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Doctors Without Borders grapples with charges of racism in its ranks

Doctors Without Borders (MSF), renowned for providing medical aid in some of the most challenging emergency zones around the world, is grappling with another kind of challenge: racism within its ranks, reports US National Public Radio.

NPR reports that on 7 February, the 50-year-old humanitarian giant, which also goes by its French acronym MSF, released to the public an internal report of the measures it is taking to address institutional discrimination and racism.

This followed current and former staffers reporting hundreds of instances of abuse and discrimination to journalists and to a grassroots advocacy group that these MSF staffers had set up over the past two years. Their accusations included racial slurs aimed at local workers of colour, segregation between local and international staff, as well as unequal pay, benefits and opportunity for advancement for local staff and staff of colour.

In 2020, MSF had more than 63,000 staffers in 88 countries. The group is best known for sending medical workers to establish medical operations and treat patients in crisis zones worldwide. But more than 90% of MSF’s workforce – including doctors, healthcare workers, logisticians and other support staff – comprises locals, or “national staff”, as MSF calls them.

According to those speaking out, MSF as a whole values its expatriate workers, usually from Europe and North America, more than local ones. The public charges of discrimination against local staff led to the creation of the MSF report, which was first published internally in December.

But the reaction to MSF’s progress report is mixed, adds NPR. Some critics say it’s a solid start, others say more should be done. MSF itself agrees with both assessments: “This process of taking stock shows us where we are now, and how far remains to travel,” MSF International’s president, Christos Christou, wrote in the introduction of the report. But “deep cultural change,” he wrote, is “inherently slow.”

Abuse and discrimination reported in a “two-tiered system”

The story broke last September in a bombshell investigation published as a podcast by Reveal from The Center for Investigative Reporting and PRX, and also as an online story by Insider, a news site. Three reporters interviewed about 100 current and former MSF workers in nearly 30 countries about their experiences of racism, mistreatment and inequality in the organisation.

“Every single person we spoke to had witnessed or experienced inequality or racism,” wrote Mara Kardas-Nelson, one of the reporters, in an email to NPR. “[We can] confidently say that there is a two-tiered system in which foreigners receive much better treatment, in everything from pay to daily workplace respect.”

The reporters say the people they spoke to charged that MSF staffers used explicitly racist language against local staff and staff of colour.

These sources also said foreign workers, even those with little experience, are given more decision-making power, higher salaries, better benefits and better protection.

Indeed, salaries are a critical point. In 2020, the average cost of an expatriate staffer (salary and benefits) was nearly six times that of the average local worker. And while some expats said they lived better in the field than they ever did at home, local workers described having to skip meals just to make ends meet. According to MSF, the pay difference is because many international workers are on short-term assignments with long-term financial commitments, like mortgages, back home – meaning they have more expenses than local workers.

Local workers also told the reporters about how expat staffers scolded them for eating food or drinking water designated for expats. And when the local workers became ill, they claim they received a lower level of medical care.

During the 2014 to 2016 Ebola crisis in Sierra Leone, for example, local staffers who contracted the virus received care in the same clinics where they worked while foreign workers were airlifted out of the country to better hospitals. This is common practice, the reporters say, by international organisations for expat staff.

Current and former staff at MSF speak out

In 2020, more than 1,000 current and former MSF staff, who had been discussing their concerns about discrimination in the organisation over WhatsApp, signed an open letter accusing their leaders of lacking any meaningful commitment to combat racism within the organisation.

According to the letter, an official motion to address racial inequity in the organisation was “infamously suppressed” in 2017 and replaced by a statement that “failed to acknowledge the full extent to which racism exists throughout our organisation”. Since then, the letter said, efforts by MSF leadership to tackle racism have been “lacklustre”.

The letter demanded immediate changes, including anti-racism training at all levels, internal audits of hiring processes and a clear roadmap for the “radical re-imagination of our approach to humanitarian action”.

After the letter was publicised in 2020, MSF issued a series of statements and commitments to do better. But after a year, the signatories – operating as a grassroots movement under the name ‘Decolonise MSF’ – said there had been no significant improvement.

What MSF has to say about it

MSF International President Christou told NPR that he read and listened to all of the personal accounts of inequality and racism and had responded to a letter the authors of the ‘Dignity at MSF’ report sent to him and other leaders of the organisation.

“What they want to tell me – that [MSF] needs to change – is something I and MSF already knew,” says Christou. “But when you hear and read all the personal stories of people suffering, no matter if you have heard 50 or 100 of them, all of them are still a shock.”

Even before the allegations against MSF were made public last September, MSF had already initiated substantial long-awaited changes.

“However, we are still not where we should be,” he said. He says MSF is doing “everything possible to make this organisation less unfair to its people”. But noticeable progress will take time, he notes. Not only does MSF need to change its policies and structure to become more equitable, he says, but there also need to be cultural shifts.

For instance, moving away from a “white saviour” mentality – in which outsiders from wealthy countries believe that only they can save poor, affected communities – may be especially difficult for some MSF veterans who have been “parachuting” into places with their expertise for more than 30 years now. A more equitable model, in which management and senior leadership positions are filled with local staff, would make these veterans less relevant.

The idea that significant change takes time sounds like an invalid excuse to Indira Govender, a South African doctor who worked for MSF from 2011 to 2014 and is a member of Decolonise MSF. Her husband works for MSF as a logistics manager in an HIV/TB project in South Africa.

“COVID made us all change very quickly, and we did it to save lives,” said Govender. “I don't think [MSF] has actually figured out what change it wants or whether it truly wants to change things.”

For instance, Mukerjee says it’s still not clear from the progress report whether MSF plans to abandon its two-tier system that places more value on international staffers than national staffers.

For MSF, Govender hopes those changes come quickly, before too many people feel compelled to abandon ship.

“That would be a very sad state of affairs because I still believe in the work that MSF does,” says Govender. “Its politics are problematic, but its work is still really important, and I don’t think there's another organisation on a global scale that can do what MSF is doing.”


NPR article – Doctors Without Borders addresses charges of racism within its ranks (Open access)


See more from MedicalBrief archives:


Allegations that MSF staff bartered medicines for sex in Africa


Staff accuse Médecins Sans Frontières of 'institutional racism'


MSF COVID-19 Accountability Report: 368 projects in 76 countries


MSF assist as thousands struggle for access to water after KZN’s floods




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