Sexual abuse and exploitation at WHO: an erosion of trust

Abstract

The final report of an Independent Commission investigating accusations of sexual exploitation and abuse arising from WHO's response to the tenth Ebola outbreak in the Democratic Republic of the Congo (DRC) was issued on Sept 28. The report describes dozens of appalling allegations made by vulnerable women and girls, including demands for sex in return for jobs and resources and nine rapes, which resulted in many pregnancies (one in a girl aged 13 years), forced abortions, and 22 children being born. 21 men employed by WHO were accused, ranging from short-term contractors to highly trained international staff. These allegations raise serious questions about the integrity, trust, and governance of WHO. How it responds to these findings will surely impact the organisation's future. A World Report in The Lancet examines the report and its recommendations in detail, as well as criticisms of WHO's response. The incidents described, in which men with power and resources use their advantages to exploit some of the most vulnerable women and girls in the world during a deadly emergency in a low-income country, could scarcely be more horrific. The people WHO strives to protect have had their lives shattered by the very individuals appointed by WHO to aid them. These incidents are not solely the result of predatory individuals and local conditions, but also poor governance, bureaucracy that shields the perpetrator, and a culture of permissiveness. The report describes structural failures, including an argument over whether one woman met a technical definition of a “beneficiary” and thus was the responsibility of WHO, a system in which accusations are only dealt with when submitted in writing—directly discriminating against those with low education—and even a situation in which an investigation was not opened because “an amicable agreement was reached” between one accuser and the WHO employee. Women and girls who come forward, acting under extreme stress, need to be believed and to see proper procedure enacted for handling complaints swiftly and with transparency. Whistle-blowers, too, need structural protection from any repercussions of coming forward. The fact that sexual exploitation and assault keep occurring in humanitarian responses is not a reason for it to be expected. The repeated failures of humanitarian missions, like Oxfam in Haiti and the UN in Central African Republic, to safeguard those they are meant to be helping must prompt these organisations to confront the toxic and misogynistic aspects of their cultures, and to set up better structures to ensure these acts do not happen again. These documented incidents are likely to represent a small proportion of the true extent of exploitation taking place in humanitarian and emergency responses. A key lesson of the tenth Ebola epidemic in DRC was that, no matter what technical resources are available, a response cannot succeed without the trust of the community. Vaccinations were refused and treatment centres attacked. 450 acts of violence or threats against health workers occurred. 25 health workers were murdered and a further 27 were kidnapped. Abuses like those documented in the report will destroy community trust. By being the vehicle for sexual abuse and exploitation, in a situation in which mistrust is already rife following centuries of colonial exploitation, WHO places its employees, its mission, and its mandate at risk. WHO officials were slow to respond to these allegations. Those who fostered a culture of permissiveness must face punishment, and the consequences must reach far up into the organisation. Those subjected to abuse must be fully compensated. Toxic masculine structures in field operations must be dismantled. As Dr Roopa Dhatt points out, “of the 2800 staff on that WHO Ebola programme, 73% were men and men held 77% of leadership roles. If women had been the majority of staff and held the majority of leadership roles, we believe this would have been a more positive story”. The Lancet has long demanded gender parity in global health leadership roles. A gender-balanced representation in all WHO programmes, particularly in senior roles, is a fundamental starting point. Vulnerable women and girls at the mercy of powerful men cannot continue to be the collateral damage of an emergency humanitarian mission. In the aftermath, WHO's leadership has stressed “zero tolerance for sexual exploitation and abuse” and has promised to take steps to respond to the allegations and prevent future incidents. But individual and organisational accountability is judged on outcomes, not on plans. The trust people place in WHO to do the right thing is being squandered, and without trust WHO cannot fulfil its mission. Experts criticise WHO response to sex abuse allegationsAn independent report has documented allegations of sexual exploitation and abuse, but commentators have called for stronger outcomes. Udani Samarasekera reports. Full-Text PDF