field teams and change the profile of our leaders and decision-makers in the medium and long term.
Data shows that our internationally mobile workforce has become more diverse over the past 10 years. In 2020, 50% of 3,326 full-time equivalents (FTEs) were from low to middle income countries (LMICs) – a two-fold increase on 2009. However, internationally mobile staff from higher income countries are still more likely to be in senior management positions.
The MSF movement is taking measures to address these issues, including setting up the ‘Rewards Review Project’ and the launch, planned for later in 2022, of the ‘International Contracting Office.’
At MSF UK, we host two initiatives aimed at staff development – the Global Health and Humanitarian Medicine course (GHHM) and the LEAP programme in humanitarian practice. We have committed to increase the number of participants in those courses who are ‘locally hired’ in the countries where we have our projects (as opposed to internationally mobile staff) and/or come from lower and middle income countries (LMICs). In 2020, 40 percent of staff enrolled in the LEAP programme were recruited locally, and in 2021, this figure was 51%. In 2020/21, for the GHHM, the figure was 39 percent (further figures are not yet available). In terms of the countries participants came from, the figures were as follows:
MSF’s global structure
In recent years, MSF has begun to question how decision-making power should be distributed across the movement. As part of this, the ‘MSF Structures Project’ has been set up, which aims to clarify ways in which new voices can become central to our collective decision-making process, while maintaining a solid and accountable governance mechanism. This project will allow for more flexibility around the creation of new entities and will allow for alternative and innovative approaches which do not fit into the current rigid structure.
Already, representation at the highest levels of the MSF movement is shifting: in 2020 and 2021, three new non-European regional sections (MSF Latin America, MSF South Asia and MSF East Africa) became voting members of MSF’s highest executive platform, bringing new voices to our governance structure, while MSF West Africa (WACA) obtained the right to run operations.
Responses to some of the points covered in the ‘Decolonising MSF’ submission (non-exhaustive)
In addition to the above outline, we thought it could be helpful to respond to some of the specific points raised by the ‘Decolonising MSF’ submission. Again, for reasons of length this cannot be exhaustive, and if there are points not covered here where the Committee would find it useful to have more information we would be happy to look into those.
We want to make clear that any such retaliation against colleagues for raising concerns about the work or behaviour of MSF is not only completely unacceptable and in violation of MSF’s policies, but goes against the very spirit of the movement, which aspires to the principles of ‘bearing witness’ or speaking out about the challenges we face. We have tried to be open about the problems that MSF faces regarding racism, and the contribution made by the Open Letter has been recognised, including by MSF’s International President, and the Leadership of the Operational Centre Amsterdam (OCA). To be clear, this is not to question the truthfulness of the account above, but to make clear that any such retaliation would be completely unacceptable, and to urge colleagues to report such behaviour via our confidential reporting mechanisms.
As the section above under ‘treatment of staff’ sets out, there are legitimate criticisms to be made regarding the inequities between different staff groups. MSF’s leadership has acknowledged these inequities and is working to address them.
As set out in the section above, under ‘transparency,’ MSF does collect and make public the number of reports it receives of abuses, including discrimination. However, we are aware that, despite some improvement, we continue to face an issue of under-reporting, and are continuing to work to build awareness of and trust in our reporting systems among our colleagues and the communities we assist. We are therefore grateful to Decolonising MSF and to other individuals and groups who work to highlight these issues and encourage the sharing and reporting of unacceptable behaviour.
Again, initiatives are also taking place at the level of individual MSF offices – at MSF UK, for example, office staff attended a series of ‘brave spaces’ sessions, facilitated by an anti-racism consultant, where discomfort and honesty were encouraged as a means of learning, challenging and developing personal responses to anti-racism. The outcomes and conclusions of the brave spaces sessions were incorporated into the above-mentioned EDI audit. The sessions also launched various grassroots staff initiatives, including an anti-racism reading circle.
As this submission hopefully demonstrates, the MSF movement acknowledges that it has significant issues to address when it comes to racism and discrimination. We also have a number of initiatives underway, ranging from the global, movement-wide level, to that of individual offices – recognising that a one-size-fits-all approach will not be appropriate in every circumstance. There are of course significant challenges when it comes to determining the detail – for example, how can we maximise fairness in staff remuneration while continuing to recruit an internationally-mobile workforce from a wide range of countries, with significant variation in the cost of living? Therefore, while we recognise that MSF has more to do, and needs to put sustained effort into this issue over a course of years, we are conscious that there will not be a single point at which this issue is ‘fixed’ – and continued vigilance, work and engagement with our colleagues and the people we assist regarding their concerns will be crucial.
 MSF’s Operational Directorate for West and Central Africa (WACA), headquartered in Abidjan, was established in 2021 and so is not referenced here.
 Core Excom statement, July 2020: https://www.msf.org/msf-management-statement-racism-and-discrimination
 See Core Excom update for further detail: https://www.msf.org/tackling-institutional-discrimination-and-racism-msf-core-excom-action-plan
 For further detail, please see the ‘People Recruitment and Development’ and ‘Staff reward including remuneration and benefits’ sections of this document: https://www.msf.org/tackling-institutional-discrimination-and-racism-msf-core-excom-action-plan
 See: https://www.theguardian.com/global-development/2020/jul/10/medecins-sans-frontieres-institutionally-racist-medical-charity-colonialism-white-supremacy-msf