How is MSF structured and what principles guide its work?

Updated

MSF (Médecins Sans Frontières, or Doctors Without Borders) is an international, independent medical humanitarian organisation. It provides medical assistance to people affected by conflict, epidemics, disasters, or exclusion from healthcare. Its work is guided by medical ethics and the principles of impartiality, independence, and neutrality. Teams are made up of tens of thousands of health professionals, logistic and administrative staff, and most of them are hired locally.

The three guiding principles

MSF states that its actions are guided by medical ethics and three principles:

  • Impartiality — assistance is based on need, not on nationality, race, religion, or political affiliation.
  • Independence — the organisation describes itself as independent, meaning its decisions are not tied to any political, economic, or religious power.
  • Neutrality — MSF does not take sides in armed conflicts or political disputes, so it can reach people on all sides.

These principles are what allow MSF to work in conflict zones, epidemic outbreaks, and disaster settings where access is otherwise difficult.

How the teams are structured

MSF's workforce is large and mixed in skills:

Staff type Role
Health professionals Doctors, nurses, surgeons, epidemiologists, mental health specialists
Logistic staff Water, sanitation, transport, construction, supply chains
Administrative staff Coordination, finance, human resources, communications

A key structural feature is local hiring: most staff are recruited in the country where the project operates. This shapes how MSF works — projects are staffed largely by people from the affected communities, supported by international staff who rotate in.

What this means in practice

The combination of principles and staffing has practical consequences:

  • Access depends on perceived neutrality. If MSF is seen as taking sides, its teams can be blocked from reaching patients.
  • Local hiring affects continuity. Because most staff are local, projects keep running even when international staff rotate out.
  • Medical ethics come first. MSF frames its decisions around patient care rather than political or institutional interests.

Scale of operations

MSF reports activity in more than 70 countries. Its International Activity Report 2025 lists figures including:

  • 17.1 million outpatient consultations
  • 3.6 million malaria cases treated
  • 1.8 million patients admitted
  • 72 countries

These numbers illustrate the scale of the organisation, but the structure behind them is consistent: independent teams, guided by medical ethics, working where people are affected by conflict, epidemics, disasters, or exclusion from healthcare.