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Dismantling structural racism in MSF Southern Africa

Reos Partners
July, 2023


Learn how Reos Partners supported Médecins Sans Frontières (MSF), or Doctors Without Borders, to dismantle structural racism in MSF Southern Africa.

Médecins Sans Frontières (MSF), or Doctors Without Borders, is an independent international medical humanitarian organisation that responds to the medical needs of people affected by conflict, disasters and epidemics and those excluded from healthcare.

MSF has experienced exponential growth and can now be found in more than 70 countries. MSF South Africa is located in Johannesburg, with an additional office in Cape Town. 

Like all European-founded international non-governmental organisations (INGOs), MSF is challenged to address colonial legacies that produce structural racism. 

The challenge

Despite several efforts to address racism within MSF, it continued to persist. In 2019, MSF Southern Africa (MSF SA) decided to respond to continued calls for transformation by embarking on a comprehensive process to address racism within the organisation. They called this initiative "Dismantling Structural Racism (DSR) in MSF Southern Africa".

These efforts to dismantle structural racism were pursued in the context of the global anti-racism movements and efforts that were heightened through the Black Lives Matter movement in 2020.

In the South African context where MSF SA is headquartered, the legacies of apartheid are still visible in tangible and intangible aspects of the society. South Africa remains one of the most unequal countries in the world, where race is a major determinant of socio-economic well-being. 

Our approach

MSF SA partnered with Reos to achieve this system change ambition. We supported MSF SA in unpacking some of the historical legacies of racism, how racism manifests as barriers to inclusion and belonging in MSF, and how to transform the organisational structures, policies, and cultures towards greater equity. 


The project was launched in early 2020 as a 3-phase project that culminated in an in-person workshop with 150 MSF staff and association members in November 2022.

Phase 1 focused on identifying structural barriers to inclusion in the organisation. The outcomes of Phase 1 provided a foundation for Phase 2 which focused on co-creating practical approaches that would help MSF SA dismantle structural racism. Phase 3 focused on strengthening these responses in a way that would ensure the continuity of the DSR efforts beyond this project’s life cycle. 

Phase 1: Learning and Accountability, Capacity Building and Accountability

This sensing phase focused on listening deeply to how people within the organisation perceived the situation of race and racism. During this phase, participants started identifying barriers to racial equity in MSF SA, the field, and the wider MSF movement. During this phase, the following activities were undertaken:

  • The development and dissemination of an initial survey for MSF SA staff
  • The collective development of a theory of change for the DSR process
  • Convening of 3 focus group sessions
  • Design and facilitation of 3 workshop sessions
  • Conceptualisation of a working definition of the terms that would be used throughout the process
  • Identification of 7 streams of work to be part of the DSR roadmap
Phase 2: Developing Practical Approaches

This phase focused on advancing the identified areas of intervention within MSF SA. The streams of work within the DSR roadmap that were identified at the end of Phase 1 created the opportunity for the development of 5 game changers that would move forward the DSR efforts. The 5 Gamechangers are the synthesis of the 7 workstreams and 63 recommendations of Phase 1.

The following 5 Gamechangers were identified:

  1. Ensuring mandatory participation in dismantling structural racism.
  2. Defusing white fragility.
  3. Instituting accountability mechanisms.
  4. Developing an anti-racism policy.
  5. Developing a leadership accelerator programme.

Phase 3: Strengthening Responses

In its third year of the project cycle, the DSR process had become largely facilitated by the MSF SA team with support from Reos facilitators. Phase 3 focused on ensuring that changes identified in phase 1 and 2 were deepened. This was done through supporting the institutionalisation of experimential interventions introduced in phase 2 and monitoring structural shifts in relationship to the accountability framework.

These activities included:

  • Launching the DSR unit, which would be an accountability and monitoring framework within MSF SA. It will support the areas of transformation identified in the DSR process.
  • Launching a Leadership Accelerator Program to address issues of career progression for black people and people of colour.
  • Facilitation of an in-person DSR workshop in November 2022. This was the first in-person workshop since the DSR process had launched. The objective of the day was to share and reflect on the process since its inception, launch the DSR Unit and the leadership accelerator program and also give room for people to unpack conversations on racism stimulated by a Dilemmas exercise and Open Space conversations.


The DSR efforts created opportunities for MSF SA to have a shared language to understand race and racism. This gave room for shared language on the identification of problems and opportunities associated with racism in MSF SA to ensure there is a shared language and communication. A glossary of terms was created for the organisation.

Through the DSR process, the voices of black people and people of colour were strengthened. People were empowered to share their experiences of racism and racial discrimination in the organisation.

Watch Dismantling Structural Racism: MSF Southern Africa



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