Insiders at Doctors Without Borders say Black and brown staffers get inferior medical care

• Doctors Without Borders, one of the world's most important global relief agencies, employs more than 60,000 around the world, almost all of them locals.
• In an Insider investigation in collaboration with the public radio broadcase "Reveal" has found a segregated medical system for staff members, with international workers receiving better access to life-saving care than locals.
• The group says it has a 'different level of responsibility' for the health and safety of international staffers than it does for locals.

Doctors Without Borders is perhaps the most famous of all international relief organizations. Known internationally by its French acronym, MSF, it has been around for nearly 50 years and employs 63,000 people from around the world. Many MSF staffers leave behind comfortable lives to tend to the sick and wounded in some of the world's most difficult settings. It is hard not to be moved by the public perception that MSF has cultivated of dashing young physicians spurning well-paying jobs in global capitals to save lives in conflict zones. MSF's tenacity helped it earn a Nobel Peace Prize in 1999 and grow into a $2 billion-a-year behemoth today.

But an Insider investigation in collaboration with the nonprofit radio show and podcast "Reveal," based on interviews with about 100 current and former staffers in nearly 30 countries and a review of thousands of pages of documents, has found that a segregated, two-tiered workplace is firmly ingrained within MSF. While a small number of international workers wield disproportionate decision-making power and enjoy plush benefits, local workers say they often feel like second-class citizens, without access to the same quality medical care, pay, and security that their international counterparts enjoy. And dozens of current and former employees say that people of color, regardless of their position within the organization, are treated unequally.

The differential treatment of local and foreign employees frequently extends - ironically, given MSF's mission - to medical care. Sources from Egypt to India describe a segregated medical system for MSF staff members, with expatriates receiving better access to life-saving care.

During the world's worst Ebola outbreak, which took place in West Africa from 2014 to 2016, national staffers in Sierra Leone were given approximately $16 a month to spend on medical care, barely enough to cover one simple doctor's visit. They also had access to a small staff clinic that was restricted in what it could provide - no fever or pain medicine, no physical checks - because of the high risk of infection. When national staffers contracted the disease, they were treated in the same clinic where they worked. Meanwhile, international staff members who contracted Ebola were airlifted to better hospitals - a common practice for all expatriates working for international organizations, including USAID and the World Health Organization.

"To me, it was actually demotivating," says Kennie Musa, a former MSF local staffer in Sierra Leone. While some of his Sierra Leonean colleagues died after being treated for Ebola at the MSF site, he says, an expatriate colleague was airlifted to Germany after being exposed. "The segregation was there clearly."

In a written statement, an MSF representative said the organization "is committed to providing the best possible care to its staff in the countries where we operate" but has a "different level of responsibility" for the health and safety of expatriate staffers "because we are contracting them for an assignment away from their home countries."

For many within MSF, the case of Dr. Sheik Humarr Khan, a legendary Sierra Leonean physician who led the fight against Ebola in his country, exemplifies the callous treatment of locals in West Africa. Though Khan did not work for MSF, he trained many of the organization's staffers and was one of the world's top doctors studying hemorrhagic fevers like Ebola. When Khan contracted Ebola in 2014, he was treated at an MSF center. Some of the organization's doctors wanted to give him a promising experimental treatment known as ZMapp, but the expatriates manning the site decided against it, saying it would be unfair to give Khan a treatment other Sierra Leoneans didn't have access to.

"There was an active decision of not offering an available and potentially effective treatment to Dr. Khan," says Nierle, the former president of MSF Switzerland. "It's an example of how you mess up clinical care by deciding on behalf of the patients, without appropriate information, without informed consent, just sacrificing them for a questionable reason."

Since Khan wasn't an employee, MSF never offered to medivac him to a better facility. By the time the World Health Organization offered to help, he was too ill; he died in the MSF treatment center in Sierra Leone.

Khan's brother, Alhajie Khan, notes that a few days after he died, two white American relief workers from another aid organization in nearby Liberia who had fallen ill with the virus were promptly treated with ZMapp and transported to the US. They survived.

In a written comment, an MSF representative described Khan's death as "a tragedy" and said the decision to administer "an untested drug" like ZMapp should not "be taken lightly - both for clinical and ethical reasons." At the time, MSF believed a "third party" would evacuate Khan to Europe, the statement said, where ZMapp could be administered with more supervision.