Eastern Chad: Investigating abuse and strengthening prevention
In late 2024, following media reporting, MSF launched an investigation into allegations of sexual exploitation, abuse and harassment linked to humanitarian operations in eastern Chad. The investigation concluded in mid-2025.
Alongside our Annual Behaviour and Accountability Reporting for 2025, something we have been doing for the past eight years, MSF is publishing an account of the findings of our investigation, and the actions taken in response, to better prevent, detect, and respond to abuse and misconduct in eastern Chad and across MSF.
Safeguarding in humanitarian emergencies
MSF is committed to ensuring an environment free from abuse, including exploitation and harassment.
The term ‘safeguarding’, used throughout this text, refers to the measures we take to prevent, detect, and respond to abuse. The safety, dignity and confidentiality of survivors, and their access to support, are at the centre of this work.
The safeguarding measures we have and are putting in place across our projects and offices aim to create a safe, dignified and respectful environment for patients, communities, and colleagues.
Investigating abuse in a humanitarian emergency
MSF has worked in Chad since 1981, responding to multiple humanitarian crises, in a country that, prior to the war in Sudan, was already hosting around one million refugees and internally displaced people.
After war erupted in neighbouring Sudan in April 2023, a further 900,000 refugees fled across the border into an area with extremely limited resources, fuelling an urgent need for medical care, shelter, food, water and sanitation. As increasing numbers of people crossed the border, existing camps and medical structures quickly became overwhelmed.
Successive waves of refugees and wounded people have followed peaks of violence in Sudan. For example, in mid-2023, 2,000 refugees were arriving each day. During one particularly intense period in June 2023, 850 wounded people arrived at MSF facilities in eastern Chad in just three days, with nearly 400 arriving at our clinics on 16 June, alone.
The speed and scale of the emergency required MSF to rapidly expand our programmes and recruit large numbers of new staff. By 2025, we employed 2,446 people and provided substantial medical and humanitarian assistance, including 586,900 outpatient consultations and 979,600 vaccinations, and distributing 362 million litres of chlorinated water throughout the year.
In late 2024, MSF was alerted by a media investigation into allegations of sexual exploitation, abuse and harassment linked to humanitarian operations in eastern Chad, including three specific allegations concerning individuals working for MSF.
Following the reports, we launched investigations and deployed trained investigators to establish the facts, enable MSF to provide support to survivors, take disciplinary action against perpetrators, and act to reduce the risk of further abuse. Although investigating specific alerts we receive is standard practice in MSF, in this case we decided to investigate across all areas where our projects operate in eastern Chad, to try to gather a more complete picture of the abuse and identify as many survivors and perpetrators as possible.
The findings published here are a summary of the investigation and the actions taken in response. They do not reproduce the underlying investigation files or case-level information. This is necessary to protect the confidentiality and safety of people involved, including survivors and witnesses, and to avoid information that could identify individuals or locations being made public.
What our investigations found
Over eight months, 16 investigators reviewed 59 allegations involving individuals working in or connected to MSF-supported activities, including employees, daily workers, and suppliers. Most allegations related to sexual exploitation, abuse, and harassment.
Reflecting broader societal inequalities and power imbalances, especially with respect to gender, survivors of abuse, and especially sexual forms of abuse, were predominantly women, and all the perpetrators identified in the process were men. Our investigations found that abuse and misconduct often occurred where there were significant imbalances of power, including between people that had power or authority and those with less power, and between humanitarian workers and the people they were meant to serve.
Every allegation was examined carefully. While some were corroborated, others could not be fully verified, including where survivors or alleged perpetrators could not be identified, or located after moving within or beyond the vast refugee camps in eastern Chad.
Only a limited number of survivors could be identified. Where they were, medical and psychological care was systematically offered, although concerns about confidentiality, judgement or retaliation affected whether people felt safe to access these services.
Where perpetrators were identified and serious misconduct was substantiated, sanctions were imposed. Eighteen staff members were dismissed and permanently barred from working with MSF. Based on our investigations, we also terminated a contract with a service provider.
Beyond individual cases, our investigations identified important shortcomings in how existing safeguarding measures had been implemented across our programmes.
During a period of rapid operational expansion, local recruitment, induction and supervision practices had not consistently ensured that all colleagues understood and upheld MSF’s behavioural commitments. Safeguarding risk assessments, which help to mitigate the risk of abuse, had not been carried out systematically. Many patients, colleagues, and community members did not know how to report abuse safely and confidentially.
The humanitarian context further heightened the risks. Conflict, displacement, deprivation, and dependence on humanitarian assistance created significant imbalances of power. While we cannot avoid this, we can and should pay even more attention to preventing and addressing abuse in such emergency contexts.
Strengthening safeguarding in eastern Chad
Our investigations in eastern Chad led directly to changes in how we prevent, detect, and respond to abuse and misconduct.
Strengthening safeguarding across MSF
The findings in eastern Chad have also informed changes across MSF. Over the past year, we have strengthened our global screening processes to prevent people found to have committed abuse or serious misconduct from moving between MSF projects and being rehired elsewhere in the organisation. We have strengthened recruitment, induction and supervision, and expanded the number of safeguarding specialists and investigators available to support country teams.
We recognise that strengthened safeguarding policies and systems alone are not evidence of success. What matters is whether they lead to safer environments, greater trust in reporting mechanisms, and better support for survivors. We will continue to assess what is working, address gaps, and report publicly on abuse and misconduct through our annual behaviour and accountability reporting.
This work does not end with the investigations in eastern Chad. Abuse and misconduct can occur anywhere, but the risks can be heightened where significant power imbalances exist. Our responsibility is to reduce those risks as much as possible, create environments where people feel safe to report concerns, support those affected and act decisively when abuse occurs. We are committed to acting on every alert, holding perpetrators accountable, and learning from every case to strengthen how we prevent, detect and respond to abuse and misconduct, wherever we work.