For MSF, bearing witness is as much a part of its mission as providing treatment. Faced with accusations of bias and disinformation campaigns, the organisation is developing strategies to defend its credibility. MSF navigates its way through a hostile environment between “personal conviction” and factual evidence, while taking responsibility for the positions it adopts.
For Médecins Sans Frontières (MSF), public communication is first and foremost a matter of institutional survival. Indeed, for an organisation that derives 99% of its funds from private generosity, it is vital to be visible, have a presence in the media and on social networks, provide information on how its financial resources are used, and, in this way, maintain the general public’s trust. The development of the humanitarian sector and the increase in de facto competition between charities have forced MSF, and indeed other organisations that appeal to the generosity of the public, to expand its media and online presence by diversifying its channels, outlets and approach – for example, targeting younger audiences and adopting a more light-hearted tone or shorter, user-friendly formats – to reach a variety of audiences and thereby secure their resources.
Caring and communicating: an unbreakable link
MSF’s reputation has been built on the image of direct front-line witnesses in major contemporary crises – often in extreme situations and sometimes as the only humanitarian resource present. The charity believes that speaking out in public is part of its social mission: public communication continues and complements the act of caring. In the Guiding Principles adopted by the entire MSF movement in Chantilly, France, in 1997, MSF regarded témoignage (witnessing) as an “integral complement” to medical action, with the intention of “improving the situation for populations in danger”.[1]Médecins Sans Frontières, Principes de référence du mouvement Médecins Sans Frontières, 17 février 1997, https://www.msf.org/sites/default/files/2022-09/CHANTILLY_FR.pdfAgain, in 2020, MSF movement endorsed a common vision for its public position, Telling it like it is, which states that “the concept of témoignage, or bearing witness, is a central pillar of our identity. It is our closeness to the populations we assist that allows us to bring the suffering we witness to the public’s attention. This act of bearing witness has a value in itself, even when it does not claim to change reality.”[2]Avril Benoît, Telling it like it is : Why we speak out, Médecins Sans Frontières, 10 December 2019, https://www.doctorswithoutborders.org/latest/telling-it-it-why-we-speak-out
“This continuity between action and speaking out in public is clearly illustrated by the ongoing war in Gaza.”
This continuity between action and speaking out in public is clearly illustrated by the ongoing war in Gaza. With no international media present, and with over 200 journalists and media professionals killed since 7 October 2023,[3]Agence Média Palestine, « 343 attaques en 2025 : Israël cible le journalisme palestinien », 28 avril 2025, … Continue reading workers are among the small number of witnesses to the destruction of the very fabric of Palestinian life. They are therefore among the few voices speaking out against the dehumanisation of Gaza’s entire population and its identification as a target. They are particularly well placed to challenge the narrative of the Israeli authorities claiming to facilitate the delivery of aid into the Gaza Strip. Carrying out relief operations in Gaza while giving up on this witness role would be an unacceptable compromise: speaking out in public is a necessary condition for intervening in such a context, even though it leads to criticism and attacks by Israel and its allies.
Building a strong conviction based on facts
When MSF is a primary source of information and narratives about a crisis, when it acts as a “humanitarian media outlet” – i.e. provides information about the contexts where it operates, even if this is limited to its field of action and under pressure from authorities there – it faces two main constraints: first, the ability to be heard and keep up with the way people consume information; second, the deterioration of the information space and the “competition for narratives” exerted by propaganda and disinformation strategies that are ever more sophisticated. Just like the media, which have developed fact-checking tools, non-governmental organisations (NGOs) like MSF are developing strategies to try to establish a bulwark against the dissemination of false or manipulated information. In turn, this raises the question of truth – the veracity of the information we have at our disposal and believe we can share in our name.
Our words must therefore be precise and detailed. They adopt the requirements demanded in information professions for the clarity and detail that a journalistic source needs in order to be legitimate, despite contexts that are often constrained, constant uncertainties and strong pressure from belligerents. Faster information flows and the popularisation of access to social media make this activity even more constrained, both in regard to deadlines and competition from alternative narratives. Striking a balance between fear of consequences of what we say – which often leads to a kind of self-censorship – and the vital ability to rationally assess windows of opportunity to express ourselves, while maintaining an environment where we can work, is undoubtedly what takes up the most time for MSF’s communication teams.
In purposefully trying to resolve the dilemmas inherent to our role as witnesses, the document Telling it like it is states that “our most successful public communications have all been the result of our ability to be assertive, relevant and timely on a given specific subject.” At the time, the MSF movement was emerging from a decade marked by bitter internal discussions about the wars in Yemen and Syria, which had brought to the fore MSF’s differences about the attribution of responsibility for attacks on civilians, humanitarian workers and health facilities. The issue of what evidence we had at our disposal to attribute the destruction of the Maarat al-Numan hospital in Syria in February 2016 and the Haydan hospital in northern Yemen in October 2015 to the Saudi and Russian air forces, respectively, divided MSF sections. While some felt that, based on a solid analysis of the context and in the absence of credible alternative versions, it was possible to point the finger of blame with the aim of holding the belligerents to account and, ultimately, changing their behaviour, others felt that, in the absence of an investigation to confirm, objectively, who was responsible, it was our duty to refrain from attributing blame for fear of jeopardising our credibility. Lastly, different positions and initiatives were able to coexist, depending on the sensitivity and choices of the MSF offices concerned.
So, in the face of denials by the parties to the conflict and the controversy provoked by speaking out about the Maarat al-Numan hospital, MSF France decided to commission, in 2017, Forensic Architecture, a group of researchers specialising in investigations based on architectural techniques, to establish the facts about this attack. This investigation established the timeline of the attack and linked it to the movements of Russian aircraft operating out of Hmeimim airbase on the Syrian coast.
“As MSF has no investigative capacity of its own, it has no choice but to base itself on a ‘deep conviction’ built on the information provided by its teams.”
As MSF has no investigative capacity of its own, it has no choice but to base itself on a “deep conviction” built on the information provided by its teams, which can variously be first-hand information about the attacks themselves, or more often about the number and nature of the injured, a description of their injuries, and accounts and witness statements from the injured themselves. It is on the basis of these factors, which MSF teams try to substantiate through verification and triangulation methods and other available sources (authorities, other organisations and media), that it becomes possible to establish a narrative and build a form of conviction about who is responsible. This approach requires an ability to change, or modify, its position over time – for example, if new evidence comes to light to contradict the original analysis. The Russian invasion of Ukraine in 2022, and even more so the destruction of Gaza by the Israeli army from October 2023, put these issues back at the very heart of MSF’s internal discussions.
In April 2022, while visiting a hospital in the southern Ukrainian city of Mykolaiv, an MSF team witnessed, first hand, an attack that most likely involved the use of cluster bombs – munitions that deliver clusters of explosives over a wide area. MSF then held the Russian army responsible. It did so on the basis of a number of factors, including the fact that other hospitals and residential areas in the city had been bombed in the preceding days, without the Russian army disputing responsibility. This attribution, which was reported, albeit cautiously, by the media,[4]Reuters deemed it necessary to specify that MSF “does not have any evidence to establish this responsibility”; Emma Farge, “MSF says its team witnessed hospital bombing in Mykolaiv”, Reuters, … Continue readingdid not generate any protests or reactions from the Russian army.
On 17 October 2023, the al-Ahli Hospital in Gaza City was hit by a projectile, causing an explosion in the hospital courtyard. MSF was quick to attribute responsibility for the attack to the Israeli army, again based on an account from one of MSF’s members on site, at a time when many media outlets and even an Israeli source had done the same, before subsequently correcting their position. Whilst alternative accounts developed in the hours following the attack – with some blaming a rocket fired by Palestinian armed groups – and whilst the death toll of the explosion also proved controversial, MSF movement failed to agree on the need to correct its position. Some sections did not consider it wise to include the attribution of responsibility on their X accounts; others, such as the French and German sections, decided to correct the original tweets. It was not until May 2024 that the MSF movement’s official position was published on its international website, stating that the association was not able to determine responsibility for the attack with any certainty, and that only an independent investigation would allow this.
Shaken by this experience, and faced with the prevailing Israeli narrative during the first months of the war – which denied any attack on hospitals and medical personnel – MSF’s French section embarked on a systematic effort to document what had happened based on first-hand observations and accounts from its teams. The aim was twofold: first, to counter Israeli narratives about attacks on the medical mission and humanitarian workers in Gaza, including MSF teams, and, second, to provide researchers, the media and other organisations with evidence to document military patterns (i.e. recurrent practices in the way the Israeli army was conducting the war in Gaza) and to establish the Israeli army’s responsibility for the campaign to destroy Gaza’s health system. Some of these initiatives have been cited in legal actions, such as South Africa’s January 2024 petition to the International Court of Justice against Israel for failure to comply with its obligations under the Genocide Convention.
Face the accusations… and sort them out
The testimony of humanitarian workers can therefore be powerful. So are the strategies put in place by States and other stakeholders to silence them. Accusations of bias, enslavement to a foreign political agenda, and malpractice are as old as humanitarian aid itself. Yet the way in which access to information has evolved, especially in unmoderated digital environments powered by ideologically driven algorithms, has multiplied its potential to cause trouble. In recent months, there have also been frontal and determined assaults on the aid system itself, led by the new US administration and its supporters. These are formidable blows not only to the functioning, but also to the image of international aid itself, the effects of which are still largely to be measured.
“We must, however, resist the tendency to regard all criticism as an attack.”
We must, however, resist the tendency to regard all criticism as an attack. In order not to retreat into victimhood or purely defensive reflexes, we must also distinguish between the various categories of accusation and threat, whether they relate to disinformation, controversies about our positions, or criticism of our actions.
The first category includes, for example, public opinion campaigns carried out by some European states, particularly Italy, that aim to criminalise migrants and the NGOs offering them aid in the central Mediterranean from the mid-2010s. By accusing NGOs of complicity with smugglers without any evidence to support their claims,[5]None of the legal actions brought by the Italian government against NGOs have resulted in a conviction.these states were aiming to slander and discredit caregivers by asking them to prove their innocence, thereby inverting the burden of proof. Similarly, with regard to the war in Gaza, several organisations, including MSF, have been the target of serious accusations from certain French media outlets linked to the far right. In September 2024, for example, the Journal du Dimanche (JDD) published an investigation[6]Lara Tchekov et Anne-Flore Marie, « Enquête – Médecins sans frontières : une ONG en crise de neutralité face aux accusations de compromission », Le Journal du Dimanche, 3 novembre 2024.into the alleged non-neutrality of MSF in the war in Gaza, even claiming that some of its members were complicit with Hamas. Based on anonymous accounts, opinions, insinuations and false allegations, these accusations are very difficult to refute. In an attempt to harm MSF, the JDD has also tried to destabilise MSF’s sources of income by contacting some public and private financial partners to inform them of its accusations. Although these attempts have not had any significant impact on MSF’s funding, they undoubtedly point to the battleground that the populist far right wants to occupy in the future in its efforts to discredit and silence NGOs. In both cases, MSF’s response was to develop educational tools – FAQs,[7]Médecins Sans Frontières, Gaza : nos réponses à vos questions, https://www.msf.fr/gaza-nos-reponses-a-vos-questionsvideos, articles, etc. – to explain its position and deconstruct hostile arguments with facts, using debunking techniques inspired by those used by traditional media outlets.
The second category includes attacks and accusations against MSF on the basis of elements that are factually accurate in part and are acknowledged as such by the association. This is the case, for example, when MSF is accused of playing into the hands of armed opposition groups by seeking to provide relief in areas under their control, to take care of all the wounded, including those from their ranks, or to engage in dialogue to obtain minimum conditions of security and access for our teams.
For example, in Burkina Faso in February 2023, MSF publicly denounced the murder of two of its employees in an attack on their vehicle near Tougan. At the time, the president of MSF France said that MSF must “quickly talk to all parties to the conflict to understand what happened,” a statement that provoked virulent reactions on social media. Some of the comments focused on MSF’s intention to establish contact with members of armed groups and to consider them “parties to the conflict” with whom discussions can be held, on a par with the regular forces. These criticisms came on top of the reactions accusing MSF of being in the pay of the French government, carrying out espionage missions and supporting terrorism. However, they did not make it into the media and remained confined to comments on social media at the time. Since then, rarely a month goes by in Burkina Faso, Mali or Niger without this type of false accusation, occasionally based on factually accurate information, being spread on a more or less large scale, and also being echoed in traditional media and political channels. In response, we use monitoring and analysis tools, we have discussions with opinion leaders and networks of influence, we provide information about our activities and the way we conduct them, and we organise visits to our projects to show the impact they are having and the diversity of our teams. We also share some of these elements on social media via our official accounts, but these actions are trivial when we are faced with campaigns orchestrated by specialist actors and they cannot protect us against attacks and hindrances to the work of our teams.
In Haiti, in February 2023, MSF was subjected to a violent campaign of intimidation and serious threats as part of a wave of incidents affecting its ambulances and hospitals, which were attacked or violently searched by Haitian law enforcement officers seeking to seize injured gang members being cared for by MSF. Influencers and Haitian online media then accused the charity of being complicit with the gangs. After yet another particularly serious incident in November 2024, when police officers attacked an MSF ambulance and executed two patients, the organisation decided to suspend its activities for several weeks. In April 2025, after another attack on a convoy of its vehicles in Port-au-Prince, MSF took the difficult decision to suspend its activities in two of the city’s hospitals where it works, for a minimum of three months.
“It is precisely because we treat everyone that we are accused.”
These situations demonstrate the attacks that MSF endures because of the very nature of its mission and activity: to talk with those who bear weapons and treat all the wounded who approach our teams, without distinction. In the context of total war waged by some states, this position is, at best, misunderstood and, at worst, perceived as hostile. Yet responding to these accusations by publicly asserting our principle of impartiality would be counter-productive: it is precisely because we treat everyone that we are accused. Strategies to counter these campaigns can point out, however, that MSF also treats non-combatants, for example women and children, in order to dispel suspicions of affiliation with a particular armed movement.
Lastly, the third category – that of public criticism of our actions – includes both justified and legitimate attacks on our ethics, protection and management failings. Scandals relating to sexual abuse in the humanitarian sector, including at MSF, cannot and must not be treated as malicious attacks on our reputation. On the contrary, they are a healthy way of scrutinising our organisations, to which we must respond with humility and transparency.
In the Democratic Republic of the Congo (DRC), an investigation conducted by Reuters and The New Humanitarian[8]Robert Flummerfelt et Nellie Peyton, « Exclusif – Plus de 50 femmes accusent des travailleurs humanitaires d’abus sexuels lors de l’épidémie d’Ebola en RDC », The New Humanitarian et … Continue reading a large number of cases of abuse committed by the staff of UN (United Nations) agencies and NGOs – including MSF – during the response to the Ebola outbreak in the east of the country between 2018 and 2020. MSF then decided to launch an internal review of its practices and procedures regarding abuse in the DRC, as well as an internal investigation into the cases raised by the journalistic enquiry. The reports presenting the findings were published in the DRC[9]Actualité.cd, Des efforts proactifs pour lutter contre les comportements abusifs (MSF), 6 juillet 2022, … Continue readingas well as on the organisation’s websites[10]Médecins Sans Frontières, République Démocratique du Congo : des efforts proactifs pour lutter contre les comportements abusifs, 7 juillet 2022, … Continue reading
These three categories are not mutually exclusive, but they help guide our thinking and response to the different types of threats and attacks we face. Above all, they allow us to identify spaces and discussions in which we can find audiences receptive to our messages. Who are we addressing when we defend ourselves against these various accusations? What realistic outcomes can we hope for? There are no easy answers to these questions, but, in general, two points can be made. On the one hand, we must, first and foremost, talk to our supporters and inform them about the reasoning behind our choices and our biases – in short, defend our actions without fear of being divisive and accept that we might upset some people. On the other hand, we must foster educational and informative approaches to audiences that do not usually support us by trusting those who are still listening and willing to believe in our good faith.
Translated from the French by Derek Scoins
Picture credit: Life Matters via Pexels
