Protecting the brand

Doctors Without Borders is nearly a one billion dollar per year organization. They raise most of that money from private donors, with the majority coming from the US. Small donors make up a large portion of the donations, and bad press can seriously hurt the financials. For this reason, MSF is obsessive about protecting their brand. Staff are not allowed to blog about their work or even post about it on social networking sights. Three staff were removed from a project in Arua, Uganda after posting negative comments about MSF on Facebook.

MSF has had its share of scandals. In an organization that allows staff to use sex workers, it’s no surprise that employees have committed statutory rape.


(Sexual) Relationships

MSF provides housing to the international staff. Men and women are asked to live together, and this naturally leads to a lot of sex among the staff. Alone, this is not a problem, but these relationships often complicate working together and bring additional stress into an already stressful working environment.

Some of the locations where MSF works do not adhere to the same beliefs as the people that MSF sends to work there. International staff have started relationships that are culturally forbidden. This has led to staff being quickly flown out of the country to avoid prosecution, a plethora of uncomfortable situations, and likely unthinkable consequences to local people in the places they work.


International staff at MSF are provided housing in the places they work. The housing is far from modest. The MSF house in Nairobi has an indoor pool. The homes are located in in the nicest parts of town. A cook/cleaner goes to the house daily to make meals, do the laundry, and clean the place immaculately. In Mozambique, even T-shirts and underwear were ironed. In addition to a salary paid in their home country (of several thousand US Dollars per month), international staff receive a per diem equal to the salary of entry level national staff. MSF international staff live like the elite in the places they work. Spending only their per diem, international staff can frequent the fanciest restaurants and bars. Places filled with only the richest nationals and expats. This is in stark contrast to the image of a selfless aid worker, but the truth is that aid workers enjoy a lifestyle that is totally out of reach for nearly everyone in the places they work.

National Staff


National staff make up the vast majority of MSF staff. These people are hired in country, and with few exceptions, are nationals of the country where the project is taking place. In my experience, national staff are generally dedicated people who have been working for MSF for years. But because they are national staff, they don’t enjoy the same privileges are the international staff.

The most striking example of this occurred when two members of our team had children. The first, an Argentinian international staff member, was flown back to Argentina and given 3 months of leave when his wife went into labor. MSF paid for his flight and those of his entire family. But when an African national staff’s wife was ready to give birth, he was forced to wait for two weeks after his child was born to see his baby. His wife was staying with family in a different part of the country while pregnant, and an international staff member was taking vacation the week his child was born. That person, a Canadian logistician, has been working for MSF for less than 4 months, yet had the authority to tell a staff member of more than 5 years that he had to wait a few weeks to see his newborn baby.


MSF’s leadership is almost completely white. The organization has five operational centers, all based in Europe. Race is very visible in international development. In public, organizations appear sensitive to race and culture, but in private, individual biases come through. The following example was provided by a female doctor employed as national staff in South Africa.

I was once in a meeting with a few senior managers from MSF in Brussels, discussing plans for a survey in KwaZulu-Natal (South Africa), when one of the highly respected directors who’s spent more than 10 years working in Khayelitsha burst into a racist rant about how South African national staff are all “victims” and how “everyone wants something”. He went on to compare South African nationals to Kenyans and Malawians saying that we have no work ethic, this was to make the point that employing staff for the survey was not going to be easy. Sadly, I was the only South African national of colour at the table and I was so shocked that I didn’t say anything. The incident was never discussed or mentioned again. But if this is the attitude from someone who’s spent so long working in the country, what can we expect from people who come there for a few months at a time?

“They all steal”


“They (Africans) all steal”

While speaking with a colleague at MSF after some things went missing, he declared that all Africans steal. This type of sentiment is very common among the international or expatriate staff at MSF. There is an “us” and “them” attitude towards national staff. MSF policies encourage this attitude with grossly differential pay scales and benefits.