• 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 broadcast "Reveal" has found that Black and brown local workers say they are paid less than their visiting colleagues.
• Doctors Without Borders has apologized for "racism and discrimination" and says it is working to change its policies.
• Visit Insider's homepage for more stories.

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 promotions 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.

While local staffers account for more than 90% of MSF's workforce, they receive only a fraction of the pay and benefits of their international counterparts. Even local doctors performing nearly the exact same tasks as foreign doctors earn a smaller salary, and have more limited benefits.

In the field, international staffers are sometimes treated like visiting royalty who must be shielded from the depredations of life in the developing world, whereas their locally employed colleagues are expected to simply endure them. International staffers are paid considerably higher salaries – overall, according to the organization's most recent financial report, the average cost of an international staff member in 2020 was nearly six times that of the average local worker.

International staffers also receive a per diem, housing, travel, and in-country transportation, sometimes with a driver. In some projects, international staff members are housed in some of the most exclusive neighborhoods in capital cities, with in-house cooks and cleaners. Several international staffers said they lived better in the field than they ever did at home.

"It's just so amazing that we allow people to live in some form of misery while others live in some form of luxury which they would never have in Europe or back home," says Thomas Nierle, who worked with the organization over a nearly two-decade span and is the former president of MSF Switzerland.

There are also pay disparities within the international staff. While all expats receive a base salary benchmarked to the French labor market and determined by their qualifications, some who come from higher-income countries are eligible for additional money. An MSF representative said this was out of recognition that some international staffers on short-term assignments might have long-term financial commitments back home: mortgages, taxes, things like that. Since Switzerland is more expensive than Congo, for instance, a Swiss expatriate would receive more compensation than a Congolese expatriate - even though they're doing the same job, in the same place.

MSF says it has acknowledged its past and current flaws and is taking strides to increase diversity and fairness in the way it treats its staff around the world. "We are deeply sorry for the pain that racism and discrimination within MSF has caused our colleagues," a representative said in a statement, adding that "reform efforts have not moved as quickly as necessary. However, we are making progress. Over the past several years MSF has begun to confront hard truths about how racism and colonialism are embedded within the organization, and how this affects our colleagues and patients."

Read our full investigation into racism and mistreatment of workers within Doctors Without Borders.