When Rosie James, a British medical doctor, publicly accused a senior WHO staff member of groping her at a WHO event in Berlin last October, the WHO Director General responded swiftly,  saying he was “sorry and horrified” and urged her to report the incident promptly to WHO’s Internal Oversight Services (IOS), which manages such complaints. 

I am so sorry and horrified to hear this and want you to know that @WHO has zero tolerance for sexual assault and we will do everything we can to help you. I truly hope you will report what happened to investigation@who.int. Please feel free to reach out directly to me. https://t.co/YMSWZ3z0H8

— Tedros Adhanom Ghebreyesus (@DrTedros) October 18, 2022

Dr Tedros Adhanom Ghebreyusus’s remarks were immediately followed by supportive comments from other senior WHO staff, including WHO’s then-Chief Scientist Soumya Swaminathan and Ren Mengui, then Assistant Director General of Universal Health Coverage.  

Five months later, however, James is still waiting for a decision on her case, the UK doctor told Health Policy Watch on Monday, March 27.

At February’s WHO Executive Board (EB) meeting, Tedros told member states that the global health agency had reformed its approach to sexual exploitation, abuse and harassment (SEAH), including a major initiative on prevention and the speedier processing of cases.  In early March, the organization also published an updated policy on preventing and addressing sexual misconduct.  

Systemic flaws in WHO’s internal justice process 

But as James’ case drags on, the question remains whether the agency has really tackled some of the more fundamental flaws in its internal justice system.

Despite the many steps WHO has taken, key, unresolved issues remain, according to seasoned WHO insiders, outside experts, member states, and people involved in cases, interviewed by Health Policy Watch over the past  month. These issues include:  

• A complex and slow-moving internal justice bureaucracy, which continues to make the pursuit of formal complaints intimidating despite recent overhaul efforts;
• Inexperienced investigators recruited by Geneva’s WHO headquarters on short-term consultancies without a Geneva post assignment for face-to-face interviews, health insurance, tax benefits or job security that regular WHO staff would typically enjoy; 
• Flaws in due process, with neither the accused nor accusers able to respond to the final investigation report produced by WHO’s Department of Internal Oversight Services (IOS) until a decision is already made on the case. That means that the DG’s decision to “charge” is based almost entirely on the IOS synthesis of the facts;  
• Lines of authority that leave the Director General as both the judge and the jury of the most serious investigations in a portfolio of hundreds of claims. 

The shortcomings in the process continue to demoralize staff, member states and complainants who had hoped that the bar of justice would be higher after nearly two years of revelations and reforms.

Exonerated on a legal loophole 

WHO’s internal justice system first burst onto the media stage following revelations in 2020  by The New Humanitarian that dozens of women in the Democratic Republic of Congo (DRC) has been sexually exploited, and even raped, by WHO and UN responders during the 2018-2020 Ebola outbreak, leaving behind a trail of victims, at least 20 of whom later bore children.  

A scathing report by a WHO-named Independent Commission released in September 2021 found major shortcomings in WHO’s processes of prevention, reporting and case management. It called for investigations against alleged perpetrators and managers “and disciplinary sanctions” for those found culpable. 

But more than two years after the first revelations, there have so far been no reports by WHO of disciplinary action against any staff – or of referrals to national authorities, particularly for cases involving consultants who are no longer employed by WHO.  

Then, in February, Tedros announced that three WHO managers implicated in the hush-up of several SEAH cases had been cleared of charges by the United Nations Office of Internal Oversight Services (UN OIOS), which had launched an independent investigation of those high-profile cases at WHO’s request. 

Speaking to the WHO EB, Tedros said that “the allegations of managerial misconduct against the three staff members identified by the Independent Commission were unsubstantiated.” 

Loopholes in WHO policies allowed exoneration of DRC managers  

The findings of the UN OIOS report, seen by Health Policy Watch, makes it clear that WHO managers who failed to report the DRC cases were cleared on the basis of a legal loophole in WHO’s policy in 2018-2020. 

In that period, WHO’s SEAH policies only applied to WHO staff or direct “beneficiaries” of WHO aid. So managers who learned about women in the “broader community”, enticed or coerced into sex, were not technically obligated to report them through the agency’s internal justice system, the UN report concluded. 

“At the time of the 10th Ebola response, WHO’s SEA policies were interpreted by WHO accountability stakeholders as being limited to victims who were beneficiaries of WHO assistance. The policies did not apply to SEA complaints brought by the broader community,” stated the final UN OIOS report. 

That shortcoming in WHO’s policies was brought to the WHO Director General’s attention already in February 2018 – in a memo co-signed by WHO’s legal counsel, the UN OIOS report further points out. But nothing was done about it then: 

“The current WHO Director-General….. was advised that the SEA policies were ambiguous as to whether they extended beyond beneficiaries of assistance, and that this created an institutional risk,” the report relates. 

“The memorandum recommended that the SEA policies be revised. Neither the Legal Counsel nor [name redacted] were aware of a response to the memorandum,” states the version of the report seen by Health Policy Watch, which redacted the names of WHO staff involved in the policy discussions, as well as those under investigation. 

Loophole closed years later

In 2021, WHO moved to close this loophole, a WHO spokesperson said in response to Health Policy Watch queries.  That update, aligning WHO with UN-wide policies on SEAH stated: “Where WHO has a mandate to serve the population at large, ‘beneficiaries of assistance’ should be broadly interpreted to cover the local population.”

Then a new WHO policy, published in early March, makes it more explicit.  WHO’s definition of “victims” was expanded to include “victims/ survivors of sexual exploitation, sexual abuse and any other forms of sexual violence or prohibited sexual behaviour may include staff members, collaborators of WHO, and members of the public in locations where WHO staff and/ or collaborators operate.”

In February, Tedros also revealed that WHO had set up a $2 million fund to help the victims. But to date, the most the victims had been offered was a one-time payment of $250, along with some limited medical support and training, stated an 8 March report by The New Humanitarian, which followed up on the fate of the victims five years later. And that, the women complained, was “too little, too late”.  

WHO Director General: more authority than ever in the process  

The DRC cases involving WHO staff have been the focus of an exceptional review by the UN’s OIOS, operating out of UN headquarters.   

For other complaints both of sexual and other forms of harassment, all roads still lead through WHO’s own internal apparatus – and to the Director General.  And that apparatus, critics say, still contains major flaws, as well as being a possible victim of some of Tedros’ recent reforms. 

Most notably,  WHO’s new head of investigations of sexual misconduct and other abusive conduct, Lisa McClennon, has been reporting directly to Tedros for over a year as per a special EB exception granted at Tedros’s request in January 2022.  

“During this period of suspension …. the Head, Investigations was made responsible for all investigations of allegations and complaints of sexual exploitation and abuse and abusive conduct and, while situated in
the Office of Internal Oversight Services, was granted the same reporting lines, namely directly to the Director-General, and the same authority as those granted to the Director of Internal Oversight Services,” states a report to the January 2023 EB session.

That means that WHO’s long-time Director of Internal Oversight Services (IOS), David Webb, a chartered accountant by training, has effectively been sidestepped.

While the aim, ostensibly, was to “fast-track investigations” of sexual exploitation and abusive conduct, including the processing of claims that had backlogged under Webb, it also means that the chief investigator responsible for IOS reports of findings, and subsequent recommendations, is also reporting directly to Tedros, who makes the final decision.  

And this creates an inherent conflict of interest by putting the DG in the position in which he could, in theory, tread more lightly on senior staff who he perceived as allies, according to some insiders.

In its February session, the EB endorsed for the third time, an extension of that special reporting arrangement until May 2023. The EB decision stated that the short-cut, instituted at the EB’s 150th session in January 2022, would remain in place “until the 153rd session of the Executive Board in May 2023.” 

Who will hold the reins of IOS following the director’s retirement?  

With Webb’s retirement imminent, the WHO’s search for a new IOS director actively underway, it remains to be seen if the traditional lines of authority whereby the IOS head of Investigations resumes reporting to the Director, IOS will be restored in May – or postponed once more.  

Meanwhile, however, what some describe as the ‘bifurcation’ of the WHO IOS system may have added to the pre-existing confusion in a system that critics say is a time-consuming maze. Given the many actors and players involved, it can be intimidating for anyone wishing to file a complaint. 

Speaking to the EB in February, Tedros said that SEAH complaints to WHO had increased substantially over the past year, reflecting increased confidence in the reforms put into place. 

However, WHO’s SEAH dashboard only provides information on cases opened and closed over the past year, rather than a year by year comparison.  Repeated requests to WHO for clarifications yield no comment.  What appears clear, however, is that there has been a steady upswing in SEAH cases filed over the past 12 months. 

Over most of the past year, more cases of SEAH, and other forms of abuse and harassment, have still been opened, as compared to closed –  leaving 403 open cases at the time of publication.

WHO Oversight Committee raised questions about shortcut to DG 

The current shortcut to the DG in reporting lines is not an arrangement with which independent observers of the WHO system are comfortable. 

As a WHO Independent Expert Oversight Advisory Committee (IEOAC) stated in April 2022:    “While such an arrangement is appropriate given the current circumstances, it may not be sustainable over the long term. A sharp, permanent division between SEAH [sexual exploitation, abuse and harassment] and other investigations risks overlaps and duplication of efforts and inefficiency in the use of investigatory resources.  

“More broadly, investigation, audit, and evaluation functions deliver the greatest collective value when they cooperate and share knowledge with each other while respecting their independence. 

“The Committee understands that WHO intends to maintain the current arrangement of splitting up investigation responsibilities until the end of 2022. The Committee recommends that WHO develop a plan for how it will manage SEAH investigations going forward.”

In his remarks to the EB this month, Tedros declared that WHO’s OIS organization had been revamped and that a “new organigram” for this all-important department was being implemented “in January 2023”. 

“The changes we have made have increased confidence and trust in our systems, as evidenced by tripling in the number of people coming forward with complaints from 166 in 2021 to 491 in 2022,” asserted Tedros to the EB. 

No further details of the department’s new structure, however, have been made publicly available. In a post-publication reply, WHO told Health Policy Watch that a new organigram would be published soon. 

As for the change in reporting lines, whereby the head of investigations reports directly to the DG, rather than to the Webb as director of IOS, WHO’s Chaib said, “David Webb has not been side-stepped. He retained his reporting lines and authorities over matters for which he was not recused. The reporting lines were granted by the EB and endorsed by the IOAC and the IEOAC as well as Member States, not by a WHO Secretariat decision.”  She added that both Webb and McClennon also report to the EB on “results of work undertaken” as well as to the DIrector General. 

Inexperienced investigators?

The qualifications of investigators is another issue that can draw out procedures, and even lead to faulty or slower decisions, according to other informed observers. 

A recent WHO advertisement  for consultants to work as IOS investigators  calls for candidates with “advanced degree in law, investigations, public administration, or related areas” and “five to 10 years of relevant experience in administrative investigations, some of which should include experience in an international organization.”

However, the monthly pay scale offered is between $7,000 and $9,000 with none of the health, pension, or social security benefits that WHO and other UN agencies provide regular staff with commensurate years of experience.  The consultants, moreover, are hired as “at home” contractors, meaning that they don’t regularly meet complainants face-to-face. 

While the salary scale might indeed be adequate to attract a certain talent pool hired remotely, hires from cities like Geneva, where the massive WHO headquarters is located, would have a comparatively low net pay due to the city’s high cost of living and social costs.  

“Some of the investigators come mainly from management backgrounds. Others are pretty young kids. They may lack both life experience as well as training in this very specialized field of human resources,” said one expert close to the IOS. 

“So they don’t even know how to put forth pertinent questions. If you see the reports, then you realize that they mainly investigate inculpatory facts (incriminating the accused), but fail to investigate exculpatory facts – in violation of their mandate. 

“And we don’t have enough investigators,” that source added. 

Speaking in response, WHO Spokesperson, Fadela Chaib said: “WHO has 18 investigators for misconduct investigations, the highest number for any UN agency. The team of investigators for SEA/SH investigations are experienced. They are a multi-disciplinary team experienced in trauma-informed, survivor-centered approaches to investigating sexual misconduct and other abusive conduct. They work full time on WHO investigative matters and have consistently done so for the previous 15 months. In their roles, they provide surge capacity for the investigative function and are not expected to establish careers with WHO. This is an interim measure while the new structure is being set up with long term contracts.

“The consultants hired as investigators were qualified in investigating misconduct, most have criminal investigation backgrounds, and had training in trauma-informed approaches. They come from a diverse range of countries, and cultures so as to better work with victims, survivors,  witnesses and alleged subjects of investigation. They set and have consistently met a benchmark of 120 days to complete sexual misconduct investigations.  And asyou know, you can be young but highly qualified for the task, or older and qualified.”

Litmus test of new policies?

Against those ongoing, internal issues, cases like James’ are being closely watched as a litmus test of WHO’s new policies. 

Can a charge of harassment by a young British doctor against a senior WHO official, about an event that reportedly occurred in the presence of witnesses, actually stick? 

After the initial posting about her experience at a WHO co-sponsored event in Berlin in October 2022, James initially expressed gratitude to WHO for the support she had received.

I am overwhelmed with all of your support, incl. from @WHO. Thank you from the bottom of my heart 🙏. Very grateful to everyone trying to make a systemic and cultural shift towards #ZeroTolerance around the world. Solidarity with those who have experienced similar. 🖤

— Dr Rosie James 🇨🇦🇬🇧🌎☮🩺 (@rosiejames96) October 18, 2022

By January, three months after filing a formal complaint, that sense of support had evaporated. 

“In my humble opinion, I definitely think the investigation is taking too long,” James told Health Policy Watch in mid-January.

WHO’s chief investigator, Lisa McClennon, meanwhile, denied allegations of foot-dragging.

“We are fast, we’re rigorous, we’re thorough. We take a contemporary and survivor-centric approach to the matters that are referred to us in this effort,” she said. “This increased effort and focus in increased resources towards this matter began over a year ago, and we have been able to clear up several cases that had perhaps languished in the past,” she told a press conference on 14 January.  “We are working these types of cases in real-time.” 

‘Frightening IOS process’

As of late March, James says she is still waiting for a decision on her case, now in its fifth month.

“I feel like I’ve opened a huge can of worms,” James told Health Policy Watch.  “I hope that no one else has to be subject to sexual harassment or abuse at WHO. And I stand in solidarity with those that have had to go through this frightening [IOS] process. 

“I am only doing it to protect others. Hopefully, we will begin to see some cultural and systemic change in WHO and other global health organizations.” 

Chaib, on behalf of WHO, says that the agency hopes to have a decision within the next month.

“WHO has set a benchmark of six months from the receipt of a complaint to the disciplinary action being taken if allegations are substantiated,” she said. “We hope to finish the process in the next month, but are committed to respecting due process for all parties.”

New WHO Advisory Board also packed by DG appointments 

In mid-February, James was informed that the IOS report on the investigation of her case was ready for review. According to the process, 3-5 members of WHO’s Global Advisory Committee on Formal Complaints of Abusive Conduct (GAC), review the IOS report, and based on that, make a recommendation to the DG on whether a ‘charge’ should be made. 

“They said I won’t have any access to that report, but it’s been submitted to the panel,” James said.  

“They gave me the names of the panellists and they said that I have five days to respond, to let them know if I have any objections to any of these panel members. I don’t know more than that,” she told Health Policy Watch.   

The panel of reviewers are drawn from a standing, 15-member “GAC Committee.” Five of its members are elected by staff. The other 10, including five senior staff, are appointed by the Director-General in consultation with WHO’s Regional Directors, according to the latest WHO policy, dated March 2021 but only made operational in January 2023.  

This means that the Director General’s appointees have the majority say in every decision taken.  

Nominally, the panel has 60 days to review the report by the investigator and then make a recommendation to the Director General, who has 30 days to render his ruling. 

And that person is, of course, Tedros. 

Lack of rebuttal process is another systemic flaw

The lack of an opportunity to review and respond to a WHO IOS report before it goes to the GAC is another flaw in the existing WHO system that hasn’t yet been repaired, experts familiar with the system assert. 

That holds true both for alleged victims as well as those accused of harassment or other forms of misbehavior. 

“Neither the accused nor the accuser can respond to the witness statements of the other side before the report goes to the GAC and the Director General takes the decision on whether or not to charge,” observed one expert source close to the WHO investigation processes. 

“So you [as the accuser or the accused] only know what you said. You don’t know what the other side said. Your right to be heard is not given and the GAC never sees the other side. The GAC regularly does not question too much what IOS is doing. They are not specialized in that field.” 

The GAC makes a judgment based on a single report

“Effectively, the GAC is forced to make a judgment, and give advice to the DG, based solely on the view of one person, the IOS investigator who wrote the report,” added the source. “They have not seen the other views. So how can they make a good judgment?” asked the source, who said that the investigative process in other UN organizations is more transparent.  

“Then, if the DG decides to charge the person, it gets even more perverse. 

“The accused and accuser finally receive the IOS report. It may be 80 pages, with hundreds more of documents with only eight days to reply to the notification of charge. You cannot do solid work in eight days.  

“The reply given by the administration [to the rebuttals] is normally not discussed in detail. You put in a detailed and substantiated 40 page reply, and receive a cursory 2-5 pages reply back. That’s also a violation of the right to be heard. Then the DG makes a final decision.”

WHO Global Board of Appeal: also controlled by Director-General’s Office

Following those steps, a staff member who feels that they have been wrongly charged and penalized may appeal the decision to a three-person panel of the WHO Global Board of Appeals (GBA), followed by the International Labour Organization’s Administrative Tribunal, which functions like the High Court of the UN system. But that process takes years, with judgment rendered long after the demotion or dismissal occurred.  

At a WHO Executive Board meeting in May 2022, WHO’s Staff Association proposed a remake of the GBA, whose members are appointed by a high-ranking official in the Director-General’s office, meaning that the GBA is more of an administrative rubber stamp than an independent body.  

“The panel of the Global Board of Appeal (GBA) should have five members,” stated the WHO Staff Association written statement. “A three-member panel – the current practice – is simply not reassuring staff that GBA deliberations are sufficiently robust. Furthermore, the staff representatives on each of the GBA panels should be selected by the respective staff association rather than selected by the GBA Chair or Deputy-Chair.”

Balancing the rights of victims and accused 

Throughout the process, balancing the rights of victims and alleged perpetrators remains a major institutional challenge. Victims may feel the need to raise their voices publicly to ensure that misdeeds aren’t just hushed up.  On the other hand, alleged perpetrators need to be granted a fair hearing over the facts that can have life-changing consequences.

James says she signed an undertaking of confidentiality to proceed with the IOS investigation when she initially reported the incident, so she has limited her public comments on the actual substance of her case since then. 

But months after her complaint was filed, the senior WHO official Dr Temo Waqanivalu was named by the Associated Press as the alleged perpetrator – in a report that uncovered similar accusations against him of misconduct during a 2017 WHO workshop in Japan – which top officials at the agency largely ignored. 

James has never publicly confirmed the identity of her alleged aggressor. But she confirms that a copy of a letter from Waqanivalu to WHO was shared with her by WHO’s IOS investigators asking for WHO to take action with respect to the media reports around his case and the reputational damage he faces.  

Election hopes – dashed? 

Prior to the incident in Berlin in October 2022, Waqanivalu was in the process of mounting a campaign for election as WHO’s next regional director in the Western Pacific Region. The former director, Takeshi Kasai, was recently dismissed from the post as a result of unrelated charges of harassment and racism.    

After being named publicly as the alleged perpetrator of the incident in Berlin as well as an earlier event in Japan, Fiji, Waqanivalu’s native country, protested the media treatment of harassment cases while WHO investigations are ongoing.

In the case of James’s complaint, there were witnesses to the incident that occurred at the World Health Summit, a public WHO event. That places the case squarely within the scope of the new WHO policy, which applies to “locations where WHO staff and/or collaborators operate.” 

But without reference to any particular case, the reputational damage that an investigation can do to both the alleged victim and perpetrator makes it all the more critical that the system be fair and transparent – with investigations processed professionally and efficiently –  and decisions made by impartial leadership, observers of the process underline.  

WHO rejects allegations of flaws in due process

Speaking post-publication, WHO rejected the suggestion that there remain significant flaws in the due process of internal justice claims.

“During the course of investigations, witnesses and subjects are interviewed. Subjects are provided an opportunity to respond to the allegations against them. The statements of the survivor and the subject are provided to the other for comment. The comments, where relevant, are incorporated into the investigative report. This approach is consistent with the practices of other UN investigative bodies,” said Chaib, on behalf of the agency.

“The final report is issued to the action official with copies to the Office of Legal Counsel and Human Resources and Talent Management (Human Resources, Policy, and Administration of Justice). Where required by policy, the action official forwards the report to the Global Advisory Committee [under the new policy, sexual misconduct no longer goes to the GAC]. The GAC reviews the investigation report and provides its recommendation to the Director-General/Regional Director concerning an appropriate course of action. Unlike audit reports, investigative reports, across the globe and within rigorous investigative bodies, do not receive final external comment prior to issuance.”

Investigations into the DR Congo SEAH cases have not led to a “dead-end” Chaib added. “They are being handled by UN OIOS and are ongoing.

With regards to the three WHO managers who were cleared of charges by the UNOIS, that process is still “ongoing” as well, and “WHO has sought the advice of the Independent Expert Oversight Advisory Committee (IEOAC) which reports to WHO’s Executive Board to weigh in on the differences in the findings of the UN OIOS report and the Independent Commission report.”

Overall, she says, “The new system, policy and reporting procedures have simplified reporting and have resulted in a unprecedented number of allegations being lodged with IOS. WHO rules are clear and accountability mechanisms are strong.”

Leadership from the top needed 

While WHO insists that most flaws in the IOS system have now been addressed, remarks by leading WHO member states both publicly at the recent EB meeting, and privately, suggest that at least some leading member states remain concerned – and hold that WHO still needs to demonstrate that it is walking the talk on needed reforms. 

Among other things, they say that stronger leadership from WHO’s senior leadership is still needed to pass the message to managers that they will be held responsible for bad behaviour amongst the people that they supervise.  

At the February EB meeting, the US delegate summed up some of the feelings among delegates in the room.

“Media reports indicating that at least one individual working in WHO recently alleged to have engaged in misconduct, and having had a record of prior accusations, really need to be addressed by WHO,” said Loyce Pace, US Assistant Secretary of State for Global Public Affairs, in what was understood by those in the room as a clear reference James’s case. 

“It’s important to many of us who have faced this personally, in our experience working in the global health and development space, and not just in terms of earlier in our careers, but even now, as seasoned global health professionals,” added Pace.

“There are many of us who stand with survivors and stand with those who identify as victims and are truly committed, but also frustrated, by where things have stood to date, and hope that we can all come together to do right by people like me, who have these stories to tell,” said Pace.

“I was really touched by the USA statement,” said James, as she waits for word about the outcome of her complaint to emerge from the WHO internal justice labyrinth.

-Updated with responses from a World Health Organization spokesperson to the issues raised, on 2 April, 2023

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