Médecins Sans Frontières (MSF) associations function according to one main principle: an elected board of directors is responsible for establishing the overarching orientation of the association’s activities, ensuring accountability and adherence to MSF's Charter and values and in some cases, overseeing an executive.

The boards of directors are elected (directly or indirectly) by the association members, who are all present or former MSF employees or volunteers, during annual General Assemblies. Most board members have a medical background, which ensures that the medical perspective remains at the core of MSF’s work.

The culture of debate, critical reflection and accountability to its members forms the basis of associative action in Médecins Sans Frontières (MSF). The season of debate kicks off with discussions organised in all field missions on topics which are relevant to the field work and resonate with the movement as a whole. These fuel content at General Assemblies, Board meetings and at the International General Assembly, and representatives can bring motions and proposals from the field to those associative bodies.

MSF Assemblies provide the space for MSF members to gather, debate and fulfil their responsibility of holding the associative leadership accountable for its actions.