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2023-12-31-accounts

MEDECINS SANS FRONTIERES (UK)

Report of the Trustees 2023

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Photo: MSF/Skye McKee
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Médecins Sans Frontières UK Annual Report and Accounts 2023

MEDECINS SANS FRONTIERES (UK)

Report of the Trustees 2023

FOR THE YEAR ENDED 31 DECEMBER 2023

Company limited by guarantee Company number 02853011 Charity number 1026588

Nurse Regina Abuk Thor examines two days old Amel Akoi Garang. The mother Catherina Peter Eduat holdes the baby in her arms. MSF runs the maternity unit in Aweil State Hospital in Northern Bahr el Ghazal, South Sudan. Photo: Oliver Barth/MSF

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Contents

1Reference and administrative details
5
2MSF UK’s medical humanitarian work in 2023
6
3How we support MSF’s medical humanitarian work
12
4MSF UK's 2023performance
18
5MSF UK’splans for 2024
31
6For thepublic beneft
38
7Principal risks and uncertainties
41
8Structure, governance and management
45
9Financial review
50
10Statement of trustees’ responsibilities
54
11Independent Auditor’s Report to Members and Trustees of Médecins Sans Frontières(UK)
56
12Financial statements
62
13Appendices
81

Details of registration

Médecins Sans Frontières (UK) was set up in September 1993 as a registered charity (charity number 1026588) and a company limited by guarantee (company number 02853011). The registered and principal office is Chancery Exchange, 10 Furnival Street, London EC4A 1AB, UK.

Phone: +44 (0)20 7404 6600

Website: www.msf.org.uk

Full contact details, including email addresses, are available at www.msf.org.uk/contact-us

Our names

The name of the charity is Médecins Sans Frontières (UK). This is commonly abbreviated to MSF UK. We are a member of the Médecins Sans Frontières movement, commonly referred to as MSF. Throughout this report, MSF UK is used when referring to the services and activities conducted and provided in the UK. MSF is used when referring to the whole movement and to our medical humanitarian projects. We are also known internationally as Doctors Without Borders.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

19-year-old Naqiba leaves the MSF-supported Band-e-Amir community health facility after receiving a postnatal consultation. MSF opened Band-e-Amir community health facility in late December 2022. The facility offers antenatal care (ANC), postnatal care (PNC), delivery and maternal care, under-5 paediatric consultations, malnutrition monitoring and referrals of complicated cases. Photo: Nava Jamshidi

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Médecins Sans Frontières UK Annual Report and Accounts 2023

1 Reference and administrative details

Directors and trustees

The directors of the Charitable Company (‘the charity’) are its trustees for the purpose of charity law. The trustees and officers serving during the year up to the date of this report were as follows:

Elected trustees

Nicola McLean – Chair of the Board of Trustees

Rachael Mary Craven – Vice-chair of the Board of Trustees (Vice-chair from 20 May 2023) Christopher Peskett

Vita Sanderson

Samuel Turner (until 20 May 2023) Robert Verrecchia Mohammed Tariq Ali Innocent Muleya Iesha Singh (from 20 May 2023)

Co-opted trustees

Eve Esther Bruce

Sophie Roberta Hodder

Derek Morgan – Treasurer, Vice-chair of the Board of Trustees (Treasurer until 7 June 2023, Vice-chair until 20 May 2023, Trustee until 30 September 2023) Timothy Symington – Treasurer (from 7 June 2023) Emery Igiraneza Jehangir Ghandhi (from 20 May 2023)

MSF UK Committee of Directors

Natalie Roberts – Executive Director

Kristen Veblen McArthur – Deputy Executive Director and Company Secretary Donald Campbell – Director of Communications

Chris Young – Director of Finance and Services

Elizabeth Harding – Director of the Humanitarian Advocacy Analysis Representation and Policy Unit (HAARP) and Humanitarian Representative (until 31 March 2023)

Ahsan Hafeez Abbasi – Director of the Humanitarian Advocacy Analysis Representation and Policy Unit (HAARP) and Humanitarian Representative (from 1 April 2023) Roland Imi – Director of Information Technology James Kliffen – Director of Fundraising Chiara Lepora – Director of the Manson Unit James Ewing – Acting Head of Executive Office (until 31 August 2023) Simone Vale – Director of Human Resources (until 21 April 2023) Patrick McConnell – Acting Director of Human Resources (from 10 July 2023)

Principal advisors

Auditors: BDO LLP, 2 City Place, Beehive Ring Road, Gatwick, West Sussex RH6 0PA Bankers: Bank of Scotland, 38 Threadneedle Street, London EC2P 2EH

Solicitors: Bates Wells & Braithwaite London LLP, 10 Queen Street Place, London EC4R 1BE

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Médecins Sans Frontières UK Annual Report and Accounts 2023

2 MSF UK’s medical humanitarian work in 2023

Médecins Sans Frontières (UK) (MSF UK) raises money and recruits staff to support the work of MSF’s medical humanitarian projects around the world. MSF UK also raises public and political awareness of MSF’s work within the UK, and provides strategic and technical support to MSF’s projects.

In 2023, MSF’s projects provided lifesaving care in more than 70 countries. The work of MSF UK and the generosity of its supporters ensure that MSF can continue to provide medical care where it is needed most.

MSF’s response in emergency situations and long-term protracted crises

MSF’s projects are designed to meet both the immediate and long-term medical humanitarian needs of those who are most vulnerable. Every situation we work in is different and our responses are tailored to the particular needs in each location.

MSF acts swiftly to understand the needs of people caught up in emergencies and unfolding crises, including armed conflicts, fast-spreading epidemics and natural disasters, to gauge and act upon how we can relieve their immediate suffering.

In protracted crises, MSF’s responses may be broader in scope and designed around longerterm projects, adapting our services as required to reflect the needs of the people and communities we are assisting.

Whether in emergency situations or protracted crises, it is our locally hired colleagues who provide the majority of care to the people MSF assists and who work tirelessly for their communities.

In 2023, the country programmes that received the largest grants from MSF UK were Mozambique (£10.9 million), Zimbabwe (£3.5 million), Ethiopia (£3.2 million) and Democratic Republic of Congo (£3 million). MSF UK also contributed grants to the Emergency Fund (£3.7 million), to support MSF’s emergency responses. We have highlighted some of MSF’s activities in these programmes in 2023 immediately below and throughout this report.

More information on MSF UK’s activities can be found at www.msf.org.uk .

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Mozambique

MSF has been present in Mozambique since 1984. For nearly four decades, MSF has been providing life-saving assistance during situations of conflict, epidemics and extreme climate events.

In Cabo Delgado, we have been responding to the growing humanitarian crisis and increasing humanitarian needs since 2019, particularly in hard-to-reach areas that receive limited or no assistance. By the end of 2023, there were over one million people in urgent need of humanitarian assistance, of which close to 630,000 remain displaced and over 540,000 returned to their villages. Our activities include primary healthcare services; mental health and psychosocial support; distribution of relief items; health promotion; and water, hygiene and sanitation. In 2023, MSF was present in the districts of Macomia, Mocimboa da Praia, Mueda, Muidumbe, Nangade, and Palma. MSF is working in existing health centres, conducts regular mobile clinics, and is also assisting with the rehabilitation of health facilities destroyed during the conflict.

In Beira, Sofala Province, MSF is providing sexual and reproductive healthcare, including termination of pregnancy, support and services for sexual and gender-based violence (SGBV), and HIV testing and treatment, to vulnerable and stigmatised groups. We also provide care for patients with advanced HIV at Beira Central Hospital and mentoring on national guidelines for key populations, including sexual and reproductive health (SRH) and advanced HIV diseases (AHD) in ten health centres.

In Nampula, MSF is providing support in preventive and curative care for vector-borne diseases, neglected tropical diseases, and surveillance and preparedness for emergencies such as cholera and natural disasters.

Mothers and children wait in the paediatric triage area at MSF’s Clinic in Nanga, Macomia, Cabo Delgado. Out of seven health posts in Macomia District functioning before the conflict, only one is working, as the other six were destroyed by armed groups. MSF runs three clinics in Macomia, Nanga being one of them. Photo: MSF/Martim Gray Pereira

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Zimbabwe

The economic situation in Zimbabwe has continued to decline, with very little funds available for public health and social services. As a result, the healthcare system has faced challenges including shortages of supplies and essential medicines.

MSF has run projects in partnership with the Ministry of Health and Child Care (MoHCC), including treatment for people living with HIV, healthcare for people on the move, sexual and reproductive health, environmental health services, and emergency response.

In Beitbridge, under a health programme for migrants, our teams offered medical assistance to migrants and deportees with specific medical needs. At the same time, in Tongogara Refugee Camp, we provided refugees and asylum seekers with mental health care.

In urban districts of Mbare and Epworth, our staff have run comprehensive sexual and reproductive healthcare services for adolescents, while also supporting the response to waterborne disease outbreaks, such as cholera and typhoid.

MSF teams supported the MoHCC in response to health emergencies like cholera and measles outbreaks in urban and rural areas of Zimbabwe.

MSF Cholera response team setting up a water bladder at Krukru Farm in Chegutu. Zimbabwe received its first cholera case in February 2023, which spontaneously spread across the country’s 10 provinces. Medecins Sans Frontieres (MSF) teams supported the Ministry of Health (MoHCC) cholera response in Chegutu, Beitbridge and Harare. Photo: MSF

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Ethiopia

In Ethiopia, in the fallout of the Tigray Conflict, MSF teams have worked in coordination with the Ministry of Health to meet the needs of local communities as well as of refugees, returnees and displaced people. In 2023, our teams delivered vital support in eight regions across the country.

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Mobile clinic in the South Omo zone, Ethiopia. Photo:MSF/Julien Dewarichet
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Médecins Sans Frontières UK Annual Report and Accounts 2023

Democratic Republic of Congo

The Democratic Republic of Congo (DRC) is home to some of MSF’s largest projects worldwide. In 2023, we responded to the devastating effects of violence – particularly in the east of the country – and to other healthcare emergencies, including malnutrition and outbreaks of infectious diseases such as measles.

In 2023, our main projects in the east were where communities have faced a huge humanitarian emergency that stretched across the three provinces of North Kivu, South Kivu and Ituri. Here, repeated clashes between armed groups have driven millions from their homes in an unprecedented displacement crisis. As of the end of October 2023, the DRC was home to 6.9 million displaced people, of which 5.6 million are in the east – this is the highest number of internally displaced people on the African continent.

In the middle of this, MSF teams responding in the eastern provinces saw 15,000 cases of cholera, 41,000 cases of measles and over 18,000 incidents of sexual violence.

Elsewhere across the DRC, people have little access to healthcare, with many communities being remote and rural. This means that there is poor surveillance and infrastructure to tackle disease outbreaks.

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Leontine Ntabanga (L) is 24-year-old. She comes from Kitchanga and has been displaced in Rusayo camp since April 2023. Prior to the clashes in her
hometown, she was studying to become a nurse. Samuel Mugabo (R) is a 25-year-old nurse who recently fled from the Masisi territory. Photo: Michel
Lunanga/MSF
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Médecins Sans Frontières UK Annual Report and Accounts 2023

Emergency Fund

In 2023, MSF UK contributed £3.7 million to the emergency fund.

This is a funding mechanism that allows us to react quickly in emergencies, with the aim of being on the ground within 48 hours.

At MSF, we plan and budget for our ongoing humanitarian work. However, we know that there will be new conflicts, natural disasters, and major epidemics that we are unable to predict.

With more than 50 years of working in emergencies, we can use this knowledge to budget for our emergency fund, which our Emergency Desks can utilise immediately when a situation arises, without waiting for the first donations to arrive. Multiple MSF sections contribute to the fund, which is managed by MSF Operational Centre Amsterdam.

In 2023, this meant that we had the resources and expertise ready to launch a rapid response to emergencies, including: the conflict in Sudan, Cyclone Mocha in Myanmar, the Pakistan floods, a measles outbreak in Chad, a cholera epidemic in Haiti, the conflict in Ethiopia and the displaced population crisis in the Democratic Republic of Congo.

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Tigray - Sheraro Project, Mobile Clinic in Zeban Gadena Health Center. Photo: Nicholas Tessier/MSF
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Médecins Sans Frontières UK Annual Report and Accounts 2023

How we support MSF’s 3 medical humanitarian work

Each MSF office, including MSF UK, plays a part in providing staff, resources and funding to the MSF operational centres so that they can maintain MSF’s projects and ensure that we are working where we are needed most.

People

In 2023, MSF UK deployed 124 UK staff to medical humanitarian projects in 38 different countries around the world. After screening hundreds of applications, we interviewed 65 potential internationally mobile staff (IMS), and added 48 new recruits to our pools of potential new staff.

At a time when operational centres are consolidating operations and making progress in diversifying the staffing of international projects, we have experienced a slight reduction (10%) in the number of departures compared with previous years; however, the impact of our work is measured beyond the number of internationally mobile staff we deploy, by looking at the operational needs to which we have responded.

In 2023, our staff joined emergency responses in countries affected by conflict or natural disasters, including Chad, Haiti, Türkiye, Occupied Palestinian Territories, Sudan, Ukraine, and Yemen, and provided medical care and support to health services in other crisis-hit countries, including Central African Republic, Ethiopia and South Sudan.

The short-notice availability and willingness to respond rapidly to emergencies has led to numerous deployments to emergencies including in Occupied Palestinian Territories and Sudan. Furthermore, we successfully deployed 34 new staff on their first international assignments, building on the pools of experienced staff ready to respond to future emergencies as they arise.

In 2024, MSF UK will play an essential role in supporting operational centres to strengthen their changing staffing models, while also developing a new international staffing strategy specific to MSF UK to ensure we maintain and build upon the key role that we play in the movement.

MSF UK focused its Learning and Development activities for both UK-based and internationally mobile staff throughout 2023 on critical courses such as Safeguarding, Welcome Days (induction) and Leadership. We had 96 participants in our Safeguarding training, and 40 in the Welcome Days induction trainings. We also facilitated MSF-specific leadership training to 48 staff from various Operational Centre Amsterdam primary partner sections, including 10 UK and two Irish staff.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Expertise

Medical and programme support

MSF UK is home to the Manson Unit, a multidisciplinary medical team that supports Operational Centre Amsterdam and the MSF movement to improve its health interventions through medical innovation, implementation science, and highly contextualised approaches in order to solve intractable problems.

After the successful outcome of the TB-PRACTECAL trial in 2022, the Manson Unit deployed its efforts to ensure that research participants and other TB patients in countries of MSF intervention have access to the safer, shorter, and more effective regimen identified for multi-drug-resistant TB. To date, seven out of the 12 countries with MSF-supported DR-TB programmes have started implementing this regimen, with over 1,000 patients benefitting from this. Globally, 47 of the 52 GDF priority countries have started or plan to start the BPaLM antimicrobial drug regimen scale-up. Further information on TB PRACTECAL is available at https://msf.org.uk/tb-practecal.

The Manson Unit’s focus on addressing intractable problems in countries of intervention prompted a renewed attention to dissemination of scientific outcomes in collaboration with the communication and advocacy efforts in the movement and with external actors. An example of this is the dissemination of the Occupational Health research and support project in Bangladesh. Since 2013, MSF has run health services in Kamrangirchar, Dhaka, focusing on providing occupational health, SGBV, and mental health services to people living and working in this area. The research showed that it is possible to mitigate the detrimental effects of child labour, child marriage, and unsafe working conditions; the project now aims at contributing to structural changes in the country by collaborating with workers, factory owners, civic society organisations, and governmental authorities.

In 2023, the Manson Unit launched three projects that are sponsored by MSF UK and funded by the TIC (Transformational Investment Capacity). TIC-funded projects are innovations proposed by MSF staff or association members that aim to dramatically improve and transform MSF’s medical assistance. The ‘Accessibility model for Field Planning and Response’ TICfunded project aims to ensure that MSF activities deliver maximum benefit to the communities in which we work by improving patient access to MSF’s health facilities via adapting, testing and implementing a World Bank-developed interactive geographic accessibility model for use in our projects. The model assesses MSF programmes’ coverage and heuristically determines the best locations for health activities. The Palliative Care project, born out of collaboration between MSF UK, MSF Italy, Operational Centre Amsterdam (OCA) and Operational Centre Paris (OCP), aims at helping MSF staff better care for dying patients and their families, addressing the quality of death for patients dying in MSF facilities. 2023 also saw the preparation and successful application of a third TIC-funded project: the MAP (Malaria Anticipation Project). This started in 2019 as a Sapling Nursery exploratory project, and will test climate-artificial intelligence (AI)-driven anticipatory models with community-based anticipatory approaches and data-light models to mitigate mortality and morbidities linked with malaria outbreaks.

In 2023, the HAARP team and the Manson Unit continued to successfully deliver our educational cohorts for the Leadership Education Academic Partnership (LEAP) and Global Health and Humanitarian Medicine courses. Further detail can be found on page 20 of this report.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Advocacy, communications and representation

In 2023, the HAARP unit continued the representation of MSF’s medical and humanitarian work to the UK government and other key stakeholders in the UK’s political and humanitarian sector. There has been follow-up on humanitarian aid funding from the UK. There have been numerous bilateral engagements with the Foreign, Commonwealth & Development Office (FCDO), including on crises in Chad, Sudan, and the ongoing situation in Gaza, as well as on various adhoc subjects, resulting in FCDO’s better appreciation of MSF perspectives.

Challenging the UK government’s hostile and harmful domestic and international migration policies has been a key focus of HAARP advocacy. Following the 2022 Nationality and Borders Act and the introduction of the ‘Illegal Migration Bill’, we advocated publicly and bilaterally about their medical and humanitarian consequences to try to prevent and mitigate some of the cruellest and most harmful policies. Despite best efforts by MSF and others, the bill was passed in July 2023. We continue to advocate against its implementation. We have also focused on exposing and speaking out about the UK government’s support for harmful migration policies across Europe and north Africa, the inhumane impacts of which we see in our projects in both the region and now the UK.

In September 2023, MSF UK, in collaboration with Operational Centre Brussels (OCB) and Doctors of the World UK (DOTW), jointly started a medical intervention (primary healthcare including mental health) for migrants, asylum seekers and refugees living in precarious conditions in the UK; predominantly those whose asylum claims cannot be submitted or progressed. The initial specific focus has been large-scale containment settings, with an intervention initiated at one centre, an ex-military barracks in Essex. This first-hand operational experience will complement and add weight to our advocacy around harmful migration policies.

Through our communications we have also continued our work to support MSF UK’s priorities around migration. Drawing on our medical experience from around the movement, we have demonstrated how the UK’s policies – modelled on those of Australia and Greece – will cause huge harm to people seeking safety, providing a distinctive medical perspective to the debate. The Media team has delivered hard-hitting news coverage and commentary, while the Digital team distributed an award-winning ‘explainer’ animation on the UK’s failure to provide safe routes, and the Public Engagement and Association team continued to engage and mobilise our associative and student groups around the issue.

Policy and advocacy work on access to products for healthcare in the UK focused on three key areas in 2023: the UK-India Free Trade Agreement (FTA), for which negotiations are still ongoing and which could have a devastating impact on access to affordable, quality medicines; ensuring equity and access conditions are built into clinical trials, building on MSF’s experiences with TBPRACTECAL and other clinical trials; and engagement to influence the WHO Pandemic Accord to ensure that the global preparedness, prevention and response efforts for future pandemics are more equitable and meet the needs of the most vulnerable. MSF’s experiences in responding to outbreaks and pandemics makes ours critical voice in influencing these negotiations, and we continue to engage the relevant UK government departments and interlocutors.

Enhancements were made to the ‘MSF Listen’ project, a web- and mobile-based platform that provides MSF projects with a secure online space to build institutional memory of community feedback, including contextual information, calls to action, and health-related misinformation. New users are signing on every week in numerous countries where MSF is running operations – at present there are 211 users. The MSF Listen project was subsequently handed over to four operational centres (OCA, OCB, OCG and OCP) in December 2023 for them to continue.

In 2023, the Communications department provided extensive support to MSF’s operational priorities across a number of serious and high-profile emergencies.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Early in the year, following the earthquake in Syria and Türkiye, we worked to ensure that the experiences of our colleagues already on the ground were communicated widely to UK and international audiences, and to bring attention to the particular plight of people in northwest Syria, who had already been living in precarious conditions for many years. Our Digital team worked closely on a fundraising campaign around the earthquake, winning three industry awards in the process.

The year saw further high-profile emergencies in locations where MSF was already active, including the catastrophic floods in Libya, and more recently the devastating attacks on Gaza by the Israeli Defence Forces (IDF) in response to Hamas’ brutal mass killing of civilians in Israel in October. Across these emergencies, the entire Communications department has pulled together to deliver high-impact results.

The Media team has continued to work effectively and ceaselessly to ensure that the voices of our teams – and in particular of our Palestinian colleagues – are heard prominently in both the UK and global English-language news media. The Digital team has ensured those voices are also prominent on our digital channels, while managing the significant demands of a fundraising campaign and social media community coordination. Our AV and editorial specialists have continued to provide crucial expertise to the wider movement, ensuring our audio/visual and written communications products are effective and engaging. The Public Engagement and Associative team has done huge amounts of work to facilitate associative debates, action, and engagement in protests.

Fundraising activities

2023 Key metric Result
In 2023, MSF UK plans to raise £67.4 In 2023, MSF UK raised £79.5
million to fund the MSF movement’s million in donations and legacies.
medical humanitarian projects.

MSF UK’s fundraising approach is focused on bringing our supporters closer to the medical humanitarian work that their generosity makes possible, through the testimonies of MSF staff and the communities that we serve. MSF UK carries out fundraising through public appeals, including through private-site face-to-face fundraising, major donor stewardship and multimedia campaigns. MSF UK does not have commercial relationships for third-party fundraising; instead, we directly control our charitable activities to raise funds.

Private individuals and organisations provide 100 per cent of our funding in the UK. We take great care to maximise the proportion of every donation that is spent on our humanitarian work. In 2023, we raised £6.53 for each pound we invested in generating funds. This compares to £6.96 in 2022. Please see the Financial Review in section 9 for further details.

We strive to provide the highest standard of stewardship to the private individuals and organisations that fund MSF UK. In 2023, we achieved eighth place for the overall experience we provided to our donors in the THINK Stewardship Tracker survey when compared to 22 other charities.

MSF UK adheres to leading standards in our fundraising activities and is a member of both the Fundraising Regulator and the Direct Marketing Association. All third-party organisations acting on behalf of MSF UK are closely supported and supervised to ensure they provide the highest possible level of service. We work hard to inspire and motivate the teams that represent us, including through regular briefings from our medical and logistical staff.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

A complaints procedure in the Fundraising department records and responds appropriately to any complaints. We feed actionable insight back to all areas of the Fundraising team and strive to improve the experience for supporters. In 2023, we received and responded to 73 complaints (compared to 66 in 2022) in relation to our fundraising activities. We also adhere to a vulnerable persons policy in relation to fundraising.

We talk with supporters across the UK to better understand their needs and motivations. These discussions define our approach to fundraising and help us meet our supporters’ wishes and interests. Feedback is highly valued and encouraged. The result is that we send fundraising appeals to our donors less frequently than is common practice; we have also never allowed other charities access to our supporters’ details.

Our overall approach to fundraising is guided and informed by the needs and wishes of our supporters. In practice this means a non-intrusive approach to fundraising, strictly avoiding unreasonable intrusions on privacy or unreasonably persistent approaches for money or other assets, and avoiding putting undue pressure on people to donate. There is continual ‘mystery shopping’ across a wide range of interactions by supporters of MSF UK, and MSF UK’s Promise To Donors sets out the standards that our fundraising activities must meet, limiting the frequency of appeals and prohibiting the exchange of supporters’ details with other charities. MSF UK adheres to the Code of Fundraising Practice.

All fundraising team members receive guidance and training on interacting with people in vulnerable circumstances, as well as guidance on working with Power of Attorney and written authority requests. This refers to the wider MSF UK policy on fundraising with people in vulnerable circumstances, with all procedures related to protecting vulnerable people reviewed on a regular basis to include up-to-date guidance drawing on experience.

Aerial view of the Bulengo IDP site on the outskirts of Goma city, North Kivu. MSF is providing free medical assistance and clean water to more than 7,000 households that have taken refuge there since 2023 following armed clashes in and around the Mweso health zone. Photo: Michel Lunanga/MSF

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Médecins Sans Frontières UK Annual Report and Accounts 2023

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MSF car driving through a body of water heading to Robis village in Tonkolili District, Northern Province of Sierra Leone, with the Integrated Community
Case Management team (ICCM). Photo: Saidu Bah
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Médecins Sans Frontières UK Annual Report and Accounts 2023

4 MSF UK's 2023 performance

2023 has been a year of recovery and consolidation for MSF UK following the disruptive effects of the COVID-19 pandemic. We have returned to the office, trialling a hybrid working approach, and have made good progress against our planned activities. For the 2023 Annual Plan, we implemented a new planning tool, which gives us much greater visibility of the progress across the full scope of all our activities — including core functional work and change work.

Key successes include developing proposals for project funding from the MSF movement’s Transformational Investment Capacity (TIC), completing a research project examining power dynamics within the MSF movement, and developing a partnership for our UK migration operations with Operational Centre Brussels (OCB) and Doctors of the World UK. At the same time, we continued to support wider MSF operations through the continued deployment of internationally mobile staff (with destinations including both Ukraine and Gaza), and in exceeding our fundraising income targets. Behind the scenes, we proceeded with making ongoing system, policy and process improvements to our support functions to make us more efficient and effective in the direct support we provide to MSF’s social mission.

Our progress against plan in 2023 in other areas was limited by capacity issues. As reflected in our risk register, we have not made as much progress with our Data Protection Programme to review our major processing activities as we had originally intended. Our policy management project was also affected, and will now conclude in 2024. The scope of our office carbon footprint work in the UK was limited to focus on statutory and movement reporting requirements, rather than progressing reduction work. Additionally, a number of continuous improvement activities to strengthen our fundraising systems were also deprioritised, either due to unfavourable risk-benefit or cost-benefit analysis. In HR, the timeline for two review projects, the benefits we offered to staff and our recruitment processes, was extended into 2024. Plans to improve accessibility in the office were superseded by a wider review of our future office needs. Finally, following the implementation of our new procurement framework, further planned work to develop more active supplier relationship capability was deferred to give the new procurement system time to embed and mature.

Strategic Direction in 2023

Following the decision by the MSF movement to extend the Resource Sharing Agreement 4 (the memorandum of understanding by which funding for each of the operational centres is calculated) period by two years, we refreshed our Strategic Direction to extend it to the end of 2025. This has included undertaking a detailed review of our original Strategic Direction 2020/2023 and producing a Strategic Direction 2020/2023 — Progress report and strategic refresh. Building on this, we also produced our Strategic Direction update to 2025, which sets out what we intend to achieve at a strategic level in the next two years. This includes setting a new Strategic Goal for how MSF UK intends to support MSF’s humanitarian action. Both of these documents are available on our website.

The progress report below summarises the main activities that we have completed in 2023 against our refreshed strategic objectives.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Supporting MSF’s Humanitarian Action

To the end of 2025, our new Supporting MSF’s Humanitarian Action Strategic Goal consists of the following five strategic objectives for the UK:

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Objective Completed actions in 2023
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Objective Completed actions in 2023
Providing access to medical
knowledge, research and
innovation		 The Manson Unit has continued to provide epidemiological and anthropological
support to a range of MSF’s humanitarian projects, while also developing projects
for anticipatory action in relation to malaria, devising an accessibility mapping tool
to help site MSF’s humanitarian projects most efectively, and working on how
to make palliative care available to the communities with whom we work. These
projects will continue into 2024.
Recruiting a diverse pool
of country-based and
internationally mobile staf		 We have successfully supported our pool of internationally mobile staf (IMS)
by managing the departures of 124 colleagues to MSF humanitarian projects,
including in Ukraine, Gaza, South Sudan and Afghanistan.
Working to deliver against
the longer-term income
targets being set by the MSF
movement		 During 2023 we have increased our fundraising to achieve our highest income to
date of £79.5 million in donations and legacies: £23.4 million from regular giving;
£20.2 million from appeals; £19.2 million from legacies; £7.9 million from charities
and trusts; £4.3 million from sponsorship, events and collections; and £4.5 million
from corporate donors.
This success has been built on growing our core fundraising activities and
delivering three successful emergency campaigns during the year. Signifcant work
has also been undertaken to identify further opportunities to grow our fundraising
activities in 2024 and beyond.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

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Objective Completed actions in 2023
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Objective Completed actions in 2023
Continuing to make access to
postgraduate education and
development opportunities
available		 In 2023, the Operational Directorate WaCA (West and Central Africa) joined the
Leadership Education Academic Partnership (LEAP) and recruited its frst students,
who will start their studies next year. In November 2023, the LEAP programme
conducted face-to-face classes in Manchester and Liverpool, with students from
across MSF’s global projects visiting the UK. This year, 40 MSF students graduated
from the programme, achieving either a Postgraduate Certifcate, Postgraduate
Diploma or Master of Science in Humanitarian Practice.
LEAP is a diverse programme: of our new students in 2023, 53% were female,
75% were from low- and middle- income countries and 43% were locally hired
staf. LEAP continues to grow and develop, with biannual student intakes and an
increasing presence across MSF.
In 2023, 169 students successfully completed the Global Health and Humanitarian
Medicine (GHHM) course, and 205 students were enrolled for 2023-2024. For the
2023-2024 cohort, 77% of students are from low- and middle-income countries.
56% of students are MSF staf, of which 77% are locally recruited staf.
In 2023, we invested in an alumni community platform to deliver the ‘community
of practice’ envisaged in the 2020-2023 strategy, which will launch in 2024. We
have also identifed alternative exam options for GHHM students to ensure that
they are able to access a range of relevant and afordable qualifcations following
the completion of GHHM, as opposed to one single exam. Furthermore, as a result
of our advocacy, exam providers have recognised that mandating in-person lab
training as an eligibility requirement for attaining a postgraduate qualifcation in
tropical medicine disadvantages students from LMIC countries. This has resulted in
online parasitology and microscopy training becoming approved, which will reduce
the overall cost of the qualifcation by at least 50%.
We successfully recruited two Associate Trustees, as a way for members of the
MSF movement to train in and experience governance processes in the UK,
without holding the responsibilities, voting rights or legal duties as a Trustee/Board
member. We have also continued to support a Humanitarian Afairs Assistant role
in our HAARP department, providing a pathway into similar roles directly attached
to MSF humanitarian projects.
With our communications,
building empathy,
understanding and action		 Our Communications department has managed challenging communications
environments, particularly following the Türkiye/Syria earthquake in February 2023
and the confict in Gaza in October 2023. Our Communications department has
successfully communicated MSF’s humanitarian message, gaining traction in the
UK media and supporting the wider movement internationally to do the same.
Our Public Engagement team provided speakers for 144 public talks across the
UK in 2023, as well as running three storytelling events for our supporters and two
national conferences for our student followers. We also produced 42 curriculum-
specifc MSF-themed teaching resources for schools.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Valuing People

By 2025, MSF UK will be an organisation in which all those who work with and for us – whether in the UK or in MSF’s projects – feel valued in their working lives and are treated with fairness and respect. MSF UK will foster a healthy working environment built on community, inclusivity, diversity, and a proactive idea of acceptance, where professional development meets the needs of both MSF and its staff.

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Objective Completed actions in 2023
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Objective Completed actions in 2023
Respect, inclusion and
enabling staf potential within
the MSF workforce		 With the Board, we reviewed and updated the Board’s Equity, Diversity and
Inclusion (EDI) Policy Statement, as well as the Expense Policy, to enable greater
opportunity for participation and inclusiveness.
During the year, our EDI Lead has delivered a range of learning and development
opportunities, including an engaging series of speakers and events. Internal
communications and the resources available to staf on the MSF UK/IE Portal site
have been enhanced.
We have refreshed our EDI Policy and Reasonable Adjustments Policy. Building
on our Standards and Accountability Policy, EDI has also been mainstreamed as a
consideration within procurement and policy development.
Dissemination of the results of the research project sponsored to examine
inequalities inside Médecins Sans Frontières and its medical humanitarian
endeavours has begun.
MSF UK/IE will have the
appropriate systems, training
and communication channels
to ensure that staf are able to
develop their skills and gain
the right experience to meet
the full potential of their roles		 The early part of 2023 saw the implementation of the remuneration phase of
our Rewards Review, with the transition to a new grade structure completed in
April 2023. In the latter part of the year, we have also conducted a review of the
benefts we ofer, and of our recruitment practices. Work to review our recruitment,
onboarding and induction processes will continue into 2024.
Safeguarding and duty of
care: MSF UK will continue to
embed best practice UK- and
INGO-sector safeguarding
standards across all UK
departments and operations.
We will be recognised as a
key resource for safeguarding
good practice, assistance
and support for the MSF
movement		 In early 2023, we completed a detailed risk safeguarding assessment across all
MSF UK ofce functions and, using this as a basis, established a Safeguarding
Strategy.
We also completed a staf survey to assess the maturity of the safeguarding
culture, and have worked with the Committee of Directors (CoDir) to map senior
accountability when safeguarding instances arise.
More broadly, our wider support to the MSF movement continues, with advice and
support being provided for the development of Operational Centre Amsterdam’s
Safeguarding Policy, which is now ready for implementation.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Igniting Change

For the period to 2025, we have identified three key themes that we wish to demonstrate impact on as an organisation during the period of the extension of the Strategic Direction: Migration, Nutrition, and Access to Products for Healthcare.

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Objective Completed actions in 2023
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Objective Completed actions in 2023
Migration: to prevent,
mitigate, reverse and respond
to the medical consequences
of the implementation of
harmful migration policies in
the UK, or by the UK in other
countries		 During 2023, our advocacy and communications havefocused on countering
the most harmful aspects of the Illegal Migration Bill 2023, including forcible
deportation fights.
We have also been working hard to deliver our ambition to become operational in
the UK to support migrant communities who struggle to access healthcare. We
have signed a partnership with Operational Centre Brussels (OCB) and Doctors of
the World UK, with MSF UK staf now seconded to Doctors of the World UK.
Nutrition: increase awareness
of and support in the UK
and Ireland for MSF’s work
in nutrition, and strategically
engage with key UK and
Irish stakeholders to increase
action and accountability in
the prevention and treatment
of acute malnutrition in
contexts where MSF works,
with a focus on infantile
malnutrition and recurrent
nutritional crises		 During our strategy refresh work, we identifed the growing crisis around
malnutrition in a variety of the countries in which MSF has humanitarian projects
as a key area for MSF UK to focus on increasing awareness and support. In 2023,
we have undertaken awareness-raising communications around malnutrition and
created new networks with UK-based stakeholders, including the UK government,
and UK-led nutrition initiatives, setting the foundations for further work on this new
strategic objective in 2024.
The UK’s contribution to
the Access to Products for
Healthcare campaign		 During 2023, the MSF UK Executive Director has been chairing the international
committee that has been tasked with overseeing the implementation of a new
model for MSF’s work in improving Access to Products for Healthcare (APH). As
part of that model, all MSF sections are encouraged to consider how they can
best contribute towards delivering tangible improvements in Access to Products
for Healthcare for people who are deprived of them, as part of MSF’s social
mission. As a new strategic objective, we will further defne our role as MSF UK in
supporting this new APH vision in 2024.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Ways of Working

By 2025, MSF UK will have begun a programme of change to create new, more effective and more efficient ways for its UK-based staff to work. To achieve this goal, we will evaluate our processes, systems, relationships and organisational design to identify where these are already functioning correctly and what barriers prevent us from reaching our full potential.

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Objective Completed actions in 2023
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Objective Completed actions in 2023
Systems, processes and
organisational design to
support efective and timely
decision-making		 We completed the review of our Procurement Policy Framework, and implemented
this across MSF UK. Additionally, our Fundraising department completed the frst
phase of its Data Warehousing project, creating a platform from which data insights
can be drawn to help us communicate with our supporters more efectively.
Work has also commenced to establish a project for delivery in 2024, looking to
strengthen our central management information reporting.
Collaboration, culture and
fexible working: create an
enabling environment for staf
to work collaboratively and
fexibly, to be empowered and
to use their initiative		 During 2023, we successfully trialled a new model of hybrid working based on the
four principles of community, collaboration, fexibility and business continuity.
Portfolio, Programme and
Project Management (P3M):
to build our planning capacity
and capability to support the
delivery of strategic objectives
within the resources available		 In 2023, through our strategy refresh work, we have fully aligned our strategic
reporting and annual plan reporting. This has allowed us to adopt some portfolio
management techniques in our2024 annual planning, enabling us to prioritise and
select a balanced mix of activities in a more structured way.
We have also invested in training up a small number of staf in both waterfall and
agile sprint methodologies.
MSF UK/IE shared context:
MSF UK and IE will
collaborate to support each
other through shared services,
and explore how to enhance
collaboration in the enabling
functions		 We aligned MSF IE’s risk management approach, refecting the changes made
to MSF UK’s approach in 2022. MSF UK and MSF IE HR continue to support
each other, and MSF UK’s IT department provides a combined MSF UK/IE IT
environment and support.
Information, governance and
data protection: MSF UK will
strengthen its governance
and institutional memory
by establishing information
governance controls		 We have continued to make progress with our policy review project, baselining an
increasing number of policies into our policy architecture and applying information
governance controls to them. We have also audited our governance assets and
published these on the MSF UK/IE Portal. Progress has been slower in our data
protection compliance activity due to capacity challenges, although we have made
steady progress in our review of the Manson Unit’s processing activities.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Climate Crisis and Global Health

Between 2020 and 2025, MSF UK has committed to act as a convener on climate and health, developing knowledge, skills and innovative approaches on behalf of the MSF movement. We have committed to bringing together data and stories from our projects to support advocacy efforts, and to providing technical and operational support to projects in contexts where climate change is impacting vulnerable groups. MSF UK has also committed to reducing its environmental footprint.

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Objective Completed actions in 2023
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Objective Completed actions in 2023
MSF UK/IE will continue to
support MSF operational
centres (primarily OCA)
to address the health
consequences of the climate
crisis		 Formed and co-led the Operational Centre Amsterdam (OCA) cross-departmental
Climate and Environmental Health (CEH) Group through the MSF UK CEH Advisor.
An action plan was established for 2020-2023, and supported MSF desks
and country programmes in their ambitions to integrate a CEH lens in medical
humanitarian programming. Currently six OCA country programmes with annual
plans have integrated a CEH lens in 2023.
Additionally, we have engaged in intersectional initiatives with OCG and MSF
Canada around a variety of diferent issues, including a review of MSF’s operational
strategy documents, in order to integrate CEH, meteorological monitoring for
anticipatory action, and an exploration of pilot programming at the intersection of
heat and health.
Supporting MSF’s operational
research and advocacy on
climate and health		 During 2023 we continued to showcase case studies and operational research
related to the health impacts of climate change in academic and policy literature
and spaces, including at the UN Climate Change Conference (COP28).
MSF UK/IE ofce
environmental responsibility:
reporting on carbon emissions
and exploring areas for
reduction in line with the
target to reduce emissions by
50% by 2030		 We conduct voluntary biannual reporting as part of the MSF movement
commitment to reducing carbon emissions. In 2023 we produced both the 2022
end-of-year report and the 2023 mid-year report on our carbon emissions.
In 2023 we improved the accuracy of our emissions calculations for magazine
inserts and therefore recalculated our total emissions fgures. We also added
one additional source of paper emissions. These sources now account for
approximately 60% of our total emissions. With these adjustments, we saw a
decrease in total carbon emissions from 2019, though this is a slight increase from
2022. We can likely attribute an increase in fight emissions to “return to normal”
travel behaviour following COVID-19. We have also seen an increase in rail travel.
Our recalculated intensity ratios demonstrate an overall decrease in carbon
emissions per staf member since 2019 and 2022.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Trustees’ oversight of MSF UK’s work

As a company limited by guarantee, MSF UK is required to report on how the trustees have discharged their duty to promote the best interests of MSF UK, and have considered the matters set out in section 172(1)(a)-(f) of the Companies Act 2006:

Our stakeholders

MSF UK is able to achieve its charitable purpose thanks to the relationships we maintain with our stakeholders. Given the nature of charitable work, our stakeholder groups are well established and remain constant. Our aspirations for these relationships are set out in the Igniting Change pillar of the Strategic Direction (as described earlier in this section).

The following table sets out our key stakeholder groups, the key considerations of each group, and how we engage with them. Trustee discussions consider the potential impact of decisions on each stakeholder group, as well as their needs and concerns.

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Key stakeholder Key considerations How we engage with them
group
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Key stakeholder
group		 Key considerations How we engage with them
Patients and
communities		 ●Providing medical humanitarian
support to those most in need
●Ensuring that as much of our
resources as possible are used for the
beneft of this group		 ●The grants we provide and the staf
we second to our operational partners
●The technical assistance we provide
to our operational partners through
the Manson Unit
MSF movement
partners		 ●Our shared values and goals bind the
MSF movement together and are a
key part of MSF UK’s identity		 ●UK representation in the OCA
Management Team
●Membership of Associative and
Executive platforms
●Participation in movement-wide
discourse facilitated through internal
websites and grassroots discussion
forums
MSF UK Association ●Arbiters and guardians of MSF identity
for MSF UK
●Developing and maintaining
relationships and interest in the
charitable purpose of the MSF
movement as potential future staf and
trustees		 ●The MSF UK Association website
●Regular mailings and direct
communications on topical issues
●Regular events; for example,
webinars, briefngs and networking
events
●Annual General Meetings
●Facilitation of social media spaces

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Médecins Sans Frontières UK Annual Report and Accounts 2023

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Key stakeholder Key considerations How we engage with them
group
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Key stakeholder
group		 Key considerations How we engage with them
Donors and supporters ●Understanding the impact of
donations through insights into our
medical humanitarian work
●Developing and maintaining
relationships and their interest in the
MSF movement		 ●The MSF UK website
●Regular newsletters and direct
communications
●MSF UK events
●Direct engagement with members of
the Fundraising department
Employees ●Training and development
●Equity, diversity and inclusion
●Wellbeing and support		 ●News, support and policies provided
through an intranet portal
●Weekly Community Days, including
all-staf meetings
●A broad range of learning and
development opportunities available to
employees
●A safeguarding survey conducted and
scrutinised by the Board, and a staf
engagement survey conducted in
2023 and scrutinised in early 2024
●Feedback and implementation of
positive change through the staf groups
Regulators ●Maintaining governance procedures to
ensure compliance with all applicable
regulatory regimes		 ●Timely submission of all necessary
flings and returns
●Self-reporting and engagement, where
appropriate
●Prompt and comprehensive responses
to requests for information, as
required

Key decisions

In making key decisions concerning the strategy and activities of MSF UK over the course of the year, the trustees considered the wider interests of our stakeholders and the broader factors set out in section 172 of the Companies Act 2006, listed above.

Key considerations included:

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Médecins Sans Frontières UK Annual Report and Accounts 2023

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Topic Decision Key considerations
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Topic Decision Key considerations
Strategy Direction Refreshing strategic objectives to update
the Strategic Direction 2025		 Refecting on the progress made against
the 2020-2023 Strategic Direction.
Ensuring that the Strategic Direction
incorporates the full scope of our work and
is stretching but grounded.
Fundraising Strategic investment to grow our
fundraising activities		 Prioritisation of net contribution over the
medium term over contribution ratio in the
short term.
Incremental growth in the frst instance to
test the depth of markets, mitigating risk
but establishing a foundation for further
investment depending on initial outcomes.
Safeguarding Authorisation of a Safeguarding Strategy Further developing MSF UK’s intent for a
Safeguarding Strategy expressed in the
existing strategy with a more concrete and
specifc vision.
Clearly defning activities prioritising on a
risk basis across the organisation.
Creating a clear line of sight on activities
spanning the organisation and creating
capacity to both monitor progress and
provide technical support to functional
areas.
Environmental
responsibility		 Prioritisation of resource allocation to MSF’s
operational centres (principally OCA)		 Operational centres account for
approximately 87% of the movement’s
carbon emissions, according to our current
measurements.
Reaching the 50% by 2030 target for the
movement requires coordinated action, and
there are limitations to MSF UK’s infuence
on the wider movement.
Need to continue to make progress in
the UK, but supporting MSF’s operational
centres (principally OCA) is likely to have
more impact.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Sustainability and carbon reporting

In 2020, MSF UK started reporting on its energy-related carbon emissions in the UK, including gas, electricity and fuel, in compliance with the Streamlined Energy and Carbon Reporting (SECR) regulatory requirements mandated for unquoted large companies and organisations.

Energy and greenhouse gas emissions

Our energy and greenhouse gas emissions for the period 1 January - 31 December 2023 are set out in the table below. We have reported all material emission sources required by the regulations for which we deem ourselves to be responsible, and have maintained records of all source data and calculations.

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UK Energy Consumption – Gas, Electricity, Fuel (Mileage)
Carbon Emissions Intensity ratio FTE
Energy source Units Consumption
(kg CO2e) (kg CO2e/FTE)
2022 2023 2022 2023 2022 2023
Electricity (Scope 2) kWh 124,552 130,080 24,086 26,936 116 131
Natural gas
kWh 105,429 101,293 19,245 18,233 93 89
(Scope 1)
Fuel – Business
miles 4,154 4,473 1,058 1,243 5 6
travel (mileage)
TOTAL (all Scopes) 44,389 46,412 214 226
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2023 Carbon Emissions by Source (kgCO2e)

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3%
39%
Electricity
Natural gas
Business travel – mileage
58%
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Médecins Sans Frontières UK Annual Report and Accounts 2023

Methodologies and estimates

MSF UK accounts for the energy and gas consumed in its London office space plus for a portion of the communal areas in the building at 10 Furnival Street. MSF UK conducts some business travel by land, for which MSF UK is responsible for purchasing the fuel or for which MSF UK reimburses its staff following claims for business mileage. This business travel includes travel to and from events, such as locations where MSF UK staff are raising funds, or events at which MSF UK staff are speaking or taking part in projects. We have continued to ensure that our fuel mileage expense claims contain a greater level of detail, which has enabled us to calculate the kg CO2e attached to mileage more accurately.

There was a slight increase in the number of fuel and mileage expenses in 2023 compared to 2022. In 2023, we accounted for 27 expense claims, compared to 25 claims in 2022. For six of these claims, we have calculated an estimation of emissions due to incomplete mileage data. We will continue to work on improving our data collection moving forward, to improve the accuracy of our calculations.

In 2022, we reported that following the return to more typical ways of working after the COVID-19 pandemic, we were able to transition from continuous air conditioning use to only running air conditioning during working hours, which led to a substantial reduction in overall gas consumption. This trend has continued in 2023, although we have had to estimate three months of data based on 2022 figures due to missing data from our supplier.

In 2023, there was an increase of seven per cent in the UK electricity emissions factor compared to the previous year due, to an increase in natural gas use in electricity generation and a decrease in renewable generation. In 2023, MSF UK saw an increase in our emissions associated with electricity. This can be partially attributed to the increase in the electricity emissions factors noted above; however, we have also seen an increase in our total electricity usage (kWh) in 2023, which is potentially due to an increase in office usage following the codification and adoption of the hybrid working strategy.

Overall, we have seen an increase in our intensity ratio, due to an increase in emissions and a decrease in the number of full-time equivalent staff members (FTEs), from 208 in 2022 to 206 in 2023. This reduction in the number of FTEs reflects a decrease in the number of internationally mobile staff deployed to MSF projects in 2023.

Measures taken to increase energy efficiency

MSF UK is continuing to make changes to improve its data collection, analysis, reporting and monitoring of its carbon emissions. Although progress slowed somewhat due to capacity limitations in 2023, we have identified key areas of the data collection process for improvement and made incremental improvements, particularly related to travel data collection in the second half of 2023.

Following the introduction of the MSF UK Responsible Travel policy in 2022, MSF UK continues to work with relevant departments within the London office to reinforce the responsibilities and expectations around international travel. Sustainability continues to be part of MSF UK’s policies and procedures and ongoing office activities.

In 2023, MSF UK has also further developed relationships across the MSF movement to share lessons learned in identifying areas for improvement and developing actionable plans to begin assessing areas for meaningful reduction.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Dr. Khassan El-Kafarna, a doctor with MSF, works in both the emergency department and the surgical unit of Kostiantynivka hospital in the Donetsk region of Ukraine. Between January to August 2023, MSF provided 231 surgical interventions in Kostiantynivka hospital. Photo: Linda Nyholm/MSF

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Médecins Sans Frontières UK Annual Report and Accounts 2023

5 MSF UK’s plans for 2024

Our 2024 Annual Plan is the first opportunity we have had to set out in detail what we intend to achieve following our strategic refresh in 2023. The 2024 Annual Plan can be contextualised against the backdrop of a volatile global picture. Escalating and ongoing conflicts as well as flooding, earthquakes and large-scale outbreaks of different diseases have meant that the demand for emergency response has remained high. This, together with high levels of inflation in many countries where we work, amplified a recent trend of significantly increased expenditure on MSF operations outstripping income projections, which has created financial instability within the movement.

In the longer term, our ambitions and capacity for growth need to be more clearly defined, in the face of infinite need, and considered along with the outcomes of the MSF We Want To Be and the Movement Evolution processes when moving into the next International Strategic Planning and Resource cycle. In the short term, even while operational centres have embarked on a process of course correction, there is a movement-wide demand for immediate efforts to be made to increase net contribution to soften the blow of sudden reductions in operational budgets.

In this context, our 2024 Annual Plan prioritises investment in our Fundraising and Communications department in order to lay the foundations to increase our income in the short term and explore longer-term options. We are also undertaking a range of activities to describe MSF UK/IE’s role as a Partner Section, defining and consolidating our activities to act on the objectives identified in our strategic refresh. Behind the scenes, we will be continuing to work to strengthen our internal systems and processes incrementally.

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Unloading of the MSF cargo in Rhoe camp, where around 70,000 people live in dire conditions. Dujgu territory, Ituri province, Democratic Republic of the
Congo. January 19, 2023. Photo: MSF/Philomène Franssen
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Médecins Sans Frontières UK Annual Report and Accounts 2023

MSF UK Supporting MSF’s Humanitarian Action in 2024

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Objective Plans
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Objective Plans
Providing access to medical
knowledge, research and
innovation		 We will develop our existing model for the Manson Unit, acting as a hub for
medical training and advice on chronic and infectious diseases, epidemiology
and antimicrobial resistance, developing international safeguarding practice
as well as supporting research and innovation, including dissemination of the
TB-PRACTECAL trial, anticipatory action around malaria, menstrual health
management, and occupational health.
We will also consolidate our approaches to medical knowledge, research and
innovation as a system. This will include developing standardised approaches to
disseminating research, and sponsoring three incubator projects funded via the
Transformational Investment Capacity (TIC).
Recruiting a diverse pool
of country-based and
internationally mobile staf		 The Internationally Mobile Staf (IMS) HR team will commence a project focused
on redeveloping our IMS workforce planning, conducting an initial assessment of
operational needs, opportunities, and capabilities to produce initial proposals for a
strategy. This is positioned within the context of ongoing movement discussions on
the international stafng and recruitment models.
Continuing to make access to
postgraduate education and
development opportunities
available		 MSF UK will continue to sponsor two educational programmes to support MSFers,
particularly from low- and middle-income countries, to access postgraduate
qualifcations where they may otherwise face barriers. We will run our Global Health
and Humanitarian Medicine (GHHM) and our Leadership Education Academic
Partnership (LEAP) programmes in 2024, and also develop proposals to expand
these postgraduate education oferings.
Working to deliver against
the longer-term income
targets being set by the MSF
movement		 Responding to challenges in the wider movement relating to fnancial instability, for
the 2024 Annual Plan we are proposing signifcant investment in our Fundraising
and Communications departments so that we can increase this direct support to
MSF operations, setting the foundations to deliver against more ambitious income
targets in the short term and exploring the potential for income growth in the longer
term.
With our communications,
building empathy,
understanding and action		 Our Communications department has maintained a high profle in the domestic
UK media market, building public support and empathy around MSF’s operations,
research dissemination and advocacy, and supporting MSF internationally to do
the same. This work will continue. In our Digital and Public Engagement teams, we
will work to strengthen the efectiveness of our online communications and face-to-
face engagement with supporters.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Valuing People in 2024

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Objective Plans
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Objective Plans
Safeguarding and duty of
care: MSF UK will continue to
embed best practice UK- and
INGO-sector safeguarding
standards across all UK
departments and operations.
We will be recognised as a
key resource for safeguarding
good practice, assistance
and support for the MSF
movement		 In 2024, we will continue our safeguarding leadership and accountability training to
enhance the leadership and management of safeguarding across MSF UK/IE. We
will also train key staf in how to conduct investigations efectively.
Our policy work to embed safeguarding across our policy architecture will continue,
including the implementation of a new, updated Criminal Records Check policy.
We will also continue to provide support to the wider movement, providing
safeguarding advice via the Executive Ofce as well as benchmarking child
protection across OCA settings and developing a vision and operational support
model in the Manson Unit.
MSF UK/IE will have the
appropriate systems, training
and communication channels
to ensure that staf are able to
develop their skills and gain
the right experience to meet
the full potential of their roles		 Key change activities in the HR department regarding the staf lifecycle will include
the implementation of recruitment, onboarding and induction reviews to ensure
efcient, safe, and fair practices that are consistent with EDI. A project to map
the employee lifecycle and provide user-friendly guidance for managers will also
continue in 2024.
Respect, inclusion and
enabling staf potential within
the MSF workforce		 Work will continue to implement our EDI Action Plan. In 2024, our main focus will
be on implementing a cyclical package of training that all staf will need to complete
on a periodic basis. This will be supported by informal learning and development
opportunities, continuing with our programme of EDI-themed speaker events
throughout the year. We will also undertake a learning needs assessment of line
managers and the delivery of the MSF International People Management Unit’s
Ways of Working training to two cohorts of MSF UK/IE managers.
We will work to embed and standardise approaches to safeguarding and EDI in
communications guidelines and policies to ensure that all MSF UK communications
respectfully and accurately represent MSF colleagues and the people whom MSF
assist. We will also review our external-facing website to ensure that it meets the
expectations set out in our EDI vision.
We will develop an Equality Impact Assessment (EqIA) process to incorporate, in
the frst instance, into our internal policy review cycle to formalise the way in which
we review and document how our internal processes meet our EDI vision.
The Manson Unit will continue with the dissemination plan for the ‘The Power
Within’ research report, which looks within MSF structures and practices to
examine dynamics of power and inequality.
We will implement the outcomes of our Benefts Review, which aims to ensure that
the benefts package that we ofer staf is proportionate, accessible and fulfls our
values as an organisation, and is fexible to the needs of diferent groups of staf.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Igniting Change in 2024

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Objective Plans
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Objective Plans
Migration: to prevent,
mitigate, reverse and respond
to the medical consequences
of the implementation of
harmful migration policies in
the UK, or by the UK in other
countries		 Our intention for 2024 is to make progress on our project to reduce morbidity in
migrants in precarious living conditions targeted by ‘hostile environment’ policies,
with a focus on detention-like containment settings, with the aim of becoming
operational. Our ongoing activities regarding migration analysis, advocacy and
representation will also continue.
Nutrition: increase awareness
of and support in the UK
and Ireland for MSF’s work
in nutrition, and strategically
engage with key UK and
Irish stakeholders to increase
action and accountability in
the prevention and treatment
of acute malnutrition in
contexts where MSF works,
with a focus on infantile
malnutrition and recurrent
nutritional crises		 In 2024, a nutrition-focused cross-departmental taskforce driven by the HAARP
department will defne the MSF UK strategy on nutrition in relation to the UK
environment, with the aims of infuencing the UK government in implementing
efective programming, and in its funding, programming and convening eforts
related to nutrition and food security.
The UK’s contribution to
the Access to Products for
Healthcare campaign		 Throughout 2024, the MSF UK Executive Director will continue to chair the
international committee overseeing the implementation of a new model for MSF’s
work in improving Access to Products for Healthcare. As a new strategic objective,
we will further defne and map our role as MSF UK in supporting the new APH
vision in 2024; for example, via our work on antimicrobial resistance (AMR) and via
research projects undertaken by the Manson Unit.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Ways of Working in 2024

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Objective Plans
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Objective Plans
Systems, processes and
organisational design to support
efective and timely decision-
making		 In IT, we will be determining the lifecycle management of all major systems to ensure
that they are replaced or updated at the correct time. IT will also begin to develop a
more structured approach to business continuity across the organisation.
In HR, the implementation of the HR Vision will be a major piece of work for the frst
half of the year. Smaller activities will be a review of efciency and value for money of
our employment law support and harmonisation of our travel management with the
Global Travel framework.
In Finance and Services, we will be undertaking a range of activities to improve
systems and processes, including the invoice approval process, updating policies,
income processing and reconciliation to fundraising CRM, VAT and tax optimisation,
reviewing fnancial reporting and analytics, and the purchase to pay, expenses and
credit card systems.
We will also be undertaking a cross-departmental project to look at how we can make
better use of the management information being generated in each department.
Information, governance and
data protection: MSF UK will
strengthen its governance
and institutional memory
by establishing information
governance controls		 In 2024, our ongoing Policy Review Project will transition into an annual core
functional work cycle, with any remaining gaps in our policy architecture being dealt
with as a matter of routine review.
We will step up our focus on data protection, reviewing the system we have in place
to underpin our data protection compliance (including our Data Protection Policy), as
well as reviewing the data protection impacts of our major processing activities.
Building on the improvements to our governance systems and processes in 2023, we
will undertake a formal review of our Scheme of Delegation, and continue to tighten
up the support we provide to the Board.
Collaboration, culture and
fexible working: create an
enabling environment for staf to
work collaboratively and fexibly,
to be empowered and to use
their initiative		 Following the trial period in 2023, we will permanently move to our new hybrid
working approach as the norm in 2024.
Activities designed to bring the ofce together as a community will also continue.
MSF UK/IE shared context:
MSF UK and IE will collaborate
to support each other through
shared services, and explore
how to enhance collaboration in
the enabling functions		 At the General Direction level, engagement with Structures and Movement
Evolution international projects in 2024 will ensure that any changes to the MSF
movement governance ecosystem are refected as necessary in changes in MSF
UK/IE governance systems and processes. We will also engage closely with the
application made by MSF Eastern and Southern Africa to become an operational
centre, including by exploring a potential partnership role for MSF UK/IE.
MSF UK and MSF IE will continue to work closely together in ensuring alignment
between risk management approaches, a shared IT infrastructure, and
collaboration between UK and IE HR teams.
Portfolio, Programme and
Project Management (P3M): to
build our planning capacity and
capability to support the delivery
of strategic objectives within the
resources available		 For 2024, taking into account the lessons learnt in our 2022 and 2023 annual
planning rounds, we are intending to strengthen our approach to annual planning
by formalising our approach in a policy document. We will also train a small
number of staf in recognised project management methodologies and tools.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Climate Crisis and Health Impact in 2024

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Objective Plans
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Objective Plans
MSF UK/IE will continue to
support MSF operational
centres (primarily OCA)
to address the health
consequences of the climate
crisis		 During 2023, MSF UK provided resource to support and lead work on Climate
and Environmental Health (CEH) through HAARP. This resource has now been
increased and moved to the Manson Unit, from where we will continue to develop
and lead OCA Public Health department activity regarding the operational impacts
of climate change and environmental degradation on health. This work includes
population and vulnerability mapping, implementing a CEH lens across MSF
operations, and standardising CEH risk assessment methods.
Supporting MSF’s operational
research and advocacy on
climate and health		 During 2023, the editorial management of MSF’s contribution towards The Lancet
Climate Countdown annual report started to transition from MSF Canada to MSF
UK. During 2024, we will lead this work, taking on the responsibility of producing
an annual report on the climate change landscape, which will be published in The
Lancet. The Manson Unit will also engage in advocacy based on political and policy
landscape mapping, including with the UK government, World Health Organization
and Wellcome Trust. The Communications team will work closely with the Manson
Unit, as well as HAARP and the wider movement, to identify the climate initiatives
that need communications support.
MSF UK/IE ofce
environmental responsibility:
reporting on carbon emissions
and exploring areas for
reduction in line with the
target to reduce emissions by
50% by 2030		 During 2024, we will continue to provide biannual reports to the Board on our
carbon emissions. We will also attempt to develop our analysis, particularly of our
fight data, to provide an assessment of the efcacy of our Responsible Travel
Policy and target parts of our supply chain where there may be opportunities for
reduction through our procurement activities.
We are also in the process of reviewing our future ofce needs, and climate impact
is one of the three key priorities identifed to inform a decision as to whether we
remain in our current location or move to a new location.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Amir Jibril Abu Al Ata is undergoing a foot surgery. Al Aqsa hospital. 29 November 2023, Middle Area, Gaza. Photo: MSF

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6 For the public benefit

MSF’s purpose

The principal objective of MSF UK, as stated in its Articles of Association, is as follows:

The Company’s objectives are to relieve suffering, promote the relief of sickness and provide medical aid to the injured, and to protect and preserve good health by the provision of medical supplies, personnel and procedures calculated to overcome disease, injury or malnutrition in any part of the world.

The trustees confirm that they have referred to the Charity Commission’s guidance on public benefit and are satisfied that the charity’s activities, grants and plans accord with this guidance.

MSF UK’s contribution to the MSF movement

MSF UK is a primary partner of Operational Centre Amsterdam (OCA), one of the five operational centres responsible for the delivery of MSF’s medical humanitarian projects (the sixth operational directorate – MSF West and Central Africa, or WaCA – is an institutional member with the right to run operations). OCA is a coordination body made up of six section offices – MSF UK, MSF Holland, MSF Sweden, MSF Canada, MSF Germany and MSF South Asia – and one branch office – MSF Ireland. The operations of OCA are hosted by MSF Holland, a separate legal entity with its own Board of Trustees. This means that the tangible elements of OCA’s medical humanitarian work and activities sit within the MSF Holland legal entity, which receives all OCA funding and directly manages all OCA projects and programmes.

In 2023, MSF UK made grants to MSF Holland (in its role as host of OCA), to MSF Belgium, which hosts Operational Centre Brussels (OCB), and to MSF France, which hosts Operational Centre Paris (OCP). OCA, OCB and OCP used these funds to implement and continue medical humanitarian projects and support social mission costs at OCA. The UK Board of Trustees receives regular reports on the projects that are funded by MSF UK through participation in the OCA Council and OCB Board, and through project visits and accounts from returning UK project staff. This rigorous process of information sharing supports MSF UK’s trustees in fulfilling their regulatory reporting requirements.

MSF UK also made grants to MSF International, which is based within Operational Centre Geneva (OCG), and to the Access to Medicines campaign (known as the Access Campaign), an international project within MSF that supports MSF’s work by advocating for improved access to treatment and for the development of essential medicines. Grants were also made to the Drugs for Neglected Diseases initiative (DNDi), a collaborative initiative for patient-centred drug development and access. The calculations for the amounts granted to MSF International, the Access Campaign and DNDi were based on a pre-approved international allocation. These grants are a condition of MSF UK’s membership of the MSF movement, and the trustees are satisfied that they are in the best interests of the charity.

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Natalie Roberts, Executive Director, is a member of the OCA Management Team and the Full ExCom, MSF’s international executive leadership platform. Chiara Lepora, Director of the Manson Unit, is the Deputy Medical Director for OCA, and has a seat on OCA’s Operational Platform, which is the key advisory platform to the OCA Operational Director.

During 2023, other members of the MSF UK Committee of Directors also participated in functional platforms across OCA and the MSF movement, including Donald Campbell, Director of Communications, and James Kliffen, Director of Fundraising.

MSF UK is an institutional member of MSF International, which has a key coordination role within the MSF movement.

Benchmarks and performance measuring

MSF UK is pleased that during 2023 we were able to commit 86 per cent of our total expenditure to charitable activities (as compared to 87 per cent in 2022).

MSF UK and the MSF movement always strive to make the best possible use of donated funds. We ensure that the maximum possible percentage of funds is used for the direct provision of medical care and, more broadly, for our social mission. In each country where MSF works, we ensure that our projects are focused on helping the most vulnerable and most in need. We continually review the impact of our work, through both in-country monitoring systems and headquarters-based specialist advisors.

Medical humanitarian projects are complex, and no single set of performance measures will suit every situation. For example, a sudden emergency will demand a rapid and relatively costly response from our medical and logistics teams, while a long-term project can be more carefully planned and resourced to maximise the effectiveness of its budget and staff. Preventative measures, such as improving water supplies and sanitation systems or implementing a vaccination campaign, are often prioritised, as these can help avoid less effective and more costly responses once a disease outbreak is underway.

MSF International compiles and analyses data from across the MSF movement, including producing the International Activity Report and International Finance Report, which are published on the MSF International website (www.msf.org). Printed copies are available on request through the MSF UK office. Audited data for 2023 was not available at the time of writing this report. However, the 2022 International Financial Report shows that, out of a total global expenditure of €2.17 billion, 80 per cent was spent on our social mission, 15 per cent on fundraising, and five per cent on management and administration.

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These aerial and ground photos show MSF’s distribution of relief items to a reception center hosting displaced families as a result of the earthquake that struck Syria and Turkey on February 6, 2023. Photo: Omar Haj Kadour

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Médecins Sans Frontières UK Annual Report and Accounts 2023

7 Principal risks and uncertainties

MSF UK maintains an organisational risk register, which is a live document showing the key risks facing the charity at any given time, and biannual organisation-wide risk reviews are conducted. Quarterly risk-monitoring reports are presented to the Committee of Directors and the Audit and Risk Committee, and biannual reports are made to the Board of Trustees.

The MSF UK approach to risk management assesses risk at different levels and management across the organisation, enabling depth in identifying and assessing risks and in planning and implementing risk responses. This allows for the delegation of responsibility for implementation of risk responses, and for the escalation and de-escalation of risks as appropriate. All staff are responsible for identifying new or changing risks in their area, and each risk is owned by a member of the Committee of Directors, who has oversight of the management of that risk. The Board is responsible for setting risk appetite and monitoring risk improvement activities. There is an explicit link between risk appetite as set by the Board and the prioritisation of risk responses informing annual planning.

MSF UK implemented a new risk management approach in 2022, which has been consolidated in 2023 through its first full annual cycle.

We consider risks according to seven categories: MSF Values and Governance; Ethics and Integrity; People; Information Security; Dignity and Respect; Resources; and Safeguarding. The Board’s aim is, through effective risk management, to reduce risk appetite year on year until the assessed risk score is in line with target risk tolerances across all risk categories.

Risk management in 2023

Following an exceptional break between risk reviews to synchronise the new risk management cycle, the April 2023 risk review set a new baseline for risk management activity in the organisation. Typically, this baseline is set at the October review for the following year.

In 2022 we reported that there were 16 risks above risk appetite, and key risks placing stress on the organisation related to data protection compliance, cyber security, the policy review project, delivery against the Strategic Direction, and the EDI Action Plan.

In April 2023 we reported a reduction in the number of risks above risk appetite to 15, a result of risk improvement and in the closure of risks due to a change in risk proximity. We adopted a broader focus on all risks above risk appetite as being priority risks for Board attention, and identified priority risk areas where there was a concentration of risks of a similar theme above risk appetite.

Of the 15 risks above risk appetite, there were five risks to MSF Values and Governance; four to Safeguarding; two to People; two to Dignity and Respect; one to Information Security; and one to Resources.

The following table outlines a summary of our principal risks/risk areas and management action in 2023.

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Priority risk/risk area Management actions
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Priority risk/risk area Management actions
Information Governance and Policy
●Without a more robust information
governance system, there is the risk of loss
of institutional memory, and inefciencies
and inconsistencies in applying policy in
line with good practice		 ●Progress of the organisation-wide Policy Review Project
continued through 2023, and now intends to close out
in 2024
●Revised Policy Development Framework approved by
the Board of Trustees for implementation in 2024, and
explicitly calls out the requirement for consultation with
technical referents including Safeguarding and EDI leads
Data Protection
●Insufcient staf capacity and depth of
knowledge in data protection
●Weaknesses in processes and support for
HRIS impacting information and physical
security		 ●Presentation of a ‘deep dive’ into data protection risks and
2024 project plan to the Audit and Risk Committee
●Strengthened internal capability by sending an individual
on a Privacy Professional course
●Updated data protection training for rollout to key
managers in 2024
●Ongoing engagement with HRIS support providers for
escalation of issues
Climate Impact
●Difculties in developing and implementing
a climate roadmap leading to not meeting
stakeholder expectations		 ●Ongoing biannual reporting on carbon emissions for
utilities, travel, and our biggest source of paper to the
Committee of Directors and Board of Trustees
●Further defned climate ambition in the strategy refresh for
the period 2023-2025
●Engagement with other MSF sections to develop
consistency in reporting across the movement
Funding MSF Operations
●Risk of not being able to maximise the
allocation of funds which are restricted to
certain countries, contexts or projects due
to the distribution of projects amongst the
MSF operational centres with which MSF
UK partners		 ●Ongoing work to develop relationships with operational
centres to increase capacity to fund MSF operations while
ensuring that UK reporting requirements are met
●Strengthened emergency fundraising strategy
Delivery of the Strategic Plan
●Failure to make sufcient progress
against the Strategic Direction due to
the disruption caused by COVID-19 and
competing emergent strategic priorities at
movement level		 ●Made improvements to the annual planning process with
demonstrable efectiveness
●Strategy refresh exercise reset strategic ambitions through
to the end of 2025
EDI Action Plan
●Implementation of EDI Action Plan
●Failure to meet expected standards should
action plan activities not be prioritised
within relevant departments		 ●Included the EDI Action Plan as a strategic deliverable in
strategy refresh
●Established EDI Programme Board to monitor progress
against plan
●Policy Development Framework includes consultation with
EDI Lead as part of process
●Strengthened relationship between annual plans and EDI
Action Plan

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Priority risk/risk area Management actions
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Priority risk/risk area Management actions
Cyber Security Awareness
●Lack of cyber security awareness amongst
staf resulting in breaches		 ●Rolled out online cyber security training programme across
the organisation
●Cyber security training policy in development
●Regular testing of awareness levels
Workforce Planning
●Need for developed approach to ensure
appropriate identifcation and allocation of
resource		 ●Improved approach to annual planning process to
understand resource needs
●Overall, specifc activities to address this risk have been
relatively de-prioritised in consultation with the Committee
of Directors and the Board of Trustees
Safeguarding Awareness and Practices
●Trauma exposure in line of work
●Investigations guidance and training
●Disparity in approaches across the
movement		 ●MSF UK Safeguarding Lead works across the movement
to support consensus building, including through
supporting OCA policy development and engaging with a
cross-sectional network on behaviour
●Trained a cohort of Mental Health First Aiders and rolled
out Mental Health First Aid initiative in the ofce
Positions of Power and Safeguarding
●Staf exploiting their position for personal
advantage, causing harm to vulnerable
individuals		 ●Partially rolled out Safeguarding refresher training to
internationally mobile staf
●Embedded safer recruitment recommendations as a key
consideration in the recruitment review (to be completed in
2024)

Through our risk management activity in 2023, the number of risks above risk appetite reduced from 15 to 10. De-escalated risks are related to cyber security awareness, the EDI Action Plan, strategic plan delivery and information governance. As a result, the Board of Trustees reviewed the current risk appetite and reduced this in line with the aim of reducing risk appetite year on year until the assessed risk score is in line with target risk tolerances across all risk categories.

By reducing the risk appetite, this escalated an additional six risks to above risk appetite for 2024. These were related to the impact of movement pressure on office costs; supplier costs; safer recruitment; HRIS data protection; the legacy of the MSF Listen project; migration operation risks; and international contracting. These risks will be managed through the 2024 risk management cycle.

Going concern

The trustees consider that the level of ongoing support from committed donors, combined with unrestricted reserves, secure MSF UK for the foreseeable future and, on this basis, consider that the charity is a going concern. The Board have reflected on the charity’s operational and financial risks and have concluded that there are no material uncertainties relating to MSF UK’s ability to continue as a going concern.

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An MSF health promoter provides information on family planning services to women awaiting for a consultation at the Bangassou Regional University Hospital (HRUB), Bangassou, Mbomou prefecture, March 2023. Photo: MSF/Julien Dewarichet

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Médecins Sans Frontières UK Annual Report and Accounts 2023

8 Structure, governance and management

Constitution

MSF UK is a charitable company limited by the guarantee of its members and governed by its Articles of Association. MSF UK is part of an international movement of independent legal entities, commonly referred to as MSF, which are bound by their shared name and identity, and a shared commitment to the MSF Charter and its principles.

The MSF Association

The MSF UK Association describes the company law members of MSF UK. It draws its membership from current and former project staff, and former office staff and office volunteers who can apply to become members of the Association after they have worked for six months with any part of the MSF movement. At the end of 2023, the Association had 640 members.

Members of the Association commit to ensuring that MSF UK maintains its focus on the effective delivery of medical care, in accordance with MSF’s core principles and the values of medical ethics, independence, impartiality, neutrality, accountability and témoignage (speaking out). They fulfil this commitment primarily through the election of, and by holding to account, the Board of Trustees at the Annual General Meeting of the charity.

The Board of Trustees

Association members delegate governance responsibilities to the Board of Trustees. The Board of Trustees ensures that MSF UK adheres to MSF’s core principles and values, and conducts its business in an effective and efficient manner, with due care and accountability, responsible management of resources, and in compliance with all legal and regulatory requirements.

The majority of trustees have a medical background, but trustees with different backgrounds are also frequently elected. While most trustees are elected at the Annual General Meeting, no more than half and up to seven trustees may be co-opted by the Board from within or outside the Association to ensure it maintains an appropriate mix of skills and experience.

The Chair of the Board, Nicola McLean, has a medical background, in line with MSF’s governance principles. She is assisted by a Vice-Chair of the Board. In 2023, the Board met eight times.

Each trustee holds office for three years, after which they may stand for re-election or be considered again for co-option, for a total mandate not exceeding six years. Newly appointed trustees are offered internal and external training on trustee responsibilities.

The Board regularly assesses its ability to work as a team. It conducts annual skills reviews, and actively considers its composition before and after the election of new trustees. During the year, the Board regularly considers the make-up of its committees and the split of responsibilities between members.

Trustees participate in Board sub-committees, alongside relevant MSF UK staff members, in order to advise the Board on specific matters.

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The Audit and Risk Committee is tasked with guiding the Board on issues relating to control, risk and compliance, and is focused on business and finance processes. The Committee is composed of four trustees, and met four times in 2023.

The Safeguarding and Duty of Care Committee oversees the governance of our medical humanitarian project work, with a focus on safeguarding. The Committee is composed of four trustees, and met four times in 2023.

The Remuneration Committee makes recommendations to the Board on the annual remuneration package for the Executive Director and the Chair, fair application of the reward policy and principles for MSF UK staff, and any adjustments to the MSF UK staff pay structure. The Committee is composed of three trustees and met four times in 2023.

The Motions Committee supports the AGM motions process and facilitates feedback mechanisms, allowing Association members to follow the progression of passed motions. The Committee is composed of two trustees, and met four times in 2023.

The Nominations Committee ensures that the trustee recruitment, performance review and learning and development approaches are formal, rigorous, transparent, objective and fair. They also oversee the Board’s composition to ensure that there is an appropriate balance of lived experience, knowledge and skills on the Board to govern effectively and efficiently. The Committee is composed of four trustees, and met six times in 2023.

Many trustees also act as ‘Board links’ to designated departments, including the Fundraising and HR departments and the Manson Unit. As links, trustees work closely with these teams, allowing them to effectively keep the Board updated on key areas of MSF UK’s work.

MSF UK and its relationship with the international movement

MSF UK is one of 26 institutional MSF Associations that make up the global MSF movement. Each MSF Association is set up under the laws of the country in which it is based and is governed by its membership.

The Associations operate as legal entities that hold charitable or non-profit status in their country of residence. These, together with a small number of connected entities, such as regional associations, comprise the international MSF movement. The movement chooses not to distinguish between the work of the separate entities in public representations in order to strengthen its collective voice and influence. MSF International, based in Geneva, acts as a coordination body between MSF offices.

Representatives from national and regional associations gather annually at the International General Assembly (IGA) to oversee the coordinated action and development of the MSF movement. The IGA delegates its governance to a Board of Trustees, the International Board. The International Board is led by the MSF International President, currently Dr Christos Christou.

MSF UK does not normally manage medical humanitarian projects directly. These are run by MSF’s operational centres. However, we participate in the broader governance of the MSF movement in a number of ways, in particular through our close relationship with OCA. In 2023, we launched UK operations in collaboration with OCB and Doctors of the World (DOTW).

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The Executive Director sits on the OCA Management Team, a body made of up of senior executives from each of OCA’s primary partners. It provides a forum for alignment on matters of strategic importance and to coordinate the work of OCA partners, while maintaining operational and functional reporting lines directly to MSF Holland. The Executive Director also sits on the Full ExCom, which is the only executive platform directly accountable to the International Board (IB). The objective of the ExCom platform is to provide international executive leadership to the MSF movement in accordance with the MSF Vision, ensuring reactivity, efficiency, relevance and consistency in MSF’s social mission and support activities. The ExCom supervises and holds to account the international platforms, the Steering Committee of the Access Campaign, and any initiative launched by the platform.

MSF Ireland is an independent legal entity registered in the Republic of Ireland and governed by its own Board of Trustees. However, within the MSF movement’s international coordination, MSF UK and MSF Ireland are grouped together as linked section and branch offices. As a result, MSF UK has a close relationship with MSF Ireland, and the two offices share a joint strategic plan for the period 2020-2023, refreshed for 2023-2025. MSF UK trustee Mohammed Tariq Ali was co-opted to the MSF Ireland Board of Trustees in October 2022. The Ireland Board Chair, Eve Bruce, was co-opted to the UK Board in April 2021.

In 2023, two MSF UK trustees, Nicola McLean and Vita Sanderson, sat on the OCA Council, which has an advisory relationship to the Board of MSF Holland.

In 2023, MSF UK Treasurer Derek Morgan sat on the OCA Audit Committee, which supports the work of the OCA Council, until succeeded by Tim Symington.

Robert Verrechia sat on the OCA Medical Committee throughout 2023.

Vita Sanderson and Rachael Craven sat on the OCA Duty of Care and Responsible Behaviour Committee throughout 2023.

Nicola McLean sat on the OCA Association Standing Committee throughout the year.

Innocent Muleya sat as an observer on the OCB Board of Trustees.

Eve Bruce is the OCA East Africa Board link.

Marc Wilkinson, elected by MSF UK Association members at the AGM in May 2022, and Nicola McLean, represent MSF UK at the IGA.

Remuneration of trustees

MSF UK trustees spend significant time preparing for and attending Board meetings, participating in committees, and conducting project visits. Several trustees volunteer their time on international coordination committees and sister entities within the MSF movement; for example, as members of OCA committees. A key role of our Chair is to represent MSF UK at meetings of the international movement, above and beyond the work they are expected to do for MSF UK specifically.

With the exception of the Chair, who receives a monthly payment in compensation for part of their time, our trustees are volunteers and do not receive remuneration for their governance work. The remuneration of the Chair is authorised in our Articles of Association, and the principles for that remuneration were approved by the Charity Commission.

By paying the Chair for part of their time, the Board believes it can attract suitable candidates with a medical background (a requirement in the MSF movement), and with the willingness and time to take on the role. In 2023, the chair received £32,204 for 145 days of work. The Board believes that this remuneration remains modest in light of the time the Chair commits to the organisation and the complexity of their duties, and is in line with the movement’s values.

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Trustees working in MSF projects

MSF UK trustees are permitted by the Charity Commission and the MSF UK Articles of Association to work for three months a year on standard project assignment contracts. The work that trustees conduct in such assignments is unrelated to their governance role. MSF UK greatly values the practical experience and insights our trustees gain through working in MSF projects, in a medical role or otherwise.

No trustees worked for MSF projects throughout 2023.

The Committee of Directors

The Board of Trustees appoints the MSF UK Executive Director, currently Natalie Roberts, who leads the Committee of Directors. The Committee of Directors is responsible for the implementation of strategy and the day-to-day management of the office and finances of MSF UK.

Remuneration policy

The policy for remuneration of UK-based staff, including senior managers, is delegated to the Remuneration Committee. In 2023, a Rewards Review was completed, and the Remuneration Committee approved the new MSF UK Rewards system, including related policies and the MSF UK staff salary grid, and recommended to the Board of Trustees the Executive Director salary and the Chair’s remuneration level. Additionally, the Remuneration Committee discussed the annual salary adjustment for all MSF UK, in advance of a Board of Trustees decision.

The remuneration policy contains a function grid and a fixed salary scale for office staff. This is in keeping with a focus on maximising the use of funds for MSF’s medical humanitarian projects, whilst upholding the core reward principles of: open and transparent; enabling workforce mobility; recognising impact and contribution; responsible stewardship; and global alignment.

In accordance with the remuneration policy and the Executive Director Rewards Proposal, in 2023 the Executive Director received an annual salary of £96,586 at the year-end (as compared to £91,044 in 2022). This is 3.7 times the salary of our lowest-paid office worker. Our Executive Director is the highestpaid employee at MSF UK. They have significant committee responsibilities at the international level and represent MSF UK on several management committees (see section 12, note 9 for details of the highest-paid staff).

Related parties

The trustees are related parties. See sections above on remuneration of trustees and trustees working in MSF projects, and notes to the financial statements in section 12. The trustees do not consider that any other person or organisation can be regarded as a related party.

Engagement with and interests of our employees

The trustees are satisfied that the employees of MSF UK have been fully engaged with and their interests accounted for in the decisions that have been made. MSF UK is grounded in a culture of consultation, which encourages employee involvement and lively, open discourse. The majority of Board meetings are held in open session. All staff are invited and there are opportunities for them to raise questions.

Trustees scrutinise MSF UK’s annual staff surveys and challenge the Committee of Directors to produce action plans that respond appropriately to staff concerns that are identified. In 2023, this included scrutinising the staff survey on safeguarding. The survey gave insight into the strengths and weaknesses of our safeguarding culture, and produced recommendations which were shared with the Board and incorporated into annual planning. MSF UK, with the full support of the trustees, encourages space for grassroots employee initiatives to thrive, including working groups addressing our London office space, climate-related initiatives, and equity, diversity and inclusion.

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An MSF speed boat docked in Toch has been loaded with boxes of hepatitis E vaccines to be transported to the MSF hospital in Old Fangak, Jonglei State. Photo: Gale Julius Dada/MSF

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Financial 9 review

Preparation of accounts on a going-concern basis

The trustees consider that the level of ongoing support from committed donors, combined with the unrestricted reserves, secures MSF UK for the foreseeable future and, on this basis, consider that the charity is a going concern. The Board has reflected on the charity’s operational and financial risk and has concluded that there are no material uncertainties relating to MSF UK’s ability to continue as a going concern.

Significant events in 2023

Overview

In 2023, MSF UK’s income totalled £85.2million, an £8.4 million (11 per cent) increase on our 2022 income of £76.8 million. Of this, 93 per cent (2022: 93 per cent) came from donations and legacies, with the rest coming mostly from charitable activities. In terms of total expenditure, MSF UK spent £84.0 million in 2023 (2022: £77.0 million), resulting in a surplus of £1.2m (2022: deficit of £0.1m). Of our total expenditure, £55.8 million or 66 per cent (2022: £51.4 million or 67 per cent) was given as grants to other MSF sections, with £53.8 million (2022: £49.8 million) going directly to MSF’s medical humanitarian work and social mission. Excluding grants, MSF UK’s other charitable activities came to £18.0 million (2022: £15.2million) and its fundraising activities cost £12.2 million (2022: £10.3 million).

Fundraising income and costs of generating funds

MSF UK raised £79.5 million in donations and legacies in 2023 compared to £71.6 million in 2022. This was a £7.9 million (11 per cent) increase in income, and is mainly attributable to significant increases in income from appeals and grants received from charities and trusts.

As in previous years, committed giving is our most significant source of income at £23.4 million, an increase of £0.1 million compared to 2022. Regular giving by direct debit and standing order is the bedrock of MSF UK’s financial independence. It provides a consistent flow of largely unrestricted funds that we can allocate where the medical needs are most acute, including in countries receiving little or no media attention at the time. We are very grateful to our loyal, long-term, committed donors for this level of support, which recognises the leading role that MSF plays in relieving suffering and in raising public awareness of crises.

Legacy income remains one of our largest sources of income, but it is inherently unpredictable on a year-by-year basis. We raised £19.2m from legacies in 2023 (2022: £18.0m). We are however aware of potential future legacy income of £18.6 million (2022: £15.5 million), which does not currently meet the conditions for income recognition under our accounting policies.

Income from appeals increased by 32% to £20.2m (2022: £15.3m). The value of grants received from charities and trusts increased by 30% to £7.9m (2022: £6.1m). In 2023 the extraordinary generosity of private individuals and organisations who made donations for MSF’s work following the Türkiye/Syria earthquake and during the Gaza conflict resulted in major increases in income.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

MSF UK invested in emergency appeals in 2023, which combined a wide range of fundraising methods to reach both potential and current supporters. The close integration of broadcast, print and digital appeals is highly important for MSF’s success in raising funds, which in 2023 was supported by increased investment.

In 2023, 85 per cent of our fundraising income was unrestricted (2022: 86 per cent). Unrestricted income is especially valuable to MSF, as it provides the flexibility to deliver aid where the medical need is greatest. Of the £11.3 million restricted fundraising income raised in 2023, £3.7 million was restricted to the OCA Emergency Fund and £1.0 million was restricted to projects in Palestinian territories. See note 14 of the accounts in section 12.

Our fundraising costs in 2023 increased by £1.9m (18 per cent) to £12.2 million. This increase was due to increased investment in digital fundraising activities, which were closely integrated to print and broadcast appeals, following the Türkiye/Syria earthquake and the start of the Gaza conflict. MSF UK also increased investment in long-term unrestricted income, through Face to Face fundraising and printed campaigns, with the goal of securing monthly donations from supporters. The increased volume of donations in 2023 resulted in a rise in expenditure on processing donations and thanking supporters. Our return on investment was 6.5:1 in 2023 (6.9:1 in 2022). This means that for every £1 spent on fundraising, we raised £6.53 (2022: £6.96).

Charitable activities: grant-making

In 2023, MSF UK granted £55.8 million to other MSF sections, with £53.8 million (2022: £49.8 million) going directly to MSF’s medical humanitarian work and social mission. Our largest grants in 2023 went to Mozambique (£10.9 million), Emergency Fund (£3.7 million), Zimbabwe (£3.5 million), Ethiopia (£3.2 million) and Democratic Republic of Congo (£3.0 million). More details of these grants can be found in note 5 of the accounts in section 12. See section 2 for more details of MSF activities associated with these grants. In addition to grants for MSF’s medical humanitarian work and social mission, we also gave grants to MSF International for coordination and movement-wide projects.

Other charitable activities

Spending on non-grant making charitable activities increased by 18 per cent to £18.0 million (2022: £15.2 million), with the increase spread over all non-grant making charitable activities.

Reserves

The trustees consider it is necessary for MSF UK to hold reserves in order to meet working capital requirements in the event that there are delays to receipts of income. In particular, receipts from income streams where the timing of receipts is inherently unpredictable (legacies and major gifts).

The trustees have agreed that MSF UK will aim to hold reserves equal to the lower of (a) and (b) below:

HQ expenditure excludes operational grants and grants to MSF International. The target level of reserves acknowledges that MSF UK also has the flexibility to manage its working capital requirements by delaying planned but uncommitted advance operational grant payments to MSF operational centres. MSF UK has decided that ‘two months of budgeted HQ expenditure’ represents an appropriate threshold above which it is most appropriate to manage working capital requirements by delaying operational grant payments rather than relying on reserves.

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Reserves are that part of a charity’s unrestricted funds that is freely available to spend on any of the charity’s purposes. Designated funds are not freely available, and hence are not included in reserves.

As of 31 December 2023, MSF UK’s reserves are in line with target. As of 31 December 2023, MSF UK held reserves of £4.4m (2022: £3.8m) compared to a current target of £4.4m. The current reserves target has been calculated on the basis described above and represents two months of budgeted Head Quarters (HQ) expenditure.

Designated funds

The MSF UK Board of Trustees has designated funds for the following purposes:

Restricted funds

Restricted funds represent donations where the donor has specified the project or emergency to which MSF UK should apply the funds. In 2023, we gave out in grants almost all the restricted income received during the year.

MSF doctor explains the test results of a patient during a consultation in one of the mobile clinics set up that day by MSF to bring healthcare closer to people in need in the old city of Hebron, West Bank, OPT. Photo: Laora Vigourt/MSF

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The outreach team of the Noma Hospital in Sokoto, Nigeria, started in January 2017 active case finding in Sokoto state. Here, in Sayinna village, the team is showing leaflets to check if someone identifies a noma case in the area. This day, an early case of noma was detected and an appointment was provided to visit the hospital. May 6, 2023. Photo: Fabrice Caterini/Inediz

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10 Statement of trustees’ responsibilities

Company law requires the trustees to prepare financial statements for each financial year in accordance with UK Generally Accepted Accounting Practice (UK Accounting Standards and applicable law). Under company law, the trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of affairs of the charity and of the incoming resources and application of resources, including the income and expenditure, of the charity for that period.

In preparing these financial statements, the trustees are required to:

The trustees are responsible for keeping adequate accounting records that are sufficient to show and explain the charity’s transactions, and disclose, with reasonable accuracy, at any time the financial position of the charity, and that enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charity, and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

Financial statements are published on the charity’s website in accordance with legislation in the UK governing the preparation and dissemination of financial statements, which may vary from legislation in other jurisdictions. The maintenance and integrity of the charity’s website is the responsibility of the trustees. The trustees’ responsibility also extends to the ongoing integrity of the financial statements contained therein.

Disclosure of information to auditors

The trustees who held office at the date of approval of this report confirm that, so far as they are aware, there is no relevant audit information of which the charity’s auditors are unaware. Each trustee has taken all the steps that they ought to have taken to make themselves aware of any relevant audit information and to establish that the charity’s auditors are aware of that information.

Auditors

BDO LLP were appointed as the charity’s auditors for the year ended 31 December 2023.

The Trustees’ Annual Report, including the Strategic Report and the Directors’ Report, was approved by the trustees on 29 April 2024 and signed on their behalf by:

Nicola McLean

Chair of the Board of Trustees

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Agathe, a community volunteer member in Kaïhoué, leads an educational talk to the community. She talks about the signs of danger in newborn babies, and how to get them to the health center as quickly as possible. Photo: Yves-Constant Tamomo

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Médecins Sans Frontières UK Annual Report and Accounts 2023

11 Independent Auditor’s Report to Members and Trustees of Médecins Sans Frontières (UK)

Opinion on the financial statements

In our opinion, the financial statements:

We have audited the financial statements of Médecins Sans Frontières (UK) (“the Charitable Company”) for the year ended 31 December 2023 which comprise the statement of financial activities, the balance sheet, the cashflow statement and notes to the financial statements, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Independence

We remain independent of the Charitable Company in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements.

Conclusions related to going concern

In auditing the financial statements, we have concluded that the Trustees’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate.

Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the Charitable Company’s ability to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue.

Our responsibilities and the responsibilities of the Trustees with respect to going concern are described in the relevant sections of this report.

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Other information

The Trustees are responsible for the other information. The other information comprises the information included in the Report of the Trustees other than the financial statements and our auditor’s report thereon. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon. Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements, or our knowledge obtained in the course of the audit, or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact.

We have nothing to report in this regard.

Other Companies Act 2006 reporting

In our opinion, based on the work undertaken in the course of the audit:

In the light of the knowledge and understanding of the Charitable Company and its environment obtained in the course of the audit, we have not identified material misstatement in the Strategic report or the Trustees’ report.

We have nothing to report in respect of the following matters in relation to which the Companies

Act 2006 requires us to report to you if, in our opinion:

Responsibilities of Trustees

As explained more fully in the Statement of Trustees’ Responsibilities, the Trustees (who are also the directors of the charitable company for the purposes of company law) are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and for such internal control as the Trustees determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Trustees are responsible for assessing the Charitable Company’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the Trustees either intend to liquidate the Charitable Company or to cease operations, or have no realistic alternative but to do so.

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Auditor’s responsibilities for the audit of the financial statements

We have been appointed as auditor under the Companies Act 2006 and report in accordance with the Act and relevant regulations made or having effect thereunder.

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

Extent to which the audit was capable of detecting irregularities, including fraud

Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, outlined above, to detect material misstatements in respect of irregularities, including fraud. The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below:

Non-compliance with laws and regulations

Based on:

We considered the significant laws and regulations to be the relevant Charities Act in the UK, the Companies Act 2006 and Taxation legislation.

The Charity is also subject to laws and regulations where the consequence of non-compliance could have a material effect on the amount or disclosures in the financial statements, for example through the imposition of fines or litigations. We identified the following areas as those most likely to have such an effect: fundraising legislation, employment law, data protection and health and safety legislation. Auditing standards limit the required audit procedures to identify non-compliance with these laws and regulators to enquiry of the Trustees and other management and inspection of regulatory and legal correspondence if any. Our procedures in respect of the above included:

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Fraud

We assessed the susceptibility of the financial statements to material misstatement, including

fraud. Our risk assessment procedures included:

Based on our risk assessment, we considered the area’s most susceptible to fraud to be Journal entries and accounting estimates.

Our procedures in respect of the above included:

We also communicated relevant identified laws and regulations and potential fraud risks to all engagement team members and remained alert to any indications of fraud or non-compliance with laws and regulations throughout the audit.

Our audit procedures were designed to respond to risks of material misstatement in the financial statements, recognising that the risk of not detecting a material misstatement due to fraud is higher than the risk of not detecting one resulting from error, as fraud may involve deliberate concealment by, for example, forgery, misrepresentations or through collusion. There are inherent limitations in the audit procedures performed and the further removed non-compliance with laws and regulations is from the events and transactions reflected in the financial statements, the less likely we are to become aware of it.

A further description of our responsibilities for the audit of the financial statements is located at the Financial Reporting Council’s (“FRC’s”) website at:

https://www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Use of our report

This report is made solely to the Charitable Company’s members, as a body, in accordance with Chapter 3 of Part 16 of the Companies Act 2006. Our audit work has been undertaken so that we might state to the Charitable Company’s members those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Charitable Company and the Charitable Company’s members as a body, for our audit work, for this report, or for the opinions we have formed.

Fiona Condron (Senior Statutory Auditor) For and on behalf of BDO LLP, Statutory Auditor Gatwick Location, UK 30 April 2024

BDO LLP is a limited liability partnership registered in England and Wales (with registered number OC305127).

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Médecins Sans Frontières UK Annual Report and Accounts 2023

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(PHU), Tonkolili District, Northern Province of Sierra Leone. She is supported by maternity nurse (MoHS) Mariatu Fornah. Photo: Saidu Bah = .\Naas WY / ai
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Médecins Sans Frontières UK Annual Report and Accounts 2023

12 statements Financial

Statement of financial activities

Incorporating an Income and Expenditure account, as required by the Companies Act 2006. The notes on pages 65-79 form part of these financial statements.

Note
Income
Donations and legacies
3
MSF UK charitable activities
4
Other income
Interest income
Other
TOTAL
Expenditure
Charitable activities
Operational grants
5
Internationally deployed staf
6
Medical & programme support
6
Advocacy, communications &
representation
6
Other grants
6
UK Programmes
6
Fundraising costs
6
TOTAL
Net exchange (loss)/gain unrealised and realised
Net (expenditure) / income for the year
Fund balances brought forward
at 1 January
Fund balances carried forward
at 31 December		 2023(£’000)
Unrestricted
Restricted
TOTAL
68,200
11,334
79,534
5,385
60
5,445
148
-
148
134
-
134
73,867
11,394
85,261
42,834
10,996
53,830
6,454
-
6,454
8,123
362
8,485
3,052
-
3,052
-
-
-
45
-
45
12,175
-
12,275
72,683
11,358
84,041
(5)
-
(5)
1,179
36
1,215
11,073
4
11,077
12,252
40
12,292		 2022(£’000)
Unrestricted
Restricted
TOTAL
61,622
10,019
71,641
4,568
188
4,756
26
-
26
406
-
406
66,622
10,207
76,829
39,850
9,927
49,777
5,899
-
5,899
6,314
478
6,792
2,539
-
2,539
1,653
-
1,653
-
-
-
10,293
-
10,293
66,548
10,405
76,953
-
-
-
74
(198)
(124)
10,999
202
11,201
11,073
4
11,077

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Balance sheet

As at 31 December 2023

The notes on pages 65-79 form part of these financial statements.

2023(£’000) 2022(£’000)
Note
Fixed Assets
Intangible assets 10 698 854
Tangible assets 11 432 480
1,130 1,334
Current Assets
Debtors 12 11,400 8,764
Cash 14,398 18,974
25,798 27,738
Current Liabilities
Creditors: Amounts falling
due within one year 13 (14,636) (17,995)
Net Current Assets 11,162 9,743
NET ASSETS 12,292 11,077
FUNDS
Unrestricted
General 14 4,423 5,123
Designated 14 7,829 5,950
Total Unrestricted 14, 15 12,252 11,073
Restricted 14, 15 40 4
TOTAL FUNDS 12,292 11,077

These financial statements were approved by the trustees on 29 April 2024 and were signed on their behalf by:

Tim Symington Treasurer

Nicola McLean Chair

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Cashflow statement

As at 31 December 2023

The notes on pages 65-79 form part of these financial statements.

Cash outfow used in operating activities
Cash outfow from investing activities
Interest received
Purchase of fxed assets
Decrease in cash in the year
Cash balance at 1 January
Cash balance at 31 December		 2023 (£’000)
(4,627)
51
(4,576)
18,974
14,398		 2022 (£’000)
148
(97)		 26
(350)		 (539)
(324)
(863)
19,837
18,974

Reconciliation of net expenditure to operating cashflow

Net expenditure
Bank interest
Depreciation & amortisation charge
Loss on disposal of fxed assets
(Increase)/decrease in debtors
Decrease in creditors		 2023(£’000)
1,215
(148)
298
3
(2,636)
(3,359)
(4,627)		 2022(£’000)
(124)
(26)
209
-
438
(1,036)
(539)

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Notes to the financial statements

1. Legal status

Médecins Sans Frontières (UK) is a registered charity and a company limited by guarantee, registered in England and Wales. On winding up, each person who is a member at that date is liable to contribute a sum not exceeding £1 towards the assets of the charity. As at 31 December 2023 the charity has 640 (2022: 606) members.

2. Accounting policies

The following accounting policies have been applied consistently in dealing with items which are considered material in relation to the financial statements.

Basis of preparation

The financial statements have been prepared under the historical cost convention in accordance with the Charities Statement of Recommended Practice (“Charities SORP (FRS 102) second edition – October 2019”), and in accordance with the Financial Reporting Standard 102, (FRS 102) and the Companies Act 2006.

The trustees consider that the level of ongoing support from committed donors, combined with the unrestricted reserves, secure MSF UK for the foreseeable future and, on this basis, consider that the charity is a going concern. The Board have reflected on the charity’s operational and financial risk and have concluded that there are no material uncertainties relating to MSF UK’s ability to continue as a going concern. The accounts have been prepared on a going concern basis accordingly.

Significant estimates and judgements

In preparing the financial statements, it is necessary to make certain judgements, estimates and assumptions that affect the amounts recognised in the financial statements. The following judgements and estimates are considered by the trustees to have the most significant effect on amounts recognised in the financial statements:

Where MSF UK has been notified of a legacy which does not have confirmation of entitlement, the amount cannot be reliably estimated and receipt is not considered to be probable, it is treated as a contingent asset and disclosed. Contingent assets, in practice, relate to residuary legacies where the realisation is dependent on the sale of properties and the finalisation of the estates. The value, measurement and timing of residuary legacies is inherently uncertain, based on estimates, subject to market fluctuations and in some case under contest. The contingent asset is valued at the best estimate of MSF UK’s share of the current market value of the underlying assets of the estate.

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Income

Income is accounted for when it meets the three recognition criteria as per the SORP (entitlement, probability and measurement).

Donations – donated income is recognised when MSF UK is entitled to it, receipt is probable, and the amount can be measured. Income from donations includes Gift Aid where appropriate.

Legacies – see estimates and judgements used in the above section.

Charitable income – income due from MSF entities for the recruitment and remuneration of staff working in MSF projects and for project expenditure is accounted for on a receivable basis. Donated gifts and services – Donations in kind with a value of over £5,000 are included at the value to the charity to the extent that this can be quantified, and are recognised when received.

Expenditure

All expenditure is accounted for on an accrual basis. Grants payable are recognised when a legal or constructive obligation commits the charity to expenditure. This is therefore recognised when the obligation exists, is probable and can be measured reliably.

For allocation of overhead costs, see estimates and judgements used in the above section.

Taxation

The company is a charity within the meaning of Paragraph 1, Schedule 6 of the Finance Act 2010. Accordingly, the company is potentially exempt from taxation in respect of income or capital gains within categories covered by Chapter 3 of part 11 of the Corporation Tax Act, 2010 or section 256 of the Taxation of Chargeable Gains Act 1992, to the extent that such income or gains are applied exclusively to charitable purposes.

Fund accounting

Unrestricted funds consist of donations and other income that are available for use without any restrictions. These are available for general use to further the objectives of the charity at the trustees’ discretion.

Designated funds – MSF UK has the following designated funds in 2023:

Restricted funds are subject to specific restrictions imposed by donors or by the purpose of the appeal under which they were raised.

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Assets and liabilities

Intangible assets

Assets have been classified as intangible assets where they meet the criteria under FRS 102 for recognition as intangible assets.

Intangible assets are recognised if it is probable that the expected future economic benefits that are attributable to the asset will flow to the charity, and the cost of the asset can be measured reliably. Intangible assets are recognised at cost as per the SORP and amortised as from the moment they are available for use on a straight-line basis over their useful economic lives as follows:

Computer software: four to ten years

Assets under construction represent capitalised costs for system changes where the benefits would start to be realised in future years. This will be amortised when the assets are put into use.

Tangible fixed assets

Assets costing over £1,000 are capitalised at cost as fixed assets and depreciated on a straightline basis over their useful economic lives, as follows:

Furniture and office equipment: five years

Computer hardware: five years

Structural alterations: over the period of the lease

Financial instruments

Financial instruments are financial assets, which comprise cash and debtors, and financial liabilities, which comprise creditors, measured at transaction price less attributable transaction costs.

Foreign currencies

Transactions in foreign currencies are recorded using the rate of exchange ruling at the date of the transaction. Monetary assets and liabilities denominated in foreign currencies are translated using the rate of exchange ruling at the balance sheet date, and the gains or losses on translation are included in the statement of financial activities. MSF UK has no hedging or derivative contracts.

Operating leases

Operating lease rentals are charged to the profit and loss account on a straight-line basis over the period of the lease.

Pensions

The charity contributes to employees’ defined contribution personal pension schemes. The amount charged to the statement of financial activities represents the contributions payable in respect of the accounting period.

Investments

The charity’s sole investment is £1 (100 per cent of the share capital) in MSF Enterprises Limited, a company incorporated in England and Wales. The charity has not prepared consolidated accounts, as the subsidiary has no assets and is dormant.

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3. Donations and legacies

. Donations and legacies
Committed and regular donations by
individuals
Income from appeals
Legacies
Grants received from charities and trusts
Sponsorship, events, collections,
uncommitted individual donations
Donations from companies & corporations
Donations in kind
TOTAL		 2023(£’000)
Unrestricted
Restricted
TOTAL
23,310
116
23,426
15,809
4,343
20,152
18,651
575
19,226
3,768
4,153
7,921
3,970
350
4,320
2,692
1,797
4,489
-
-
-
68,200
11,334
79,534		 2022(£’000)
Unrestricted
Restricted
TOTAL
23,204
123
23,327
11,368
3,942
15,310
17,297
674
17,971
3,053
2,999
6,052
3,554
597
4,151
3,146
1,684
4,830
-
-
-
61,622
10,019
71,641

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Legacy Income is not recognised until MSF UK has entitlement to the funds, the amount can be quantified and there is probability of receipt. The estimated value of legacies, which have been notified, but not recognised at 31 December 2023 was £18.6m (2022: £15.5m). This value relates to residuary legacies where the realisation is dependent on the sale of properties and the finalisation of the estates. The value, measurement and timing of these residuary legacies is therefore uncertain based on estimates, subject to market fluctuations. We do not attempt to weigh the probability of receipts.

4. Income from charitable activities

Income related to internationally deployed staff is received from the other MSF entities to whom the staff are seconded. See note 6 for further details.

In 2023, we received restricted grants from MSF International for ‘transformative projects’ that were undertaken on behalf of the movement. See page 13 for more details on the Palliative Care, Malaria Anticipation and Access project.

International deployment of operational staf
International deployment of other staf
Educational activities
Grants for Transformational Investment
Capacity projects (TIC)
TOTAL		 2023(£’000)
Unrestricted
Restricted
TOTAL
2,515
-
2,515
2,663
-
2,663
207
-
207
-
60
60
5,385
60
5,445		 2023(£’000)
Unrestricted
Restricted
TOTAL
2,466
-
2,466
2,102
-
2,102
-
-
-
-
188
188
4,568
188
4,756

5. Charitable activities (grants)

MSF operational centres are responsible for medical humanitarian projects in over 70 countries. MSF UK’s operational grants to these projects have been grouped by country or programme category in the table below. Note that these projects are not managed by MSF UK.

The decision on which projects and programmes to fund is retained by the Board but influenced by need as expressed by the MSF operational centres that we fund.

See pages 6-11 for more details on the main projects supported by MSF UK.

Grant recipient
MSF Holland
MSF Belgium
MSF France
TOTAL		 2023(£’000)
35,522
17,038
1,270
53,830		 2022(£’000)
33,657
15,910
210
49,777

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Main programmes
Mozambique
Emergency Fund
Zimbabwe
Ethiopia
Democratic Republic of
Congo
Yemen
Afghanistan
South Africa
Nigeria
Somalia
South Sudan
Chad
Haiti
Search and Rescue
Bangladesh
Palestinian Territories
Sudan
Ukraine
India
Libya
Myanmar
Pakistan
Central African Republic
Syria
Sierra Leone
Iraq
UK Migration
Kenya
Morocco
Venezuela
Mali
Greece
Social Mission
TOTAL GRANTS		 2023(£’000)
Unrestricted
Restricted
TOTAL
10,860
1
10,861
-
3,653
3,653
3,539
1
3,540
3,024
176
3,200
2,399
601
3,000
1,731
969
2,700
1,899
595
2,494
2,396
4
2,400
1,766
634
2,400
2,211
189
2,400
1,440
860
2,300
1,266
134
1,400
1,200
-
1,200
943
57
1,000
804
296
1,100
-
1,000
1,000
787
13
800
-
753
753
582
118
700
245
415
660
594
6
600
478
22
500
499
1
500
-
449
449
400
-
400
200
-
200
-
45
45
19
1
20
-
3
3
-
-
-
-
-
-
-
-
-
3,552
-
3,552
42,834
10,996
53,830		 2022(£’000)
Unrestricted
Restricted
TOTAL
8,779
1
8,780
-
-
-
2,955
2
2,957
495
105
600
2,714
986
3,700
1,099
601
1,700
1,090
3,626
4,716
4,070
-
4,070
2,120
280
2,400
874
526
1,400
4,118
882
5,000
651
49
700
896
4
900
428
572
1,000
384
216
600
-
-
-
798
402
1,200
-
513
513
277
123
400
537
263
800
1,000
-
1,000
1,052
148
1,200
1
249
250
1,561
339
1,900
34
16
50
200
-
200
-
-
-
-
4
4
-
-
-
351
9
360
-
10
10
-
1
1
3,366
-
3,366
39,850
9,927
49,777

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Emergency Fund
Democratic Republic of Congo
Sudan
Ethiopia
Haiti
Pakistan
Chad
Myanmar
Sub-total		 2023(£’000)
Unrestricted
Restricted
TOTAL
-
1,000
1,000
-
600
600
-
500
500
-
500
500
-
500
500
-
353
353
-
200
200
-
3,653
3,653		 2022(£’000)
Unrestricted
Restricted
TOTAL
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

6. Other expenditure

In addition to operational grants, MSF UK’s other charitable activities contribute to the medical humanitarian projects of the MSF operational centres and the strategic objectives of the MSF movement. Analysis of the expenditure associated with these other charitable activities as well as fundraising costs is shown below.

Charitable activities
Operational grants
Internationally deployed staf
Medical & programme support
Advocacy, communications &
representation
Other grants
UK programmes
Fundraising costs
Total after allocated costs		 2023(£’000)
Direct
Expenditure
Management,
general
administration
& overhead
costs
allocated
Total after
allocated
costs
53,830
-
53,830
5,840
614
6,454
6,039
2,447
8,485
1,786
1,266
3,052
-
-
-
45
-
45
10,158
2,017
12,175
77,698
6,344
84,041		 2022(£’000)
Direct
Expenditure
Management,
general
administration
& overhead
costs
allocated
Total after
allocated
costs
49,777
-
49,777
5,236
663
5,899
4,804
1,988
6,792
1,460
1,079
2,539
1,653
-
1,653
-
-
-
8,716
1,577
10,293
71,646
5,307
76,953

Management, general administration, overheads and governance costs are those functions that support the charitable activities of the charity.

These support costs have been allocated between the charitable activities on the basis of fulltime equivalent headcount. The breakdown of these support costs is shown below.

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Executive Ofce
Finance
Governance
HR
IT
Ofce costs
International coordination
TOTAL		 2023
1,065
529
166
1,376
1,171
1,066
971
6,344		 2022
974
1,474
112
863
916
968
-
5,307

In 2022 International coordination was included in Other Grants and not as an allocated support cost. The breakdown of the total grant to MSF International is shown below.

MSF International
International Coordination and Strategic Activities, (under Management and
general administration)
Transformational (TIC) Programme Support, (under Medical and programme
support)
Access Campaign, (under Advocacy, communications & representation)
Drugs for Neglected Diseases Initiative, (under Medical and programme
support)
TOTAL		 2023(£’000)
1,086
489
200
147
1,922		 2022(£’000)
1,303
-
202
148
1,653

In 2022, this grant was presented separately as an ‘other grant’ on the face of SOFA. In 2023 this presentation has been improved to allocate the elements of the grant to the other main rows of the SOFA, as indicated in the table above.

Internationally deployed staff

Internationally deployed staff are employed by MSF UK and deployed internationally in operational roles (medical humanitarian projects) or in various roles in other MSF entities.

Operational staff are seconded to MSF operational centres to work in medical humanitarian projects in a variety of roles including medical roles and logistical roles. These staff are also referred to as internationally mobile staff (IMS). The direct costs include the wages of these operational staff. MSF UK recruits and supports these operational staff; the other costs relate to the recruitment and support activity.

In addition, MSF UK employs staff based in the UK who are seconded to work for other MSF entities in a variety of non-operational roles. The direct costs include the wages of these other staff.

MSF UK receives income from the relevant other MSF entities in relation to the direct costs of

deployed staff (see also note 4).

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Direct costs of deployment of operational staf
Other costs of deployment of operational staf
Total costs for deployment of operational staf
Direct costs of deployment of other staf
Total costs of internationally deployed staf		 2023(£’000)
2,515
661
3,176
2,663
5,839		 2022(£’000)
2,466
843
3,309
1,927
5,236

7. Trustees’ remuneration, expenses and donations

Governance costs include the remuneration of our Chair: Nicola McLean (from 1 January to 31 December 2023). Nicola McLean received £32,204 for 145 days of work (2022: £23,062 for 165 days). The Chair’s remuneration is sanctioned by the charity’s Articles of Association and was determined by the Board, in the absence of the Chair, based on a recommendation of the Remuneration Committee. The Chair receives a fixed monthly retainer in compensation for the time spent fulfilling their Chair duties above that of other trustees. No other trustee received compensation for their role as trustee.

During the year, 12 trustees were reimbursed for expenses, or had expenses paid on their behalf by the charity, to the value of £7,676 in relation to MSF UK business (2022: £10,218 to 10 trustees). Trustees’ expenses principally comprise training costs and the cost of travel to attend governance meetings in the UK and overseas to other MSF entities.

8. Net movement in funds for the year is stated after charging / (crediting)


harging / (crediting)
Auditor's remuneration for statutory audit
Auditor's remuneration for other services
Exchange (gains) / losses
Operating lease payments		 2023(£’000)
62
58
5
452		 2022(£’000)
54
64
(31)
452

9. Staff numbers and costs

The total number of employees throughout the year was:

Internationally deployed operational staf
Recruitment and support of internationally deployed operational staf
Medical & programme support
Advocacy, communications & representation
Fundraising
Management, general administration, overhead and governance
TOTAL		 2023(£’000)
151
14
54
29
46
49
343		 2022(£’000)
219
17
61
31
43
44
415

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Médecins Sans Frontières UK Annual Report and Accounts 2023

The average number of employees throughout the year was:

Internationally deployed operational staf
Recruitment and support of internationally deployed operational staf
Medical & programme support
Advocacy, communications & representation
Fundraising
Management, general administration, overhead and governance
TOTAL		 2023(£’000)
61
11
43
22
35
34
206		 2022(£’000)
76
13
39
21
31
28
208

The costs of employing staff during the year were:

The costs of employing staf during the year were:
Wages & salaries
Social security costs
Pension costs
Termination payments
TOTAL		 2023(£’000)
9,609
899
818
29
11,355		 2022(£’000)
8,750
822
726
-
10,298

The number of employees with total compensation (excluding employer pension costs) greater than £60,000 are:

2023 2022
Between £60,000 and £70,000 16 16
Between £70,000 and £80,000 10 3
Between £80,000 and £90,000 3 -
Between £90,000 and £100,000 2 -

Employer contributions to defined contribution pension schemes on behalf of staff paid over £60,000 amount to £211,668 (2022: 128,033).

The highest-paid role of MSF UK is the Executive Director at £96,205.

There are 31 employees with total compensation over £60,000; nine are members of MSF UK’s Committee of Directors, who are judged to be key management personnel. See page 48 for MSF UK’s remuneration policy.

The total employee benefits, excluding pension scheme contributions, of the Committee of Directors were £729,090 (2022: £704,495).

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Médecins Sans Frontières UK Annual Report and Accounts 2023

10. Intangible assets

Cost
At beginning of year
TOTAL
Amortisation
At beginning of year
Charge for the year
TOTAL
Net book value
At beginning of year
At end of year		 Computer
Software
(£’000)
1,250
1,250
396
156
552
854
698		 TOTAL
(£’000)
1,250
1,250
396
156
552
854
698

11. Tangible fixed assets

Cost
At beginning of year
Additions
Disposals
TOTAL
Depreciation
At beginning of year
Charge for the year
Disposals
TOTAL
Net book value
At beginning of year
At end of year		 Computer
Hardware
(£’000)
536
89
(22)
603
175
109
(19)
265
361
338		 Furniture and
Equipment
(£’000)
114
4
-
118
111
1
-
112
3
6		 Structural
Alterations
(£’000)
629
4
-
633
513
32
-
545
116
88		 TOTAL
(£’000)
1,279
97
(22)
1,354
799
142
(19)
922
480
432

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Médecins Sans Frontières UK Annual Report and Accounts 2023

12. Debtors

2. Debtors
MSF International Members
Legacies receivable
Other debtors
Prepayments
TOTAL		 2023(£’000)
1,355
6,699
2,931
415
11,400		 2022(£’000)
1,263
5,108
1,993
400
8,764

‘MSF International Members’ relate to the entities that make up the worldwide MSF movement (see Appendix 1).

13. Creditors: amounts falling due within one year

MSF International Members
Tax and social security
Deferred income
Accruals
Other creditors
TOTAL		 2023(£’000) 2022(£’000)
12,394
827
-
672
743		 15,332
1,236
290
671
466
14,636 17,995

There was no deferred income in 2023. See below for the movement of deferred income during the year:

At beginning of year
Released
Deferred income
At end of year		 2023(£’000)
290
(290)
-
-		 2022(£’000)
-
-
290
290

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14. Movements in funds

Unrestricted funds
General fund
Designated fund Legacies
Designated fund Fixed Assets
Sub-total
Restricted funds
Afghanistan
Palestinian Territories
Bangladesh
Democratic Republic of Congo
Ethiopia
India
Libya
Syria
Nigeria
Search and Rescue
Somalia
South Sudan
Chad
Ukraine
Yemen
Emergency Fund
Other
Sub-total
TOTAL FUNDS		 1 January
2023
(£’000)
5,123
5,108
842
11,073
(3)
-
-
-
-
-
-
-
-
-
-
-
-
-
(1)
-
8
4
11,077		 Income
(£’000)
73,867
-
-
73,867
598
1,000
296
601
176
118
415
449
634
57
189
860
134
753
970
3,653
491
11,394
85,261		 Expenditure
(£’000)
(67,282)
(5,108)
(298)
(72,688)
(595)
(1,000)
(296)
(601)
(176)
(118)
(415)
(449)
(634)
(57)
(189)
(860)
(134)
(753)
(969)
(3,653)
(459)
(11,358)
(84,046)		 Transfers
(£’000)
(7,285)
6,699
586
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-		 31 December
2023
(£’000)
4,423
6,699
1,130
12,252
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
40
40
12,292

See note 2 on accounting policies for details of the ‘Designated funds’ for 2023.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Unrestricted funds
General fund
Designated fund Legacies
Designated fund Capital Projects
Sub-total
Restricted funds
Afghanistan
Bangladesh
Central African Republic
Democratic Republic of Congo
Ethiopia
India
Libya
Nigeria
Pakistan
Search and Rescue
Somalia
South Sudan
Sudan
Ukraine
Yemen
Other
Sub-total
TOTAL FUNDS		 1 January
2022
(£’000)
4,989
4,746
1,264
10,999
186
-
-
-
-
-
-
-
-
-
-
-
-
-
-
16
202
11,201		 Income
(£’000)
66,622
-
-
66,622
3,438
216
249
986
105
123
263
280
148
572
526
882
402
513
600
904
10,207
76,829		 Expenditure
(£’000)
(61,687)
(4,746)
(115)
(66,548)
(3,627)
(216)
(249)
(986)
(105)
(123)
(263)
(280)
(148)
(572)
(526)
(882)
(402)
(513)
(601)
(912)
(10,405)
(76,953)		 Transfers
(£’000)
(4,801)
5,108
(307)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-		 31 December
2022
(£’000)
5,123
5,108
842
11,073
(3)
-
-
-
-
-
-
-
-
-
-
-
-
-
(1)
8
4
11,077

Analysis of net assets between funds

Unrestricted funds
Restricted funds
TOTAL		 2023(£’000)
Fixed
Assets
Current
Assets
TOTAL
1,130
11,122
12,252
-
40
40
1,130
11,162
12,292		 2022(£’000)
Fixed
Assets
Current
Assets
TOTAL
1,334
9,739
11,073
-
4
4
1,334
9,743
11,077

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Médecins Sans Frontières UK Annual Report and Accounts 2023

16. Lease payments

The charity has entered into a rental agreement for its offices, which is currently due to expire in 2025 and which is classified as an operating lease. The total future minimum payments on this lease are as follows:


lease are as follows:
No later than one year
Between one year and not later than fve years
After more than fve years
TOTAL		 2023(£’000)
452
38
-
490		 2022(£’000)
452
491
-
943

17. Pension arrangements

The charity operates a defined contribution group personal pension scheme. The charge in respect of the contributions in the year was £969,836 (2022: £810,581). The cost is recognised on the accrual basis with £108,691 outstanding as at 31 December 2023 (2022: £91,237).

18. Related party transactions

MSF Enterprises is a fully owned subsidiary of MSF UK. During the year, MSF Enterprises has been dormant.

See note 7 on trustees for further details. We do not consider there to be any further related party transactions that require disclosure.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

Funke Adagboyega, MSF counsellor from the Mental health department, talks to Aisha L., a 45-year-old survivor from Yobe state, before her surgery. Aisha L. is proud to be an example to other people suffering noma. ‘Anyone with noma who sees me would be willing to come to the hospital and get treated’. May 5, 2023. Photo: Fabrice Caterini/Inediz

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Médecins Sans Frontières UK Annual Report and Accounts 2023

13 Appendices

Appendix 1: Structure of MSF

Médecins Sans Frontières (MSF) : An international, independent medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, natural disasters and exclusion from healthcare. MSF was founded in France in 1971, in the wake of war and famine in Biafra, Nigeria. We have expanded to become a worldwide movement of current and former project-based staff, grouped into 26 national and regional associations.

MSF UK : This is a company and a charity. MSF UK is a corporation and a legal entity, distinct from its members, with a legal name, rights, responsibilities, assets and liabilities.

MSF sections : Sections are the operating entities that make up the MSF movement. There are 24 affiliated sections worldwide; MSF UK is one. Sections run operational projects and provide operational project support and/or indirect operational support activities (such as fundraising and communications). They are institutional members of MSF International, and meet other requirements as defined by the International Board.

MSF branch offices : Branch offices also run indirect operational support activities, but have no executive autonomy in the MSF movement. They are represented by sections in MSF’s international coordination bodies.

MSF UK Association : The company law members of MSF UK. These are former and current staff, including volunteers, who are members of the company MSF UK, guaranteeing MSF UK’s purpose and direction. Internationally, each MSF section has a similar governance structure involving an association of staff and volunteers who have worked for MSF.

MSF operational centres : MSF field projects are delivered by five operational centres, located in Amsterdam, Barcelona, Brussels, Geneva and Paris. There is also a sixth newest entity, the West and Central Africa Association (WaCA), which is an institutional member with the right to run operations. The operational centres are not separate legal entities, but are collaborations between various MSF entities. The tangible elements of each operational centre sit within the particular MSF entity in the country in which it is located. For example, Operational Centre Amsterdam sits within MSF Holland. The operational centres directly manage medical humanitarian projects, prepare budgets and allocate resources. MSF entities are usually affiliated to a specific operational centre; MSF UK is affiliated to Operational Centre Amsterdam.

MSF International : A Swiss non-profit entity which provides coordination, information and support to the whole of MSF. It also hosts the higher governing structures: the International General Assembly, the International Board, the Executive Committee, and the International Office.

MSF International General Assembly : This Assembly is constituted of democratically elected members of MSF Associations (two representatives per MSF Association). It meets annually in June to debate and decide issues of policy and strategy. The International General Assembly is the highest authority in MSF; it elects the International President and most of the International Board, and is charged with safeguarding MSF’s medical, humanitarian and social mission.

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Médecins Sans Frontières UK Annual Report and Accounts 2023

MSF International Board : A majority democratically elected board with delegated powers from the International General Assembly. A minority of members are Chairs of the operational centres’ governance bodies. It meets on average eight times a year to govern MSF International and oversee the Executive Committee.

MSF Executive Committee : A platform comprising the Executive Director of each MSF section. The Executive Committee is charged with providing international executive leadership to MSF; coordinating the implementation of an international work plan; and ensuring reactivity, efficiency, relevance and consistency in MSF’s social mission and other support activities. There is a smaller Core Executive Committee made up of the General Directors of the five operational centres plus two elected members from the wider movement.

Appendix 2: Principal offices

MSF International

140, Route de Ferney 1202 Geneva, Switzerland

MSF Belgium

Seat of Operational Centre Brussels 46 rue de l’Arbre Bénit 1050 Brussels, Belgium

MSF France

Seat of Operational Centre Paris 14-34 avenue Jean Jaurès 75019 Paris, France

MSF Holland

Seat of Operational Centre Amsterdam Plantage Middenlaan 14 1018 DD Amsterdam, The Netherlands

MSF Spain

Seat of Operational Centre Barcelona-Athens Carrer de Zamora 54 08005 Barcelona, Spain

MSF Switzerland

Seat of Operational Centre Geneva 140, Route de Ferney 1202 Geneva, Switzerland

MSF West and Central Africa (WaCA)

MSF WaCA (Association MSF Afrique de L’Ouest et Centrale) Zone 4-Lot 44 Ilôt 7 Biétry Zone 4B Abidjan, Côte d’Ivoire

Other MSF locations

MSF entities in other countries recruit project staff, raise funds and advocate on behalf of people caught up in crises. A complete and up-to-date list of these entities can be found on our website: www.msf.org.uk.

CONTENTS

82

For more information on MSF UK, please visit: www.msf.org.uk

Find us on:

----- Start of picture text -----
An MSF nurse triages a child at the Emergency Room of Boost Provincial Hospital in Lashkar Gah, Helmand Province. The triage nurses or doctors assess
the patients’ vital signs, symptoms, and medical history. Our medical teams see more than 850 patients daily in both the male and female sections of the ER
of Boost Provincial Hospital. Photo: Paul Odongo/MSF
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----- End of picture text -----

MEDICINS SANS FRONTIERES (UK) Audit Completion: year ended 31 December 2023 Report to the Audit Committee * -

2 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Contents

Table of contents Table of contents Table of contents 2 2
Introduction 3 3
Introduction 3 3
Executive summary 4 4
Executive summary
Audit Scope and Materiality		 4 4
Executive summary
Audit Scope and Materiality		 5 5
Audit Scope and Materiality 5 5
Audit Scope and Materiality
Key matters		 6 6
Key matters 6 6
Key matters
Overview of risks
Management override		 Key matters
Overview of risks		 7 7
7 7
Management override 8 8
Management override 8 8
Management override
Revenue recognition		 9 9
Revenue recognition 9 9
Revenue recognition
Grant income		 10 10
Grant income 10
Legacy income 11
Legacy income 11
Legacy income
Estimates & Key Judgements
Going concern		 Legacy income
Estimates & Key Judgements		 12
12
Estimates & Key Judgements
Going concern		 13
Going concern 13
Advantage overview
Advantage Financial Analyser
Going concern		 Advantage overview
Going concern		 14
14
Advantage overview
Advantage Financial Analyser		 15
Advantage Financial Analyser 15
Advantage Financial Analyser
Advantage Financial Analyser		 16
Advantage Financial Analyser 16
Additional consideration
Advantage Financial Analyser		 Additional consideration
Advantage Financial Analyser		 17
17
Unadjusted errors 18
Unadjusted errors 18
Unadjusted errors
Adjusted disclosures		 19
Adjusted disclosures 19
Adjusted disclosures
Significant control deficiencies		 20
Significant control deficiencies 20
Significant control deficiencies
Control deficiencies: Other		 21
Control deficiencies: Other 21
Control defciencies: Prior year 22
Control defciencies: Prior year 22
Control defciencies: Prior year
Control defciencies: Prior year		 23
Control defciencies: Prior year 23
Audit report overview
Control defciencies: Prior year		 24
Audit report overview 24
Audit report overview
Additional matter req.		 25
Additional matter req. 25
Additional matter req.
Outstanding matters		 26
Outstanding matters 26
Outstanding matters
Independence Threats		 27
Independence Threats 27
Independence Threats
Charity sector insight and updates		 28
Charity sector insight and updates
Financial reporting and governance		 28
Charity sector insight and updates
Financial reporting and governance		 30
Financial reporting and governance 30
Financial reporting and governance
Financial reporting and governance		 31
Financial reporting and governance 31
Financial reporting and governance
Tax		 32
Tax 32

Charity financial and regulatory 33

3 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Welcome

Introduction

Fiona Condron Partner

We have pleasure in presenting our Audit Completion Report to the Audit Committee. This report is an Introduction integral part of our communication strategy with you, a strategy which is designed to ensure effective Executive summary two way communication throughout the audit process with those charged with governance.

We discussed these matters with you at the Audit Committee meeting on 17 April 2024, and received your input. This report has been updated following finalization of all the matters that were outstanding in our previous report.

This report contains matters which should properly be considered by the Board as a whole. We expect that the Audit Committee will refer such matters to the Board, together with any recommendations, as it considers appropriate.

We would also like to take this opportunity to thank the Management and staff of the Charity for the co-operation and assistance provided during the audit.

e: Fiona.Condron.co.uk m: +44 (0) 7583 022 125

Victor Tarus Audit Manager

e: Victor.Tarus@bdo.co.uk m: +44 (0) 7818 486 265

Fiona Condron

Partner

1 May 2024

This report has been prepared solely for the use of the Audit Committee and should not be shown to any other person without our express permission in writing. In preparing this report we do not accept or assume responsibility for any other purpose or to any other person. For more information on our respective responsibilities please see the appendices.

4 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Overview

Executive summary

Table of contents

Introduction

Executive summary Audit Scope and Materiality Key matters Overview of risks Estimates & Key Judgements

Advantage overview Additional consideration Unadjusted errors Adjusted disclosures

Significant control deficiencies Control deficiencies: Other Control defciencies: Prior year Control defciencies: Prior year Audit report overview Additional matter req.

Outstanding matters Independence Threats Charity sector insight and updates

This summary provides an overview of the audit matters that we believe are important to the audit of the financial statements for the Charity for the year ended 31 December 2023.

It is also intended to promote effective communication and discussion and to ensure that the results of the audit appropriately incorporate input from those charged with governance.

Trustees’ responsibilities

The trustees are responsible for preparing and filing an Annual Report and financial statements which show a true and fair view, and have been prepared in accordance with FRS 102, the Charities SORP (FRS 102) 2019 and the Charities Act 2011.

Our audit of the financial statements does not relieve Management nor those charged with governance of their responsibilities for the preparation of the financial statements.

We recognise that you may wish to publish your annual report and financial statements and our audit report on your website or distribute them by means such as e-mail. If you choose to do so, it is your responsibility to ensure that such publication properly presents the financial information and any auditors’ report.

Further information regarding these responsibilities is provided in the engagement letter.

Overview

Our audit work is complete and all outstanding matters have been resolved.

There were no significant changes to the planned audit approach and no additional significant audit risks have been identified.

No restrictions were placed on our work.

Audit report

We anticipate issuing an unmodified audit opinion on the financial statements.

Independence

We confirm that the firm and its partners and staff involved in the audit remain independent of the Charity in accordance with the FRC's Ethical Standard.

It is also your responsibility to advise us prior to publication of the annual report, financial statements and/or our audit report of any proposed changes and/or differences from the version approved and signed, no matter how minor, to determine whether they are acceptable or not and so we can ensure that the Firm is not misrepresented.

BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

5

Audit Scope and Materiality

Executive summary

Table of contents

Final Materiality

Introduction

Materiality was determined based on 2.75% of total income.

Executive summary

Audit Scope and Materiality Subsequent to the presentation of our planning report, materiality has been Key matters updated to reflect the actual year end results.

Estimates & Key Judgements

Unadjusted audit differences

Advantage overview

We have identified two audit adjustments which, if posted, would increase reported net income by £105k. See page 18 of this report.

----- Start of picture text -----
CLEARLY
TRIVIAL
£46k
MATERIALITY
£2,300k
----- End of picture text -----

Charity sector insight and updates

6 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Key matters

Executive summary

Table of contents

Introduction

Executive summary Audit Scope and Materiality Key matters

Overview of risks Estimates & Key Judgements

Advantage overview Additional consideration Unadjusted errors Adjusted disclosures

Financial reporting

Other matters that require discussion or confirmation

Significant control deficiencies Control deficiencies: Other Control defciencies: Prior year Control defciencies: Prior year Audit report overview Additional matter req.

Outstanding matters Independence Threats Charity sector insight and updates

7 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Overview of risks

Table of contents

Introduction Executive summary

As identified in our audit planning report we assessed the following matters as being the most significant risks of material misstatement in the financial statements. These include those risks which had the greatest effect on: the overall audit strategy; the allocation of resources in the audit and the directing of the efforts of the engagement team.

Overview of risks

Management override Revenue recognition Grant income Legacy income

Estimates & Key Judgements

Advantage overview

Additional consideration

Unadjusted errors

Adjusted disclosures

Significant control deficiencies

Control deficiencies: Other Control defciencies: Prior year Control defciencies: Prior year Audit report overview

Additional matter req. Outstanding matters

#
Significant audit risk
Significant
management
judgement
Use of
experts
required
Unadjusted
error
reported
Adjusted
error
reported
Significant
control findings
reported
Specific letter of
representation
point
~~Pe hE~~		 #
Significant audit risk
Significant
management
judgement
Use of
experts
required
Unadjusted
error
reported
Adjusted
error
reported
Significant
control findings
reported
Specific letter of
representation
point
~~Pe hE~~		 #
Significant audit risk
Significant
management
judgement
Use of
experts
required
Unadjusted
error
reported
Adjusted
error
reported
Significant
control findings
reported
Specific letter of
representation
point
~~Pe hE~~		 #
Significant audit risk
Significant
management
judgement
Use of
experts
required
Unadjusted
error
reported
Adjusted
error
reported
Significant
control findings
reported
Specific letter of
representation
point
~~Pe hE~~		 #
Significant audit risk
Significant
management
judgement
Use of
experts
required
Unadjusted
error
reported
Adjusted
error
reported
Significant
control findings
reported
Specific letter of
representation
point
~~Pe hE~~		 #
Significant audit risk
Significant
management
judgement
Use of
experts
required
Unadjusted
error
reported
Adjusted
error
reported
Significant
control findings
reported
Specific letter of
representation
point
~~Pe hE~~		 #
Significant audit risk
Significant
management
judgement
Use of
experts
required
Unadjusted
error
reported
Adjusted
error
reported
Significant
control findings
reported
Specific letter of
representation
point
~~Pe hE~~		 #
Significant audit risk
Significant
management
judgement
Use of
experts
required
Unadjusted
error
reported
Adjusted
error
reported
Significant
control findings
reported
Specific letter of
representation
point
~~Pe hE~~
1 Management override Yes No No No No
No
~~ee~~ ~~ee~~ ~~ee~~ ~~ee~~ ~~ee~~ ~~ee~~ ~~ee~~
~~see~~
~~ee~~ ~~ee~~ ~~ee~~ ~~ee~~ ~~ee~~ ~~ee~~ ~~ee~~
~~see~~
2 Estimation error in accrued Yes No No No No
Yes
legacy income (Valuation of
legacies)
3
Legacy income could be
~~a~~		 Yes No No No No
Yes
recorded in incorrect period
~~sss~~ ~~sss~~ ~~sss~~ ~~sss~~ ~~sss~~ ~~sss~~ ~~sss~~
~~sss~~ ~~sss~~ ~~sss~~ ~~sss~~ ~~sss~~ ~~sss~~ ~~sss~~
4 Grant income – cutoff risk No No No No No
No

Independence Threats Charity sector insight and updates

BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

8

Management override of controls

Risk Detail

Table of contents

Significant risk ~~oO~~ Elevated risk ~~1~~ Moderate risk ~~A~~ Fraud risk

Introduction Executive summary

Overview of risks

Management override Revenue recognition Grant income Legacy income

Related controls identified to mitigate riskto mitigate risk ~~ff~~ Significant Management estimates & judgements estimates & judgements ~~ef~~ Data analytics testing approach

We have found no management bias with respect to estimates or other issues through our work in journals.

Charity sector insight and updates

Our audit procedures included the following:

9 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Fraud in revenue recognition

Risk Detail

Table of contents

Audit Approach

Introduction

Executive summary

Overview of risks Management override Revenue recognition Grant income Legacy income

Estimates & Key Judgements

Advantage overview Additional consideration 

  - We sample tested income streams and performed analytics testing over donation income which traced income from source, through to the general ledger and bank. See page 16 for further information.

Significant risk Elevated risk Moderate risk Fraud risk Related controls identified to mitigate risk

Significant Management estimates & judgements

Controls testing approach Data analytics testing approach Substantive testing approach

Discussion and conclusion

Source 2023 draft accounts

No issues have been identified relating to income from charitable activities and other income. However, we noted unaccrued donation income of £105k relating to Paypal amounts notified before the year end. We have raised an unadjusted audit difference in this report (see page 18).

See the pages that follow for more details on legacy and grant income.

10 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Fraud in revenue recognition (continued)

Grant income – Cutoff risk

Risk Detail

Discussion and conclusion

From the testing performed, we have not identified any misstatements above triviality and therefore have no issues to report.

Table of contents

Significant risk

Introduction

Elevated risk

Moderate risk

Fraud risk

Related controls identified to mitigate risk

Significant Management estimates & judgements

Controls testing approach

Audit Approach

Data analytics testing approach

Substantive testing approach

11 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Fraud in revenue recognition

Legacy income valuation and cutoff risk

Risk Detail

Discussion and conclusion

► Legacies should be recognised in line with the From the testing performed we have noted that the recognition criteria set out in SORP 2019 (i.e. accounting policy of the charity is in line with the . Table of contents where entitlement existed before the 31 SORP requirements, and that this policy has been ~~So~~ Significant risk ~~>~~ Introduction December 2023, there is probability of receipt consistently applied through the sample of items ~~>~~ Executive summary and the amount is measurable, then the legacy is selected and tested. Elevated risk included in accrued income). ~~>~~ Overview of risks We noted that management has correctly accrued Moderate risk Management override ► There are specific risks over whether the income for cash receipts of £2,499k between year end and Revenue recognition is recorded in the correct period (cut off), the March 2024 where this indicates that entitlement to Fraud risk Grant income completeness and accuracy of the income the legacy existed at the balance sheet date. Legacy income recognised given the judgement exercised in the Related controls identified

Fraud risk Related controls identified to mitigate risk

We will continue to monitor legacy receipts up to Estimates & Key Judgements recognition of income as well as the to mitigate risk the approval of the financial statements in order to ~~po >~~ Advantage overview completeness of restrictions imposed by legacies. assess any additional accrual that may need to be Significant Management Additional consideration ► There is therefore a risk that the legacy accrual recognised or noted on our schedule of unadjusted @ estimates & judgements > items. ~~pO~~

Unadjusted errors

Controls testing approach

Adjusted disclosures

Audit Approach

Audit Approach Our discussions with management did highlight that ~~>~~ Significant control deficiencies the value of the unaccrued legacy pipeline is £18.6M, ► We reviewed the legacy pipeline and ~~>~~ Control deficiencies: Other which is almost one year of legacy income. When correspondence files to assess completeness of ~~>~~ Control defciencies: Prior year the legacy accrual; benchmarked against other charities, the value of the pipeline is quite significant. Whilst it is difficult ~~>~~ Control defciencies: Prior year ► We tested a sample of legacies received post to draw any accurate conclusions as to why this ~~>~~ Audit report overview year end and considered the timing of situation arises, management may wish to consider ~~>~~ Additional matter req. recognition; the trends pertaining to amounts which are ~~>~~ Outstanding matters subsequently received versus the disclosed pipeline ► We tested the assumptions made by management value to see if the element of optimism is accurate.

Data analytics testing approach Substantive testing approach

In addition, we note that MSF does not have a system for recording and monitoring legacies and that this continues to be driven by a spreadsheet. Given the value of legacy income we would endorse management’s view that investment in a legacy system such as First Class is becoming an imperative to ensuring that the data and associated correspondence is secure and accessible. A more sophisticated system would also enable better management reporting.

Our testing of accrued legacy income is complete and no other issues have been identified.

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

BDO LLP

Estimates and Key judgements

Table of contents ~~————————~~ Estimates: Legacy income accrual > Introduction ~~me~~ > Executive summary Overview Discussion > Overview of risks Legacy income is recognised when the SORP criteria of entitlement, In addition to the details set out in the revenue recognition risk, we have Estimates & Key Judgements probability and measurability are met. Due to the complexities involved further discussed with management their process for notification, tracking, Going concern with the valuation of some estates, timeliness of payments and potential and recording legacy income throughout the year and at year the end. > Advantage overview claims against the estate, there is a significant level of estimate and Additional consideration judgement that is involved in determining whether the income meets all Overall, MSF UK’s legacy income recognition policy is in accordance with the three of the income recognition criteria at the year end. Charities SORP and management has demonstrated their application of the > Unadjusted errors three revenue recognition criteria when determining whether income should > Adjusted disclosures MSF UK’s legacy accounting policy states that legacy income is be recorded in the year. > Significant control deficiencies recognised when MSF UK has confirmation of entitlement, can reliably > Control deficiencies: Other estimate the amount due and considers receipt to be probable. Where MSF > Control defciencies: Prior year UK has been notified of a legacy which does not meet these criteria, it is treated as a contingent asset and disclosed if material. > Control defciencies: Prior year > Audit report overview Impact > Additional matter req. < lower higher > > Outstanding matters ~~_~~ > Independence Threats Charity sector insight and updates

Overall, MSF UK’s legacy income recognition policy is in accordance with the Charities SORP and management has demonstrated their application of the three revenue recognition criteria when determining whether income should be recorded in the year.

13 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Going concern

Risk Detail

budgeting process and the entity’s risk assement process.

► It is the Trustees’ responsibility to make an assessment of the Charity’s ability to continue Discussion and conclusion . Table of contents as a Going Concern to support the basis of From the work we have performed relating to the > Introduction preparation for the financial statements. This charity’s assessment of going concern, we have ~~>~~ Executive summary is a requirement of both Companies Act 2006 noted that MSF UK is in a unique position whereby and accounting standards. This assessment ~~.~~ Overview of risks a significant portion (63% per 2023 draft accounts) should be supported by detailed cash flow Estimates & Key Judgements forecasts with clear details of the key of total expenditure is controllable by the charity in the form of operational grants. These grants are Going concern underlying assumptions and a consideration of determined at year end based on the financial > Advantage overview the forecast’s sensitivity to reasonably possible ~~Pe~~ forecast review. This control over expenditure Additional consideration variations in those assumptions along with any allows MSF UK to control the level of reserves it tC ) other relevant factors.

From the work we have performed relating to the charity’s assessment of going concern, we have noted that MSF UK is in a unique position whereby a significant portion (63% per 2023 draft accounts) of total expenditure is controllable by the charity in the form of operational grants. These grants are determined at year end based on the financial forecast review. This control over expenditure allows MSF UK to control the level of reserves it maintains and, with careful control over forecasting, mitigate future losses.

Unadjusted errors

Adjusted disclosures

Significant control deficiencies Control deficiencies: Other Control defciencies: Prior year Control defciencies: Prior year Audit report overview

In addition to this, we noted that, typically, around 30% of total donations and legacies income arises from regular donors which allows MSF UK to forecast income from these sources with reasonable accuracy.

These points, coupled with £12M unrestricted cash balances as at year end and healthy cashflow projections, indicate that the going concern assumption arrived at by management is reasonable and that no material uncertainties have been identified.

Additional matter req.

Outstanding matters

Independence Threats Charity sector insight and updates

Audit responsibilities and planned audit response

We have not identified any issue from our review that would indicate the adoption of going concern assumption would be inappropriate.

Our assement of going concern up to the date of signing did not identify any issue that would indicate the adoption of going concern assumption would be inappropriate nor any material uncertainties relating to going concern.

Significant risk

Elevated risk

Fraud risk

Related controls identified to mitigate risk

Significant Management estimates & judgements

Controls testing approach

Data analytics testing approach

Substantive testing approach

We obtained an understanding of the business model, objectives, strategies and related business risks, the measurement and review of the entity’s financial performance including forecasting and

14 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

IT Audit Approach BDO Advantage Guided Data Analytics

Table of contents

Introduction

Executive summary > Overview of risks Estimates & Key Judgements Advantage overview Advantage Financial Analyser Advantage Financial Analyser Additional consideration > Unadjusted errors > Adjusted disclosures > Significant control deficiencies > Control deficiencies: Other > Control defciencies: Prior year > Control defciencies: Prior year > Audit report overview > Additional matter req. > Outstanding matters > Independence Threats Charity sector insight and updates

Our Advantage Data Analytics specialists transform your transactional, bank and payroll data into our BDO Advantage solutions to enable performance of data analytics tests (DATs) and Risk Assessment Data Analytics (RADAs) which have been scoped based on the risk areas identified in our planning report

Overview

BDO Advantage is our in house developed Data analytics software.

The BDO Advantage Data Analytics Solutions we have used are:

Analyser Used For Narrative ~~a~~ Advantage Financial Analyser Audit of Journals The AFA enables identification of fraud and other areas where risks of material misstatement (AFA)] is present as well as deeper analysis and sample extraction of data when performing audits of journals. Refer to page 15 of this report. ~~a~~ Donation Analyser (DA) Audit of donation The DA enables a deeper analysis and testing of donation income through three way matching income (e.g. from the source to the finance system all the way through to the bank statement).Refer to page 16 of this report for further information.

15 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

IT Audit Approach

BDO Advantage Guided Data Analytics

Table of contents

Introduction

Executive summary

Overview of risks . Estimates & Key Judgements Advantage overview . Advantage Financial Analyser Advantage Financial Analyser Additional consideration Unadjusted errors Adjusted disclosures Significant control deficiencies Control deficiencies: Other Control defciencies: Prior year > Control defciencies: Prior year > Audit report overview > Additional matter req. > Outstanding matters ‘ Independence Threats Charity sector insight and updates

Advantage Financial Analyser

Data Completeness:

The reconciliation of journal transactions to Trial Balance (TB) shows a difference of £ 527k relating to prior year deficit. This is an expected difference and therefore we have assurance that the data provided for analysis is complete and not missing any additional data and hence analysis based on this data set is valid.

Data Quality:

Data quality tests have yielded several results to note as follows:

16 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

IT Audit Approach

BDO Advantage Guided Data Analytics

Donation analyser

Donation analyser system, they explored whether it would be possible to record some of the source data to We have used our donation analytics test to reduce the number of income GL accounts in match data from Woods Valldata through to the > Table of contents use. However, we understand that aligning GL finance system and ultimately all the way to the > Introduction bank. codes with the new system required extensive => > ~~>~~ Executive summary effort and would have significantly affected Our review of donation income in the year using some third parties and their systems. As a > ~~>~~ Overview of risks this approach has identified notable observations result, additional capacity was required, but . Estimates & Key Judgements as detailed below : the fundraising and finance team did not have ~ > Advantage overview ► Total income for the year is £82,762k. capacity to support or implement this change. ~~ > a Advantage Financial Analyser We recommend that this is reconsidered going Advantage Financial Analyser Excluding legacy income and income from forward.

. Estimates & Key Judgements as detailed below : the fundraising and finance team did not have ~ ras > Advantage overview ► Total income for the year is £82,762k. capacity to support or implement this change. ~~ > a > Advantage Financial Analyser We recommend that this is reconsidered going Advantage Financial Analyser Excluding legacy income and income from forward. Additional consideration charitable activities, donation income is £60,883k of which we have reconciled 63% ► We noted some immaterial differences Unadjusted errors (£30,108k) from payment processor between the payment processors, GL and Adjusted disclosures (CAF,BACS, Woods Valldata, Braintree website bank. Upon further investigation we found Significant control deficiencies & Gaye) to the general ledger and back to the that, in some cases, the amounts were coded ~~>~~ Control deficiencies: Other bank statements as noted in the chart below; to a different GL code, some entries moved income out of suspense accounts, donations ~~>~~ Control defciencies: Prior year ► We noted that there are over 30 income paid directly to bank accounts and processed ~~>~~ Control defciencies: Prior year account codes with some having very through the payment processor or cheque ~~>~~ Audit report overview immaterial amounts. This would imply that amounts being received in the bank one or ~~>~~ Additional matter req. some of the 30 accounts codes are largely two days later hence processed on a different superfluous but still require reconciliation and d Outstanding matters associated controls and therefore absorb date (cut off). 4 ~» Independence Threats management time. Management noted that during the implementation of the new finance Donation income reconciled by Gl ,paynment processor bo bank ; of ~ 4 _

d Outstanding matters Independence Threats Charity sector insight and updates

17 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Matters requiring additional consideration

Table of contents

Fraud

Related parties

Introduction

Whilst the trustees have ultimate responsibility for prevention and detection Executive summary of fraud, we are required to obtain reasonable assurance that the financial Overview of risks statements are free from material misstatement, including those arising as a Estimates & Key Judgements result of fraud. Our audit procedures did not identify any fraud. We will seek Advantage overview confirmation from you whether you are aware of any known, suspected or Additional consideration alleged frauds since we last enquired when presenting the audit plan on 22 November 2023.

Laws and regulations

Whilst you are responsible for the completeness of the disclosure of related party transactions in the financial statements, we are also required to consider related party transactions in the context of fraud as they may present greater risk for management override or concealment or fraud.

We did not identify and significant matters in connection with related parties.

18 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Unadjusted audit differences: Detail

Details for the current year

Table of contents

> > Introduction Income and expenditure
Balance sheet
> Executive summary Unadjusted audit differences
£’000
£’000
£’000
£’000
£’000
> Overview of risks
Estimates & Key Judgements Surplus for the year before adjustments
1,215
~~a~~
> Advantage overview Adjustment 1: Under accrual of donation income in the period (entitlement
Additional consideration pre-year-end)
Unadjusted errors
~~>~~
~~a~~
DR: Accrued donation income
105
Adjusted disclosures
~~>~~
~~a~~
CR: Donation income
105
Significant control deficiencies
~~>~~
> Control deficiencies: Other Control deficiencies: Other
~~pt~~
> Control defciencies: Prior year Control defciencies: Prior year Adjustment 2: Being reclassification of grants for TIC projects to donation
> Control defciencies: Prior year Control defciencies: Prior year grants
~~A~~
> Audit report overview DR: Income from charitable activities
60
> Additional matter req.
> Outstanding matters CR: Donations and legacies
60
> Independence Threats ~~a~~
Charity sector insight and updates Total unadjusted audit differences
60
165
105
Surplus for the year if adjustments accounted for
1,320

BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

19

Adjusted disclosure omissions and improvements

Disclosure omissions and improvements

Table of contents

Introduction

Executive summary

Overview of risks

We are required to bring to your attention other financial reporting matters that the Audit Committee is required to consider.

We have completed our review of the Trustees’ Annual Report and the resulting comments have been satisfactorily addressed by management.

Estimates & Key Judgements

Advantage overview

Additional consideration

Unadjusted errors

Adjusted disclosures

Significant control deficiencies Control deficiencies: Other Control defciencies: Prior year Control defciencies: Prior year Audit report overview Additional matter req.

Outstanding matters ~~>~~ Independence Threats Charity sector insight and updates

20 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Control environment: Significant deficiencies

Table of contents

Introduction

Estimates & Key Judgements

Advantage overview

Additional consideration

Unadjusted errors

We are required to report to you, in writing, significant deficiencies in internal control that we have identified during the audit. These matters are limited to those which we have concluded are of sufficient importance to merit being reported to the Audit Committee.

During the course of our audit work, we identified no such significant deficiencies to report.

As the purpose of the audit is for us to express an opinion on the Charity’s financial statements, you will appreciate that our audit cannot necessarily be expected to disclose all matters that may be of interest to you and, as a result, the matters reported may not be the only ones which exist.

As part of our work, we considered internal control relevant to the preparation of the financial statements such that we were able to design appropriate audit procedures. This work was not for the purpose of expressing an opinion on the effectiveness of internal control.

Additional matter req.

Outstanding matters

Independence Threats Charity sector insight and updates

BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

21

Control environment: Other deficiencies

Table of contents
Introduction		 Table of contents
Introduction		 Area Observation & implication Recommendation Management response
Executive summary Approval of Although management In the absence of a system Agreed. We will action by
Overview of risks
Advantage overview
Estimates & Key Judgements		 journals before
posting		 reviews journals before
being posted, there is
currently no evidence of
this review as there is no		 generated way of ensuring
all journals are approved
before being posted, and in
recognition of the		 end of 2024.
Additional consideration formal sign off of journals relatively small number of
Unadjusted errors being posted (i.e., journals individuals in the finance
Charity sector insight and updates Adjusted disclosures
Significant control deficiencies
Control deficiencies: Other
Control defciencies: Prior year
Audit report overview
Additional matter req.
Outstanding matters
Control defciencies: Prior year
Independence Threats
Charity sector insight and updates
 were posted to the system
without having been
approved).
Our discussions with
management highlighted
that many accounting
systems have built in
workflows which do not
allow the journal to be
processed without the
required system approval
being given.
A lack of evidence
surrounding how the		 team, we recommend that
management enhances the
documentation relating to
how journals have been
reviewed. This could be
based on risk criteria,
unusual account code
combinations or outside of
normal working hours.
approval process has been
implemented, there exists
a risk of journals being
posted as a result of fraud
or error.

22 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Control environment: Follow up of prior year deficiencies

Area
Observation & implication
Original recommendation
Original management
response
Progress
Management response
Table of contents
Introduction
Executive summary
>
3 ~~a~~
~~>~~
Review of
the legacy
accrual
schedule
In line with the ISA 315
requirements and our
approach to driving
efficiency from controls
We recommend that MSF
UK Finance team prepares
the legacy schedule
monthly and not just as
Management agrees with the
observation. Management
commits to consider the
recommendation, in
The legacy schedule
continues to be
prepared as part of
year end process and
As per 1 Dec 2023 ARC
Meeting, the ARC
acknowledged that MSF UK
Finance team has not
Overview of risks
Advantage overview
Estimates & Key Judgements
~~>~~
~~>~~
testing, we have been
part of the year end
particular to consider the
currently maintained
made any changes to the
Additional consideration
unable to identify a
process. This should be
value this would add and the
in excel format.
legacy accrual process in
Unadjusted errors
~~>~~
Charity sector insight and updates structured, documented
control(s) for the
documentation and review
of the items pertaining to
the year end legacy
accrual. The absence of
these documented controls
had prevented us from
relying on a control testing
approach in the CY which
could have reduced the
number of samples to be
tested substantively.
reviewed and signed off by
the finance manager and
Head of Finance.
Subject to resource
constraints, independent
sample checks during the
year could also be
performed in order to
evidence a control which is
designed to identify any
material errors in the
legacy accrual accounting
during the year.
resource cost of
implementing.
Considering the
substantial amount of
legacy income and
accruals managed by
MSF UK, we
recommend more
frequent reviews of
the legacy schedules.
We endorse
management’s view
that investment in a
legacy reporting and
monitoring system
2023, and they do not
plan to change it in 2024.
Instead, they intend to
develop the internal
processes and systems
that are used to record
the legacy pipeline in the
subsequent annual plans.
Development of systems
will include migration of
legacies data onto a
database. The timetable
for this is yet to be
Adjusted disclosures
Significant control deficiencies
Control deficiencies: Other
Control defciencies: Prior year
Audit report overview
Additional matter req.
Outstanding matters
Control defciencies: Prior year
Independence Threats
Charity sector insight and updates
~~>~~
~~>~~
~~>~~
~~>~~
~~>~~
~~>~~
~~>~~
~~>~~
~~>~~
should be a priority.
confirmed and will need
to be considered alongside
a number of other
priorities within the
fundraising team.

BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

23

Control environment: Follow up of prior year deficiencies

,
>
>
>		 ,
>
>
>		 Table of contents
Introduction
Executive summary
Overview of risks
 Table of contents
Introduction
Executive summary
Overview of risks
 Table of contents
Introduction
Executive summary
Overview of risks
 Table of contents
Introduction
Executive summary
Overview of risks
 Area
Observation & implication
Original
recommendation
Original management
response
Progress
Management response
MSF Ireland
Bank
Confirmation
We noted two other liabilities
of £11,250 and £85,000 from
the confirmation letter
We recommend
that clear
instructions be
Management agrees with
the observation and
recommendation. We will
The initial confirmations
received from the bank
included other liabilities.
Management has taken
reasonable and
proportionate actions to
~~a~~		 Area
Observation & implication
Original
recommendation
Original management
response
Progress
Management response
MSF Ireland
Bank
Confirmation
We noted two other liabilities
of £11,250 and £85,000 from
the confirmation letter
We recommend
that clear
instructions be
Management agrees with
the observation and
recommendation. We will
The initial confirmations
received from the bank
included other liabilities.
Management has taken
reasonable and
proportionate actions to
~~a~~		 Area
Observation & implication
Original
recommendation
Original management
response
Progress
Management response
MSF Ireland
Bank
Confirmation
We noted two other liabilities
of £11,250 and £85,000 from
the confirmation letter
We recommend
that clear
instructions be
Management agrees with
the observation and
recommendation. We will
The initial confirmations
received from the bank
included other liabilities.
Management has taken
reasonable and
proportionate actions to
~~a~~		 Area
Observation & implication
Original
recommendation
Original management
response
Progress
Management response
MSF Ireland
Bank
Confirmation
We noted two other liabilities
of £11,250 and £85,000 from
the confirmation letter
We recommend
that clear
instructions be
Management agrees with
the observation and
recommendation. We will
The initial confirmations
received from the bank
included other liabilities.
Management has taken
reasonable and
proportionate actions to
~~a~~		 Area
Observation & implication
Original
recommendation
Original management
response
Progress
Management response
MSF Ireland
Bank
Confirmation
We noted two other liabilities
of £11,250 and £85,000 from
the confirmation letter
We recommend
that clear
instructions be
Management agrees with
the observation and
recommendation. We will
The initial confirmations
received from the bank
included other liabilities.
Management has taken
reasonable and
proportionate actions to
~~a~~		 Area
Observation & implication
Original
recommendation
Original management
response
Progress
Management response
MSF Ireland
Bank
Confirmation
We noted two other liabilities
of £11,250 and £85,000 from
the confirmation letter
We recommend
that clear
instructions be
Management agrees with
the observation and
recommendation. We will
The initial confirmations
received from the bank
included other liabilities.
Management has taken
reasonable and
proportionate actions to
~~a~~
Estimates & Key Judgements letter received from Bank of Ireland given to Bank of ensure the However, upon our request address this issue. No further
> Advantage overview on 01 February 2023. We Ireland to only recommendation is for a reconfirmation, we action is planned and we
>
>		 Additional consideration
Unadjusted errors
Adjusted disclosures		 inquired with the finance
team and it was noted that
the liabilities included within
the confirmation letter are		 confirm the
balances and
financial
transactions of		 actioned. obtained an updated
confirmation containing
solely the balances
pertaining to MSF UK.		 accept the risks associated
with Bank of Ireland's
repeated mistakes. Note
that this relates to a single
> Significant control deficiencies Significant control deficiencies that of MSF Ireland however MSF UK solely on old bank account which is
> Control deficiencies: Other Control deficiencies: Other Bank of Ireland have not confirmation only used to receive a
>
>		 Control defciencies: Prior year
Control defciencies: Prior year		 Control defciencies: Prior year
Control defciencies: Prior year		 confirmed this fact. letters. relatively small amount of
donations.
> Audit report overview Donation During our testing of The monthly We have completed our In the current year, two of Noted. We will add an
Charity sector insight and updates Additional matter req.
Outstanding matters
Independence Threats
Charity sector insight and updates
>
>
>		 income cut-
off		 donations and grants, we
noted that some donations
income was recognised in
January 2022 but it was
related to December 2021.		 reconciliation
process should be
used to reconcile
income to bank
receipts and		 procedures on donations
income cut-off for FY22
and we can confirm that
we have not identified any
these instances within the		 our 2024 January
donations samples related
to to December 2023. The
income related to the
PayPal reconciliation		 explicit task in the year end
project plan to check the
PayPal income cut-off to
minimise the risk that
similar immaterial errors are
The income related to PayPal confirm that samples we had selected where entitlement (based repeated in future years.
receipts that should have been income is for testing. on the notification
identified in the PayPal recognised in the received) was pre-year end
reconciliation as part of the correct period. but the income was
monthly/year end recognised post year end
reconciliation process. when the cash was
received. As a result, we
have raised an unadjusted
audit misstatement (refer
to page 18 of this report).

24 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Audit report overview

Table of contents

Opinion on financial statements

Introduction

Overview of risks

Estimates & Key Judgements

Advantage overview

Unadjusted errors

Adjusted disclosures

We anticipate issuing an unmodified opinion on the financial statements.

There are no matters disclosed in the financial statements that we wish to draw attention to by way of ‘emphasis of matter’.

Going concern

Our report will:

Other information

We have reviewed the other information accompanying the financial statements in the Group’s annual report. We have not identified any material misstatements that would need to be referred to in our report.

We have identified no material misstatements in the statutory other information accompanying the financial statements.

25 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Additional matters we are required to report

Table of contents
Introduction
Executive summary
Overview of risks
Estimates & Key Judgements		 Table of contents
Introduction
Executive summary
Overview of risks
Estimates & Key Judgements		 Table of contents
Introduction
Executive summary
Overview of risks
Estimates & Key Judgements		 Table of contents
Introduction
Executive summary
Overview of risks
Estimates & Key Judgements		 Issue
Comments
1
Significant difficulties encountered during the audit.
No exceptions to note.
2
Written representations which we seek.
We enclose a copy of our draft representation letter.
~~eee~~
~~a~~		 Issue
Comments
1
Significant difficulties encountered during the audit.
No exceptions to note.
2
Written representations which we seek.
We enclose a copy of our draft representation letter.
~~eee~~
~~a~~		 Issue
Comments
1
Significant difficulties encountered during the audit.
No exceptions to note.
2
Written representations which we seek.
We enclose a copy of our draft representation letter.
~~eee~~
~~a~~		 Issue
Comments
1
Significant difficulties encountered during the audit.
No exceptions to note.
2
Written representations which we seek.
We enclose a copy of our draft representation letter.
~~eee~~
~~a~~
Advantage overview 3 Any fraud or suspected fraud issues. No exceptions to note.
Additional consideration
Unadjusted errors
Adjusted disclosures
Significant control deficiencies		 4
5
~~a~~		 Any suspected non-compliance with laws or regulations.
Significant matters in connection with related parties.		 No exceptions to note.
No exceptions to note.

Control deficiencies: Other Control defciencies: Prior year Control defciencies: Prior year Audit report overview

Additional matter req.

Outstanding matters

Independence Threats Charity sector insight and updates

26 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Outstanding matters

Table of contents

Introduction

Executive summary

Overview of risks

Estimates & Key Judgements

We have completed our audit work in respect of the financial statements for the year ended 31 December 2023.

All previously reported outstanding matters have now been resolved.

Advantage overview

Additional consideration Unadjusted errors

Adjusted disclosures

Significant control deficiencies Control deficiencies: Other Control defciencies: Prior year Control defciencies: Prior year Audit report overview Additional matter req.

Outstanding matters

Independence Threats Charity sector insight and updates

27 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Independence Threats and Safeguards

Table of contents

Introduction

We have provided services other than audit to the Charity as set out below. We also describe below any relationships between the company, its subsidiaries and directors and the firm. We do not consider there to be any other threats that may be considered to bear on our objectivity and independence. Our overall assessment is that the safeguards described below are appropriate and effective.

Executive summary

Overview of risks

Estimates & Key Judgements

Advantage overview

Fees 2023
Fee 2022
Threats
Safeguards
Advantage overview
>
Additional consideration
Non audit services
Unadjusted errors
Adjusted disclosures
~~>~~
~~a~~
~~>~~
VAT Advisory services
54,300
£46,000
Self-interest,
The VAT advisory services are performed
Significant control deficiencies
~~>~~
Management and
self-review
by a team completely independent from
the audit team.
Control deficiencies: Other
Control defciencies: Prior year
~~>~~
~~>~~
Tax services
-
£2,744
Self-interest and
The tax advisory services are performed by
Control defciencies: Prior year
~~>~~
self-review
a team completely independent of the
Audit report overview
~~>~~
audit team.
Additional matter req.
~~>~~

~~>~~ Outstanding matters

~~>~~ Independence Threats Charity sector insight and updates

28 BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

Charity sector insight and updates

Our latest guidance, updates and resources for charities, including our regular webinar series

Charity Update webinar series

Table of contents

Charity Fraud Report 2023: Increasing pressure causing a risk in fraud

Introduction We host regular webinars specifically for charities on the latest hot topics and provide Increasing pressure causing a risk in fraud > Executive summary technical updates. The most recent three can be viewed by clicking the images below. In our latest report, get a snapshot > Overview of risks ; You can view all previous webinars on our website. view of how some charities in the UK Estimates & Key Judgements have been affected by fraud over the ReportCharity29344 Fri Advantage overview last year. As is demonstrated by the > Additional consideration Unadjusted errors AnnualJanuaryupdateDEAS | PEOPLE finance webinar 2024| TRUST Gi eyQ - Ps [BDOWebinar:OptimisingHDEAS Charity| PEOPLE | UpdateTRUST 74 : Webines{BDO } 83)G bs; AA ‘ survey results, the impact of fraud is not just financial – fraud impacts pedi ,° > Adjusted disclosures _Charity sector f rh tw/F7 yourcost base charity’s td aSSCreating Compelling— TG» * . A\ all parts of an organisation – from staff turnover to negative press > Significant control deficiencies m7? 8 j. EmployeeProposition Value and impact on reputation. / > Control deficiencies: Other Witt now [BDO — > Z A were 1OtAS | PEOPLE| TRUST | Find out how UK charities view > Control defciencies: Prior year i) fraud risk, the losses that can be ‘ > Control defciencies: Prior year sustained, and most importantly, y} Audit report overview Articles what measures charities can put 4. ~~>~~ Additional matter req. A selection of our most recent articles are in place to combat fraud risk ~~.~~ Outstanding matters below and our latest newsletter to the right. |BDOes Rethink during times of great pressure ite:aa | and uncertainty. > Independence Threats View the rest on our website. BDO Charity and Not For Profit Digest

Find out how UK charities view i) fraud risk, the losses that can be ‘ sustained, and most importantly, y} what measures charities can put 4. in place to combat fraud risk during times of great pressure ite:aa | and uncertainty. DOWNLOAD YOUR COPY TODAY FOR THE FULL INSIGHTS a ee

Charity sector insight and updates

Financial reporting and governance ➢ THE TOP TAX AND FINANCE CONCERNS OF Financial reporting and governance Tax THE CHARITY SECTOR Charity financial and regulatory

Dates for the diary

Our charity retail sales tracker may be of interest to charities with retail operations. eo More info here. ees

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Looking forwards

BDO LLP

30

Looking forwards

Financial reporting and Table of contents governance matter Summary ~~>~~ Introduction ~~>~~ Executive summary Annual Review of The FRC has published its Annual Review of Corporate Governance Reporting. While reporting on governance has improved, the FRC highlights a Corporate Governance lack of clarity in explaining governance matters, inconsistent reporting, and too much use of boiler plate language. They would also like to see ~~>~~ Overview of risks Reporting more evidence of how workforce and stakeholder engagement has led to better outcomes. While the Governance Code for charities is different Estimates & Key Judgements and not mandatory, these comments can usefully apply to charities’ annual reports. ~~>~~ Advantage overview Additional consideration ~~>~~ Unadjusted errors Review of reporting by the The FRC has published a “review of reporting by the UK’s largest private companies.” Unlike listed entities, some private companies need to focus UK’s largest private less on shareholders information needs - like charities they are therefore encouraged to think of other users of the accounts. The FRC make the ~~>~~ Adjusted disclosures companies following points that are relevant to charities: ~~>~~ Significant control deficiencies • Better descriptions of the nature of an entity’s operations would help users’ understanding, though better reporting does not automatically ~~>~~ Control deficiencies: Other require greater volume. ~~>~~ Control defciencies: Prior year • Accounting policies should be tailored to the entity, not just boilerplate. This is especially true in respect of complex transactions and revenue ~~>~~ Control defciencies: Prior year recognition. ~~>~~ Audit report overview • Users benefit from greater clarity and/or quantification of sensitivities in estimates and judgements, and over the nature and uncertainties ~~>~~ Additional matter req. relating to provisions. ~~>~~ Outstanding matters Many of the issues identified could have been avoided if a sufficiently critical review of the annual report and accounts had been conducted prior ~~>~~ Independence Threats to finalisation. This includes taking a step back to consider whether the report as a whole is clear, concise and understandable, omits immaterial information and whether additional information is necessary to understand particular transactions, events or circumstances. It also includes a Charity sector insight and updates review for internal consistency and more detailed presentation and disclosure matters. Financial reporting and governance Financial reporting and governance Tax Charity financial and regulatory

Looking forwards

BDO LLP

31

Looking forwards

Charity sector insight and updates

Financial reporting and governance Financial reporting and governance Tax Charity financial and regulatory

Looking forwards

BDO LLP

32

Looking forwards (continued)

Table of contents
>		 Table of contents
>		 Table of contents
>		 Table of contents
>		 Table of contents
>
Introduction
>		 Tax matter Summary
Executive summary
Overview of risks
>
>		 Charities – VAT relief for
construction		 HMRC has updated this guidance to include information about the new 'Wakefield' 2-stage test. Charities need to apply the test (involving assessing
whether a supply is for consideration, and for the purpose to obtain income) when deciding if their activities are business or non-business, and
Estimates & Key Judgements considering whether any of the building projects to be used for their activities are eligible for VAT at the zero rate. Certificates issued before 1
Advantage overview
Additional consideration
>		 June 2022 will continue to be valid for the period covered by the certificate. Trustees will need to consider this in respect of projects that started
before 1 June 2022, or were certificated before then.
Unadjusted errors
Adjusted disclosures
>
>		 Salary sacrifice
arrangements for cars
~~		 ~~
Significant control deficiencies
>		 Significant control deficiencies employee to be treated as outside the scope. As employers are able to recover maintenance charges in full however, HMRC have indicated their
Control deficiencies: Other
>		 Control deficiencies: Other concern that maintenance costs then onward supplied to employees do not fall within this carve out, and therefore employers should be
Control defciencies: Prior year
>		 Control defciencies: Prior year accounting for VAT on this. This would however only apply where there is a separate supply of the car hire and maintenance cost recharge –
employers making a single supply of a maintained vehicle would not be impacted. We are expecting further commentary by HMRC on this in the
Control defciencies: Prior year
>		 Control defciencies: Prior year coming months, businesses do not need to take any action as yet.
Audit report overview
>		 Audit report overview
Additional matter req.
Outstanding matters
>
>		 Reporting rules for UK
digital platforms
~~		 ~~
Independence Threats
>		 and services on their platform. HMRC will then exchange the information with the other participating tax authorities for the jurisdictions where
Charity sector insight and updates the sellers are tax resident. This guidance should be considered by charities that sell goods online to ensure they declare the right income.
Financial reporting and governance
Financial reporting and governance		 Financial reporting and governance
Financial reporting and governance
Tax
Charity financial and regulatory		 Charity financial and regulatory VAT relief for energy-
saving materials		 VAT zero-rating relief on the installation of energy saving materials has been extended to buildings used for charitable purposes – i.e. those
qualifying as used wholly (>95%) for a Relevant Charitable Purpose (non-business use). This will apply until 31 March 2027, at which point the
reduced rate will apply. The relief has also been extended to additional technologies, including water-source heat pumps, as well as certain
groundworks necessary to install the pumps.
Membership subscriptions Apart from the tax changes affecting all businesses, the 2024 Budget referred to one specific charity sector issue. Proposed legislation relating to
digital subscriptions had the potential to preclude them from gift aid, due to the repayment possibilities. The budget has promised to address this:
it is a reminder that subscriptions to charities can operate under the gift aid regime where they meet the definitions and conditions of a donation.

Looking forwards

BDO LLP

33

Looking forwards (continued)

Table of contents
>		 Table of contents
>		 Table of contents
>		 Table of contents
>		 Table of contents
>		 Charity financial and
Introduction
>		 regulatory matter Summary
Executive summary
>		 Charity Fraud In our most recent Charity Fraud Report we highlight that the most common type of detected fraud continues to focus on the insider threat. This
Overview of risks
>		 year, 42% of respondents reported misappropriation of cash or assets as the most common type of fraud experienced over the year, followed by
Estimates & Key Judgements staff expenses fraud, with 35% of respondents. Levels of payment diversion fraud, also known as Authorised Push Payment fraud, was also high this
Advantage overview
>		 year, with 33% of respondents targeted over the year. Payment diversion fraud happens when a fraudster impersonates a supplier by creating or
amending what appear to be genuine invoices or other payment requests to divert funds to bank accounts under their control. For further
Additional consideration information and detail please see:
https://www.bdo.co.uk/getmedia/f7053446-3c29-4047-ac73-2b4a96692f0b/IND-NFP-Charity-fraud-report-
Unadjusted errors
>		 2023.pdf
~~—____~~
Adjusted disclosures
Significant control deficiencies
>
>		 ~~eee~~ Refusing donations to
~~eee~~		 New Charity Commission guidance sets out the principles for trustees to apply when considering whether to return or refuse a donation. Charities
~~eee~~
~~........Q°¢~~
Control deficiencies: Other
>		 Control deficiencies: Other charity should start from a position of accepting donations, and the new guidance does not contain any new law or powers. However it requires trustees to
Control defciencies: Prior year
>		 Control defciencies: Prior year consider:
Control defciencies: Prior year
>		 Control defciencies: Prior year •
the risks involved in refusing or returning the donation, or accepting it,
Audit report overview
>		 Audit report overview •
how the decision aligns with their charitable purpose,
Additional matter req.
>		 •
what steps they can take to mitigate the risks, and
Outstanding matters
Independence Threats
>
>		 •
to disregard personal opinion or irrelevant external factors
Charity sector insight and updates They also say: If your charity is considering returning grant-funding, you should take legal advice if you think the grant may be a contract rather
Financial reporting and governance
Financial reporting and governance		 Financial reporting and governance
Financial reporting and governance		 than a donation. This is because different legal rules relevant to contracts will apply. The particular terms of the contract will also be relevant,
for example any termination provisions.
Tax
Charity financial and regulatory		 Charity financial and regulatory Public Trust in Charities
2024		 In their regular survey of the sector, the Charity Commission have reported as follows: There is stability in the public perception of charities who
are more trusted than most other institutions and sectors in public life. However there are few, if any, signs of trust returning to pre-2015 levels,
after high profile cases involving large household name charities. People are not necessarily convinced that charities can be fully trusted to
manage funds and create genuine impact. Therefore, demonstrating prudent stewardship of funds continues to be critical. Some organisations
have to work harder than others to demonstrate that they are doing this effectively and that they are driven by the right intentions. The public –
particularly the less secure part of the population – are much less inclined to trust larger, international, and professionalised charities than
smaller, local, volunteer-run concerns.

Looking forwards

BDO LLP

34

Looking forwards (continued)

Table of contents Table of contents Charity financial and
Introduction regulatory matter Summary
Executive summary Economic Crime and The Economic Crime and Corporate Transparency Act 2023 (“ECCTA”) gained Royal Assent on 26 October 2023 and introduces significant reforms in
Overview of risks Corporate Transparency relation to economic crime, including a new corporate offence of failure to prevent fraud. Under the proposed offence, an organisation will be
Estimates & Key Judgements
Advantage overview		 Act 2023 liable where a specified fraud offence is committed by an associated person for the organisation’s benefit, and the organisation did not have
reasonable fraud prevention procedures in place. The Act defines fraud as comprising the following offences:
Additional consideration •
Fraud by false representation, by failing to disclose information, or by abuse of position (sections 2-4 Fraud Act 2006)
Unadjusted errors •
Obtaining services dishonestly (section 11, Fraud Act 2006)
Adjusted disclosures •
Participation in a fraudulent business (section 9, Fraud Act 2006)
Significant control deficiencies Significant control deficiencies •
False accounting (section 17, Theft Act 1968)
Control deficiencies: Other
Control defciencies: Prior year		 Control deficiencies: Other
Control defciencies: Prior year		 •
False statements by company directors (section 19, Theft Act 1968)
Control defciencies: Prior year Control defciencies: Prior year •
Fraudulent trading (section 993, Companies Act 2006)
Audit report overview •
Cheating the public revenue (common law).
Additional matter req. “Associated persons” include employees, agents or subsidiaries of the relevant organisation, an employee of a subsidiary or a person who
Outstanding matters otherwise performs services for or on behalf of the organisation. The timetable for implementation of the ECCTA will be communicated when draft
Independence Threats secondary legislation is published. Only large charitable companies will fall within the scope of this legislation.

Charity sector insight and updates

Financial reporting and governance Financial reporting and governance Tax Charity financial and regulatory

BDO LLP

MEDICINS SANS FRONTIERES (UK) AUDIT COMPLETION REPORT FOR THE YEAR ENDED 31 DECEMBER 2023

For more information: Fiona Condron

e: Fiona.Condron.co.uk m: +44 (0) 7583 022 125

The matters raised in our report prepared in connection with the audit are those we believe should be brought to your attention. They do not purport to be a complete record of all matters arising. This report is prepared solely for the use of the company and may not be quoted nor copied without our prior written consent. No responsibility to any third party is accepted.

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