For decades, Doctors Without Borders has been admired for bringing desperately needed medical care to crises around the globe and pioneering modern-day humanitarian aid. It’s an organization with radical roots, promising to do whatever it takes to deliver life-saving care to people in need. But now, it’s struggling to address institutional racism.

The organization, also known by its French acronym MSF, has about 63,000 people working in 88 countries. While foreign doctors parachuting into crisis zones get most of the attention, 90 percent of the work is being done by local health workers. 

In the summer of 2020, more than 1,000 current and former staffers wrote a letter calling out institutional racism at MSF. They say that MSF operates a two-tiered tiered system that favors foreign doctors, or expat doctors, over local health workers. 

On the eve of MSF’s 50th anniversary, reporters Mara Kardas-Nelson, Ngozi Cole and Sean Campbell talked to about 100 current and former MSF workers to investigate how deep these issues run. We meet Dr. Indira Govender, a South African doctor who in 2011 accepted what she thought was her dream job with MSF in South Africa, only to get a front-row seat to the organization’s institutional racism. Even though she’s officially the second-in-command of her project, she says it feels like a select group of European expats and White South Africans are running the show.  

Then, Kardas-Nelson and Cole take us inside the inequities MSF staffers experienced during the 2014 Ebola outbreak in Sierra Leone. While expat doctors had their meals together and socialized, local health workers were left out. But inequities ran deeper. If expat doctors got sick, they would be evacuated out of the country, while local workers didn’t get that care – they were treated at the same center where they worked. Kardas-Nelson and Cole reported the story from Sierra Leone in the Spring of 2021 and spoke to former National MSF clinicians.

Finally, we talk about what can change in humanitarian aid. Govender is part of a group of current and former MSF workers called Decolonize MSF. While she and others are pushing the organization to commit to changes that address racial inequities, some are skeptical about what will actually change. 

This week’s episode was created in partnership with the global news site Insider.