Médecins Sans Frontières - Misconduct and abusive behaviours in MSF programs (ENG)

Unique Identifier Code / URN MSF210551

Date taken / Date Recorded 01/12/2015 12:00 AM

Commissioning section MSF-FRANCE

Photographer / videographer / producer Armelle Loiseau

Copyright MSF

Usage Rights (MSF) Internal Use Only

Formal Consent Copy available no

Editor's rating ★★★★★ (C)

Video format h264 (Constrained Baseline) (avc1 / 0x31637661)

Duration 19m8s

Maximum Size 1920px × 1080px 1.09 GB

Additional Information / Shotlist Abuse:
1. Improper, excessive or unfair use of something
2. Excessive use of a right or a reprehensible act resulting in the violation of others’ rights, such as the unfair use of power

COMMENTARY (20 sec)
By employing more than 5,600 people in 30 countries and many different contexts, MSF is taking exposed to the risk – that some people may take advantage of their status as aid worker, the vulnerability of the people they’re supposed to help or the breakdown of the societies in which they operate - as a way to gain personal advantage. for personal gain

Sandrine Sabatier, Manager, WhistleblowingUnit (in French)
“This is one of the reasons the Whistleblowing Unit was created in 2007. Its goal is to prevent, handle and also record all cases of individual abusive behaviour in our programmes.”

COMMENTARY (20 sec)
As an NGO, MSF has several responsibilities. The first is to its donors, who entrust MSF with their money. MSF must limit the risks of improper use of resources, whether it’s a question of money, drugs or medical and logistical supplies.
Our second responsibility is to our beneficiaries, which means our patients and their family caretakers. MSF must ensure that they do not fall victim to inappropriate or abusive behaviours by its staff.

Sandrine Sabatier, Manager, Whistleblowing Unit (in French)
“As an employer, we also have a responsibility to our employees, both national and expatriate. And this responsibility involves creating and maintaining the healthiest working environment possible. In a sense, the Whistleblowing Unit protects the institution. But in practical terms in the field, it contributes to protecting people, meaning employees and beneficiaries, protecting material resources and protecting MSF’s image. So you could say there’s a potential for three types of abuse: abuse of people, abuse of MSF material resources and abuse of MSF’s image.”

On-SCREEN TEXT
Abuse of people
This type of misconduct represents 60-80% of the cases handled by the unit each year, with around 40% eventually qualified as abusive.

Sandrine Sabatier, Manager, Whistleblowing Unit (in French)
‘‘There are We see two types of abusive behaviours involving people: first, abuses between expatriates or problems with expatriates and second, abuses between national staff or problems with national staff. It’s important to note that, at least over the past three years, very few complaints have been made by expatriates against national staff or national staff against expatriates.”

COMMENTARY (10 sec)
Abusive behaviours against individuals include lack of respect, verbal or physical violence, psychological harassment, abuse of power, sexual harassment and sexual abuse.

Sandrine Sabatier, Manager, Whistleblowing Unit (in French)
‘‘If we look at the cases that we’ve actually handled over the past few years, starting with the first category of abuse, between expatriates, they mainly concern sexual harassment. Expatriates work and live together, and there have been incidents in the past. In 2014, we also had cases where expatriates brought prostitutes into MSF houses and this, again, is a problem. We’ve been making efforts to raise awareness over the past two years to avoid this kind of problem. Expatriates may also engage in inappropriate behaviour off-site and outside working hours, especially after alcohol consumption. MSF, of course, has a process to deal with this type of behaviour. Such misconduct may also be subject to disciplinary action, especially when it harms MSF’s image.
When our image is damaged, it often affects local communities’ respect for MSF. And we know that our staff’s safety in the field is partly dependent on how well they are accepted by these communities. So when our image is harmed, depending on the situation, it MAY have an impact on team security

COMMENTARY (10 sec)
While MSF respects its expatriates’ private life, they do represent the organisation and are identified as such, especially in isolated areas. As a result, their behaviour must not negatively affect its image.
The cases of abusive or inappropriate behaviour between national staff often involve a lack of respect and verbal and physical violence, including death threats.

Sandrine Sabatier, Manager, Whistleblowing Unit (in French)
“The cases we have handled in the category, psychological harassment, often involve the abuse of power, meaning that they occurred between people at different levels in the organisation. I want to take this opportunity to stress that being a supervisor does not mean having power over others, but primarily involves having responsibility and in my opinion, the main responsibility is to develop team cohesion as this makes working together easier and therefore improves efficiency.”

COMMENTARY (10 sec)
The Whistleblowing Unit’s policy applies to both patients and family caretakers, who have the same rights. While these rights draw on MSF’s ethical practices, they are mainly based on the code of medical ethics.

Sandrine Sabatier, Whistleblowing Unit Manager, (in French)
‘‘We unfortunately have had cases where the medical or paramedical staff acted completely inappropriately toward patients or caretakers, including instances of verbal and, although rare, even physical violence. But the most common incidents have involved staff soliciting sexual relations with caretakers. Strong disciplinary action was taken in all these cases, of course, because we expect irreproachable conduct toward our patients and caretakers, from all our employees, both expatriates and national staff.”

COMMENTARY (20 sec)
During field visits or training at headquarters, the Whistleblowing Unit explains the policy to staff, as well as its criteria for getting involved, which is that either the country coordination team or directly the Unit will quickly intervene if the behaviour harms either MSF’s image, team life or the project’s operations.

Sandrine Sabatier, Manager, Whistleblowing Unit (in French)
‘‘In conclusion, if we look at all the cases of inappropriate and abusive behaviour that we’ve handled in our programmes , it becomes clear they have something in common – a lack of respect for others. And lastly on this point,, the abuse policy promotes what the MSF charter already clearly states, which is respect for others and respect for differences, be they cultural, ethnic or religious. And I would like to add, “regardless of position or level”. Besides, when it comes to level, what’s really essential at MSF is that every position is important. And it’s not at all a question of level; it’s really a question of responsibility. And what we really want is for each person, each employee, whatever their position, to be respected as they work and not feel under pressure. I like to give the example of hospital hygienists because without them we couldn’t operate our hospitals. Also, I remember that during one of the recent awareness-raising visits in Ethiopia, a hygienist explained what she understands by respect and her words were very relevant.”

Nyayual Deng, Hygienist (15:38 à 16:08)
"Hello my name is Nyayual Deng. Respect is the most important thing. Respect is good. If you do something wrong to your children, they will not respect you. If you do good to them, your children will respect you. Respect your children and respect others because nothing wrong will happen. I appreciate what told us today. You talked about respect and that makes me happy because I know now that nothing wrong will happen inside the MSF hospital. I’ve said all I have to say. My name is Nyayual."

On-SCREEN TEXT
Abuse of resources
This category represents 20-30% of cases handled by the unit and includes theft of money, drugs and logistical supplies. Most such cases are confirmed.

COMMENTARY (12 sec)
In ninety percent of cases, theft occurs due to improper compliance with or lack of a monitoring system. Rather than being a sign of mistrust, these rules represent good practice.

Sandrine Sabatier, Manager, Whistleblowing Unit (in French)
‘‘The problem is that we sometimes have managers who fail to run controls because they trust their supervisor. And I have to admit there’s some confusion between trust and management controls. But management controls are is essential; a lack of checking leaves the door open to temptation, and to the tempation to steal.”

COMMENTARY (20 sec)
Without management controls, there cannot be transparency as to the use of MSF money and resources. Control and transparency processes are carried out at every level: directly on the project, then by the coordination team and finally by headquarters. And every year, MSF must open its books to an outside auditor. Such transparency gives donors confidence in MSF.

Sandrine Sabatier, Manager, Whistleblowing Unit (in French)
‘‘At times, management controls may appear to be in place, but the problem actually stems from a lack of analysis. And that often results from a lack of time in the field. Managers responsible for approving orders or outgoing stock forget to analyse the orders or, in any case, forget to determine whether their orders and outgoing stock are in sync with their operational needs. And analysis is really important for preventing any misappropriation or abuse of resources. So this unit also helps limit these abuses, with a focus on control procedures and the distribution of tasks so that a single person is never in charge of the whole process, something that contributes to good practice as well. And again, it’s a matter of not confusing trust and management controls.”

On-SCREEN TEXT
Abuse of MSF’s image

COMMENTARY (18 sec)
Abusive behaviour by individuals can harm MSF’s image and have negative consequences for operational security, which we’ve already addressed. But here we’re talking about another type of abuse: the use of MSF’s image in the strict sense of the term – MSF’s name or logo – for personal benefit.

Sandrine Sabatier, Manager, Whistleblowing Unit (in French)
‘‘This category is a little unusual, so to explain it I’d like to provide an example. We had a case on a field project a while ago where we were forced to dismiss an administrator who was requesting Shengen visas on behalf of MSF for people from outside MSF probably in exchange for money. So MSF was incurring liability without its knowledge, which could have harmed the organisation.”

COMMENTARY (5 sec)
This type of case occurs rarely; there have only been two or three instances over the past three years.

Sandrine Sabatier, Manager, Whistleblowing Unit (in French)
‘‘In conclusion, our policy aims to reduce all risks of abuse in our programmes. It’s important to note that we have more than 5,000 national employees and over 600 expatriates working on our programmes, so the risk does exist. It should also be noted that our field staff work under the pressure of a heavy work load and, as I said before, the goal is to create a working environment that doesn’t increase the pressure but rather which helps everyone to work with as much peace of mind as possible.”

On-SCREEN TEXT
The Whistleblowing Unit receives an average of 25 direct complaints a year. Managers in the field handle about 30 other cases on an annual basis with support from the unit, if necessary. Out of all the cases investigated, all categories included, 25-35 cases of abuse or misconduct are confirmed each year.

On-SCREEN TEXT
A project coordinator’s perspective
Interview with Renée Madrolle, project coordinator, MSF (in French)

Clip 3616 TC 00'33 > 01'50 (1'20)
‘‘As project coordinators or as managers and coordinators in general, it’s true that we sometimes have to handle difficult situations. I myself have had to deal with different types of abuse during my assignments, including abuse of resources and abuse of power, which is more complicated. Abuse of resources on a field project may be, for example, theft of expired drugs which are then used in the community. This can have an impact on MSF’s image in the community or have major consequences for security.
So these situations are pretty difficult to manage. First you have to get past the stage of damage control and then you need to talk to the whole team and try to set up new procedures. You can always point the finger at certain people when a drug has been stolen, but in fact it’s often a collective responsibility or a case of procedures that haven’t been set up or followed. So you need to talk with your teams, who’ll often have other operational priorities, but you need to review the way the team works and improve certain aspects.”

Clip 3616 TC 02'02 > 02'38 (36 sec)
‘‘From the lowest to the highest ranking expatriate and national staff, we’re all responsible for what we do, for our activities. It’s important to be accountable and transparent. When I receive visits from my head of mission, he or she will always check certain things, but that doesn’t mean they don’t trust me. Even though there are other operational priorities, it’s important to tackle the issue of abuse of resources and to try to improve our standards and procedures so that everyone is accountable and does the right thing.”

Clip 3620 TC 00'00 > 00'06 (6 sec)
‘‘The second situation that’s hard to manage is the abuse of power.’’

Clip 3618 TC 01'40 > 01'57 (17 sec)
‘‘You have to be alert and listen to your team. But this can be a tricky situation because sometimes the only information we get is bits of gossip rather than the genuine facts. And it’s hard to figure things out in this type of situation and not be manipulated.

Clip 3618 TC 02'29 > 03'09 (40 sec)
“With a high turnover of expatriates, we don’t really know the projects sites that well and can’t claim to know them. And it’s in this kind of situation, when you have several people talking about a major abuse of power, that as project coordinator you feel a bit helpless and don’t know exactly what to make of things. I know that it helped me enormously to call the Whistleblowing Unit for advice in this type of situation. You realise you’re not alone, that it’s happened before in other countries, and they guide you through the various steps for further investigating the problem.”

Clip 3620 TC 00'44 > 01'12 (28 sec)
‘‘There’s one thing I think is essential or in any case I believe I learned from my various experiences, and that’s the importance of treating everyone equally. Certain coordinators might have a closer relationship with some people than with others, which gives the impression to the rest of the staff that they are protected and will therefore go unpunished , which may or may not turn out to be true.”

Clip 3620 TC 02'11 >02'30 (19 sec)
‘‘So I think it’s essential for a project coordinator or any other manager or coordinator to handle abuse or misconduct on MSF programmes because it conveys an image of transparency and ensures there’s no security risk resulting from an abuse of resources or power.’’

How the Whistleblowing Unit works:
• Employees working on an MSF programme who believe they are the victim of abuse or who witness abusive behaviour must first notify a manager in the field, such as the site’s project coordinator or the head of mission or another member of the coordination team.

• The person making the complaint, however, may find it difficult to notify a manager in the field, either because the abusive person is in management or because they fear reprisals, are concerned about their safety or simply prefer to contact someone not on the program.

• In these cases, employees may directly contact the Whistleblowing Unit in Paris. This is called the “alternative channel”.
• The unit receives and investigates complaints, decides whether to characterise them as abusive and refers them to the general director, providing an opinion recommending appropriate measures or disciplinary action. The general director takes the final decision.
• This decision is then sent to the complainant both the person who made the complaint and person under investigation.
• Anyone can contact the Whistleblowing Unit by phone or by sending an email to the unit’s specific address. In all cases, however, they must identify themselves by name, job title and country. The unit will not review anonymous complaints but guarantees the confidentiality of the process and makes every effort to protect the the person making a complaint complainants, including their name if necessary.

(Texte à l'écran)
To submit a complaint
Contact the appropriate manager (project coordinator, head of mission, etc.)
or
Sandrine Sabatier
Whistleblowing Unit
[email protected]
(name, job title and country must be included)
Mobile phone: +33 (0)6 72 24 34 78
Landline: +33 (0)1 40 41 28 60

Special thanks to Fouad Ismael
who established the Whistleblowing Unit in 2007