Sex trafficking and sexual exploitation in settings affected by armed conflicts in Africa, Asia and the Middle East: systematic review

Background: Sex trafficking and sexual exploitation has been widely reported, especially in conflict-affected
settings, which appear to increase women’s and children’s vulnerabilities to these extreme abuses.

Methods: We conducted a systematic search of ten databases and extensive grey literature to gather evidence of
sex trafficking and sexual exploitation in conflict-affected settings. International definitions of “sexual exploitation”
and “sex trafficking” set the indicator parameters. We focused on sexual exploitation in forms of early or forced
marriage, forced combatant sexual exploitation and sexual slavery. We extracted prevalence measures, health
outcomes and sexual exploitation terminology definitions. The review adhered to PRISMA guidelines and includes
quality appraisal.

Results: The search identified 29 eligible papers with evidence of sex trafficking and sexual exploitation in armed
conflict settings in twelve countries in Africa, Asia, and the Middle East. The evidence was limited and not
generalizable, due to few prevalence estimates and inconsistent definitions of “sexual exploitation”. The prevalence
estimates available indicate that females were more likely than males to be victims of sexual exploitation in conflict
settings. In some settings, as many as one in four forced marriages took place before the girls reached 18 years old.
Findings suggest that the vast majority of former female combatants were sexually exploited during the conflict.
These studies provided various indicators of sexual exploitation compatible to the United Nation’s definition of sex
trafficking, but only 2 studies identified the exploitation as trafficking. None of the studies solely aimed to measure
the prevalence of sex trafficking or sexual exploitation. Similar descriptions of types of sexual exploitation and
trafficking were found, but the inconsistent terminology or measurements inhibited a meta-analysis.

Conclusions: Findings indicate there are various forms of human trafficking and sexual exploitation in conflictaffected
settings, primarily occurring as early or forced marriage, forced combatant sexual exploitation, and sexual
slavery. The studies highlight the extraordinary vulnerability of women and girls to these extreme abuses.
Simultaneously, this review suggests the need to clarify terminology around sex trafficking in conflict to foster a
more cohesive future evidence-base, and in particular, robust prevalence figures from conflict-affected and
displaced populations.

Keywords: Sexual exploitation, Human trafficking, Sex trafficking, Child trafficking, Conflict, Forced marriage, Early
marriage, Sex slavery, Forced conscription