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Beyond dichotomies: Understanding survival sex as a coping mechanism during armed conflict

Published online by Cambridge University Press:  07 April 2026

Maria Carolina Aissa de Figueredo Open the ORCID record for Maria Carolina Aissa de Figueredo [Opens in a new window]
Maria Carolina Aissa de Figueredo*
Affiliation:
Adviser for the Protection of Civilians, International Committee of the Red Cross, Geneva, Switzerland
*
Email: maissadefigueredo@icrc.org
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Abstract

Survival sex is prevalent in conflict-affected settings, yet humanitarian actors’ understanding of the structural inequalities driving such exchanges remains limited. Stigma and discriminatory attitudes among practitioners continue to shape humanitarian responses, resulting in the exclusion of those engaged in survival sex from assistance and protection. This article examines how prevailing narratives have reduced survival sex to dichotomous categories of sex work or sexual violence, overlooking the systemic dimensions of what is best described as a coping mechanism. After defining survival sex, it analyzes the root causes of the phenomenon through wider scholarship on transactional sex. Based on secondary sources and the author’s operational experience addressing gendered harm in humanitarian settings, the article examines how survival sex impacts individuals, families and communities. The author concludes by providing recommendations for how humanitarian actors can enhance protection for persons engaged in survival sex through broader stigma reduction efforts.

Keywords

genderintersectionalitytransactional sexsurvival sexsexual violencesexual exploitation and abusecoping mechanismsstigma reductioncommunity outreach

Information

Type
Research Article
Information
International Review of the Red Cross , First View , pp. 1 - 27
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NoDerivatives licence (http://creativecommons.org/licenses/by-nd/4.0), which permits re-use, distribution, and reproduction in any medium, provided that no alterations are made and the original article is properly cited.
Copyright
© The Author(s), 2026. Published by Cambridge University Press on behalf of International Committee of the Red Cross.

Introduction

Human rights advocates and legal scholars have long debated whether the exchange of sex for resources is a form of exploitation or violence.Footnote 1 In analyzing questions around consent and coercion, public health experts and anthropologists have identified a diversity of experiencesFootnote 2 among women, men and gender-diverse individuals who exchange sex “to gain access to a continuum of material and consumer needs”.Footnote 3 Intersectional feministsFootnote 4 have also injected much-needed nuance into these conversations by underscoring the role of individual agency and challenging unhelpful gendered, racialized and class-driven assumptions about people who exchange sex.Footnote 5

Rather than understanding people who exchange sex as traversing a spectrum of conflict- and crisis-related harms, however, humanitarian actors often oversimplify their experiences. This is largely due to individual cognitive biases which can limit humanitarians’ capacities to navigate seemingly contradictory realities when assessing needs during a crisisFootnote 6 (e.g., persons exchanging sex can be both victims of armed conflict requiring emergency support and individuals who exercise autonomy when coping with impossible circumstances). At the organizational level, reductive vulnerability criteria have further restricted affected people who do not fit into neat boxes by labelling them as either worthy recipients or outside of scopeFootnote 7 because of their individual characteristics, perceived choices and traumatic events.Footnote 8

As Brun notes, this rigid classificatory logic obscures the structural forces that produce vulnerability by shifting responsibility onto individuals rather than the systems that constrain them.Footnote 9 By fixating on the legitimacy of individual behaviours,Footnote 10 humanitarian programming to address gendered harm has overlooked how laws, policies and systems of power that emerge during armed conflict create the enabling conditions for certain coping mechanisms; for example, restrictions of movement on internally displaced persons (IDPs) that create asymmetric dependencies on camp authorities or State policies which can deepen food insecurity may intensify reliance on survival sex in humanitarian settings.

This article asserts that the binary nature of the current discourse on survival sex in humanitarian emergencies (i.e., survival sex can only be sexual violence or consensual sex work) overlooks the structural drivers of this practice. By oversimplifying important questions around consent and coercion during armed conflict, humanitarian actors have further contributed to the exclusion and stigmatization of adultsFootnote 11 exchanging sex to survive.Footnote 12 This article seeks to nuance existing practitioner conversations by unpacking how survival sex is used as a coping mechanism to mitigate structural harms that are endemic to armed conflict. It first examines the wider literature on both transactional and survival sex to propose a common conceptual framework through which humanitarians can engage with survival sex. By drawing on specific operational examples, the article then examines how survival sex impacts individuals, families and communities across diverse populations.Footnote 13 The article concludes by illustrating how stigmaFootnote 14 reduction efforts can be integrated into humanitarian programming to offset conflict-related risks of further harm against those who rely on this coping mechanism.

Defining survival sex

In a somewhat artificial quest to define whether all transactional or survival sex is inherently exploitative or not, humanitarian actors have regularly evoked the legal concepts of consent and coercion. However, determining whether the exchange of sex in humanitarian settings is consensual or coercive is not a straightforward task, partly because neither transactional nor survival sex are international law concepts. While this article does not intend to propose new legal definitions, it does seek to illustrate the complexity of any such assessment and to further nuance existing assumptions about survival sex. This is done through a brief examination of the elements required for certain types of sexual exchanges to amount to sexual violence under international humanitarian law (IHL), as well as the definition of consent according to international human rights law (IHRL).

IHL considerations

Under IHL, the term “sexual violence” is used to describe any act of a sexual nature committed against any person under circumstances that are coercive.Footnote 15 In the event of armed conflict, several conditions must be met to consider survival sex as amounting to sexual violence under IHL. Firstly, a situation of armed conflict must be present as this is the general condition for IHL applicability. Secondly, there must be a connection or nexus with the armed conflict. For an act to be regulated by IHL, it is not sufficient for it to be committed at the same time as an armed conflict is taking place; rather, the act must be closely related to the conflict. In particular,

the existence of an armed conflict must, at a minimum, have played a substantial part in the perpetrator’s ability to commit [the crime], [their] decision to commit it, the manner in which it was committed or the purpose for which it was committed.Footnote 16

The assessment of this condition will depend on the concrete circumstances of each case.Footnote 17

Thirdly, the act must have been committed under coercive circumstances. Coercive circumstances include force, threat of force, or coercion caused, for example, by fear of violence, duress, detention, psychological oppression or abuse of power. Situations where the perpetrator takes advantage of a coercive environment or a person’s incapacity to give genuine consent are also included. The force, threat of force or coercion can be directed against either the victim or another person.Footnote 18

IHRL considerations

During both peace and wartime, survival sex may also amount to a violation of IHRL. The IHRL framework considers lack of consent as the core element differentiating sexual intercourse from sexual violence.Footnote 19 Which elements constitute consent or lack thereof have rarely been elaborated in jurisprudence, but in the 2022 Angulo Losada v. Bolivia case, the Inter-American Court of Human Rights (IACtHR) did provide a list of elements that can determine the lack of consent.Footnote 20 These are the use of force or the threat of the use of force, coercion or fear of violence or its consequences, intimidation, detention or deprivation of liberty, psychological oppression, abuse of power, and finally, incapacity to understand sexual violence.Footnote 21 The Court added that consent cannot be inferred in cases when the victim is or has been made unable to freely consent, from the silence or lack of resistance of the victim, and when a relationship of power exists which forces the victim to act in a certain way for fear of the consequences, thus creating a coercive environment.Footnote 22 The jurisprudence of human rights courts and other bodies on sexual violence suggests that the context and circumstances of each case are essential to understanding whether or not consent is freely and voluntarily given.Footnote 23

In other words, establishing whether survival sex amounts to sexual violence is a highly technical endeavour. Such processes require a multitude of facts and a degree of legal analysis that typically exceed the capacities and mandates of most front-line humanitarian actors. Humanitarians addressing gendered harm can, however, meaningfully contribute to reducing risk exposure to sexual violence by ensuring that the self-perceptions of people exchanging sex are considered and influence how programming is designed. In doing so, humanitarian actors can help debunk harmful assumptions about survival sex and recentre the conversation around how structural conditions drive conflict-affected people’s reliance on this coping mechanism.

Survival sex as a subset of transactional sex

Some scholars have argued that the term “survival sex” is semantically “anachronistic” and “ill-suited to a rights-based framework” because it strips individuals of their agency.Footnote 24 While recognizing that the term is imperfect, this article deliberately uses it for greater precision and clarity. Whereas transactional sex encompasses an infinitely broad spectrum of resource-driven sexual exchanges, including consensual sex as a deliberate income-generating strategy, survival sex should be defined as a distinct subcategory therein (see Figure 1) due to:Footnote 25

  1. 1. the objective of the exchange, which aims at ensuring survival (see below for definition);

  2. 2. the unequal power relations between the person who is exchanging sex and the one who is receiving it, which increases potential for coercion; and

  3. 3. the unclear terms of the exchange. The frequency, duration and outcomes of the exchange may not necessarily be stated outright; furthermore, the perceived or implied cost of the exchange may suddenly change depending on the growing severity of needs to be met.

Figure 1. Visualizing the relationship between survival sex and other types of sexual exchanges. Source: the author, 2023.

In view of these conditions, this article defines survival sex as a coping mechanism. Survival sex consists of the exchange of sex to meet an individual, family and/or community’s protection and assistance needs, as well as to reduce or prevent further harm. It is important to note that survival sex can be both life-saving and life-sustaining (i.e., not only limited to an exchange for food, water and/or shelter);Footnote 26 it can be life-sustaining when it enables affected people or their dependents to exit phases of vulnerability.Footnote 27 Persons who engage in survival sex may do so for a variety of reasons, including to obtain what they perceive as safer, more dignified outcomes to ensure their well-being and that of their familiesFootnote 28 or even the broader community.Footnote 29 The term “survival sex” also contributes to the destigmatization of the discourse on sexual exchanges in humanitarian settings by centring the focus on survival, a universal human need, rather than the material or financial dimensions of such practices.

An epistemic approach to addressing survival sex

Conflicting perspectives about who is most likely to exchange sex and why have fuelled endless debates about terminology,Footnote 30 resulting in fragmented approaches to addressing the needs of persons engaged in such practices. The present research has found that the earliest paper to use the term “transaction” or “transactional” sex was published in 1989 within the context of human immunodeficiency virus (HIV) prevention research in sub-Saharan Africa during the 1990s.Footnote 31 While several such studies centred on the prevalence of sexually transmitted infections (STIs) and HIV rates among commercial sex workers, public health researchers also found similar risks among those in “multiple concurrent partnerships” with “regular and casual partners”.Footnote 32

Transactional sex subsequently became a catch-all and value-laden term used to describe persons engaged in informal sexual exchanges to meet a social or economic need. Subsequent studies challenged this undifferentiated thinking by contextualizing behaviour to illustrate how (a) persons exchanging sex identify themselves according to a wide array of highly context-specific terms,Footnote 33 and (b) the objective and purpose of these sexual exchanges vary greatly depending on localized social power dynamics and structural inequalities.Footnote 34 These subtle nuances eventually gave rise to the term “survival sex” in the early 2000s, as social scientists unpacked how marginalized groups used sex to mitigate the effects of poverty, social exclusion and discrimination.Footnote 35 Most research during this period examined the economic and livelihood drivers of survival sex among population categories labelled as at-risk or vulnerable in low- and middle-income countries, including homeless youth, drug users and survivors of intimate partner violence. Findings from these studies provided another perspective by highlighting how survival sex could be utilized as a coping mechanism to prevent further harm.Footnote 36

Further evidence also confirms that survival sex has been a consistent yet invisible feature of war.Footnote 37 In the 1990s and early 2000s, public reports drew attention to the correlation between food insecurity and survival sex.Footnote 38 Causal assumptions about key drivers of this practice were challenged post-2012 when a wave of global crises (such as those in Nigeria, the Democratic Republic of the Congo (DRC), Iraq, Syria, Ukraine and Sudan) and the COVID-19 pandemicFootnote 39 demonstrated how conflict-affected individuals continued to rely on survival sex despite the large-scale provision of humanitarian assistance.Footnote 40 Research on early marriage and displacement in humanitarian settings also contributed to reshaping pre-existing narratives by illustrating how sex within the context of formal or informal marriages is used as a tool to ensure longer-term and multigenerational survival.Footnote 41 Similar studies have contributed to a more nuanced understanding of survival sex as a coping mechanism to preserve the individual as well as secure the survival of the collective,Footnote 42 including in response to water and resource scarcityFootnote 43 and climate-related shocks.Footnote 44

While academic research on survival sex in humanitarian settings has evolved, humanitarian organizations have been slow to integrate the evidence into their operations. This is, in part, due to an unintended dichotomy that emerged following the #AidToo movement.Footnote 45 In a laudable effort to end decades of sexual exploitation and abuse (SEA), the humanitarian sector invested heavily in developing safeguarding policies to prevent staff misconduct.Footnote 46 This regulatory approach, however, framed a wide spectrum of sexual and gender-based harms as a policy problemFootnote 47 that could be resolved though procedures and paperwork, and this tendency has shifted the focus of humanitarian programming aimed at addressing gendered harm towards “the needs of the [humanitarian] organisation – rather than the perspective of the victim/survivor – as a starting point”.Footnote 48

The sector’s current prevention of SEA (PSEA) architecture has also unintentionally reinforced a flat understanding of what drives survival sex in humanitarian contexts.Footnote 49 By prioritizing disciplinary action at the individual level rather than addressing the structural causes of sexual exploitation (e.g., gendered and racialized power imbalances),Footnote 50 existing PSEA approaches have oversimplified the diversity of experiences of persons who exchange sex.Footnote 51 Within this framework, humanitarian actors have tended to approach those exchanging sex during a crisis through only one of two prisms: either as victims of exploitation who require an internal compliance-based response or as professionalized sex workers who are excluded from humanitarian programming due to stigma, discrimination or even donor restrictions.Footnote 52

It is important to underscore that there are two notable exceptions where humanitarian actors have programmatically engaged with survival sex through a person-centred approach: the United Nations’ (UN) operational guidance manual on responding to the health and protection needs of people selling or exchanging sex in humanitarian settings,Footnote 53 and the Women’s Refugee Commission’s guidance note on working with refugees engaged in sex work. Both documents emphasize that international organizations cannot claim to uphold humanitarian principles like non-discrimination while excluding individuals engaged in survival sex from their programming.Footnote 54

Understanding the structural drivers of survival sex during armed conflict

While new guidance is a meaningful step forward, it cannot be effectively implemented without a deeper analysis of the structural push factors that shape how, why and with whom people rely on survival sex as a coping mechanism. This article argues that civilians must navigate a minimum of three intersecting loci of power to survive during armed conflict: (1) communities, (2) civilian/military authorities and (3) international actors. Whether by design or by default, each of the accompanying systems of power constrains individual autonomy, reducing civilians’ capacity to absorb conflict-related shocks. To demonstrate how these constraints influence individual decision-making, the following section examines some of the systemic drivers of survival sex based on pre-existing research in communities hosting displaced persons, front-line areas, and peacekeeping settings.

Community structures of power

Armed conflict aggravates the inequitable distribution of power within communities.Footnote 55 In addition to undermining informal social safety nets,Footnote 56 prolonged violence harms social cohesion.Footnote 57 When individuals or families lack strong ties to local communities, they may also be less likely to cope with the effects of violenceFootnote 58 which can create or increase reliance on survival sex. This dynamic is perhaps most well documented in displacement contexts: a multi-country study focused on refugees living in Lebanon, Jordan, Turkey, Greece and Switzerland, for example, found that 70% of participants interviewed had observed or experienced transactional/survival sex.Footnote 59 These figures are not unique to those countries nor indicative of a recent spike in survival sex among displaced people; a study conducted by the Office of the UN High Commissioner for Refugees (UNHCR) nearly fifteen years earlier similarly found that out of a sample of 150 displaced women in IDP camps in Port-au-Prince, Haiti, nearly all had either been directly involved in or had witnessed the exchange of sex as a coping mechanism.Footnote 60

Individuals and families who flee across borders and engage in survival sex not only lose access to their regular coping mechanisms (income-generating opportunities, local markets, family support etc.) but are often living on the margins of the host communities they inhabit.Footnote 61 In addition to restrictive national and international legal frameworks that may limit movement and access to services, displaced people may be heavily reliant on local host community resources to meet their needs.Footnote 62 For example, displaced people may depend on host properties – such as schools, gyms or warehouses – for shelter, and when their housing is at risk, they may exchange sex with community members managing these spaces.Footnote 63 Equally, those living with host families or in private accommodation may engage in survival sex as a means of sustaining these precarious living arrangements or to cover the costs of housingFootnote 64 without having to make other sacrifices such as removing children from school. In contexts where resource- or identity-based tensions emerge, host communities may leverage their power to restrict displaced people’s access to services like educationFootnote 65 or land,Footnote 66 which can also increase risks of exploitation.

Community leaders may also choose to limit the extent to which external actors can support people exchanging sex. In one context where the International Committee of the Red Cross (ICRC) addresses sexual violence, for example, multi-purpose cash support was used to reduce risks of sexual violence among young women exchanging sex to survive. When engaging with community leaders in the area, however, several such leaders voiced concerns that emergency interventions to support women exchanging sex would promote unwanted or immoral behaviour. This type of response is not uncommon and further illustrates the extent to which possibilities for survival may be constrained by prevailing social norms within a community, including the stigmatization of certain behaviours.

Civilian and military structures of power

During armed conflict, local civilian leaders or elites may leverage their social capital and “gatekeep” access to material resources.Footnote 67 As access to life-saving and -sustaining resources becomes increasingly asymmetrical, individuals and families who are already living on the margins may no longer be able to adapt their coping strategies to offset conflict-related stressors.Footnote 68 During conflict in urban areas, where critical infrastructure systems are deeply interconnected,Footnote 69 hostilities can disrupt entire supply chains and livelihoods, thereby isolating residents and limiting their capacity to support their households.Footnote 70 Civilians living under military occupation or in front-line communities are also more likely to rely on military actors to meet their essential needs, including, but not limited to, water,Footnote 71 sanitation and health services.Footnote 72

Operations to evacuate civilians from front-line areas can also pose particular risks as civilians are directly dependent on emergency responders for safe passage.Footnote 73 During displacement, individuals may also engage in survival sex to pay for their travel, to pass through checkpoints or borders (both visible and invisible) controlled by weapons bearers, or to sustain themselves or their families while on the move.Footnote 74 Once settled in formal IDP and refugee camps, poor site planning and restrictions of movement imposed by both civilian and military authorities will be key causal drivers of survival sex.Footnote 75 Those living in contested territories under non-State control may also struggle to obtain civil documentation, which can prevent them from accessing national services during the conflict and for many years thereafter.Footnote 76 Individuals may therefore exchange sex to obtain documents in order to register for social benefits and other services. In each of these cases, the boundaries between consent and coercion become highly tenuous, rendering it difficult to determine where survival sex ends and sexual violence begins.

Due to the stigma associated with survival sex, civilians who have exchanged sex on the front lines may be exposed to higher risks of sexual violence for years thereafter. In one protracted crisis where the ICRC carries out protection activities, displaced community members shared concerns about armed actors proactively searching for women rumoured to have engaged in survival sex in the early stages of their displacement. According to these community members, armed actors would enter the IDP camp and search tent by tent for women who were said to have engaged in survival sex. While it is unclear whether these women had already left the camp, no longer wished to engage in survival sex or were simply too afraid to do so with these individuals, the stigma alone exposed the entire community to further violence. Notably, the community alleged that when the armed actors did not find any individuals “willing” to exchange sex with them, they began raping displaced women and girls in the camp at random.

International structures of power

At the onset of a crisis, international organizations that wield significant material, social and political resources often substitute services typically provided by the State.Footnote 77 Following the deployment of these global actors, “a constellation of power relations that govern those whom [humanitarians] help and the spaces in which they reside”Footnote 78 emerges. Many have argued that the inequities embedded in systems of humanitarian governanceFootnote 79 are not accidental but are, rather, rooted in discriminate biopower.Footnote 80 In such scenarios, rigid eligibility criteria and programming requirements are a form of “paternalistic control”Footnote 81 which can undermine existing coping mechanisms.Footnote 82 Increased reliance on new technologies for humanitarian action has exacerbated these asymmetries by requiring affected people to surrender large amounts of personal data in exchange for access to basic humanitarian services.Footnote 83

The underlying forces driving survival sex in peacekeeping contexts offer a particularly useful lens through which to unpack this “complex matrix” of coercion, agency and survival in humanitarian settings.Footnote 84 As is the case for most humanitarian and development hubs,Footnote 85 peacekeeping environments stimulate grey economies rooted in unequal social, racial and gender dynamics between internal actors and local communities.Footnote 86 The conflict-affected populations that host peacekeeping contingents frequently shift their livelihoods toward the informal service sectorFootnote 87 to meet the demands of foreign personnel, and may earn up to 500–1,000 times the average local wage by doing so.Footnote 88 Communities’ often non-consensual proximity to peacekeeping bases further blurs the boundaries between the private and professional spheres, normalizing or even encouraging uneven exchanges over time.Footnote 89

In these environments, the nebulous nature of survival sex extends beyond the moment of the initial sexual act. Evolving expectations, relational dynamics and individual needs shape how persons exchanging sex understand their experiences, negotiate the terms of exchange and reassess their willingness to continue over the long term. Vahedi, Bartels and Lee’s 2014 study of Haitian women who had children from sexual exchanges with peacekeepers, for example, revealed that most did not identify as victims/survivors of sexual violence at the outset. However, many described their willingness to engage in these exchanges as being shaped by a set of “unwritten rules” or promises made by peacekeepers to meet their material or relational expectations.Footnote 90 For some, their understanding of whether these exchanges were consensual or exploitative shifted once they became pregnant. In cases where the peacekeeper refused to continue the relationship, eschewed child support responsibilities or simply left the country, the underlying terms (i.e., long-term emotional and financial support) were no longer fulfilled.Footnote 91 Such examples underscore how the process of consent in situations of survival sex is a fragile and precarious one.

Disentangling the humanitarian consequences of survival sex

While individuals engaged in survival sex should not be treated as a monolithic group, many of the humanitarian consequences are recurrent across contexts. This is because survival sex is frequently embedded in contexts of deprivation, constrained choice and inadequate systems of protection that reproduce specific vulnerabilities at the individual, family, community and structural levels. The following examples illustrate how survival sex generates cascading physical, mental, legal and multigenerational consequences which, when unaddressed, weaken resilience to conflict-related shocks.

Health consequences

There has been extensive research on the physical health consequences of survival sex, with a particular focus on exposure to STIs, including HIV.Footnote 92 In conflict-affected countries where safe termination of pregnancy is criminalized or severely restricted, unsafe abortions constitute a major concern, in particular to young girls. A 2016 study which surveyed 480 persons engaging in survival sex in the DRC, for example, found that nearly half reported having undergone one or more unsafe abortions.Footnote 93 While this could be due to a variety of factors, persons engaged in survival sex may be afraid of accessing sexual and reproductive health care (SRH) services due to fear of stigma or criminalization. Even in contexts of armed conflict where quality SRH services are legally available, they may be inaccessible due to overburdened health-care systems and attacks on medical infrastructure.Footnote 94 In both scenarios, persons who become pregnant when exchanging sex will be forced to seek services through lesser-known informal networks where the risks of health complications are high.Footnote 95

Harmful health-care provider attitudes can delay or prevent timely access to critical SRH services,Footnote 96 sometimes resulting in disability or death.Footnote 97 In addition to stigma, health-care providers’ limited understanding of survival sex or narrow patient criteria make it difficult for persons engaged in survival sex to regularly use these services.Footnote 98 For example, access to clinical management of rape and other life-saving care may be conditioned or withheld if providers cannot easily check a box on an intake form to confirm that the patient is a victim/survivor of rape. In conflict settings where medications are in short supply, providers may be reticent to repeatedly provide the same treatment to a patient engaged in survival sex. When mandatory reporting regulations for sexual and gender-based violence apply, medical staff may feel pressured to report a case of survival sex to law enforcement. Some medical personnel may therefore refuse or discontinue care in order to avoid reporting obligations that can have unintended consequences such as reprisals against medical staff or further violence against the presumed victim/survivor.Footnote 99

Whereas the specific mental health consequences associated with survival sex during conflict have not been extensively researched, work with similar populations during peacetime confirms that there is indeed a psychological impact.Footnote 100 Studies from non-conflict settings indicate that anxiety, depression and post-traumatic stress disorder are prevalent within populations that engage in survival sex, such as homeless persons and victims/survivors of intimate partner violence.Footnote 101 In conflict settings, these experiences are also compounded by multiple other stressors such as restrictions of movement, deprivation of liberty and family separation.Footnote 102

Legal consequences

Due to restrictive laws and policies, persons engaged in survival sex may face long-term structural consequences. Such persons may, for example, be punishedFootnote 103 in contexts where domestic legal frameworks penalize sex work or impose countercharges for adultery and alleged “morality crimes”;Footnote 104 police harassment, fear of imprisonment and lack of legal protections contribute to further marginalization and stigma.Footnote 105 This may place persons engaged in survival sex in an eventual loop of illegality which exposes them to risks of other violence, including sexual violence,Footnote 106 while also limiting their access to public services in times of crisis.Footnote 107

Multigenerational consequences

Although typically overlooked, survival sex produces multigenerational consequences that reshape family relationshipsFootnote 108 and may alter the social fabric of communities.Footnote 109 In addition to long-term socio-economic and health consequences,Footnote 110 persons exchanging sex, along with their families, face social isolation and discrimination.Footnote 111 One study on stigma against women who exchanged sex with peacekeepers in the DRC, for example, found that even years after the initial sexual exchange, nearly 53% were still unable to marry due to negative community perceptions.Footnote 112 In Sierra Leone, young women who had exchanged sex to survive and had subsequently become pregnant were ostracized by their community at the end of the conflict, leaving them unable to marry and create their own families.Footnote 113

When persons exchanging sex were already part of a marginalized group prior to the conflict, their ostracization will inevitably increase their exposure to further violence as the conflict intensifies. These stigma-related consequences will be further compounded if the individual has been exchanging sex with someone their community views as belonging to the opposing party to a conflict and/or rival group. Research from northeast Nigeria, for example, found that women and girls who were subjected to forced marriage or sexual slavery by armed groups then engaged in survival sex after their escape due to social rejection by their families and communities.Footnote 114 Children born of survival sex are also more likely to become caught in a cycle of poverty due to their mothers’ precarious socio-economic statuses, which limit access to education and other life-altering opportunities.Footnote 115

Through its operations to address sexual violence, the ICRC has also interestingly observed how survival sex can be used as a mechanism to prevent other harmful, multigenerational consequences linked to armed conflict. In contexts where children have been separated from their families due to displacement or forced recruitment, for example, young adults often care for small siblings without adequate social support. When foisted into a head-of-household role with limited educational and livelihood opportunities, young adults may rely on survival sex to provide better opportunities for future generations.Footnote 116 Such cases are an important reminder that survival sex is not only used as a tool to secure individual survival but may be used to protect the family unit in all its diverse forms.

Destigmatizing survival sex as a coping mechanism

When discussing the consequences of survival sex, humanitarian actors have fixated on individual behaviours rather than the root causes of this coping mechanism, and this has minimized the conflict-related enablers of this practice.Footnote 117 This is partly because many of the structural drivers that prompt individuals to rely on survival sex during an emergency – such as deeply entrenched social inequality, resource capture by weapons bearers, the politicization of aid, or accountability deficits in the humanitarian sector – are multifaceted and therefore complex to address. This has gradually contributed to one-dimensional responses that not only fail to address why individuals are relying on survival sex as a coping mechanism but also overlook the evolving protection risks faced, which can accelerate harm.Footnote 118 While there is no one-size-fits-all solution, new evidence from the ICRC’s work to address sexual violence provides useful insights for how humanitarian actors can strengthen protection for marginalized community members through destigmatization efforts.

Future directions: Applying the ICRC’s Stigma Impact Model to survival sex

In 2022, the ICRC launched its Prevention of Sexual Violence Programme (PSVP) to address harmful attitudes that increase conflict-affected communities’ exposure to sexual violence and stigma. As part of its efforts to shift harmful community behaviours towards helpful ones, the ICRC co-created a Stigma Impact Model,Footnote 119 as shown in Figure 2, in 2024. The model was developed through extensive consultation on the risks arising from stigma with 948 individuals – of whom 27% were victims/survivors of sexual violence – and sixty-six survivor-led and survivor advocate organizations.Footnote 120

Figure 2. ICRC Stigma Impact Model. Source: ICRC, How Does Stigma Impact Victims/Survivors of Sexual Violence during Armed Conflict?, policy brief, Geneva, 2024, p. 5.

Each layer of the Stigma Impact Model illustrates how stigmatizing beliefs and practices against victims/survivors of sexual violence generate new protection risks, starting at the individual level and expanding outwards to the community and structural levels. The ICRC currently uses the Stigma Impact Model to guide its engagement with communities affected by sexual violence. Initial results from two conflict-affected contexts where the ICRC has used this tool to conduct community stigma reduction efforts indicate that such an approach can increase help-seeking behaviours and prevent further harm.Footnote 121 Given that survival sex results in similar stigma-driven consequences, humanitarians should also explore similar layer-by-layer approaches to shift the stigma away from those who rely on this coping mechanism.

At the individual and household levels, humanitarian actors can reduce stigma against people exchanging sex by integrating opportunities for safe disclosures into the programme cycle. Using a participatory and intersectional approach,Footnote 122 individual or household needs assessments can provide a space where respondents establish their own baseline for survival versus well-being, resulting in richer coping strategy indexes.Footnote 123 Language around survival and coping mechanisms should be regularly revised to counter implicit forms of stigma that deter participants from speaking about survival sex (e.g., judgemental or binary questions that frame certain coping mechanisms as either “positive” or “negative”). Alternative methodologies for individual and household surveys should also be explored to mitigate social desirability biases which fuel misconceptions about survival sex. List experiments, for example, have yielded promising results in estimating the prevalence of wartime sexual violenceFootnote 124 and could therefore be adapted to measure assumptions about the prevalence of survival sex in conflict settings. During programme implementation, tools such as results journaling or ecological momentary assessments (EMAs) can equally support safe disclosures and even improve well-being; in at least one study, EMAs were associated with positive mental health outcomes for people exchanging sex.Footnote 125

By strategically adapting the programmatic vectors through which the core needs of people relying on survival sex are addressed, humanitarian actors can reduce stigma and strengthen conflict-affected communities’ resilience to further shocks. This begins by involving community members in problem analyses and solutions design, so that humanitarian responses are context-appropriate and do not cause further harm. In some conflict-affected settings where the ICRC addresses sexual violence, for example, communities engaged in focus discussion groups have asked humanitarian actors to address survival sex discreetly for fear of jeopardizing their primary coping mechanism.

Similarly, where the terms “transactional” or “survival” sex are difficult to translate or carry significant stigma, humanitarians can partner with community-based actors to identify more appropriate terminology so that those exchanging sex can still identify and safely access services. This also applies to how humanitarian programming is labelled and presented within the wider community: in the DRC, grassroots initiatives led by persons exchanging sex in South Kivu have focused on common priorities and mutual capacity-strengthening as entry points. Rotating savings schemes, credit associations, and soap-making groups have subsequently emerged as inclusive spaces for promoting social healing and strengthening livelihoods.Footnote 126 These are precisely the types of non-stigmatizing community-led approaches that humanitarians can support if appropriate and aligned with the wishes of affected people.

Community networks are also a powerful tool that can be leveraged during humanitarian emergenciesFootnote 127 to reduce stigma and improve the well-being of persons engaged in survival sex. When carrying out awareness-raising sessions on health or sexual and gender-based violence, for example, humanitarians can automatically integrate key messages on stigma reduction. Additional information on accessible services and referral pathways can fill knowledge gaps and counter misinformation so that affected people – including those who may have exchanged sex and would not like to be recognized as such – are aware of their rights and available options. Where survival sex can be addressed explicitly, peer-to-peer outreach involving persons who have exchanged sex can also be used to improve public health outcomes.Footnote 128

Perhaps most importantly, humanitarian institutions must structurally address how their own norms, inequalities and unconscious biases create programming that harms,Footnote 129 rather than supports, those engaged in survival sex as a coping mechanism.Footnote 130 For example, reductive gendered assumptions can influence how eligibility criteria are designed and can thereby contribute to exclusionary programming.Footnote 131 This is particularly concerning as some research suggests that non-inclusive service delivery reinforces reliance on survival sex for individuals who are already struggling to access aid because of legal or social barriers to access.Footnote 132 To begin addressing these issues, humanitarians must draw on evidence, rather than value-driven assumptions, about how different population groups navigate the effects of violence and deprivation.

In the long term, humanitarian actors must also consider investing in programming that moves towards creating pathways for well-being.Footnote 133 This can be achieved by improving market access (e.g., repairing critical infrastructure to reconnect conflict-affected communities with local markets) or diversifying livelihood programming through effective partnerships with the development sector and other relevant actors. For example, some have called for governments and the private sector to facilitate displaced people’s participation in the global digital economy when physical participation in the local labour market is restricted.Footnote 134 Such innovative partnerships could help to mitigate risks of survival sex not only at the individual level but for entire families, including children who are impacted by the multigenerational consequences of survival sex.

Conclusion

As illustrated throughout this article, survival sex does not exist as a binary but rather operates on a fraught continuum of coercion, consent and agency. During armed conflict, intensifying violence exacerbates deeply rooted structural inequalities between individuals or groups struggling to survive and local community, civilian/military and international power brokers. As these asymmetries grow, conflict-affected people may rely on sex as a coping mechanism to meet needs or prevent further harm, and this can expose them to higher risks of gendered violence, including sexual violence.Footnote 135 Many humanitarian actors, however, continue to engage with survival sex through a reductive in-/out-of-scope binary.Footnote 136 Such stigmatizing practices only further constrain the choices of persons exchanging sex to survive, reduce capacities to absorb conflict-related shocks, and limit possibilities to move beyond survival and towards well-being.

By unpacking where, how and why survival sex takes place during armed conflict, this article has attempted to challenge existing cognitive biases which contribute to exclusionary humanitarian programming. Current trends analyzed in this article further confirm that survival sex is indeed a structural phenomenon, which, when occurring in armed conflict, is driven by weak systems of civilian protection, unequal access to critical services and limited livelihood opportunities. Rather than continuing to engage in circular debates about whether survival sex is sex work or sexual violence, humanitarians should instead approach survival sex much like an early warning system – i.e., when survival sex is occurring at a large scale in crisis settings, it is a clear indicator of insufficient or dysfunctional humanitarian protection and assistance programming that must be rectified to prevent harm-doing. The onus should therefore not be on conflict-affected individuals to pick “better” coping mechanisms, but should rather be on humanitarians to reduce stigmatizing practices that perpetuate “violation[s] of personhood and autonomy”.Footnote 137

As this article has argued, humanitarian actors can initiate this paradigmatic shift by reframing survival sex as a coping mechanism which must be addressed throughout the programmatic cycle in a non-stigmatizing manner. This will, however, require closer collaboration with people engaging in survival sex in humanitarian settings. For example, academia and humanitarians can partner with conflict-affected people exchanging sex to identify causal drivers and develop practical solutions rooted in lived experiences. Donors can also contribute to shifting the stigma by funding the operationalization of policy and programmatic recommendations co-created with people exchanging sex in humanitarian settings. Collectively, such approaches can create pathways for affected communities to drive transformative action aimed at tackling the structural drivers of survival sex, reducing exclusion and enhancing the well-being of all conflict-affected people.

Footnotes

*

With special thanks to the ICRC’s Regional Adviser for Addressing Sexual Violence in Africa, Maria Oleka, who originally proposed this topic and provided valuable inputs into the research process based on her operational experiences addressing sexual violence and survival sex in the Africa region.

The advice, opinions and statements contained in this article are those of the author/s and do not necessarily reflect the views of the ICRC. The ICRC does not necessarily represent or endorse the accuracy or reliability of any advice, opinion, statement or other information provided in this article.

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10 For a more in-depth analysis of how international actors’ assumptions and biases about why individuals exchange sex can perpetuate a cycle of exclusion, see Laura María Agustín, Sex and the Margins: Migration, Labour Markets and the Rescue Industry, Zed Books, London, 2017, Chap. 5.

11 Unaccompanied and separated children, children living on the street, children associated with armed forces and armed groups, and/or internally displaced and migrant children often exchange sex with adults to offset increased socio-economic vulnerabilities during armed conflict, but they are not the focus of this article. When referring to the exchange of sex to meet needs or prevent further harm (i.e., survival sex), this article is referring exclusively to adults engaged in this practice. This is because, in accordance with international law and sectoral standards, sexual acts between adults and children always constitute sexual violence; see Convention on the Rights of the Child, 1577 UNTS 3, 20 November 1989 (entered into force 2 September 1990), Arts 19, 34.

12 Global Network of Sex Work Projects, Sex Workers in Conflict Zones and Humanitarian Crises, policy brief, Edinburgh, 2023, p. 9; Paula Dupraz-Dobias, “The Aid System’s ‘Double Standards’ on Sex Workers”, The New Humanitarian, 14 August 2024, available at: www.thenewhumanitarian.org/interview/2024/08/14/aid-systems-double-standards-sex-workers (all internet references were accessed in March 2026).

13 This article presents examples from International Committee of the Red Cross (ICRC) operations which illustrate how conflict-affected communities are engaging with the practice of survival sex. These cases were identified by examining internal data from the ICRC’s global programming addressing sexual violence to which the author has had access in her capacity as a member of the ICRC’s Addressing Sexual Violence team. In accordance with the ICRC’s confidentiality policies, each example has been decontextualized to avoid referencing specific contexts or actors.

14 In the context of this article, the term “stigma” is used to refer to “a perceived negative attribute that causes someone to devalue a person or group of people”, potentially leading to various forms of societal and structural discrimination. See ICRC, Guidelines on Mental Health and Psychosocial Support, Geneva, March 2018, p. 9 fn. 2. For more information on the humanitarian consequences of stigma, see ICRC, How Does Stigma Impact Victims/Survivors of Sexual Violence during Armed Conflict?, policy brief, Geneva, 2024.

15 ICRC, Commentary on the Fourth Geneva Convention: Convention (IV) relative to the Protection of Civilian Persons in Time of War, 2nd ed., Geneva, 2025, Art. 3, para. 789. See also International Criminal Tribunal for Rwanda (ICTR), The Prosecutor v. Jean-Paul Akayesu, Case No. ICTR-96-4-T, Judgment (Trial Chamber), 2 September 1998, para. 688.

16 ICTR, Prosecutor v. Georges Anderson Nderubumwe Rutaganda, Case No. ICTR-96-3-T, Judgment (Appeals Chamber), 26 May 2003, para. 570; International Criminal Tribunal for the former Yugoslavia, Prosecutor v. Dragoljub Kunarac, Radomir Kovač, and Zoran Vuković, Judgment (Appeals Chamber), 12 June 2002, para. 58.

17 Gloria Gaggioli, “Sexual Violence in Armed Conflicts: A Violation of International Humanitarian Law and Human Rights Law”, International Review of the Red Cross, Vol. 96, No. 894, 2014, p. 517.

18 International Criminal Court, Elements of Crimes, 2002, Art. 8(2)(b)(xxii)-6, 8(2)(e)(vi)-6; see also Art. 7(1)(g)-6.

19 See, among others, Committee on the Elimination of Discrimination against Women (CEDAW), “General Recommendation No. 35 on Gender-Based Violence against Women, Updating General Recommendation No. 19”, UN Doc. CEDAW/C/GC/35, 26 July 2017, para. 29(e); Dubravka Šimonović, Rape as a Grave, Systematic and Widespread Human Rights Violation, a Crime and a Manifestation of Gender-Based Violence against Women and Girls, and Its Prevention: Report of the Special Rapporteur on Violence against Women, UN Doc. A/HRC/47/26, 19 April 2021, paras 27, 85(a); Council of Europe Convention on Preventing and Combating Violence against Women and Domestic Violence (Istanbul Convention), 11 May 2011 (entered into force 1 August 2014), Art. 36; Inter-American Court of Human Rights (IACtHR), Angulo Losada v. Bolivia, Judgment, Series C, No. 466, 18 November 2022, paras 145–148; IACtHR, J. v. Peru, Judgment, Series C, No. 275, 27 November 2013, para. 358; European Court of Human Rights (ECtHR), M. C. v. Bulgaria, Appl. No. 39272/98, Judgment, 4 December 2003, para. 166.

20 The IACtHR discussed these elements in the context of indicating what elements should be included in national legislation in relation to lack of consent for the crime of sexual violence. The elements listed by the Court are in line with General Recommendation No. 3 of the Committee of Experts of the Follow-up Mechanism to the Belém do Pará Convention on this topic.

21 IACtHR, Angulo Losada, above note 19, paras 147–148.

22 Ibid.

23 See, among others, ibid., paras 145–148; IACtHR, J., above note 19, para. 358; CEDAW, Vertido v. Philippines: Views under the Optional Protocol to the Convention on the Elimination of All Forms of Discrimination against Women, Communication No. 29/2008, 22 September 2010; ECtHR, M. C., above note 19, para. 166.

24 Women’s Refugee Commission, Working with Refugees Engaged in Sex Work: A Practical Guide, Washington, DC, 2016, p. 3.

25 These criteria are informed by the distinctions drawn between transactional sex and survival sex in Grace Bantebya, Eric Ochen, Paola Pereznieto and David Walker, Cross-Generational and Transactional Sexual Relations in Uganda: Income Poverty as a Risk Factor for Adolescents, Overseas Development Institute, London, December 2014, pp. 3–4.

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27 Jennifer Cole, “Fresh Contact in Tamatave, Madagascar: Sex, Money, and Intergenerational Transformation”, Journal of the American Ethnological Society, Vol. 31, No. 4, 2008, p. 581; Leso Munala, Bethlehem Yewhalawork, Nene Okunna and Jesse Kihuha, “‘Girls are the Ones who Save the Family’: Factors and Consequences of Engaging in Age-Disparate Transactional Sex Relationships”, Journal of Interpersonal Violence, Vol. 38, No. 5–6, 2022, pp. 4473–4474.

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31 John C. Caldwell, Pat Caldwell and Pat Quiggin, “The Social Context of AIDS in Sub-Saharan Africa”, Population and Development Review, Vol. 15, No. 2, 1989, p. 203.

32 Amy E. Weber et al., “Sex Trade Involvement and Rates of Human Immunodeficiency Virus Positivity among Young Gay and Bisexual Men”, International Journal of Epidemiology, Vol. 30, No. 6, 2001, p. 1450.

33 Janet Maia Wojcicki, “‘She Drank His Money’: Survival Sex and the Problem of Violence in Taverns in Gauteng Province, South Africa”, Medical Anthropology Quarterly, Vol. 16, No. 3, 2002, p. 284.

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37 For further research that has documented evidence of survival sex during World War I and World War II, for example, see U. Ü. Üngör, “Orphans, Converts, and Prostitutes: Social Consequences of War and Persecution in the Ottoman Empire, 1914–1923”, War in History, Vol. 19, No. 2, 2012, p. 187; Pascale R. Bos, “Barter, Prostitution, Abuse? Reframing Experiences of Sexual Exchange during the Holocaust”, Journal of Holocaust Research, Vol. 38, No. 3–4, 2024, pp. 7–12; Jeffrey Burds, “Sexual Violence in Europe in World War II, 1939–1945”, Politics and Society, Vol. 37, No. 1, 2009, pp. 41–59; Gabrielle Hauth, “Sex for Survival: Intimacy in Nazi Concentration Camps and Its Post-Liberation Effect on Survivors”, honours thesis, Louisiana State University, May 2014, pp. 29–31.

38 Mercedes Sayagues, “The Invisibility of Refugee Women”, World Food Programme Journal, Vol. 19, 1992, pp. 17–20; Department for International Development, “Humanitarian Crisis in Southern Africa Background Briefing”, London, December 2002, available at: https://reliefweb.int/report/angola/humanitarian-crisis-southern-africa-background-briefing-december-2002; Naeema Al Gaseer and Gwen Brumbaugh Keeney, “Status of Women and Infants in Complex Humanitarian Emergencies”, Journal of Midwifery and Women’s Health, Vol. 49, No. 4, 2004, p. 9.

39 Lauren Jacobson, Alexandra Regan, Shirin Heidari and Monica Adhiambo Onyango, “Transactional Sex in the Wake of COVID-19: Sexual and Reproductive Health and Rights of the Forcibly Displaced”, Sexual and Reproductive Health Matters, Vol. 28, No. 1, 2020, pp. 78–79.

40 Amnesty International, Not a Private Matter: Domestic and Sexual Violence against Women in Eastern Ukraine, London, 2020, pp. 65–67; Shirin Heidari et al., “Liminality and Transactional Sex among Queer Refugees: Insights from Lebanon, Turkey, Greece, and Switzerland”, Journal of Refugee Studies, 2024, pp. 8–9; Michael Kunuuji et al., “Transactional Sex in Humanitarian Settings: A Comparative Analysis of Livelihood and Demographic Predictors”, African Journal of Reproductive Health, Vol. 28, 2024, pp. 69–70.

41 Aisha Hutchinson, Philippa Waterhouse, Jane March-McDonald, Sarah Neal and Roger Ingham, “Understanding Early Marriage and Transactional Sex in the Context of Armed Conflict: Protection at a Price”, International Perspectives on Sexual and Reproductive Health, Vol. 42, No. 1, 2016, pp. 46–47; Ruba Al Akash and Morgen A. Chalmiers, “Early Marriage among Syrian Refugees in Jordan: Exploring Contested Meanings through Ethnography”, Sexual and Reproductive Health Matters, Vol. 29, No. 1, 2021, pp. 293–294; UN Women, Inter-Agency Assessment: Gender-Based Violence and Child Protection among Syrian Refugees in Jordan, with a Focus on Early Marriage, Amman, July 2013, pp. 29–33; Sung Kyung Kim, “‘I Am Well-Cooked Food’: Survival Strategies of North Korean Female Border-Crossers and Possibilities for Empowerment”, Inter-Asia Cultural Studies, Vol. 15, No. 4, 2014, pp. 560–563.

42 Constance Formson and Dorothea Hillhorst, The Many Faces of Transactional Sex: Women’s Agency, Livelihoods and Risk Factors in Humanitarian Contexts: A Literature Review, Working Paper No. 41, Wageningen University, Wageningen, 2016, p. 18.

43 Swani R. Keelson, “Justice at the Crossroads: Addressing Water Scarcity and Transactional Sex in Ghana’s Remote Villages – A Call for Action against Period Poverty”, International Journal for Water Equity and Justice, Vol. 10, No. 1, 2024; Kathryn J. Fiorella, Pooja Desai, Joshua D. Miller, Nicky O. Okeyo and Sera L. Young, “A Review of Transactional Sex for Natural Resources: Under-Researched, Overstated, or Unique to Fishing Economies?”, Global Public Health, Vol. 14, No. 12, 2019, pp. 4–6; Lawrence P. O. Were, “Climate Change, Transactional Sex, HIV/AIDS and Sustainable Livelihoods among Fishing Communities around Lake Victoria: A Scoping Review Protocol”, BMJ Open, Vol. 16, 2026, p. 2.

44 Carole Treibich, Eleanor Bell, Elodie Blanc and Aurélia Lépine, “From a Drought to HIV: An Analysis of the Effect of Droughts on Transactional Sex and Sexually Transmitted Infections in Malawi”, Population Health, Vol. 19, 2022, p. 6.

45 For a brief history of sexual exploitation and abuse scandals in the humanitarian sector and the evolution of the prevention of SEA (PSEA) agenda, see Jessica Alexander, “Then and Now: 25 Years of Sexual Exploitation and Abuse”, The New Humanitarian, Geneva, 11 February 2021; Clea Cahn, Michelle Alm Engvall, Shirin Heidari, Megan Denise Smiith and Dorothea Hilhorst, “Rethinking Transactional Sex in Humanitarian Settings: Reflections for the Way Forward”, ISS Blog Bliss, 27 February 2022, available at: https://issblog.nl/2022/02/27/rethinking-transactional-sex-in-humanitarian-settings-reflections-for-the-way-forward/.

46 UNICEF, Protection from Sexual Exploitation and Abuse: UNICEF IASC Championship 2018–2019, October 2019, pp. 10–11.

47 Jasmine-Kim Westendorf et al. “Sexual Exploitation, Abuse and Harassment in Humanitarian Contexts”, Bulletin of the World Health Organization, Vol. 102, No. 12, 2024, p. 6.

48 CHS Alliance, Victim/Survivor-Centred Approach to Protection from Sexual Exploitation, Abuse, and Harassment in the Aid Sector: Foundational Paper, Geneva, 30 January 2023, p. 4.

49 Jasmine-Kim Westendorf, “‘Do No Harm’: The Challenge of Transactional Sex in Humanitarian Operations”, Alternatives Humanitaires, No. 16, 2021, pp. 106–107; Kristin Bergotra Sandvik, “‘Safeguarding’ as Humanitarian Buzzword: An Initial Scoping”, Journal of International Humanitarian Action, Vol. 4, No. 3, 2019, pp. 3–4; Diane Otto, “Making Sense of Zero Tolerance Policies in Peacekeeping Sexual Economies”, in Vanessa Munro and Carl F. Stychin (eds), Sexuality and the Law: Feminist Engagements, Routledge-Cavendish, Oxford, 2007, p. 271; Kaitlin Gibson, Alina Dixon, Allison Goebel and Susan A. Bartels, “Love, Sex, and Exchange in the Context of Peacebuilding in the Democratic Republic of Congo”, International Peacekeeping, Vol. 29, No. 4, 2022, pp. 686–687; Jena McGill, “Survival Sex in Peacekeeping Economies: Re-reading the Zero Tolerance Approach to Sexual Exploitation and Sexual Abuse in United Nations Peace Support Operations”, Journal of International Peacekeeping, Vol. 18, 2014, pp. 25–28.

50 Junru Bian et al., “Gender, Race, Sexuality and PSEA”, in Jasmine-Kim Westendorf and Elliot Dolan-Evans (eds), Sexual Exploitation and Abuse in Peacekeeping and Aid, Bristol University Press, Bristol, 2024, pp. 162–165; Jasmine-Kim Westendorf, “Rethinking PSEA: Reflections for Policy Makers”, in J.-K. Westendorf and E. Dolan-Evans (eds), above, pp. 221–225; Nour Abu-Assab, “From ‘Cultural Sensitivity’ to ‘Structural Sensitivity’”, in J.-K. Westendorf and E. Dolan-Evans (eds), above, pp. 188–190; Giulia Piccolino, “How an Uproar over Aid and Sexual Exploitation Ignored Women’s Actual Experiences”, The Conversation, Loughborough, 5 April 2018, available at: https://theconversation.com/how-an-uproar-over-aid-and-sexual-exploitation-ignored-womens-actual-experiences-92200.

51 Michelle Alm Engvall, “Sex Work and Humanitarianism: Understanding Predominant Framings of Sex Work in Humanitarian Response”, master’s thesis, Uppsala University, Uppsala, May 2019, pp. 21–23.

52 UN Population Fund (UNFPA), A Rapid Scoping Assessment of the Impact of COVID-19 on Sex Worker Programmes in East and Southern Africa, Johannesburg, 2021, p. 3; Open Society Institute, Sex Worker Health and Rights: Where is the Funding?, New York, June 2006, p. 9.

53 Office of the UN High Commissioner for Refugees (UNHCR) and UNFPA, Operational Guidance: Responding to the Health and Protection Needs of People Selling or Exchanging Sex in Humanitarian Settings, New York, 2021.

54 Women’s Refugee Commission, above note 24, p. 6; UNHCR and UNFPA, above note 53, p. 16.

55 Dilan Nenningsland, “Equality after Conflict: Assessing the Effects of Transitional Justice on Horizontal Inequalities”, Peace and Conflict: Journal of Peace Psychology, Vol. 30, No. 4, 2024, pp. 495–506; UN Educational, Scientific and Cultural Organization, The Hidden Crisis: Armed Conflict and Education, Paris, 2011, p. 136; Sirianne Dahlum, Håvard Mokleiv Nygård, Siri Aas Rustad and Gudrun Østby, The Conflict–Inequality Trap: How Internal Armed Conflict Affects Horizontal Inequality, UNDP Human Development Report, Background Paper No. 2-2019, UN Development Programme, Geneva, 2019, p. 6; Patricia Justino, “The Impact of Armed Civil Conflict on Household Welfare and Policy”, IDS Working Papers, Vol. 2011, No. 384, 2011, pp. 16–18.

56 Merry Fitzpatrick, Hassan Alattar Satti, Sarra Beheiry and Elizabeth Stite, Harnessing Informal Social Safety Nets for Resilience and Development, Feinstein International Center, April 2022, p. 9.

57 Charlotte Fiedler, “What Do We Know about How Armed Conflict Affects Social Cohesion? A Review of the Empirical Literature”, International Studies Review, Vol. 25, No. 3, 2023, p. 29.

58 Itunu O. Ilesanmi and August T. E. Beirman, “Aging and Vulnerability in Conflict Zones: Exploring the Experiences of Older Internally Displaced Persons and Returnees during Armed Conflict”, Journal of Internal Displacement, Vol. 16, No.1, 2026 p. 75–77; Timothy Sunday, Joshua1 Menyeneabasi and Franklin Chuks, “Social Protection and Border Communities: A Critical Analysis of Policy Responses to Cross-Border Vulnerabilities in the Sahel Region”, African Journal of Sustainability and Development, Vol. 17, No 2, 2025, p. 1183; Aleksandra Anatol’evna et al., “Exclusion as a Criterion for Selecting Socially Vulnerable Population Groups”, Economic and Social Changes, Vol. 2, No. 44, 2016, p. 37–40; Irina Kuznetsova, The Social Consequences of Population Displacement in Ukraine: The Risks of Marginalization and Social Exclusion, policy brief, University of Birmingham, Birmingham, 2018, pp. 14–15. For more information on how strong social networks may help communities to mitigate the impact of armed conflict and can influence decisions to stay with or flee their communities, see Nadine Biehler, Why People Stay: Decision-making in Situations of Forced Displacement and Options for Humanitarian Aid and Development Cooperation, SWP Research Paper, Berlin, December 2023, pp. 20–21; Nathalie E. Williams, “How Community Organizations Moderate the Effect of Armed Conflict on Migration in Nepal”, Population Study, Vol. 67, No. 3, 2013, pp. 12–13.

59 S. Heidari et al., above note 40.

60 UNHCR, Driven by Desperation: Transactional Sex as a Survival Strategy in Port-au-Prince IDP Camps, Geneva, 2011, p. 5.

61 Tsega Gebreyesus et al., “Life on the Margins: The Experiences of Sexual Violence and Exploitation among Eritrean Asylum-Seeking Women in Israel”, BMC Women’s Health, Vol. 18, No. 135, 2018, pp. 5–6.

62 International Organization for Migration, No Escape: Assessing the Relationship between Slavery-Related Abuse and Internal Displacement in Nigeria, South Sudan, and the Democratic Republic of the Congo, Geneva, 2022, pp. 31–35.

63 Rachel E. McGinnis, “Sexual Victimization of Male Refugees and Migrants: Camps, Homelessness, and Survival Sex”, Dignity: A Journal of Analysis of Exploitation and Violence, Vol. 1, No. 1, 2016, p. 10.

64 Francesco Vecchio and Alison Gerard, “Surviving the Politics of Illegality”, in Sharon Pickering (ed.), The Routledge Handbook on Crime and International Migration, Routledge, London, 2014, pp. 12–13; J. Pannetier et al., “Prevalence and Circumstances of Forced Sex and Post-Migration HIV Acquisition in Sub-Saharan African Migrant Women in France: An Analysis of the ANRS-PARCOURS Retrospective Population-Based Study”, Lancet Public Health, Vol. 3, No. 1, 2018, pp. 18–21.

65 Internal Displacement Monitoring Centre and Geneva Graduate Institute, A Multi-Country Analysis of the Impacts of Internal Displacement, Geneva, December 2022, pp. 14–24.

66 Syprose Achieng, Ashebir Solomon, Carolina Cenerini, Alberto di Grazia and Paolo Groppo, How to Deal with People in Post Displacement – Reintegration: The Welcoming Capacity Approach, FAO Land and Water Division Working Paper No. 7, Rome, March 2014, p. 28.

67 Matthew Jenkins, Corruption in Humanitarian Assistance in Conflict Settings, U4 Helpdesk Answer 2024: 6, Chr. Michelsen Institute and Transparency International, Bergen, 2024, p. 16.

68 Jacqueline Fonkwo et al., “The Effect of the Anglophone Crisis on Youth Sexual and Reproductive Health in the Northwest Region of Cameroon: A Qualitative Study”, Journal of Global Health Reports, Vol. 7, 2023, pp. 3–4; Roshni Chakraborty and Jacqueline Bhabha, “Fault Lines of Refugee Exclusion: Statelessness, Gender, and COVID-19 in South Asia”, Health and Human Rights, Vol. 23, No. 1, 2021, pp. 244–245; Tamaryn L. Crankshaw, Jane Freedman and Victoria M. Mutambara, “Intergenerational Trajectories of Inherited Vulnerabilities amongst Young Women Refugees in South Africa”, Comparative Migration Studies, Vol. 11, No. 10, 2023, pp. 13–15.

69 ICRC, War in Cities: Preventing and Addressing the Humanitarian Consequences for Civilians, Geneva, 25 May 2023, p. 87.

70 Stacy Banwell, “Security, Peace and Development: Unpacking Discursive Constructions of Wartime Rape and Sexual Violence in Syria”, International Journal of Peace and Development Studies, Vol. 9, No. 2, 2018, p. 21.

71 Juliane Schillinger and Gul Özerol, “Non-State Armed Groups with Territorial Control as Emergent Actors of Wartime Water Governance”, Environment and Security, Vol. 1 No. 3–4, 2023, pp. 3–5.

72 Abdulkarim Ekzayez, Yasser Alhaj Ahmad, Hasan Alhaleb and Francesco Checchi, “The Impact of Armed Conflict on Utilisation of Health Services in North-West Syria: An Observational Study”, Conflict and Health, Vol. 15, No. 1, 2021, pp. 4–7; Eleonora Heim, “Case Study: Syria, the Battle for Aleppo”, How Does Law Protect in War?, 2016, available at: https://casebook.icrc.org/case-study/syria-battle-aleppo.

73 For more information on risks of sexual exploitation and abuse, including survival sex, during search and rescue operations, see International Federation of Red Cross and Red Crescent Societies, Unseen, Unheard: Gender-Based Violence in Disasters, Geneva, 2015, p. 30–31.

74 Cesar Infante et al., “Rape, Transactional Sex and Related Factors among Migrants in Transit through Mexico to the USA”, Culture, Health and Sexuality, Vol. 22, No. 10, 2020, p. 1153; Leslie Alcouffe et al., “Sexual Vulnerability of Migrant Women in the Multicultural Context of French Guiana: A Societal Issue”, Frontiers in Public Health, Vol. 10, 2022, pp. 5–7.

75 Luisa Muenter and Sarah Achermann, “Preventing Gender-Based Violence (Camps and Prolonged Encampments)”, fact sheet, Sustainable Sanitation and Water Management Toolbox, 2018, available at: https://sswm.info/humanitarian-crises/prolonged-encampments/hygiene-promotion-community-mobilisation/important/preventing-gender-based-violence-%28camps-and-prolonged-encampments%29; Paula O. Adekola and Sunday A. Adedini, “Sexual Violence, Disclosure Pattern, and Abortion and Post-Abortion Care Services in Displaced People’s Camps in Africa: A Scoping Review”, International Journal of Environmental Research and Public Health, Vol. 21, No. 8, 2024, pp. 10–12.

76 Norwegian Refugee Council, Life in the Margins: Re-examining the Needs of Paperless People in Post-Conflict Iraq, Oslo, 2022, pp. 16–21; ICRC, Navigating Violence: Learning from Civilian Experiences and Strengthening Humanitarian Action in Contested Territories, Geneva, 2025, p. 23.

77 Clara Egger and Doris Schopper, “Organizations Involved in Humanitarian Action: Introducing a New Dataset”, International Studies Quarterly, Vol. 66, No. 2, 2022, p. 9; Esther Meininghaus, “Humanitarianism in Intra-State Conflict: Aid Inequality and Local Governance in Government- and Opposition-Controlled Areas in the Syrian War”, Third World Quarterly, Vol. 37, No. 8, 2016, pp. 1459–1481. For a more complete analysis of the exertion of sovereignty in contexts of humanitarian crisis, see Clea Khan and Andrew Cunningham, “Introduction to the Issue of State Sovereignty and Humanitarian Action”, Disasters, Vol. 37, Supp. 2, 2013, pp. S140–S143.

78 Jennifer Hyndman, “To Help or Not to Help? Humanitarian Spaces, Power, and Government”, in Mat Coleman and John Agnew (eds), Handbook on the Geographies of Power, Edward Elgar, Cheltenham, 2018, p. 380.

79 On the topic of humanitarian governance, see Michael Barnett, “International Paternalism and Humanitarian Governance”, Global Constitutionalism, Vol. 1, No. 3, 2012, pp. 486–487.

80 Julian Reid, “The Biopoliticization of Humanitarianism: From Saving Bare Life to Securing the Biohuman in Post-Interventionary Societies”, Journal of Intervention and Statebuilding, Vol. 4, No. 4, 2011, pp. 398–402; Luca Mavelli, “Governing Populations through the Humanitarian Government of Refugees: Biopolitical Care and Racism in the European Refugee Crisis”, Review of International Studies, Vol. 43, No. 5, 2017, pp. 811–815.

81 Tom Scott-Smith, “Control and Biopower in Contemporary Humanitarian Aid: The Case of Supplementary Feeding”, Journal of Refugee Studies, Vol. 28, No. 1, 2014, p. 28.

82 Ponsiano Bimeny, Deconstructing Notions of Resilience: Exploring Coping Strategies and Resilience in Post-Conflict Uganda, LSE Firoz Lalji Centre for Africa, Working Paper No. 1, London, July 2019, p. 13.

83 Olufunke Fayehun, “Data Gathering and Utilization: Humanitarian Targeting and Ethical Issues in Northeastern Nigeria”, Journal of International Humanitarian Action, Vol. 8, 2023, pp. 5–7; Kristin Begtora Sandvik, “Humanitarian Wearables: Digital Bodies, Experimentation and Ethics”, in Daniel Messelken and David Winkler (eds), Ethics of Medical Innovation, Experimentation, and Enhancement in Military and Humanitarian Contexts, Springer, New York, 2020, pp. 100–101.

84 Alice M. Miller, “Sexuality, Violence against Women, and Human Rights: Women Make Demands and Ladies Get Protection”, Sexuality, Human Rights, and Health, Vol. 7, No. 2, 2004, p. 39. For more research analyzing conflict- and violence-affected communities’ perceptions and understandings of consent in peacekeeping settings, see Athena Rebecca Kolbe, “‘It’s Not a Gift When It Comes with Price’: A Qualitative Study of Transactional Sex between UN Peacekeepers and Haitian Citizens”, International Journal of Security and Development, Vol. 4, No. 1, 2015, p. 4; Kathleen M. Jennings, Protecting Whom? Approaches to Sexual Exploitation and Abuse in UN Peacekeeping Operations, FAFO, Oslo, 2008, p. 24.

85 Dinah Rajak and Jock Stirrat, “Parochial Cosmopolitanism and the Power of Nostalgia”, in David Mosse (ed.), Adventures in Aidland: The Anthropology of Professionals in International Development, Berghahn Books, New York, 2011, pp. 167–170.

86 Kathleen M. Jennings, “Service, Sex, and Security: Gendered Peacekeeping Economies in Liberia and the Democratic Republic of Congo”, Security Dialogue, Vol. 45, No. 4, 2014, pp. 315–316; Kathleen M. Jennings, “Life in a ‘Peace-Kept’ City: Encounters with the Peacekeeping Economy”, Journal of Intervention and Statebuilding, Vol. 9, No. 3, 2015, pp. 309–310.

87 Kathleen M. Jennings and Morten Bøås, “Transactions and Interactions: Everyday Life in the Peacekeeping Economy”, Journal of Intervention and Statebuilding, Vol. 9, No. 3, 2015, pp. 282–283.

88 Kylie Alexandra, “Peacekeepers’ Privilege and Sexual Abuse in Post-Conflict Populations”, Peace Review, Vol. 23, No. 3, 2011, p. 373.

89 K. M. Jennings, “Life in a ‘Peace-Kept’ City”, above note 86, pp. 298–299; Georgia Fraulin, Sabine Lee, Sandrine Lusamba and Susan Bartels, “‘It Was with My Consent since He Was Providing Me with Money’: A Mixed Methods Study of Adolescent Perspectives on Peacekeeper-Perpetrated Sexual Exploitation and Abuse in the Democratic Republic of Congo”, Conflict Health, Vol. 15, No. 80, 2021, pp. 12–13.

90 Luissa Vahedi, Susan Bartels and Sabine Lee, “‘Even Peacekeepers Expect Something in Return’: A Qualitative Analysis of Sexual Interactions between UN Peacekeepers and Female Haitians”, Global Public Health, Vol. 16, No. 5, 2021, p. 699.

91 Ibid., p. 700; Sabine Lee and Susan Bartels, “‘They Put a Few Coins in Your Hand to Drop a Baby in You’: A Study of Peacekeeper-Fathered Children in Haiti”, International Peacekeeping, Vol. 27, No. 2, 2019, p. 191.

92 C. Formson and D. Hilhorst, above note 42, p. 16.

93 Ibid. Another study with university women in a non-conflict-affected context (Ghana) found that survey respondents who reported having engaged in transactional sex had over three times higher odds of having contracted STIs in the last twelve months and two and a half times higher odds of having had an abortion in the last twelve months compared to those who had not engaged in transactional sex. See Patience Konlan and John Kumuuori Ganle, “Transactional Sex and Associated Factors among Young Women in a Tertiary Institution in Northern Ghana: Evidence from a Cross-Sectional Survey”, BMC Women’s Health, Vol. 25, No. 1, 2025, p. 5.

94 Neha S. Singh, “Evaluating the Effectiveness of Sexual and Reproductive Health Services during Humanitarian Crises: A Systematic Review”, PLoS ONE, Vol. 13, No. 7, 2018, p. 2; Giulia Bonavina et al., “Women’s Health amidst Sudan’s Civil War”, The Lancet, Vol. 403, No. 10439, 2024, p. 1849.

95 Samantha Chareka, Tamaryn L. Crankshaw and Pemberai Zambezi, “Economic and Social Dimensions Influencing Safety of Induced Abortions amongst Young Women Who Sell Sex in Zimbabwe”, Sexual and Reproductive Health Matters, Vol. 29, No. 1, 2021, pp. 126–126.

96 Megan Daigle, Alexandra Spencer, Jasmin Lilian Diab, Bechara Samneh and Aida Afandi, Sex, Health and Rights in Displacement and Humanitarian Response: Crises upon Crises in Lebanon and Beyond, Humanitarian Policy Group, London, October 2023, pp. 38–39.

97 Rose Mary Asong Tazinya, Ieman Mona El-Mowafi, Julia Marie Hajjar and Sanni Yaya, “Sexual and Reproductive Health and Rights in Humanitarian Settings: A Matter of Life and Death”, Reproductive Health, Vol. 20, No. 42, 2023, p. 3.

98 Susan Gichuna et al., “Access to Healthcare in a Time of COVID-19: Sex Workers in Crisis in Nairobi, Kenya”, Global Public Health, Vol. 15, No. 10, 2020, pp. 1436–1438.

99 For more information on the humanitarian consequences of mandatory reporting, see Maria Carolina Aissa de Figueredo, “Forced to Report: Mandatory Reporting of Sexual Violence in Armed Conflict”, Humanitarian Law and Policy Blog, 4 July 2024, available at: https://blogs.icrc.org/law-and-policy/2024/07/04/forced-to-report-mandatory-reporting-of-sexual-violence-in-armed-conflict/.

100 Maria Krisch, Margit Averdijk, Sara Valdebenito and Manuel Eisner, “Sex Trade among Youth: A Global Review of the Prevalence, Contexts and Correlates of Transactional Sex among the General Population of Youth”, Adolescent Research Review, Vol. 4, No. 2, 2019, p. 128.

101 M. J. Mimiaga et al., above note 36; J. Watson, above note 36.

102 International Geneva Global Health Platform, “No Peace of Mind: Mental Health under Military Occupation and War” webinar, Geneva, March 2024, available at: www.graduateinstitute.ch/communications/events/watch-no-peace-mind-mental-health-under-military-occupation-and-war; Marianne C. Kastrup, “Mental Health Consequences of War: Gender Specific Issues”, World Psychiatry, Vol. 5, No. 1, 2006, p. 33.

103 Royce Bernstein Murray, “Sex for Food in a Refugee Economy: Human Rights Implications and Accountability”, Georgetown Immigration Law Journal, Vol. 14, No. 4, 2000, p. 1017.

104 For an analysis of gaps in sharia law which may expose victims or survivors of sexual violence to countercharges and criminalization, see Abdel Salam Sidahmed, “Problems in Contemporary Applications of Islamic Criminal Sanctions: The Penalty for Adultery in Relation to Women”, British Journal of Middle Eastern Studies, Vol. 28, No. 2, 2001, pp. 196–199.

105 Karen M. Hampanda, “The Social Dynamics of Selling Sex in Mombasa, Kenya: A Qualitative Study Contextualizing High Risk Sexual Behaviour”, African Journal of Reproductive Health, Vol. 17, No. 2, 2013, p. 145; Brendan Kiernan, Ranit Mishori and Maurice Masoda, “‘There Is Fear but There is No Other Work’: A Preliminary Qualitative Exploration of the Experience of Sex Workers in Eastern Democratic Republic of Congo”, Culture, Health and Sexuality, Vol. 18, No. 3, 2015, p. 6.

106 Monica Adhiambo Onyango and Shirin Heidari, “Care with Dignity in Humanitarian Crises: Ensuring Sexual and Reproductive Health and Rights of Displaced Populations”, Reproductive Health Matters, Vol. 25, No. 51, 2017, p. 3.

107 Victor H. Mlambo and Mfundo Mandla, “Humanitarian Action: The Plight of Sex Workers in a Criminalized Setting in South Africa during COVID-19”, International Journal of Interdisciplinary Social and Community Studies, Vol. 19, No. 1, 2024, pp. 193–196.

108 J. Cole, above note 27, p. 582; Beth Maclin, Jocelyn Kelly, Justin Kabanga and Michael VanRooyen, “‘They Have Embraced a Different Behaviour’: Transactional Sex and Family Dynamics in Eastern Congo’s Conflict”, Culture, Health and Sexuality, Vol. 17, No. 1, 2014, pp. 124–126.

109 Laura Stark, “Transactional Sex, Early Marriage, and Parent-Child Relations in a Tanzanian Slum”, Ethnologia Europaea, Vol. 46, No. 1, 2016, p. 87.

110 S. Heidari et al., above note 40.

111 Harasankar Adhikari, “Attachment of Stigma in Sex Workers’ Milieu (Family and Community): A Hindrance of Psychosocial Development of their Children”, Atılım Sosyal Bilimler Dergisi, Vol. 1, No. 2, 2011, p. 108; Atmaja Acharya1 and Sameena Azhar, “We Are Treated as Outsiders in Our Own City”: Lived Experiences of Intersectional Stigma against Sex Workers in Kolkata, India”, Sexuality Research and Social Policy, Vol. 22, 2024, pp. 1423–1424.

112 Samantha Gray, Susan Bartels, Sabine Lee and Heather Stuart, “A Cross-Sectional Study of Community Perceptions of Stigmatization amongst Women Affected by UN Peacekeeper Perpetrated Sexual Exploitation and Abuse”, BMC Public Health, Vol. 21, No. 1, 2021, p. 7.

113 Mary Burman and S. McKay, “Marginalization of Girl Mothers during Reintegration from Armed Groups in Sierra Leone”, International Nursing Review, Vol. 54, No. 4, 2007, pp. 319–321.

114 International Alert and UNICEF, Bad Blood: Perceptions of Children Born of Conflict-Related Sexual Violence and Women and Girls Associated with Boko Haram in Northeast Nigeria, Lagos, 2016, pp. 14–18.

115 Heather Tasker, Katie van der Werf, Annie Bunting and Susan Bartels, “‘Those MONUSCO Agents Left While We Were Still Pregnant’: Accountability and Support for Peacekeeper-Fathered Children in the DRC”, Journal of Peace Research, Vol. 61, No. 6, 2024, p. 1032; Luissa Vahedi, Susan Bartels and Sabine Lee, “‘His Future Will Not Be Bright:’ A Qualitative Analysis of Mothers’ Lived Experiences Raising Peacekeeper-Fathered Children in Haiti”, Children and Youth Services Review, Vol. 119, 2020, p. 3.

116 Sammy Besong Arrey-Mbi, “Prostitution in Bamenda: A Trade and a Coping Strategy for Some Women”, Asian Journal of Social Sciences and Humanities, Vol. 9, No. 2, 2020, p. 57.

117 Geneva Graduate Institute, Liminality Consortium and Listen H Project, Beyond Silence and Stigma: Towards Coherent Action on Transactional Sex in Forced Displacement and Humanitarian Settings, conference report, January 2026, Geneva, p. 2.

118 J.-K. Westendorf, above note 49, pp. 102–103.

119 ICRC, How Does Stigma Impact Victims/Survivors, above note 14, p. 2.

120 Ibid., p. 1.

121 Preliminary results from the PSVP indicate that this methodology is highly effective, as victims/survivors are seven times more likely to access health-care services in areas where the ICRC is conducting community outreach to reduce stigma. According to recent data from one context where the ICRC’s PSVP community outreach programme is ongoing, almost one third of victims/survivors surveyed reported experiencing greater support and acceptance at religious and social gatherings following stigma reduction activities. Nearly half of the survivors surveyed attribute this change to the community outreach sessions for stigma reduction carried out by ICRC-trained community influencers. For more information, see ICRC, “Influencing Behavioural Change for Better Prevention of Sexual Violence in Armed Conflict”, 1 August 2025, available at: www.icrc.org/en/article/influencing-behavioural-change-sexual-violence-armed-conflict.

122 Some examples of effective risk assessment and reduction methodologies can be found in Daniel Forchain and Frances Kelsey, Finding Ways Together to Build Resilience: The Vulnerability and Risk Assessment Methodology, Oxfam GB, Oxford, January 2016, pp. 9–14; Alina Potts, Loujine Fattal, Elizabeth Hedge, Farah Hallak and Amelia Reese, Empowered Aid: Reducing Risks of Sexual Exploitation and Abuse in Food Distribution – Lebanon Policy Brief, Global Women’s Institute and CARE, Washington, DC, January 2020, pp. 2–4; Whitney Moret, Vulnerability Assessment Methodologies: A Review of the Literature, ASPIRES, London, March 2014, pp. 22–23; Médecins Sans Frontières, Partnering with Communities to Co-Design Humanitarian Health Strategies: A See Change, Community First Framework for Implementation in MSF Projects, Barcelona, 2023, pp. 13–16.

123 For more information on contextually adapted coping strategy indexes, see Oxfam International, Measuring Household Stress: The Development of a Contextualized Multi-Sector Coping Strategy Index for Afghanistan, Oxford, May 2018, pp. 6–13.

124 Carlo Koos and Richard Traunmuller, The Social and Political Consequences of Wartime Sexual Violence: New Evidence from List Experiments in Three Conflict-Affected Populations, WIDER Working Paper No. 2022/11, United Nations University World Institute for Development Economics Research, New York, January 2022, pp. 6–7; Bélen González and Richard Traunmüller, “The Political Consequences of Wartime Sexual Violence: Evidence from a List Experiment”, Journal of Peace Research, Vol. 61, No. 6, 2024, p. 1036.

125 In a study involving twenty-five women engaged in transactional sex, daily individual interviews were coupled with EMAs – a form of close-ended diary writing – over a four-week period. Results from this research demonstrated direct mental health benefits. See Marisa Felsher, Sarah Wiehe, Jayleen K. L. Gunn and Alexis Roth, “‘I Got It Off My Chest’: An Examination of how Research Participation Improved the Mental Health of Women Engaging in Transactional Sex”, Community Mental Health Journal, Vol. 54, 2018.

126 Liminality Research Consortium and Listen H Project, Technical Dialogue on Transactional Sex in Forced Displacement and Humanitarian Settings, facilitation report, Geneva, November 2025.

127 Joey Ager, Elena Fiddian-Qasmiyeh and Alastair Ager, “Local Faith Communities and the Promotion of Resilience in Contexts of Humanitarian Crisis”, Journal of Refugee Studies, Vol. 28, No. 2, 2015, pp. 213–215; Neha Kapil, Araunima Bhatnagar, Mohammad Alamgir and Ataul Gani Osmani, “Communication and Community Engagement to Contain Disease Outbreaks and Improve Well-Being: Rohingya Refugee Response, Bangladesh”, in Erma Manoncourt, Rafael Obregon and Ketan Chitnis (eds), Communication and Community Engagement in Disease Outbreaks, Springer, New York, 2022, pp. 183–185.

128 Chris Beyrer et al., “An Action Agenda for HIV and Sex Workers”, The Lancet, Vol. 385, No. 996, 2015, p. 4.

129 Jan Verlin, “How to Better Understand the Management of Sexist and Sexual Violence Committed by Humanitarian Aid Workers”, Alternatives Humanitaires, No. 16, 2021, pp. 37–39; Valerie de Koeijer, Sarah E. Parkinson and Sofia J. Smoth, “‘It’s Just How Things Are Done’: Social Ecologies of Sexual Violence in Humanitarian Aid”, International Studies Quarterly, Vol. 67, No. 3, 2023, pp. 5–7; Mirette Baghat, Survival Strategies and Coping Mechanisms of Syrian Female Head[s] of Household[s] in Egypt, master’s thesis, American University in Cairo, 2015, p. 26.

130 For more information on how humanitarian actors’ internalized gender norms can influence needs and vulnerabilities assessments as well as shape programming and resource prioritization, see Megan Daigle, Gender, Power and Principles in Humanitarian Action, Humanitarian Policy Group, London, March 2022, pp. 16–19; Michelle Lokot, “The Space between Us: Feminist Values and Humanitarian Power Dynamics in Research with Refugees”, Gender and Development, Vol. 27, No. 3, 2019, pp. 474–477.

131 For example, most humanitarian assessments target households which are defined according to a presumed nuclear family structure. This unit of analysis may then exclude “non-traditional families” not traditionally recognized by States or humanitarian actors, such as multigenerational and extended families or chosen families. For more information on how humanitarians’ limited understanding of changing gender and family relations can impact programming, see Simon Levine, Changing Gender Relations on Return from Displacement to the Newly Merged Districts of Pakistan, Humanitarian Policy Group Working Paper, London, October 2020.

132 UN Protection Cluster Mozambique, Humanitarian Assistance in Emergencies: Mainstreaming Gender and Protection, 2016, p. 2; UNHCR, Woman Alone: The Fight for Survival by Syria’s Refugee Women, Beirut, 2015, p. 37; George Washington University Global Women’s Institute, Empowered Aid: Transforming Gender and Power Dynamics in the Delivery of Humanitarian Aid, Washington, DC, January 2020, pp. 9–11.

133 Irina Mosel and Kerrie Holloway, Dignity and Humanitarian Action in Displacement, Humanitarian Policy Group, London, March 2019.

134 Lorraine Charles and Lana Cook, “Opening the Global Digital Economy to Refugees”, Forced Migration Review, Vol. 71, 2023.

135 For example, data from a study conducted in a non-conflict-affected context clearly illustrates that people exchanging sex are usually at higher risk of sexual violence: see Kristin L. Dunkle et al., “Transactional Sex among Women in Soweto, South Africa: Prevalence, Risk Factors and Association with HIV infection”, Social Science and Medicine, Vol. 59, No. 8, 2004, pp. 1586–1587.

136 For further recommendations on how to address the in-/out-of-scope binary, see Liminality Research Consortium and Listen H Project, above note 117, p. 10.

137 Konrad Czechowski, John Sylvestre and Serena Corsini-Munt, “Survival Sex: Sexual Agency and Consent in a State of Deprivation? A Scoping Review”, Canadian Journal of Human Sexuality, Vol. 31, No. 2, 2022, p. 293.

Figure 0

Figure 1. Visualizing the relationship between survival sex and other types of sexual exchanges. Source: the author, 2023.

Figure 1

Figure 2. ICRC Stigma Impact Model. Source: ICRC, How Does Stigma Impact Victims/Survivors of Sexual Violence during Armed Conflict?, policy brief, Geneva, 2024, p. 5.