Medical treatment

Médecins Sans Frontières staff members complain of racism in the medical treatment of workers

  • Médecins Sans Frontières, one of the world’s largest global relief agencies, employs more than 60,000 people worldwide, almost all locals.
  • In an Insider investigation in conjunction with public radio show ‘Reveal’, found a separate medical system for staff members, with international workers enjoying better access to life-saving care than locals.
  • The group says it has a “different level of responsibility” for the health and safety of international staff members than for locals.

Médecins Sans Frontières is perhaps the most famous of all international humanitarian organizations. Known internationally by its French acronym, MSF, it has been around for almost 50 years and employs 63,000 people worldwide. Many MSF staff members leave behind comfortable lives to care for the sick and injured in some of the world’s most difficult contexts. It’s hard not to be moved by the public perception that MSF has cultivated of dashing young doctors rejecting well-paying jobs in world capitals to save lives in conflict zones. MSF’s tenacity allowed it to win the Nobel Peace Prize in 1999 and today become a giant of 2 billion dollars a year.

But an Insider investigation in conjunction with the nonprofit radio show and podcast “Reveal,” based on interviews with about 100 current and former employees in nearly 30 countries and a review of thousands of pages of documents, has revealed that a segregated, two-tier workplace is firmly entrenched within MSF. While a small number of international workers wield disproportionate decision-making power and enjoy social benefits, local workers say they often feel like second-class citizens, without access to the same quality medical care, the same salary and the same security as their international counterparts. And dozens of current and former employees say people of color, regardless of their position in the organization, are treated unequally.

The difference in treatment between local and foreign employees often extends — ironically, given MSF’s mission — to medical care. Egyptian and Indian sources describe a separate medical system for MSF staff members, with expatriates enjoying greater access to life-saving care.

During the world’s worst Ebola outbreak, which took place in West Africa from 2014 to 2016, national staff in Sierra Leone received around $16 a month to spend on medical care, barely enough to cover a single visit to the doctor. They also had access to a small staff clinic that was limited in what it could provide – no fever or pain medication, no physical checks – due to the high risk of infection. When national staff members contracted the disease, they were treated at the same clinic where they worked. Meanwhile, international staff members who have contracted Ebola have been airlifted to better hospitals – a common practice for all expatriates working for international organizations including USAID and the World Health Organization.

“For me, it was actually demotivating,” says Kennie Musa, a former MSF local staff member in Sierra Leone. While some of his Sierra Leonean colleagues died after being treated for Ebola at the MSF site, he says, an expatriate colleague was flown to Germany after being exposed. “The segregation was there clearly.”

In a written statement, an MSF representative said the organization is ‘committed to providing the best possible care to its staff in the countries where we operate’ but has a ‘different level of responsibility’ for health and safety. expatriate staff “because we contract them for a mission far from their country of origin.”

For many within MSF, the case of Dr Sheik Humarr Khan, a legendary Sierra Leonean doctor who led the fight against Ebola in his country, illustrates the callous treatment of people in West Africa. Although Khan did not work for MSF, he trained many of the organization’s staff and was one of the best doctors in the world to study haemorrhagic fevers like Ebola. When Khan contracted Ebola in 2014, he was treated at an MSF centre. Some of the organization’s doctors wanted to give him a promising experimental treatment known as ZMapp, but the expats who ran the site decided against it, saying it would be unfair to give Khan a treatment to which d other Sierra Leoneans did not have access.

“There was an active decision not to offer available and potentially effective treatment to Dr Khan,” explains Nierle, the former president of MSF Switzerland. “This is an example of how you spoil clinical care by deciding on behalf of patients, without proper information, without informed consent, simply sacrificing them for some questionable reason.”

As Khan was not an employee, MSF never offered to evacuate him to a better facility. By the time the World Health Organization offered to help, he was too ill; he died in the MSF treatment center in Sierra Leone.

Khan’s brother, Alhajie Khan, notes that within days of his death, two white American aid workers from another aid organization in neighboring Liberia who had fallen ill with the virus were promptly treated with ZMapp and flown to the United States. They survived.

In a written comment, an MSF representative described Khan’s death as “a tragedy” and said the decision to administer “an untested drug” like ZMapp should “not be taken lightly – both for clinical and ethical reasons. At the time, MSF believed a “third party” would evacuate Khan to Europe, the statement said, where ZMapp could be administered with more supervision.