Sexual misconduct remains a persistent and largely hidden menace within the corridors of clinical and academic medicine in South Africa, with any allegations frequently ‘managed’ as reputational risks and institutional inconveniences, rather than as warning signs of systemic failure.
In an SA Medical Journal editorial, a group of leading health professionals slam the “silence, invisibility and complicity” despite professional codes of conduct and institutional policies in place.
This comes as a Labour Court ruling upheld a disciplinary finding which cleared a Cape Town nursing clinic manager of sexual harassment allegations against a colleague, although the court acknowledged that the application was not frivolous, with both sides presenting valid arguments requiring careful consideration (see story below).
And, notes MedicalBrief, in the UK, nearly a fifth more trainee doctors reported unwelcome sexual conduct on a daily or weekly basis this year.
In the SA Medical Journal editorial K Moodley, K Louw, N S Munung, A McKay, T Burgess, Z Essack and T Roussouw say ethical practice in the health sciences – in both clinical environments and academic institutions – is founded on the principles of beneficence, justice and respect, with the goal of first doing no harm.
They write:
“But for many women and gender-diverse people working and training within clinical and academic medicine, these principles are undermined by experiences of sexual harassment, discrimination, assault and other forms of sexual misconduct.”
They add that the problem is not simply the behaviour of individual perpetrators. “It is the institutional culture that renders misconduct invisible, discourages reporting, and protects institutional reputations rather than the people it is meant to protect who are harmed by such abuse.”
Sexual misconduct ranges from misogynistic language, undermining the professional authority of women, sexism and sexist discrimination, to unwanted sexual advances, sexual coercion, sexual assault and rape, they note.
“Women and gender-diverse people working in clinical and academic medicine are particularly vulnerable because of entrenched hierarchies and unequal power relationships… Students depend on supervisors for assessment and career progression; junior clinicians rely on senior colleagues for training and references; and early career academics depend on established researchers for mentorship, funding and promotion.”
These asymmetries create opportunities for exploitation and make disclosure of sexual misconduct exceptionally difficult.
But beyond its devastating impact on individuals, sexual misconduct erodes trust within clinical and academic medicine, drives talented clinicians and researchers away from their professions, undermines mentorship and weakens the ethical foundations on which health sciences education and patient care depend.
In South Africa, where gender-based violence has been recognised as a national crisis, health sciences institutions have both ethical and constitutional obligations to provide safe environments for learning and work, they write.
And despite universities and healthcare institutions having policies that address sexual harassment, these have not necessarily translated into significant protection for the most affected groups, given the reported cases of sexual misconduct that make their way to public media outlets, even before universities report on them.
“Furthermore, women and gender-diverse people continue to report profound distrust of institutional processes, particularly where organisational climates are perceived as tolerant of harassment or unsupportive of complainants.”
Fear of retaliation, and concerns about confidentiality, reputational damage and the potential loss of career opportunities remain important barriers to reporting sexual harassment.
There are also issues with how institutions respond to complaints.
“Disciplinary processes are frequently perceived as opaque and slow, and don’t offer relief or protection to complainants. Outcomes remain confidential – sanctions appear inconsistent or disproportionately lenient. When influential perpetrators are protected while complainants bear the professional and emotional consequences of reporting, silence becomes an understandable strategy rather than a personal failing.”
Additionally, women in leadership positions may often, unintentionally, perpetuate sexual misconduct, embedded within historically male-dominated organisations.
Some may distance themselves from junior women, minimise misconduct reports, or hold female colleagues to higher standards than their male peers – a pattern historically described as the ‘Queen Bee’ phenomenon.
Contemporary evidence suggests these behaviours are not inherent characteristics of women leaders, but adaptive responses to organisational cultures in which success has traditionally depended on conforming to masculine norms.
But perhaps the most troubling manifestation of institutional complicity is the treatment of sexual misconduct as an isolated disciplinary issue, rather than as an ongoing risk to others, writes the group.
“Institutions may negotiate settlements, issue minimal sanctions, or allow perpetrators to resume positions of authority after a so-called ‘first offence’. Such responses fail to recognise that sexual misconduct is not merely a breach of institutional policy; it represents a breach of professional ethics, a violation of human dignity and a failure to uphold the constitutional right to a safe working and learning environment.”
Every inadequate institutional response increases the likelihood that future students, trainees and colleagues will be exposed to similar harm. These risks extend beyond hospitals and university campuses.
Conferences, research collaborations and academic travel often occur in environments with reduced institutional oversight, altered professional boundaries and increased dependence of junior researchers on senior colleagues for mentorship, networking opportunities and financial support.
Addressing sexual misconduct requires transparent and independent reporting mechanisms, survivor-centred support services, timely investigations and sanctions that prioritise the safety of current and future staff and students.
Professional boundaries, trauma-informed responses, bystander intervention and ethical leadership should be integral components of medical and health sciences education, rather than optional training modules.
“Institutional transparency is equally important,” they urge. “While confidentiality … is essential, institutions must demonstrate that allegations are investigated fairly, consistently and without regard for the status or influence of the accused.
“Medicine cannot credibly advocate for the health, dignity and safety of society while failing to protect its own members. Sexual misconduct in clinical and academic medicine is sustained by institutional silence, unequal power and cultures that continue to privilege reputation over accountability.
“The true measure of an academic institution is not whether it has a sexual harassment policy, but whether all the people who work and train within it believe that they will be protected when they use it.”
Not just in SA…
The problem is endemic, notes MedicalBrief. Medscape Medical News reports that Britain’s General Medical Council’s (GMC) 2026 National Training Survey recently found that nearly a fifth more trainee doctors reported unwelcome sexual conduct on a daily or weekly basis this year.
The survey, which assesses working conditions, workplace culture, and training quality for doctors in postgraduate medical posts across the UK, ran between March and May and drew responses from more than 51 000 doctors in training and nearly 23 000 trainers.
The GMC said that despite a small improvement in the burnout and fewer experiences of discrimination there had been a “small but real increase” in the number of trainees reporting unwelcome sexual conduct.
Compared with last year, almost 20% more trainees reported unwelcome sexual conduct on a daily or weekly basis. “Any rise in this measure matters, and trainees must be able to work and learn free from harassment,” the GMC said.
In the Cape Town Labour Court case, reports the Cape Argus, Acting Judge AC Oosthuizen concluded that the decision by disciplinary chairperson Stephanie Sirmongpon to acquit FA, nursing clinic manager at Rocklands Clinic, was reasonable.
The allegations dated back to the period between August 2022 and January 2023.
The City of Cape Town had sought to have this finding reviewed and set aside, but the court said it was conducting a review rather than an appeal, assessing whether the original decision was reasonable based on the evidence available.
The allegations against FA included frequently hugging the complainant and other employees, making gestures that appeared to blow kisses towards her and telling her she was beautiful.
The most serious allegation concerned an incident in January 2023 in which FA allegedly touched the woman (TJ) on the buttocks while she was standing near a printer.
TJ testified that FA then left the room giggling.
FA admitted that she had touched TJ’s buttocks, but disputed the incident, denying that the contact involved grabbing or pinching and vehemently denying immediately leaving the room giggling.
The court considered each category of alleged conduct in its workplace context.
The court said the touching of the buttocks required closer consideration, with the judgment acknowledging that touching an intimate part of a person’s body can constitute sexual harassment, depending on the circumstances.
However, the judge drew a distinction between a deliberate sexual act, like pinching or grabbing a colleague’s butt, and fleeting physical contact that occurs without sexual or improper intent.
The court ultimately accepted the latter characterisation of the incident.
A further consideration was the fact that TJ took five months to report the incident to management or lodge a grievance. The judgment said there was a “vast difference” between FA fleetingly brushing TJ’s buttock area without sexual or improper intent and TJ’s version that AF had pinched her buttock before leaving the room giggling.
Hugging not sexual conduct
Concerning allegations of hugging, the court noted evidence from other employees indicating that the Rocklands Clinic was a workplace where staff frequently hugged one another.
One witness described this as normal workplace behaviour, while evidence indicated that FA was known to hug colleagues as a gesture of support and affection.
FA herself acknowledged that she regularly hugged fellow employees, which was intended as a gesture of support.
The judge found her evidence had not been shown to be improbable or untrustworthy, and that her actions could not be described as being of a sexual nature.
On allegations that FA blew kisses towards TJ, other witnesses testified that FA would sometimes make such gestures when thanking colleagues for assistance.
The evidence indicated that similar affectionate gestures occurred among employees at the clinic and were not regarded as unusual.
In that context, the court found that the kiss-blowing gestures did not constitute conduct of a sexual nature or fall within the applicable definition of sexual harassment.
Review application dismissed
The Labour Court found that the disciplinary chairperson’s decision was reasonable, leading to the dismissal of the City’s review application.
The court made no order as to costs, noting that the City has a duty to prevent workplace harassment, which may include seeking judicial review of disciplinary decisions it believes to be unreasonable.
The court also acknowledged that the application was not frivolous, with both sides presenting valid arguments requiring careful consideration.
K Moodley – Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town;
K Louw – Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University;
N S Munung – Department of Pathology, Faculty of Health Sciences, University of Cape Town;
A McKay – NRF South African Research Chair in International Law, Faculty of Law, University of Johannesburg;
T Burgess – Department of Health and Rehabilitation Sciences, Faculty of Health
Sciences, University of Cape Town
Z Essack – School of Law, Faculty of Law, University of KwaZulu-Natal;
T Rossouw – Department of Immunology, Faculty of Health Sciences, University of Pretoria.
Medscape article – Trainee Doctors Report Rise in Unwelcome Sexual Conduct (Open access)
Cape Argus – Cape Town nurse acquitted of sexual harassment over affectionate gestures (Open access)
See more from MedicalBrief archives:
Cape Town surgeon suspended for alleged harassment
Dismissed nurse fights back in alleged sexual harassment case
UK medics at work despite sexual assault, rape allegations
Discrimination a reality for most female surgeons