Duty of care and health worker protections in the age of Ebola: lessons from Médecins Sans Frontières

McDiarmid, Melissa; Crestani, Rosa

Compared with other responding teams, MSF-deployed staff had significant experience in Ebola response and safety practices leading into 2014. Another specific difference, considering their lower staff infection rate, may be the agency's 'duty of care'. The BMJ Global Health concept of duty of care has roots in both ethics and the law and is generally defined as an obligation to conform to certain standards of conduct for the protection of others against an unreasonable risk of harm. 8 The duty of care principle appears in professional codes of ethics for health workers to provide care for their patients, including obligations to populations during pandemics. 9 After the severe acute respiratory syndrome epidemic and the notable loss of life among health workers, several authors raised the ethical need to consider the added risk workers assumed. They suggested that employers have a reciprocal obligation to their employees, which in some settings has become legally binding, to provide the needed training, organisation and protective equipment to make hazardous work as safe as possible. 10 11 Given their mission to respond to humanitarian emergencies, MSF is well aware of the out-sized safety and security risks that threaten health workers. Thus, duty of care as a policy, having evolved over time, was formalised in 2004. The policy committed the agency to operate under the obligation to protect its staff. 12 As was observed during the Ebola outbreak, an imbalance in this reciprocity endured more broadly, where employers in both limited income and well-resourced countries failed to take commensurate protective actions against the risks workers were expected to shoulder.