Médecins Sans Frontières (Doctors Without Borders) has acknowledged that its staff were accused of sexually abusing at least 59 Sudanese refugees in eastern Chad, with the offences dating to 2024. Young girls were among the exploited. In many cases food or jobs were offered in exchange for sex — a pattern MSF’s own internal report described as potentially amounting to “sexual trafficking.” MSF says it has dismissed 18 individuals but was unable to identify some of the other alleged perpetrators. Victims reportedly chose not to report abuse for fear that aid access would be withheld in retaliation; those who did report frequently received no response, and MSF has admitted its complaints procedures were “mostly ineffective.” The abuse occurred in the context of Sudan’s civil war — now in its third year — which has produced what the UN describes as the world’s worst humanitarian crisis, with more than 11 million displaced and 28 million facing acute hunger.
The received wisdom
The mainstream NGO sector and sympathetic press coverage tends to frame scandals of this kind as isolated failures of individual bad actors within otherwise functional institutions — painful revelations that should lead to better training, improved complaints mechanisms, and stronger reporting requirements. MSF’s own response follows this template: acknowledge the harm, express deep regret, report the dismissals, commit to systemic improvement. The Guardian’s coverage of Sudan’s broader crisis has emphasised the scale of civilian suffering and the importance of continued humanitarian operations. The received wisdom holds that aid organisations are operating in extraordinarily difficult conditions — active conflict zones, severe resource constraints, limited oversight capacity — and that the lesson from scandals is to reform rather than defund. Cutting aid to the world’s most vulnerable populations because of the misconduct of some staff would compound the crime.
A different read
The argument for not punishing beneficiaries for the sins of their supposed protectors is humane and correct as far as it goes. But the pattern here — not just in MSF, not just in Sudan — is so persistent and so structurally predictable that continuing to treat each instance as an aberration requiring better training has become its own kind of moral failure.
Consider what the MSF internal report actually found. The pattern of exploitation included food-for-sex and job-for-sex arrangements — not one-off predation but systematic exchange structures. The complaints system was “mostly ineffective.” Victims feared retaliation. MSF could not identify some perpetrators despite conducting an internal investigation. This is not a description of isolated bad actors operating outside the system; it is a description of a system that created the conditions for exploitation and then failed to investigate it effectively. The July 2024 internal report apparently noted the potential for “sexual trafficking” — meaning senior MSF officials had this information for roughly eleven months before it became public. The AP news agency, which first broke the investigation, is a journalistic body rather than a regulatory authority.
The structural problem in the humanitarian sector is well documented. A 2018 Oxfam Haiti scandal produced a wave of sector-wide reform commitments. The UN’s own internal oversight investigations have documented similar patterns in peacekeeping missions from the Central African Republic to the Democratic Republic of Congo. Each scandal produces a period of institutional soul-searching, reform pledges, and strengthened safeguarding language in donor contracts. And then, years later, another organisation in another conflict zone is reported to have done the same thing.
The reason this keeps happening is not, primarily, that individual aid workers are systematically predatory. It is that the structural conditions are consistently reproduced: extreme power differentials between staff and beneficiaries, beneficiaries dependent on access to aid for survival, limited external oversight in conflict zones, complaints mechanisms administered by the organisations being complained about, and a culture of institutional protectiveness that prioritises mission continuity over accountability. These conditions are as present in eastern Chad in 2024 as they were in Haiti in 2010.
The reform argument requires answering a question it rarely does: why should we expect the fifteenth round of internal safeguarding reforms to succeed where the previous fourteen did not? What has changed structurally? The answer, generally, is nothing fundamental. Aid organisations remain largely self-regulating on accountability. Donor governments impose conditions but rarely withdraw funding over safeguarding failures. Host governments in conflict zones lack the capacity or political will to enforce accountability. Beneficiaries lack legal standing and practical recourse. The accountability gap is not a bug; it is, in the absence of external enforcement, a structural feature.
None of this argues for defunding humanitarian operations in Sudan, where 28 million people face acute hunger in a war zone. It argues for something the sector has consistently resisted: genuine external accountability mechanisms — independent complaint bodies with investigative authority, mandatory reporting to donors with enforceable conditions, and credible whistleblower protection that does not depend on the goodwill of the organisation being whistleblown against.
What to watch
- Donor government response: Whether major humanitarian donors — the UK’s FCDO, USAID, the European Commission’s DG ECHO — attach enforceable independent accountability conditions to new MSF grants will determine whether this produces structural change or another cycle of institutional self-reform.
- Host country accountability: Whether Chad or international bodies pursue any criminal accountability for identified perpetrators — the 18 dismissed by MSF — matters for deterrence.
- Sector-wide review: Whether umbrella bodies like the Inter-Agency Standing Committee use this case to push for independent external complaint mechanisms, rather than strengthened internal ones, is the critical institutional question.
- Sudan crisis visibility: The broader crisis — 28 million facing acute hunger, 150,000 to 400,000 dead — risks being overshadowed by the accountability story. Watch whether Western governments increase humanitarian and diplomatic engagement with Sudan’s conflict, or allow it to remain the world’s most underfunded emergency.
— J