Doctors, photographers, human rights activists and academics have written to Médecins Sans Frontières to raise concerns that the medical charity is exploiting the trauma of vulnerable patients to promote its work. In an open letter to the international president and MSF board, almost 50 signatories, who include current and former staff, allege that the aid organisation has commissioned, published and allowed the sale of photographs that endanger and exploit vulnerable black people, including children. The letter highlights several examples for sale on stock image libraries, including one of a 14-year-old girl photographed at an MSF clinic while seeking HIV-preventive drugs and treatment for internal injuries after being gang-raped. Other images include a portrait of a west African boy crying while suffering from cholera at an MSF clinic, available as a fine-art canvas wall print. The letter comes after MSF, which provides medical services to people in developing countries and conflict zones, removed two photos of a teenage rape survivor from the Democratic Republic of the Congo from its website, following criticism that the images were unethical and racist. Among signatories to the letter, organised by Benjamin Chesterton, director of the UK film production company Duckrabbit, are Spencer Botolo, a board member of MSF South Africa, and Smita Sharma, a photojournalist who won an Amnesty media award for documenting the trafficking of children for sexual abuse in India and Bangladesh. Another signatory, Dr Hassaan Zahid, a founder of Decolonise MSF, which campaigns against discrimination within the NGO, said some staff had expressed disquiet in recent years “about the disproportionate use of black and brown children in photographs in order to do fundraising”. Zahid, a former MSF worker in Karachi, Pakistan, added: “The whole business model of MSF is based on selling human misery, which is a part of its colonial heritage. As long as this business model remains the same, we will continue to steal the dignity from patients in the name of funding operations.” He said concerns were raised that some Western staff who organised photoshoots in developing countries often ignored the critical views of local colleagues. Zahid said MSF should stop allowing photographs taken while on assignment for the NGO to be sold. Some MSF staff had raised concerns internally about the photos from DRC, which clearly identified a 16-year-old girl who was gang-raped by three armed men. An article on the Souk MSF website, a platform for staff to discuss the NGO’s operations, criticised the photo essay by Newsha Tavakolian, an Iranian photographer with Magnum, for “offer[ing] a problematic vision, both of the DRC, of ​​sexual violence and of the women who suffer it”. Tavakolian said MSF had selected the photos for publication and removed them without informing her. “They also refrained from publicly explaining the reasons for making this decision, nor did they highlight the fact that I was never told not to take images of minors,” she said. “It simply was never discussed.” Jacob Burns, director of studies at the Centre de Réflexion sur l’Action et les Savoirs Humanitaires), part of the MSF Foundation that assesses and analyses the charity’s work, said on Twitter: “These photos and their framing were heavily criticised by numerous colleagues. Clearly indefensible to publish identifiable photos of a teenage rape survivor, and the issues with this project don’t end there.” A spokesman for MSF said its work with photographers was done to raise awareness of under-reported crises. “MSF does not profit from those stock image sales. In most agreements we have with photographers, there is an understanding that they will keep the copyright and will be able to publish or sell their stories and images. The aim is to highlight neglected crises as widely as possible – along with the stories of those involved, where they consent.” But he added: “Unfortunately, some of the images, especially those collected a long time ago, are far from meeting adequate standards in terms of dignified representation of patients or communities. We intend to address this issue. “We will also seek to limit the commercial sale of these media assets and ensure appropriate access restrictions on their usage.” Tavakolian added: “I will continue to work on sexual violence as it is very close to my heart, and I have told this particular story in a way I find ethical.”