Ellen Willmott, General Counsel at Médecins Sans Frontières USA, speaks to In-House Perspective about her career working for humanitarian non-profits, the impact of cuts to foreign aid and her experience guiding organisations through periods of transition.

Ellen Willmott says she ‘fell into’ non-profit work – but then became deeply committed after seeing the impact that humanitarian response can have. As General Counsel of Médecins Sans Frontières USA, Willmott helps the organisation navigate complex legal issues, which might range from helping colleagues to send a US medical device into a sanctioned country, through to supporting a global fundraising project.

The organisation is the New York-based arm of the international humanitarian non-profit Médecins Sans Frontières (MSF), which provides emergency medical care to people affected by conflict, disease outbreaks, natural disasters and exclusion from healthcare in over 70 countries. While it doesn’t run any medical programmes itself, the organisation’s US office recruits healthcare and logistics professionals for missions outside the country, while also raising funds and advocating on the issue of global health policy. The office also assists a global team of lawyers in ensuring that the organisation complies with extraterritorial US laws, such as export controls.

Willmott – who joined the organisation in 2023 following senior roles at three major US-based charities – describes herself as an ‘operational enabler’ rather than acting as the ‘Office of No’ and being perceived to be preventing staff from taking work forward. The most pressing legal risks she manages include helping the wider MSF movement to comply with American and other extraterritorial sanctions regimes, particularly where US money, staff or medical equipment are involved in work taking place in a sanctioned or high-risk country. Another major challenge is managing cross-border risk and employment issues in situations where US doctors or other staff are sent to conflict zones.

As a tax-exempt public charity, MSF USA must comply with federal Internal Revenue Service rules, lobbying restrictions and charitable fundraising laws in more than 40 states. Thankfully, Willmott says fundraising regulation has been her ‘daily bread for multiple decades.’ She highlights that ‘loss of tax-exempt status – and potentially criminal penalties – can be a result if the risks aren’t mitigated, so these legal risks can be existential.’

A time of uncertainty

The 2024 US presidential election had a major impact on Willmott’s role at MSF USA. In the first few months of the Trump administration – which began in January 2025 – a slew of executive orders affecting the non-profit sector created uncertainty and additional legal review work, even where directives didn’t directly apply to the organisation. ‘Mondays were spent asking: how does this impact us? And figuring out whether there was something MSF USA needed to address,’ she says. Willmott describes it as a time in the US during which non-profits went from being perceived as ‘good’ to being seen as requiring greater regulation.

The sharp reduction in foreign aid by the US and other wealthy donor nations in recent years has created gaps in global health systems and presented a major challenge for MSF. According to the OECD, 2025 saw a historic decline in foreign aid, with a 23.1 per cent decrease in funding compared to the previous year. Willmott says the cuts have forced the organisation to identify new ways to partner with governments or local entities and address health communications in countries where they may face resistance. ‘The retraction of international aid continues to create hurdles that organisations like MSF need to address as we try to provide healthcare in a somewhat detached and broken system,’ she says.

Leadership through crisis and transition

Earlier on in her career, Willmott worked at Save the Children US between 1997 and 2012. A friend and mentor who had become General Counsel at the organisation recruited her during a difficult period when it needed additional legal support. Moving from a personal injury law firm, her new role forced Willmott to quickly get up to speed on US non-profit regulation, tax-exempt status and the legal framework governing humanitarian organisations. Willmott frequently flew overseas to help the charity navigate legal risks related to project implementation in foreign countries. ‘I was amazed at the paradigm shifts created by the work being done in the US and around the world,’ she says. ‘I was well and truly hooked on serving the international community’.

One of Willmott’s most significant achievements was supporting Save the Children US in a multi-year effort to transform its global operating model. The aim was to move away from multiple Save the Children entities operating separately in the same country, towards a coordinated model with one unified presence in each jurisdiction. The reform reduced duplicate employment practices, costs and structures and enabled more money and expertise to reach programmes. ‘I keep a small copy of all the documents on my desk so that when I think something is too overwhelming, I’ll just look at that and be reminded of what I was able to help accomplish,’ Willmott says.

After 15 years at Save the Children US, Willmott was offered the role of General Counsel at another major US charity: the Susan G Komen Breast Cancer Foundation. In a similar way to her previous role, Willmott joined the organisation at a time of transition and helped to stabilise it and re-establish its reputation as a global leader in women’s health. A major achievement was supervising the launch of Komen’s ‘Health Equity’ initiative, which focused on addressing disparities in health outcomes for Black women. After eight years, she planned her own exit and took a three-month ‘self-care’ break, which mainly involved spending time on the ski slopes in Utah.

Following this time off and before joining MSF USA, Willmott took an interim CEO role at Mothers Against Drunk Driving, which she held between 2021 and 2023. At the time, the organisation was looking for ways to regain visibility post-Covid-19, and its advocacy work was more urgent than ever due to an increase in impaired driving deaths during the pandemic. Willmott assisted the organisation with its efforts to campaign for the introduction of the HALT Drunk Driving Act, which was signed into law in late 2021. The law requires all new passenger vehicles to feature anti-drunk driving technology. ‘It was energising to help with that work,’ she says.

Outside her legal work, Willmott is a great supporter of animal welfare and is a ‘dog momma’ to two rescue dogs. ‘I am always appalled when humans are unkind to the marginalised and voiceless, and helping rescues is one of the things that keeps me focused on the good that can be done,’ she says.

She’s also committed to family and friends, exploring the New York City food scene and, when the weather permits, travelling up to the Northeast to ski and enjoy some leisurely turns down the mountain.

Willmott’s early exposure to the law was through her cousin, who, as a recent Yale Law School graduate, ‘held court’ at a dinner when she was a teenager. ‘I was impressed by how he captured attention and how he expressed his hope and confidence,’ she says. ‘He ended up a professor at Touro Law Center, where they are committed to academic excellence, human dignity and community service, which seems so prescient when looking back.’