ARCHIVE: GA 2017 (Stockholm)

Agenda for the 2017 General Assembly

Medical Ethics

Harassment and misconduct in MSF

Growth

Joint Nordic Motions:

Prevention and management of harassment and abuse of power in MSF work spaces and creating a culture of zero tolerance towards harassment and abuse of power - MOTION PASSED

Motion 2: Survey regarding sexual violence and harassment - MOTION PASSED

Motion 3: Use the PowWow as pre-GA - MOTION FAILED

The following were elected to the MSF Sweden Board of Directors in 2017:

Anna Bergström, regular Board Member (2017-2020)

Karin Fischer, alternate Board Member (2014-2019)

Sophie Graner, regular Board Member (2017-2020)

Adam Thomas, Regular Board Member (2017-2020)

MSF Sweden's Annual Report

Proposed changes in statutes for MSF Sweden (Swedish, English)

Election Committee guidelines

Status of motions

FAD report 2017

Minutes from the 2017 General Assembly in Stockholm


DEBATE

Medical Ethics

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Topic: Ethical dilemmas in medical humanitarian practice

Ethical challenges and dilemmas are an inherent part of medical humanitarian practice. Medical ethics generally applies to the relationship between medical staff and patients, whilst public health ethics applies to the interaction between a health provider and the community. Sometimes these two ethics collide – particularly when facing the reality of humanitarian assistance. How do we translate diverging ethical principles into practice in the field? How can we better prepare to deal with these challenges, when facing patients with tuberculosis, Ebola or in need of an emergency caesarian section? When resources are limited and opportunities for follow-up are lacking, how do we prioritize, and what is our responsibility?

Moderator:

Johan Von Schreeb, MD, PhD, Associate Professor, MSF fieldworker, Specialist in General Surgery and Disaster Medicine

Panelists:

Arianne Shahvisi, Lecturer in Ethics and Medical Humanities, Brighton & Sussex Medical School

Hella Hultin, Surgeon and MSF fieldworker

Mats Blennow, Pediatrician and MSF fieldworker

Øyunn Holen, MD, MSF Norway’s Medical Referent and Infectious Disease Specialist

Reading Materials

Medical Ethics versus Public Health Ethics

Ethical dilemmas in medical Humanitarian practice: Cases for reflection from Médecins Sans Frontières

Topic 1: Harassment and misconduct in MSF   

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A series of reports on sexual abuse and harassment within humanitarian aid organizations have been published in recent years, while research on harassment in different levels of society has been going on for decades. This debate aims to inspire MSF work forward for safe work environment for all its staff. 

To what extent and how is MSF staff influenced by (societal) norms that allows for harassment and abuse? To what extent and how does the MSF organizational culture impact such behavior? Do we understand and address all aspects of harassment and abuse – and its consequences? How effective are MSF different systems for reporting, stopping and preventing harassment? Are MSF staff and patients aware of what mechanisms to use in face of abuse and harassment?

These are some of the questions that we seek to briefly cover, as a step way forward to better understand this important topic on the safety and well-being of all our staff and patients.

Moderator:

John Tzanos, Former MSF Head of Mission and Emergency Coordinator

Panelists:

Megan Nobert, Founder and Director of Report the Abuse, will give us an overview and a perspective of the problem from across the field of humanitarian aid. 

Sandrine Sabatier, Head of Ethics & Conducts Cell, General Directorate, Paris, will give us statistics and an insight into what mechanisms OCP has put in place to prevent abuse/misconduct. 

Emmanuel Noyer, Intersectional (OCB/OCG/OCBA) focal point on behavior, will give a more detailed understanding of what structures the other OCs have, with a focus on OCG

Brice De Le Vingne, Operational Director OCB, will give us an insight from operations.

Extra Materials:

This video explains intersectionality and the different norms that can have a part in harassment and abuse.

 

The article “'It was like being in a boys' club': female aid workers on sexual harassment at work” published in the Guardian (also referred to in the Background text).

Female managers and how the gender norm affects management and organisation structures and its impact on staff health 

Inadequate data on how gender affects the security of humanitarian staff... Most organizations that the study reviewed lacked gender-specific security policies and procedures, relying on the faulty underlying assumption that gender-neutral security policies equate to gender-equality. How does Gender affect the security of Humanitarian Staff?

Sexual abuse against Humanitarian and Development Aid Workers, is a briefing paper on the research carried out in 2016 by Feinstein International Center, Friedman School of Nutrition Science and Policy at Tufts University. It states the methods used, key findings and also proposed ways to prevent and respond to sexual abuse in the Humanitarian and development sector.

The organizations Humanitarian womens network and Report the abuse are two organizations working to reduce the sexual violence, abuse and harassment in the humanitarian sector. In their respective web pages they present their views regarding this issue and show further statistics on the research carried out on the subject.

Topic 2: Growth

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Growth in the movement has been a central topic for debate over many years, both from an Associative and Operational perspective. Over the last 10 years MSF has expanded rapidly in order to respond to the growing needs that we see. However, it increasingly appears that there are currently inadequate planning and control measures throughout the Movement to cope with this sustained level of growth. This has the potential to undermine the quality of our operations as well as to create tensions when it comes to the Associative culture within MSF.

With growth come challenges, responsibilities and risks. Where do we stand in this development and where do we want to go?

Moderator:

Adam Thomas, Former MSF Head of Mission and Project Coordinator, MSF SE Board Member

Panelists:

Christopher Stokes, General Director, Operational Center Brussels (OCB)

Joan TUBAU, General Director, Operational Center Barcelona (OCBA)

Adrio Bacchetta, MSF Hong Kong’s Board Member and author of the MSF 2016 Global Institutional Footprint Report

Chanjiv Singh Mehta, President of MSF SARA (South Asia Regional Association)

Reading materials

Concerns about current and projected growth within the MSF Movement (MSF Sweden’s Board of Directors, February 2017). This letter, sent to the different local Boards and International Board representatives in the spring of 2017, is an attempt from the Board of MSF Sweden to encourage debate on growth across the movement. While operational ambitions expand as a respond to humanitarian needs, the Swedish Board recalls on the lack of a clear goal framing growth. MSF operational expansion has only been shadowed by the lack of Human Resources, but in fact agreements trying to address of limit growth are easily overlooked by the different OCs. The letter addresses aspects to growth, such as the quality of medical services, our ethical responsibility vis-à-vis our donors, efficiency and the lack of a coordinated strategy for growth among the Boards governing the movement. Is MSF ready to transit toward a clear, long-term vision framing its growth? What’s the role of the Association through this path?

Response letter from MSF Sweden Board to the MSF Boards and IB members. This is a response letter following the MSF Growth letter sent in February 2017 from the Swedish Board. It raises concerns about how the movemnet is handling the growth of MSF.

Review of the MSF Global Institutional Footprint (Bacchetta and Mousseau 2016). This report highlights the trends in institutional growth that MSF is developing since the governance reform of 2012. MSF is expanding across the global and becoming a more diverse movement. But while regionalization is a reality, proven by the creation of new entities and more operational autonomy to missions, it is also true that there is a continuation of European growth. In fact, “over the past 12 years [European HQ costs] have increased more than double those of the rest of the world and the gap is widening.” Does MSF want to continue this trend or increase investment outside Europe? And if so, how much global growth is the MSF movement capable of managing? The organizations’ culture, rather organic and of “little planning” is likely to shape the future of the movement and lead to further expansion. However, a risk envisaged by the authors is also that growth could lead to MSF becoming bureaucratic and more difficult to react in an agile way to operational challenges. Different and simultaneous trends taking place in our movement and leading us to the question of how to drive growth.


JOINT NORDIC MOTIONS

Click here to download them in PDF

Motion 1: Prevention and management of harassment and abuse of power in MSF work spaces and creating a culture of zero tolerance towards harassment and abuse of power - MOTION PASSED

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Motion sponsors: Eugene Bushayija, Maria Schutz and John Tzanos

Destination: To the Board of MSF Norway and MSF Sweden, with next destinationto the OCB Gathering.

Motion text: Recent studies (see link at bottom) have lifted the lid on the prevalence of sexual harassment, discrimination and abuse of power in the international aid sector. These studies also include respondents that are MSF colleagues. That the problem of harassment permeates all levels of society and exist also within MSF – only recently we have had examples of this problem surfacing in discussions and debates during the Nordic Returnee workshop.

Further to that, an increasing number of complaints of harassment from different MSF offices (field and headquarters) indicate that socially constructed unequal power relations exist within MSF and that current measures to prevent harassment and misconduct in the MSF work environments are not addressing the issue in its full magnitude. What is needed is creating a well anchored culture of zero tolerance on harassment, discrimination and abuse of power through all MSF missions and work spaces.

Modern work spaces and especially within humanitarian aid organisations need to be safe for all its staff, regardless of age, sex, gender, sexual orientation, ethnic belonging, abilities, creed and socio-economic status. Several examples demonstrate the negative impact discrimination has on a person's health (see for instance reports from the Equality Ombudsman [Diskriminerings ombudsmannen, DO] , the National Board of Health and Welfare [Socialstyrelsen] report on the health impact from discrimination against persons with a sexual orientation, gender, sexual identity and/or sexual expression that diverges from the hetero-norm (hbtq), or the Public Health Agency in Sweden [Folkhälsomyndigheten] annual reports). The negative health impact can probably further be derived to socio-economic consequences first and foremost for the individual but also in terms of quality and cost of the employer's operations.

Managers in modern work spaces must be aware of how socially constructed identities permeates the work environment, both internally through its own staff, policies and steering documents as well as externally from its interactions with different institutions. Equally important, managers in modern work spaces must also know how the abuse of power through these constructed identities may be expressed, how to support the person abused and stop the harassment from occurring though preventative measures as well as immediate responsive measures.

This motion calls for a work environment that is free from power abuse and harassment, by asking on behalf of the MSF Sweden and Norway associations that the boards of MSF Sweden and MSF Norway mandate the OCB Board to:

Ensure that all future and current managers (that are responsible for staff) and human resources staff at field, headquarters and partner section level are trained and given tools to identify, prevent and stop any form of power abuse and harassment. It is recommended that MSF management endorses the intersectionality  perspective to this end (on intersectionality see for instance https://www.youtube.com/watch?v=cxqIh-yazLU in Swedish or Framing Intersectionality by Lutz, Vivar and Supik (2011) or other scholarly works)

Ensure that the MSF-OCB institutionalises adequate measures for reporting and accountability mechanisms of abuse, misconduct and harassment of its staff

Ensure that a SANOU like training addressing the issue of abuse of power, harassment (including sexual harassment) and discrimination is created and regularly presented in all OCB missions.

http://humanitarianwomensnetwork.org/wp-content/uploads/2014/09/Who-Responded.pdf

https://www.devex.com/news/sexual-assault-and-harassment-in-the-aid-sector-survivor-stories-89429


Motion 2: Survey regarding sexual violence and harassment - MOTION PASSED

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Motion sponsor: Lindis Hurum, Alan Lefevre, Agnese Pinto, Dina Hovland, Tonje Karlsen

Destination: To the Board of MSF Norway and MSF Sweden, the various OC's and the IGA.

Intro text – background:

Anyone who has experienced sexual harassment knows how confusing, embarrassing, painful and stressful it is. It can drain the pleasure out of work, lead to sleepless nights, anxiety, loss of self-esteem and even fear of losing your job. Sexual violence can lead to severe PTSD with lifelong psychological consequences, STD and unwanted pregnancy. Sexual harassment and sexual violence often inflict stigma, which can reduce the likelihood of reporting the incident(s).

The victims can be both male, female and LGTB’s, but the percentage of women are generally overrepresented in existing statistics.

Humanitarian work should be designed to save lives, reduce suffering, and protect human dignity. Therefore, to many it might seem contradictory that sexual harassment could occur in a humanitarian work context. Yet it does and incidents of sexual violence and harassment committed by and against humanitarian aid workers can have a significant impact on survivors, office relationships, quality of programming and our interactions with the local population.

Identifying, stopping and preventing sexual harassment can be difficult under any circumstances. The circumstances of humanitarian work can add to the confusion. Often co-workers are thrown closely together for long periods of time. They might live and work in the same place, limiting privacy. Isolation can lead to tunnel vision and lack of objectivity. Separation from loved ones often increases dependency on co-workers for emotional support. Some would even say that humanitarian organisations like MSF risk cultivating a culture that is much more liberal and condoning than what is the norm in other contexts, relating to alcohol, drug use and sexuality. All of this can result in confusion about how to recognize and what to do about sexual harassment.

Sexual harassment was not broadly recognized as a legal and ethical problem until the 1970s. Previously, many people, especially those who were not affected by it, thought of sexual behavior in the workplace as a harmless flirtation, but sexual harassment is a form of sex discrimination that violates the civil rights of an individual.

Some argue it is hard to tell the difference between consensual sexual behavior and harassment. In order to better understand what this motion is addressing specifically, this is the current legal definition in the United Stated of sexual harassment:

Sexual behavior is considered harassment when it is uninvited and unwelcome verbal or physical behavior of a sexual nature, especially by a person in authority toward a subordinate.”

Regarding sexual violence, the Inter-Agency Standing Committee’s definition is useful:

               “Sexual violence includes, at least, rape/attempted rape, sexual abuse and sexual exploitation. Sexual violence is ‘any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic a person’s sexuality, using coercion, threats of harm or physical force, by any person regardless or relationship to the victim, in any setting, including but not limited to home and work. Sexual violence takes many forms, including rape, sexual slavery and/or trafficking, forced pregnancy, sexual harassment,sexual exploitation and/or abuse, and forced abortion."

IASC, Guidelines for Integrating Gender-Based Violence

Aid agencies and INGO’s are slowly beginning to recognize that sexual harassment, discrimination and assault against aid workers, female in particular, is a serious problem within the industry — and that perpetrators are often men holding senior positions.          

It is longtime overdue to put this topic on the agenda in the humanitarian world, MSF included, and two advocacy groups formed in the past 18 months by women working in the sector — the Humanitarian Women’s Network (HWN) and Report the Abuse — have finally lifted the lid on the problem, collecting survey data from hundreds of female aid workers. The results reveal that sexual harassment, unwanted touching, sexual comments and - in some cases - rape, are common experiences for women working in humanitarian settings.

According to a study done by HWN, out of 1005 female respondents from 70 different organizations – including some from MSF, 55% indicated that they had experienced unwanted sexual advances from male colleagues throughout their professional career. Moreover, 48% reported “unwanted touching”, while 4%, e.g 40 women, said that they had been raped. The survey further showed that 60% of women choose not to report what has happened to them

We are deeply concerned by the findings of this survey, and we are further concerned by the reported climate of impunity in which this discrimination, sexual harassment and sexual abuse take place. Thus, we think it is urgent that MSF take action to determine the scope of the problem within our own organization. In difference to the HWN survey, we believe this assessment needs to include all staff, not only female.

We believe there is a knowledge gap preventing an informed discussion and implementation of appropriate measures throughout the movement. Just like when designing a project in the field, we need to do an assessment to enable documentation and analysis regarding prevalence rates, patterns of sexual assault (who, what, where, when), the effects on victims/survivors, and MSF’s response

Inspired and encouraged by the survey recently initiated by MSF OCB on this topic, we believe it is urgent and imperative that the same kind of survey is done throughout the movement, by all OC’s.

This is important because it will send a strong signal to all our staff regardless of which OC you work for that MSF as a movement is taking this very seriously; thus making it a priority to gather reliable, transparent and objective data. If only one OC carry out this survey, the impact will not be the same. 

Motion text:

We ask the MSFNO and MSFSE board to engage the whole MSF movement to perform a large-scale representative survey of its workforce (office and field staff, female and male) in order to enable documentation and analysis regarding prevalence rates and patterns of sexual violence and harassment, the effects on victims, and MSF’s response.

The result of the assessment should guide the MSF movement in identifying and implementing procedures aiming to reduce exposure and improve the follow up of the victims. 


Motion 3: Use PowWow as pre-GA - MOTION FAILED

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Motion sponsor: John Tzanos

Destination: To the Board of MSF Norway and MSF Sweden, with extension to the Danish Association.

Motion text: As the Nordic associations are growing and since several years have been conducting joint annual General Assemblies (GA) – with a possibility of a future merging of a common MSF-Nordic association – the associative processes and work face a number of challenges.

One of these challenges is to ensure enough time and insight for all the MSF Nordic members on the different motions that are being voted upon during the GA – ultimately to facilitate that the growing number MSF association members have the time to inform themselves on the work that the MSF boards are asked to perform. The motion writer has experienced several annual assemblies where motions are rushed through with several of the association's members' questions and/or comments left unheard.

As the current set-up of the General Assembly already takes a considerable amount of time (2 days, with a fully packed agenda), it is suggested to find other ways to expand the GA. One option that this motion explores is to use the PowWow, also an annual associative event, to be part of the GA. This motion suggests that the PowWow, instead of a stand alone event, becomes a preamble to the GA and prior and in conjunction to (4- 6 weeks) the GA. The purpose would be to allow for time to discuss motions (that will have to be submitted prior to the PowWow in this case).

The expected results of such a change would be to increase the opportunities for association members to discuss in a more exhaustive manner the motions, get informed about possible impacts of the motions, BEFORE the voting takes place in the GA. In essence it aims to strengthen the democratic processes of the GA. It may also increase the associative engagement by expanding some of the core activities of the association (engagement in the board's work!).

Thus, this motion calls for the MSF-Sweden and MSF Norway boards to adjust the “stadgar” in order to allow for the organisation of the annual PowWow as a preamble to the annual General Assembly, starting year 2018 to discuss motions (no voting) to strengthen the democratic processes of the General Assemblies and also improve the associative engagement beyond the GA.

By: Rebecca Cederholm