Four tests for WHO leadership on sexual exploitation, abuse, and harassment

The World Health Organization wants you to know it is cleaning up its act on sexual exploitation, abuse, and harassment (SEAH). This follows a long history of women being diminished and abused by men associated with WHO, and a recent exposé published in the Telegraph.1 WHO says it has been busy since an independent commission published its findings in 2021 on the organisation’s link to instances of sexual abuse and exploitation of women and girls during the response to the Ebola epidemic in the Democratic Republic of Congo (DRC) during 2018-2020. The results of that investigation noted serious institutional failings.2

WHO now has a lead focal point for SEAH, Gaya Gamhewage, and an online dashboard recording new SEAH cases and the outcomes of WHO investigation of these cases.3 WHO also reports that it has got through the backlog of old cases that were lingering in the system.

In response to another investigation, published in February 2023, that details extensive complaints of sexual abuse and harassment against a senior adviser to the organisation,1 WHO gave a press briefing. The briefing stated that as of January 2023 it has 340 focal points—individual points of contact for SEAH—in 127 countries, including 40 staff members working full time on the problem, and an institutional commitment to completing investigations of SEAH within 120 days of an allegation being submitted.4 Gone, we are told, is the confusing policy that had a massive loophole—that SEAH only counts as a problem for WHO if the victim is a direct beneficiary of their assistance.4 A new policy is on its way, WHO says.

For cases where perpetrators broke the law, WHO has an assistance fund to pay for legal aid for anyone who experienced SEAH.5 In 2022 there were 107 complaints against WHO staff and 75 investigations that resulted in three dismissals (one of these dismissals was a staff member who had already left the organisation). The perpetrators remained anonymous for legal reasons but their level of seniority is identified. Of the three dismissed male staff members one was of the highest ranking director level, the others were mid-career. All those subject to SEAH were more junior than them, with the director sexually harassing a female intern.3

Director General Tedros Adhanom Ghebreyesus has replaced his 2020 health security catchphrase “No one’s safe until everyone’s safe” with “Zero tolerance,”6 and Gamhewage wears a #NoExcuse pin on her chest.4 Those are a lot of promises. To show what zero tolerance and standing up for victims means in practice, WHO must navigate four tests.

The first will be its relief work in the aftermath of the 6 February earthquake in Turkey and Syria. This is the first humanitarian emergency since WHO implemented its new approach to SEAH. This is a big test because of the scale of the crisis, the expected role WHO will play there, and the short period of time the organisation has had for new expectations and mechanisms of zero tolerance to SEAH to take root. WHO has two part time focal points in Turkey and two part time and one full time focal point in Syria.5 These must be fully involved and integrated in the health cluster of the humanitarian response, and coordinate with their counterparts in other agencies across the system.

Secondly, WHO can only move on if senior leadership take genuine accountability for what happened, is happening, and what they know. Sorry is not enough. WHO maintains that Tedros acted in DRC as soon as he heard about allegations of sexual abuse and exploitation linked to WHO workers during the Ebola response efforts in the press in 2020 and immediately set up the independent commission.2 While the report of the Office of Internal Oversight Services published in January 2023 was confidential and has not been officially released, its findings, which have leaked, raises questions as to how early Tedros knew about the matter. If this is correct, why did Tedros not apply his zero tolerance approach earlier? This would raise concerns about institutional failings and failure of leadership.

Then there is the glaring loophole that only beneficiaries of WHO assistance can be subject to SEAH. Senior leadership reportedly warned about this back in 2018 before the scandal in DRC.7 Wrangling over who is considered a beneficiary or works for WHO and therefore whether they count as a victim reflects badly on WHO as it suggests SEAH is tolerated by the institution and that a hierarchy exists for who can be affected.7 WHO’s new Preventing and Responding to Sexual Exploitation, Abuse, and Harassment team, led by Gamhewage, is clear this loophole no longer applies.4 But it leaves questions about why the loophole existed in the first place, who among WHO leadership was advancing this stance, and if their position is tenable.

Thus far, no one on the WHO senior leadership team, executive board, or the director general have lost their job for what happened in DRC, the biggest SEAH case in UN history. It’s been reported that there were attempts to inform senior management multiple times but there are still denials that they knew anything until 2020. Ongoing questions over what senior management knew will harm WHO as trust, transparency, and accountability in senior management are fundamental for its new commitments and approach to be effective.

Thirdly, the backlash. If WHO is successful in its new approach to tackling SEAH then the number of reported cases will most likely rise and new crises will emerge. The harm and fallout for victims is incalculable. The names of perpetrators will often be leaked to the press. This will be difficult for staff at WHO as friends and colleagues come forward as victims and perpetrators, and if trusted leaders potentially know more than they admit. Those subject to SEAH may be retraumatised as their stories of exploitation are retold and recycled. Soon mutterings of “going too far,” “witch hunts,” and “understanding the cultural context” will begin. Backlash is an inevitable part of any advancement in gender equality and women’s rights. Navigating this backlash for WHO, and providing accountability for those who’ve been victimised, will depend on the organisation’s new policies and procedures being transparent and consistent, and maintaining the confidence of member states. Again, this will come down to the leadership.

Finally, the major test will be who comes forward, who is listened to, and who is subject to disciplinary action in the coming years. Immediate action and focus is important, but institutional change must be long term. Risks of SEAH will always exist in systems with hierarchies, and in crisis situations where there is a wealth and power disparity between providers and recipients of humanitarian healthcare. This is a fundamental problem in all global health activity that in many ways transcends WHO. Where there are power imbalances, this risk will never go away.

If WHO wants an end to SEAH institutionally it needs to get real about gender equality, end the culture of a “misogynistic pissing circle,”1 and show real leadership through total accountability. We need a cultural shift across global health, starting with WHO.