A special strategic meeting at the 74th World Health Assembly on Friday discussed how the World Health Organization (WHO) is scaling up powers to investigate sexual exploitation, abuse and harassment in emergency situations. WHO officials said this effort involves a “mass of inspectors” to prioritise investigations in at least eight countries.

The intervention comes in the wake of a sex-for-jobs scandal in the Democratic Republic of Congo (DRC), where dozens of workers alleged abuse by WHO employees during the 2018-2020 Ebola outbreak. One nursing assistant had charged that a WHO doctor offered her a double salary in exchange for sex, one of multiple misconduct cases WHO allegedly knew about but failed to act on.

The scandal spurred at least 53 countries to voice concern about how the agency handles sexual abuse and exploitation. Although the World Health Assembly, WHO’s highest decision-making body, hasn’t devoted a specific agenda item to the alleged DRC misconduct, Friday’s roundtable session discussed how to prevent sexual abuse.

Senior WHO management, including WHO Health Emergencies Programme Executive Director, Mike Ryan,  Assistant Director-General for Emergency Response,  Ibrahima Soce Fall, and Gaya Gamhewage, Head of Learning and Capacity Development, admitted some failures in the organisation’s efforts against sexual exploitation and abuse.

Ryan said the sex scandals had forced WHO to do a self-assessment: “You sometimes see something in the mirror you don’t want to see. It’s being able to look in that mirror, and accept that what you see is not really up to scratch… and then promising to get better.”

Addressing donors and member states, he said that “In many ways, we’re all to blame for what happens in these situations, and we all need to commit to making it better.”

Fall said, “We are looking at what has to be done [dealing with sexual exploitation and abuse]. This is a colossal job which requires a lot of work on our part, but also on the part of our partners.”

The DRC, Ethiopia, Afghanistan, Somalia, South Sudan, Sudan, Venezuela and Yemen are the first target countries where inspectors will be deployed. Fall said this service eventually will cover all 30 countries with ongoing WHO operations: “The objective is to protect vulnerable populations and save lives. We obviously cannot tolerate in any way whatsoever, ever, any kind of abuse, including sexual abuse.”

In addition to the inspectorate, WHO also set up a working group to identify priority policies, including strengthening training modules for staff, “people on the ground” and management. The new module will contain an entire section on sexual abuse and exploitation, Fall said.

Ryan said the alleged DRC scandal “deeply impacted” staff, though the investigation has not been finalised. He said WHO, its member states and partners should “commit ever more fiercely” to the Latin injunction to Primum non nocere (do no harm).  

Following the strategic lunchtime meeting, WHO Director-General Tedros Adhanom Ghebreyesus later told delegates at the main session of the WHA  that an independent commission was set up in Goma in March and that WHO had hired an investigative firm that began field investigations in early May. The independent investigation should issue findings by the end of August.

Dr Tedros said abusive behaviour was “totally incompatible with WHO’s mission” and  “undermine trust in WHO and threaten the critical work we are doing”.

During the WHA session, Leslie Norton, Canada’s ambassador to the United Nations. in Geneva, read out a statement on behalf of 53 countries, including the United States, Japan and European Union members, urging the WHO to speed up the investigation and provide an update in June.

Prevent  and Respond to Sexual Abuse Cases

Senior WHO management addressing the lunchtime briefing agreed on the need to “prevent things going wrong in the first place”.

“Prevention must be the foundation on which we build any decent protective system. Prevention  means abuse avoided, trust and dignity maintained and lives improved through better health, said Catharina Boehme, WHO’s Chef De Cabinet.

Gamhewage said WHO staff were “outraged” by the latest allegations, so the session was held to focus on practical actions being taken to address the complex issue.

Stella Chungong, WHO health emergencies country preparedness director, said WHO was working on an holistic approach to achieve a transformed gender agenda by working on inequities that contribute to abuse. “But we’re also looking inwards, identifying ways in which our internal culture and systems can promote gender equality, respect, and an environment where abuse in any form is not tolerated.”

WHO also identified potential barriers to equal female leadership and decision-making positions within programmes, she said. “All of this in the medium and longer term will help make WHO more accountable for implementing concrete and evidence-based actions for prevention of sexual abuse and exploitation.” 

Hotlines and Training Help Raise Awareness

WHO frontline workers from Ukraine, Guinea, Bangladesh and Libya shared various measures to prevent and deal with sexual exploitation and abuse in their work.

 In Ukraine, of 3.4 million people needing humanitarian assistance, 1.8 million are women in highly vulnerable situations. Israel Gestoso, who works as a WHO sexual exploitation and abuse focal point there, said economic desperation and consequences of conflict situations increase sexual exploitation risks.

“The most vulnerable groups are women and children,” Gestoso said. “Families whose family members died or were injured in the tragic events, in particular with women who now became the only providers for the family.”

Gestoso detailed training and awareness programmes for staff and consultants that include online training before employment, one-on-one induction sessions and monthly meetings. “There is a very shallow perception of sexual exploitation and abuse, and we have achieved to break that translucent glass, and be open to discuss, share, and understand the complexity of sexual exploitation and abuse,” he said.

WHO representative Marius Jones said Guinea has trained 326 staff how to prevent sexual exploitation and abuse and how to manage clinical cases. Other activities include setting up a hotline to report abuse, distributing multilingual education materials and engaging with communities through organisations and platforms.

Dr Elizabeth Hall said Libya is also setting up a dedicated hotline and community-based systems to report sexual abuse.

UK: “Very Good Chance That Victims Will Be Listened To”

🇨🇦 was pleased to join 53 countries + EU in calling on @WHO to strengthen approaches to preventing + addressing sexual exploitation, abuse +harassment. We welcome the DG’s commitment to this issue, including via institutional culture change + a survivor centered approach. #WHA74 pic.twitter.com/mlbj6VMSvB

— Canada in Geneva 🍁 (@CanadaGeneva) May 28, 2021

A delegate from the United Kingdom called for transparent monitoring and case-number reporting of allegations and investigations. This will demonstrate to survivors that if they are courageous enough to report incidents, there is a “very good chance that they will be listened to and action will be taken”.

In response to allegations of slow WHO response to the DRC scandal, the delegate said: “[This] is why it’s so important that the WHO and member states are crystal clear that we have zero tolerance for PSCA, that we listen to survivors, and that we act promptly and transparently to respond to their allegations.”