on the street and even operate on some of them there. the gutters around the hospital ran red with blood. the woman had not just been attacked with a machete, but her entire body rationally and systematically mutilated. her ears had been cut off. and her face had been so carefully disfigured that a pattern was obvious in the slashes. she was one among many—living an inhuman and simply indescribable suffering. we could do little more for her at the moment than stop the bleeding with a few necessary sutures. we were completely overwhelmed, and she knew that there were so many others. she said to me in the clearest voice i have ever heard, 'allez, allez...ummera, ummerasha'—'go, go...my friend, find and let live your courage.' — james orbinski, nobel acceptance speech for msf orbinski affirmed the organisation's commitment to publicising the issues msf encountered, stating silence has long been confused with neutrality, and has been presented as a necessary condition for humanitarian action. from its beginning, msf was created in opposition to this assumption. we are not sure that words can always save lives, but we know that silence can certainly kill. — james orbinski other awards 2015 lasker-bloomberg public service award, from the new york based lasker foundation. 2016 hamdan award for volunteers in humanitarian medical services, from hamdan medical award. namesakes a number of other unrelated non-governmental organisations have adopted names ending in "sans frontières" or "without borders", inspired by médecins sans frontières, for example: engineers without borders, avocats sans frontières ('lawyers without borders'), reporters sans frontières ('reporters without borders'), payasos sin fronteras ('clowns without borders'), bibliothèques sans frontières ('libraries without borders'), and homeopaths without borders. the french game show jeux sans frontières ('games without frontiers') is older than msf, being first broadcast in europe in 1965. ethical concerns and criticism questions about the ethical treatment of msf staff, clients and communities by msf as a result of some of its policies and practices have arisen, with issues being canvassed by employees, others in the development sector, and the media. msf has maintained separate employment conditions and pay for its "national staff" (those employed locally for field missions) and its "international staff" (those deployed from regional or national units to field missions in other countries). the international staff tend to hold the senior posts on a mission, with the national staff most often reporting to the senior staff who have come from elsewhere. there are ongoing complaints from national staff that they are treated less favourably, employed on more dangerous tasks, paid considerably less, and are without access to benefits of housing, health care, and other advantages afforded incoming expatriate staff. msf stated in 2020 that this policy would be reviewed with the intent to eliminate differential treatment. these practices, amongst other concerns, were the catalyst for a 2020 statement by 1,000 of its current and former employees outlining their concerns regarding the organisation's perceived structural racism. included in the collective staff statement was testimony of personal experiences of racism within msf, both in the form of adverse treatment in the workplace, and what is perceived as a white supremacist and colonial mindset expressed in the formation and implementation of programmes. while msf hires ninety percent of its staff for missions "in-country", the organisation continues to have a preponderance of europeans in its higher management. despite the percentage of its international programme coordinators originating from the global south rising from 24 percent to 46 percent over the decade 2012−2022, the international president christos christou acknowledged that the highest echelons of msf were still dominated by those from the global north. with its headquarters and five operational units located in western europe, msf's policies and operations were characterised in the 2020 msf-staff statement as "eurocentric". in 2018, there were revelations of sexual misconduct by msf employees, including sexual harassment and abuse of patients, local community members or other msf staff. nineteen people were fired as a result of msf's investigations of complaints. the complaints ranged from sexual harassment by msf colleagues; exploitation of local (and possibly underage or solely "survival sex") sex workers by field staff, against msf policy; and disparaging attitudes and remarks from staff regarding the supposed sexual availability of patients or community members, or an expressed intent to barter medical treatment for sex. nearly all the resulting dismissals related to inter-staff sexual misconduct. another controversy involved images taken without informed consent of vulnerable patients, some of whom were minors without adult guardians. some images were criticised as exploitative and objectifying. they included a photograph of a mother mourning the death of her baby, with the boy's body visible; child rape survivors and sexual and domestic abuse survivors, with details of their experiences included. intended to increase awareness of dire conditions prevailing in places where msf works and the need for their programmes, the images were used on msf and community websites and in print publications. licensing of the images were available for sale to image databases. the ethics of exposing devastated or victimised individuals, sometimes with partially identifying information was questioned. following the criticism, msf decided to cease use of the images. the removal of the images was in turn also criticised. msf's funding model has come under scrutiny after blackrock donated $500,000 towards its covid-19 crisis fund, leading to calls of hypocrisy from staff and other humanitarian organisations. selected non-fiction works about msf hope in hell, 2006 book by dan bortolotti brown, damien (2013). band-aid for a broken leg: being a doctor with no borders (and other ways to stay single). sydney: allen & unwin. isbn 978-1743315569. a doctor's memoir of his first msf posting on the medical frontlines in angola, mozambique, and south sudan the photographer: into war-torn afghanistan with doctors without borders, graphic 'novel' (a memoir in graphic-novel format) by guibert, emmanuel (2009); photography and narration by didier lefèvre; colourist: frédéric lemercier. new york: first second books. isbn 978-1596433755 living in emergency: stories of doctors without borders, 2008 documentary film by mark n. hopkins that tells the story of four msf volunteer doctors confronting the challenges of medical work in war-torn areas of liberia and congo six months in sudan, 2009 memoir by doctor james maskalyk an imperfect offering, 2008 memoir by former msf president james orbinski triage: dr. james orbinski's humanitarian dilemma 2007 documentary