International humanitarian group Medecins Sans Frontieres (MSF), better known in the United States by the English version of its name “Doctors Without Borders,” issued a statement on Wednesday announcing that it received 146 complaints about sexual harassment and abuse against its staff in 2017.

The group took action on 24 cases and fired 19 of its employees.

The Associated Press notes the MSF case parallels the explosive allegations against Oxfam, another charity organization that has been criticized for insufficient transparency about a wave of shocking abuse allegations against staffers. MSF’s statement offered few details about the sexual harassment cases and did not name the individuals who were terminated.

Deutsche Welle highlights one bit of information that the statement did provide: two of the 24 cases involved “situations of sexual abuse or harassment by MSF staff against non-MSF staff (patients or members of the community).”

“Though reports of abuse through our grievance mechanisms are steadily increasing, MSF believes misbehavior remains underreported today,” the statement added, conceding that local team leaders may have received reports of even more cases but not forwarded them to the attention of Doctors Without Borders headquarters.

MSF is one of the largest humanitarian organizations in the world, with some 40,000 staffers spread across 24 associations. At any given moment, it can be conducting operations in over 60 different countries, many of them dangerous conflict zones with shaky local government and minimal law enforcement.

“The reasons for underreporting are probably similar to those found in society at large, including the fear of not being believed, prevailing stigma, and possible reprisals,” the MSF postulated. “This is all the more acute in many crisis settings where MSF operates, such as conflict areas, where there is often a general lack of protection mechanisms for victims, a high level of generalized violence and impunity, and where populations may be highly dependent on external assistance.”

The group said that a “broad awareness campaign” against abuse has been in progress for several years, but promised to step up its efforts to “increase awareness of reporting mechanisms across MSF and to improve these protocols and procedures.”

The sexual harassment report is especially disappointing because sexual violence is one of the major concerns addressed by MSF operations.