Children Born of Conflict-Related Sexual Violence: A Review of Interdisciplinary Responses to Their Needs and Experiences

Abstract

Background: Conflict-related sexual violence (CRSV) with the intent of forced pregnancy is common in conflict, and used as a way to dominate women and their society/community. There is growing recognition of the needs of children born of CRSV, particularly by humanitarian practitioners who are coming into contact with them in emergency settings. We sought to find out what is the state-of-the-art on interventions to support children born of CRSV (and their families)? Methods: We systematically searched electronic databases (JSTOR, Google Scholar, Scopus, Cairn Info and Embase) and hand searched reference lists of key publications, as well as non-governmental organisations (NGO), United Nations (UN) agencies, international organisations and governmental reports on this topic and in the area of genderbased violence (GBV), child protection, health and other sectors addressed at humanitarian practitioners. Results: Experiences of children born of CRSV include psychological, economic, medical, and legal aspects. Responses to their needs include food aid, medical care, housing assistance, financial support for the mothers of children born of CRSV, and therapeutic games and counselling. However, these responses remain insignificant and partial, and are very often only implemented in one setting. The paucity of the evidence base is clear. Conclusion: Children born of conflict related sexual violence are a special population, both because of the context in which they were conceived, and because of the experiences they face. To deal with the complexity of their situation and thus respond effectively to their holistic needs, various actors must work in synergy.

Full text

Children Born of Conflict-Related Sexual Violence:
A Review of Interdisciplinary Responses
to Their Needs and Experiences
Cecilia Agino Foussiakda
Université de Liège; Université Evangélique en Afrique
Kimberley Anderson
University of Amsterdam; Foundation Children Born of War Project
Laura Pasquero
Université de Genève
Adélaïde Blavier*
Université de Liège
Abstract
Background:
Conict-related sexual violence (CRSV) with the intent of forced pregnancy is
common in conict, and used as a way to dominate women and their society/com-
munity. There is growing recognition of the needs of children born of CRSV, particu-
larly by humanitarian practitioners who are coming into contact with them in
emergency settings. We sought to nd out what is the state-of-the-art on interventions
to support children born of CRSV (and their families)?
Methods:
We systematically searched electronic databases (JSTOR, Google Scholar, Scopus,
Cairn Info and Embase) and hand searched reference lists of key publications, as well
DOI 10.7590/266644723X16875292791283 2666-447x 2023 Journal of Human Trafficking,
Enslavement and Conflict-Related Sexual Violence
*
Cecilia Agino Foussiakda: Centre d’Expertise en Psychotrauma et Psychologie, Légale, Faculté
de Psychologie, Logopédie et Sciences de l’Education, Université de Liège, Belgium, Centre
d’Excellence Denis Mukwege, Université Evangélique en Afrique.
Kimberley Anderson: Centre for Urban Mental Health, University of Amsterdam, Netherlands,
Foundation Children Born of War Project, k.anderson@uva.nl.
Laura Pasquero: Geneva Centre of Humanitarian Studies, Université de Genève.
Adélaïde Blavier: Centre d’Expertise en Psychotrauma et Psychologie, Légale, Faculté de Psy-
chologie, Logopédie et Sciences de l’Education, Université de Liège, Belgium.
Authors Cecilia Agino Foussiakda and Kimberley Anderson designed the review, conducted
searches, and wrote and reviewed the manuscript. Cecilia Agino Foussiakda was responsible
for analysis, with support from Kimberley Anderson. Laura Pasquero designed the review,
conducted searches and reviewed the manuscript. Adélaïde Blavier oversaw the process and
reviewed manuscript drafts. All authors have reviewed the final manuscript.
JOURNAL OF HUMAN TRAFFICKING, ENSLAVEMENT AND CONFLICT-RELATED SEXUAL VIOLENCE
59JHEC vol. 4, nr. 1, 59-82,©2023 Paris Legal Publishers

as non-governmental organisations (NGO), United Nations (UN) agencies, interna-
tional organisations and governmental reports on this topic and in the area of gender-
based violence (GBV), child protection, health and other sectors addressed at human-
itarian practitioners.
Results:
Experiences of children born of CRSV include psychological, economic, medical,
and legal aspects. Responses to their needs include food aid, medical care, housing
assistance, nancial support for the mothers of children born of CRSV, and therapeutic
games and counselling. However, these responses remain insignicant and partial,
and are very often only implemented in one setting. The paucity of the evidence base
is clear.
Conclusion:
Children born of conict related sexual violence are a special population, both
because of the context in which they were conceived, and because of the experiences
they face. To deal with the complexity of their situation and thus respond effectively
to their holistic needs, various actors must work in synergy.
1. Background
1.1. Conflict-Related Sexual Violence – Active Conflict and Post-
Conflict Settings
In times of conflict, sexual violence is or has been used as a
strategy in many countries around the world, including – but not limited to –
the First and Second World War,1in Peru,2Colombia,3Sierra Leone,4Uganda,5
K Grieg ‘The War Children of the World, War and Children Identity Project, Bergen, Norway’
(2001) <http://www.warandchildren.org/report1.html> accessed 4 March 2023.
1
K Theidon ‘Hidden in Plain Sight’ (2015) 56 Current Anthropology S191.
2
J Neenan, ‘Closing the Protection Gap for Children Born of War Addressing Stigmatisation
and the Intergenerational Impact of Sexual Violence in Conflict’ (2017) Centre for Women
Peace and Security: London.
3
M Denov, ‘Children Born of Wartime Rape: The Intergenerational Realities of Sexual Violence
and Abuse’ in Ethics, Medicine and Public Health (Elsevier Masson SAS 2015) 61.
4
G Akello ‘Experiences of Forced Mothers in Northern Uganda: The Legacy of War’ (2013) 11
International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed
5
Conflict 149.
T Atim, D Mazurana and A Marshak ‘Women Survivors and their Children Born of Wartime
Sexual Violence in Northern Uganda’ (2018) 42 Disasters S61.
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-160
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER

Rwanda,6Iraq,7the Democratic Republic of Congo,8Bosnia,9and Kosovo.10
There are various reasons why this type of violence takes place. For some per-
petrators, the aim is to create a new generation of children, as observed in the
conflict in Bosnia and Herzegovina during the 1990s11 or in Uganda through
sexual slavery and forced motherhood from 1986 to 2007.12 Indeed, sexual vio-
lence can also be part of opportunistic behaviour by troops, much of which is
tolerated by commanders, who have argued that fighters cannot afford to pay
for sex, and disregarded the rape of non-combatants as a substitute for consent.13
One example is the Japanese military, who forced 200,000 German and Asian
women to serve as ‘comfort women’, subjecting them to rape, torture, and death
during the Second World War.14 Rape is also used in ethnic cleansing campaigns.
Between 20,000 and 50,000 Muslim women were raped by Serbian soldiers
for this purpose during the conflict in Bosnia and Herzegovina15 and closer to
350,000 women were raped during the 1994 genocide in Rwanda in the same
context.16 In most cases, rape as a weapon of war is used to dominate and de-
grade not only women but also their society/community. Women and girls may
be raped in front of their husbands, fathers, or sons to demonstrate the
powerlessness of men to protect women.17 In this respect, children born of
D Nikuze, ‘Parenting Style and its Psychological Impact on Rape Born Children: Case of Raped
Survivors of the 1994 Genocide Perpetrated against Tutsi in Rwanda’ (2013) International
Journal of Development and Sustainability Online 2.
6
B Rohwerder, ‘Reintegration of Children Born of Wartime Rape Question What Lessons Have
Been Learned from Efforts to Reintegrate Children Born of Wartime Rape into Communities?’
7
(2019) Institute of Development Studies <https://opendocs.ids.ac.uk/opendocs/bitstream/
handle/20.500.12413/14592/628_Reintegration_of_Children_Born_of_Wartime_Rape.pdf?se-
quence=63> accessed 4 February 2023.
AC Foussiakda, N Mutama Kabesha, G Furaha Mirindi, C Gavray and A Blavier, ‘Gender Re-
lations and Social Reintegration of Rape Survivors in South Kivu: An Analysis of Favorable
8
and Unfavorable Factors for Reintegration’ (2022) Journal of Aggression, Maltreatment and
Trauma.
L Strupinskiene, ‘Living in the Shadows of Past Atrocities: War Babies of Bosnia’ (2012) 10
Wagadu: A Journal of Transnational and Women’s and Gender Studies 55.
9
K Mitchell, ‘Children Born from Rape: Overlooked Victims of Human Rights Violations in
Conflict Settings’. Paper presented in Master of Public Health Capstone Symposium (2005)
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
10
RC Carpenter, ‘War’s Impact on Children Born of Rape and Sexual Exploitation: Physical,
Economic and Psychosocial Dimensions’ (2007) in Coalition to Stop the Use of Child Soldiers;
University of Pittsburgh: Pittsburgh, PA, USA, 2007.
11
Akello (n 5).
12
D Cohen, A Hoover Green and E Wood ‘Wartime Sexual Violence Misconceptions, Implications
and Ways Forward’ (2013) United States Institute of Peace, Washington, DC.
13
Kaiser et al 2015 (n2); G Jonsson ‘Can the Japan-Korea Dispute on “Comfort Women” be Re-
solved?’ (2015) 46 Korea Observer 1-26.
14
I Skjelsbæk, ‘Victim and Survivor: Narrated Social Identities of Women Who Experienced Rape
During the War in Bosnia-Herzegovina’ (2006) 16 Feminist Psychology 373.
15
Bijleveld, A Morssinkhof and A Smeulers, ‘Counting the Countless: Rape Victimization During
the Rwandan Genocide’ (2009) 19 International Criminal Justice Review 208.
16
Foussiakda et al (n 8).
17
61JHEC vol. 4, nr. 1, 61-82,©2023 Paris Legal Publishers
CHILDREN BORN OF CONFLICT-RELATED SEXUAL VIOLENCE

CRSV can be viewed by some as an insult and a continual reminder of the col-
lective violence that results in the perceived public ownership of women’s’
sexuality. CRSV is tantamount to attacking an entire community, and while it
is a crime committed against all genders, the impact of this attack is greater
when a woman becomes pregnant.18
1.2. A Question of Terminology
In published literature, policy documents and historically
among civil society organisations, ‘children born of war’ has been the most
common term used to refer to children born in times of conflict and post-con-
flict, irrespective of types of conflict, geographical location, historical and repro-
ductive contexts.19 It largely refers to a child where one parent is a member of
the military or peacekeepers (often the father) and the other parent (often the
mother) is a civilian.20 However, this is not homogeneous group.21 This term
includes sub-categories of children conceived with or without consent in conflict
and post-conflict situations. These include children born to enemy soldiers,
children born to allied soldiers (stationed forces),22 children born to occupying
forces,23 children born to armed rebel groups,24 children born to peacekeepers
and children born to female soldiers.25
The recently published Platform for Action by the UK Foreign, Common-
wealth and Development Office, presents a much-needed elaboration of the
well-used terminology surrounding children born of sexual violence, to the
following: ‘children born of CRSV as individuals born from a pregnancy that
was the result of conflict-related sexual violence, regardless of the individual’s
current age. The circumstances of their conception impact these individuals
throughout their lives, even after they reach the age of 18. It includes children
born of sexual exploitation and abuse by peacekeepers during and following
conflict’. We, henceforth, refer to this terminology.
Foussiakda et al (n 8).
18
IC Mochmann, ‘Children Born of War - A Decade of International and Interdisciplinary Re-
search’ (2007) 41 Historical Social Research 320.
19
Grieg (n 1).
20
L Vahedi, S Bartels and S Lee, ‘“His Future will not be Bright”: A Qualitative Analysis of
Mothers’ Lived Experiences Raising Peacekeeper-Fathered Children in Haiti’ (2020) 119 Children
and Youth Services Review.
21
Grieg (n 1).
22
IC Mochmann and S Larsen, ‘The Forgotten Consequences of War: The Life Course of Children
Fathered by German Soldiers in Norway and Denmark During WWII – some Empirical Results’
(2008) 33 Historical Social Research 347.
23
Foussiakda et al 2022 (n 8).
24
A Delić, P Kuwert and H Glaesmer, ‘Should the Definition of the Term “Children Born of
War” and Vulnerabilities of Children from Recent Conflict and Post-Conflict Settings Be
Broadened?’ (2017) 46 Acta Medica Academica 67.
25
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-162
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER

1.3. Scale of The Issue
The exact number of children born of CRSV is unknown, and
although some attempts have been made to quantify, this is likely greatly un-
derestimated. International humanitarian organisations have reported that at
least 100 babies have been born in Kosovo as a result of sexual violence;26 in
Sierra Leone, between 4,500 and 5,760 pregnancies were reported27 in Uganda,
during the Lord’s Resistance Army (LRA) civil war, it is estimated that 10,000
girls were raped, not counting those who returned from captivity with children
or who were pregnant.28 10,000 to 25,000 children were said to have been
conceived as a result of CRSV during the genocide against the Tutsi in Rwanda
in 199429 and of the 40% of women raped in the Democratic Republic of the
Congo, 17% are estimated to have become pregnant as a result of these rapes.30
One of the reasons for the lack of accurate statistics is the likely reluctance of
women to report rape and the pregnancy following for fear of being stigmatised.31
1.4. International Framework and Momentum Building
In the past decade, the global attention and momentum sur-
rounding the issue of children born as a result of CRSV has been steadily
growing. In 2012, former UK Foreign Secretary William Hague and UN Special
Envoy Angelina Jolie established the Preventing Sexual Violence Initiative
(PSVI), a worldwide campaign to stop sexual violence against women and girls
in conflict. In 2014, representatives from more than 120 countries, including
experts, faith leaders, youth organisations and representatives of civil society
and international organisations gathered at the Global Summit to End Sexual
Mitchell (n 10).
26
Denov (n 4).
27
Akello (n 5).
28
O Kantengwa, ‘How Motherhood Triumphs Over Trauma Among Mothers with Children from
Genocidal Rape in Rwanda’ (2014) 2 Journal of Social and Political Psychology 417.
29
MC Mukangendo ‘Caring for Children Born of Rape in Rwanda’ in Carpenter, RC (ed) Born
of War: Protecting Children of Sexual Violence Survivors in Conict Zones (Kumarian: West
Hartford 2007) 40.
M Denov, L Woolner, JP Bahati, P Nsuki and O Shyaka, ‘The Intergenerational Legacy of
Genocidal Rape: The Realities and Perspectives of Children Born of the Rwandan Genocide’
(2020) 35 Journal of Interpersonal Violence 3286.
J Scott, C Mullen, S Rouhani, P Kuwert, A Greiner, K Albutt., C Burkhardt, M Onyango,
M VanRooyenand S Bartels, ‘A Qualitative Analysis of Psychosocial Outcomes Among Women
30
with Sexual Violence-Related Pregnancies in Eastern Democratic Republic of Congo’ (2017)
International Journal of Mental Health Systems 11.
Mitchell (n 10).
J Kelly, K Albutt, J Kabanga, K Anderson and M VanRooyen, ‘Rejection, Acceptance and the
31
Spectrum Between: Understanding Male Attitudes and Experiences Towards Conflict-Related
Sexual Violence in Eastern Democratic Republic of Congo’ (2017) 17 BMC Women’s Health 1.
63JHEC vol. 4, nr. 1, 63-82,©2023 Paris Legal Publishers
CHILDREN BORN OF CONFLICT-RELATED SEXUAL VIOLENCE

Violence in Conflict. This initiative of the UK Foreign, Commonwealth & De-
velopment Office, agreed on practical steps to tackle impunity for the use of
sexual violence as a weapon of war, and to begin to change global attitudes to
these crimes. In 2016, a report by the same organisation32 first identified the
distinct stigma faced by children born as a result of sexual violence in conflict.
Since then, the momentum has grown worldwide by (inter)national organisa-
tions (at policy, research and societal levels), in identifying and addressing the
needs of these children. As mandated by Security Council Resolution 2467 in
January 2022, the UN Secretary-General published a report33 which focused
exclusively on women and girls who become pregnant as a result of sexual vio-
lence in conflict, and on children born of CRSV. This report urged Member
States to strengthen legal and policy frameworks and adequately respond to
these children’s needs. Children themselves have also used their voices in
drawing attention to the issue. In late 2022, 10 years since the launch of the
PSVI, more than 50 countries and the UN agreed urgent action to end sexual
violence in conflict. For the first time, this includes a platform for action34 spe-
cifically outlining principles and actions to promote the rights and wellbeing
of children born of CRSV. This platform has since been endorsed by 17 interna-
tional stakeholders, who have agreed in their specific capacity to ensure the
rights and wellbeing of children born of CRSV; to provide space for children
and survivors who wish to share their knowledge safely and meaningfully; to
strengthen legal and policy frameworks to eliminate barriers to accessing rights;
and encourage child-sensitive approaches to humanitarian assistance.
1.5. Psychosocial Impact
For survivors who conceive and give birth to a child as a result
of sexual violence, in addition to post-traumatic stress disorder,35 sexual violence
is associated with stigmatisation, abandonment, divorce/separation, labelling
Preventing Sexual Violence Initiative ‘Shaping Principles for Global Action to Prevent and
Tackle Stigma’, UK Foreign, Commonwealth & Development Office, Wilton Park (2016) <ht-
32
tps://www.wiltonpark.org.uk/wp-content/uploads/WP1508-Report.pdf> accessed 3 Febru-
ary 2023.
United Nations Security Council, ‘Women and Girls Who Become Pregnant as a Result of
Sexual Violence in Conflict and Children Born of CRSV in Conflict (2022) Report of the Sec-
33
retary-General <https://www.un.org/sexualviolenceinconflict/wp-content/uploads/2022/02/re-
port/auto-draft/N2223437.pdf> accessed 3 February 2023.
Preventing Sexual Violence in Conflict Initiative, ‘Policy Paper: Platform for Action Promoting
the Rights and Wellbeing of Children Born of CRSV’ (2022) UK Foreign, Commonwealth &
34
Development Office <https://www.gov.uk/government/publications/platform-for-action-pro-
moting-rights-and-wellbeing-of-children-born-of-conflict-related-sexual-violence/platform-for-
action-promoting-the-rights-and-wellbeing-of-children-born-of-conflict-related-sexual-violence>
accessed 3 February 2023.
Kaiser et al (n 14).
35
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-164
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER

of the victims by their relatives and by society/community, who experience it
as a dishonour and a betrayal, especially when the victim makes the ‘scandalous
choice’ not to abort the ‘enemy’s child’.36 According to Carpenter, the fact that,
in many situations, these children are immediately confined to the concept of
‘war children’ is problematic and means that they often escape attention. Indeed,
the concept ‘war child’ has been constructed as a paradigm referring to being
affected by war, which rather posits the notion of a childhood ‘disturbed’ by
war. The suffering of children born of CRSV is thus implicitly hidden/concealed
in the same way as that of other children who, for example, lose their parents,
experience the psychosocial effects of having witnessed violence, etc. Despite
the growing international attention, there remains a gap in knowledge of the
needs of children born of CRSV. Current provisions are largely limited to socio-
economic aspects by some states and communities.37
This has consequences for the mental health, not only of sexual violence
survivors, but for their children and families as well. Women raped during the
genocide against the Tutsi in Rwanda, for example, experienced familial com-
plications due to the traumatic context of the genocide and the fact of raising
a child born of rape.38 On one hand, female victims may be forced to bear their
attacker’s children, have unsafe abortions, or may be rendered infertile as a result
of multiple acts of violence or mutilation. In many countries where abortion is
legal, women who conceive as a result of CRSV may be unable to access abortion
services because of discrimination, disruption of the medical system, lack of
safety, fear and shame39 On the other hand, some women choose to continue
their pregnancies through a desire to give birth, love for their unborn child or
religious beliefs that prevent termination.40
1.6. A Holistic Approach to Care
Given the complex needs of survivors and their children, a
holistic response has been promoted by international standards. The most
recognised holistic model of care for survivors of CRSV was derived at Panzi
Hospital, in Eastern DRC. In order to heal, survivors often require care that
deals with all of the interconnected potential consequences of sexual violence
— medical, psychological, legal and socio-economic. This model of holistic care
Foussiakda et al (n 8).
36
M Denov and AA Lakor, ‘When War Is Better Than Peace: The Post-Conflict Realities of Children
Born of Wartime Rape In Northern Uganda’ (2017) 65 Child Abuse and Neglect 255.
37
Kantengwa (n 29).
38
Mitchell (n 10).
39
SM Loning, ‘Beyond “Born of War”: Children, Youth and Young Adults Conceived in Sexual
Violence’ (in press) Global Journal of Medicine & Public Health.
40
65JHEC vol. 4, nr. 1, 65-82,©2023 Paris Legal Publishers
CHILDREN BORN OF CONFLICT-RELATED SEXUAL VIOLENCE

is integrated41 within a general hospital, whereby coherent referrals and coordi-
nation between services can take place. Each survivor has a social assistant as-
signed to him or her from the start. Together they design a tailor-made healing
pathway that includes the four domains listed above, including medical care
which may involve emergency care such as treatment of severe gynaecological
and other physical injuries, post-exposure prophylaxis (PEP) to prevent HIV in
case of exposure, emergency contraception, prevention of sexually transmitted
infections; psychological support including one-to-one support, group coun-
selling and other forms of therapy; legal assistance including judicial coun-
selling, accompaniment throughout the judicial process and other forms of
legal advocacy; and socio-economic assistance to survivors such as literacy
training, small business management and microcredit programmes. Despite
this, the Panzi model currently has no specific implementation for children
born of CRSV. The objective of this review is therefore to map the experiences
of responses to, and recommendations for, the needs of children born of CRSV.
This will enable us to identify gaps in knowledge and practice in conflict and
post-conflict settings. Our research question is, therefore, what is the state-of-
the-art on interventions to support children born of CRSV (and their families)?
2. Methods
2.1. Design and Data Sources
Given the relatively scant literature on this subject, it was de-
cided that a scoping review would be the most appropriate methodology42 to
address such an objective. An electronic search was conducted on the databases
Google Scholar, Scopus, Cairn Info, Embase and JSTOR. We also systematically
searched the work of authors known for their contributions to the literature on
this topic, and hand searched key journals, such as Conflict & Health, Sexual
and Reproductive Health Matters, Intervention and the Journal of Human
Trafficking, Enslavement and Conflict-Related Sexual Violence. Searches of
organisational reports and international guidelines included, non-governmental
organisations (NGO), United Nations (UN) agencies, governmental reports or
papers on this topic, plus international guidelines in the area of gender-based
violence (GBV), child protection, health and other sectors aimed at humanitar-
DM Mukwege and M Berg, ‘A Holistic, Person-Centred Care Model for Victims of Violence
in Democratic Republic of Congo: The Panzi Hospital One-Stop Centre Model of Care’ (2016)
13 PLoS Medicine 13.
41
Z Munn, MDJ Peters and C Stern, ‘Systematic Review or Scoping Review? Guidance For Authors
When Choosing Between a Systematic or Scoping Review Approach’ (2018) 18 BMC Med Res
Methodol 43.
42
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-166
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER

ian practitioners who support survivors of GBV including sexual violence.
Targeted electronic searches included reference list screening of documents
that were identified, hand search of websites mainly of GBV Area of Responsi-
bility (AoR), Child Protection AoR, UNICEF, UNFPA, World Health Organisa-
tion (WHO), UN Women, PSVI, hand search of the repository of documents
of the global GBV Community of Practice (CoP), and request of advice from
the members of the global GBV CoP via email. The GBV CoP is a platform for
professionals working in the field of GBV to share knowledge and expertise.
2.2. Study Selection
This review was conducted according to the PRISMA extended
guidelines for scoping review.43 After the first database search, titles and abstracts
were screened. Relevant articles were selected for a second round, where full
texts were retrieved and read in full. Once authors agreed on the final list of
articles, data extraction began.
2.3. Eligibility Criteria
We included scientific articles and other reports published
between 1980 and 2022 concerning children born of CRSV in conflict or post-
conflict countries. We included dissertations, doctoral theses and reports
available online. Owing to language capabilities of the team, we searched articles
in English and French.
2.4. Search Strategy
The search strategy was defined as terms containing adjectives
or derivatives of ‘children,’ ‘sexual violence’ and ‘intervention’ in English and
French. Interventions/projects known to the research team (eg, ‘Panzi One-
Stop Care Model’) were searched for by name. The following keywords were
used in the databases: (children born of sexual violence* children born of con-
flict-related sexual violence* OR children born of rape* OR children born of
wartime*) AND (intervention* responses* OR approaches* OR trauma* OR
experiences* OR integration*)
For organisational guidelines, searches included the following terms: ‘born’,
‘conceived’; when no results were obtained with these two words, the following
words were subsequently searched ‘rape’ and ‘children’ and checked whether
these words were used in the context of children born of CRSV.
AC Tricco, E Lillie, W Zarin, KK O'Brien, H Colquhoun, D Levac et al, ‘PRISMA Extension
For Scoping Reviews (PRISMA-ScR): Checklist And Explanation’ (2018) 169 Ann Intern Med
467.
43
67JHEC vol. 4, nr. 1, 67-82,©2023 Paris Legal Publishers
CHILDREN BORN OF CONFLICT-RELATED SEXUAL VIOLENCE

All searches were completed by 4 February 2023 and each eligible full-text
study was double rated by the first and second authors. Disagreements were
discussed with the third and the fourth authors and consensus was reached on
the final inclusion of studies.
2.5. Data Extraction and Analysis
Mendeley and EndNote were used to store the data. Selected
articles were tabulated and analysed on the basis of country, objectives, meth-
odology and results. The results were analysed in the light of the research
question. The significant results were then synthesised and classified into four
domains (psychological, socio-economic, medical, and legal), based on those
outlined by Mukwege & Berg.44
3. Results
This review included 26 articles, and 42 organisational reports.
See Figure 1 for full screening process.
With regard to the four domains of support, some articles and reports ad-
dressed only one area which can be useful for the purposes of programming
and designing interventions. However, some articles responded to multiple
aspects, meaning that these teams/organisations are offering a holistic perspec-
tive, which is important given that often the domains are intertwined and reflect
the complexity of needs and therefore the need for a comprehensive/holistic
response. Equally, an aspect in one domain can have a knock-on effect of another
aspect in a different domain. For example, the process of birth registration
(socio-economic or legal) can be triggering for mothers, leading to poor mental
well-being (psychological).
Mukwege & Berg (n 41)
44
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-168
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER

Figure. 1 Study selection flow diagram
3.1. Socioeconomic
Experiences from a socioeconomic perspective were the most
common, described in 21 academic articles and 17 organisational re-
ports/guidelines. Since this domain touches on many aspects of the lives of
survivors and their children, it is the most entwined with other domains, and
is the most explicitly documented. The vast majority of articles draw upon the
consequences of shame and stigma for mothers and children, how this affects
their access to services, education, land and citizenship, the importance of
educating their communities, as well as obtaining reparations. We were not
able to find interventions that focus on education for children born of CRSV.
One report suggests that the competence and capacity of children-centred
services should be increased including shelter, adoption, and economic sup-
port.45 In practice, in Uganda, mothers and their children born of CRSV were
Dr Denis Mukwege Foundation, ‘Understanding Conflict Related Sexual Violence in Ethiopia’
(2022) <https://cpb-us-w2.wpmucdn.com/sites.wustl.edu/dist/1/2391/files/2022/11/
CRSV_ETHIOPIA_REPORT_221025_FINAL-corrected.pdf> accessed 4 February 2023.
45
69JHEC vol. 4, nr. 1, 69-82,©2023 Paris Legal Publishers
CHILDREN BORN OF CONFLICT-RELATED SEXUAL VIOLENCE

provided food such as rice and beans, cooking utensils, seeds, seedlings, and
field tools such as hoes and machetes upon return from LRA captivity to civilian
life.46 They were also assisted in the construction of small housing huts and
given meagre funds to start a new life. Some of the children returned from
captivity passed through one of the reception centres in Northern Uganda before
being reintegrated into civilian life for a period of stay ranging from a few weeks
to several months or even a year. From there, children born of CRSV received
support in the form of medical care, food, shelter and counselling.47 In many
villages in South Kivu, DRC, traditional community leaders and local associations
such as civil society are not so indifferent to the issue of children born of CRSV.
They nurture and protect them from the system of violence.48 In addition, the
children’s parents and legal guardians are supported financially (25 USD per
meeting session) in order to strengthen their income-generating activities and
their mutual solidarity group.49 In Uganda, at the request of children born of
CRSV, radio talk shows were set up by researchers, and led by the children
themselves, to talk about the stigma and marginalisation they face in their
communities.50 Elsewhere in Rwanda,51 youth camps are run by local NGOs
(SEVOTA and The Survivors Fund) to bring young people conceived of rape
together twice in a one-year period. At these camps they play games and sports,
attend workshops on business and entrepreneurship, as well as spending time
in small groups for sessions where they share experiences with others. Young
people who attended these camps described a sense of social connectedness,
enhanced skills around mental well-being, and in caring for their mothers, all
ultimately leading to increased stability in family life.
Adoption is another means of support for mothers following the birth of
children born of CRSV. In Bosnia, through religious groups and in particular
the transnational Islamic community, adoption gave these children the chance
to integrate into society by offering them a family that has chosen to have them.52
Institutionalisation through orphanage services is another way to protect them.
For example, children born of CRSV are left in the care of authorities in conflict
zones in the short or long term.
Denov & Lakor (n 37).
46
Denov & Lakor (n 37); Neenan (n 3).
47
JK Mauwa, SB Kaye and DM Mukwege, ‘Protecting and Nurturing Children Born from Rape
in South Kivu Communities: A Challenge for Civil Society’ in CK Kiyala and GT Harris (eds),
48
Civil Society and Peacebuilding in Sub-Saharan Africa in the Anthropocene, The Anthropocene:
Politik—Economics—Society—Science (Springer nature 2022) 397.
Les Enfants de Panzi et d’Ailleurs, ‘Rapport Synthèse des Activités Réalisées au Quatrième
Trimestre : Octobre, Novembre, Décembre’ (2022) <https://enfantsdepanzi.org/index.php/fr/ac-
cueil/> accessed 19 March 2023.
49
Denov and Lakor (n 37).
50
Loning (n 40).
51
R Gledhill, ‘Muslims Give Adoption Warning’ (1993) in London Times, January 5.
52
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-170
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER

3.2. Mental Health and Psychosocial Support
12 academic articles and 19 organisational reports and interna-
tional guidelines highlighted experiences in the psychological domain. This
perspective included information on the response to the sexual violence itself,
as well as the psychological impact on the relationship between mother and
children, familial relationships and community responses.
Ugandan NGO, Refugee Law Project (RLP)53 describes that children born
of CRSV continue experiencing lifetime challenges resulting from gruesome
social treatment, stigma, discrimination, identity crisis and labelling. The expe-
rience of child abuse is not without consequences. It is a major risk factor for
mental health problems triggering suffering in these children that leads to in-
secure attachment patterns derived from childhood figures.54 Children born of
CRSV carry the trauma of their stigmatisation, abuse and marginalisation, and
additionally experience the effects of their mother’s trauma.55 From a very young
age, they are often exposed to traumatic events, such as mothers refusing to let
them feed until contented when they ask for breast milk,56 the difference in
treatment between them and other children in the house, etc.57 They endure
hatred from relatives and abuse as they grow up, causing and accumulating
traumatic experiences.58 Most of these children, especially girls born in captivity
to traumatised abducted sex slaves, were in turn also traumatised as a result of
witnessing and experiencing sexual violence, perpetual violence, life in captivity,
misery and cruelty, fear, continuous displacement and conditions of extreme
deprivation.59
Refugee Law Project, ‘Bringing Children Born of War into Peace and Security Discourse Re-
quires Political Support’ (2018) <https://refugeelawproject.org/files/events_and_press_re-
53
leases/International_Day_for_the_Elimination_of_Sexual_Violence_in_Conflict_Statement1.pdf>
accessed 4 February 2023.
Kaiser et al (n 14).
54
S Kahn and M Denov, ‘“We Are Children Like Others”: Pathways to Mental Health and Healing
For Children Born of Genocidal Rape in Rwanda’ (2019) 56 Transcultural Psychiatry 510.
55
B Bihabwa Mahano, S Amalini and MR Moro, ‘When Presupposed Innate Becomes a Challenge
of Survival: Resilience of Children Born to Raped Mothers in Eastern DR Congo’ (2019) 177
Annales Medico-Psychologiques 236.
56
Foussiakda et al (n 8); S Roupetz, JY Stein and K Anderson, ‘Mother-Child Relationship Rep-
resentations of Children Born of Sexual Violence in Post-WWII Germany’ (2022) 32 J Child
Fam Stud 1398.
57
Bihabwa Mahano, Amalini and Moro (n 54).
58
E Baines and C Oliveira, ‘Securing the Future: Transformative Justice and Children ‘Born of
War’ (2021) 30 Social and Legal Studies 341.
59
Akello (n 5); Denov and Lakhor (n 37); J Damour Banyanga and K Björkqvist, ‘The Trauma of
Women Who Were Raped and Children Who Were Born as a Result of Rape during the
Rwandan Genocide: Cases from the Rwandan Diaspora’ (2017) <http://www.pyrexjour-
nals.org/pjasd> accessed 24 November 2022.
71JHEC vol. 4, nr. 1, 71-82,©2023 Paris Legal Publishers
CHILDREN BORN OF CONFLICT-RELATED SEXUAL VIOLENCE

According to Kahn & Denov,60 children born of CRSV may be beneficiaries
of the legacy of intergenerational trauma. This type of trauma is the unconscious
and conscious assimilation by a child of the experiences of parents affected by
traumatic events and discrimination.61 In such cases, infants show lower levels
of responsiveness and involvement with their traumatised mothers.62 The ICRC
recommends that to avoid perpetuating stigma, any psychological response
involves all the children in the community, ie, avoiding activities that only target
specific groups of children, such as those associated with armed forces or chil-
dren born of CRSV. Home visits are used in some areas to promote privacy
and confidentiality and allow children and their parents to feel more comfortable
opening up and identifying their needs. These visits are a way for psycho-social
workers to identify risk factors against the growth and development of children
born of sexual violence.63 Peer support, loyalty, shared history and friendship
are also noted as a resilience factor for children born of CRSV, as their peers
help them to regain hope and confidence in the future. As Refugee Law Project
states, ‘Children born of war need to be given space, time and opportunity to
share their ordeals, and to engage with duty bearers in forging workable solu-
tions to the challenges they grapple with’ (p 3), this is something that is working
to great success in Rwanda, with camps for the children to attend.
In Uganda and Colombia,64 some responses from religious, NGO and
community leaders in Uganda include: individual psychosocial support, group
psychosocial support and counselling; child family reunification programmes;
community sensitisation meetings held by local government officials; local
leader-led roundtable meetings; and religious and cultural leadership. Thera-
peutic games are also used in the psychological care of these children. They are
seen as an effective way of restoring life and joy to the suffering child, a means
of providing a therapeutic relationship in a setting or place that encourages
creativity. Through play, the child manipulates phenomena from the outside
world and previous experiences and puts them to work in the service of his or
her imagination.65
Kahn and Denov (n 55).
60
E Van Ee and RJ Kleber, ‘Growing Up Under a Shadow: Key Issues in Research on and Treat-
ment of Children Born of Rape’ (2013) 22 Child Abuse Review 386.
61
E van Ee, RJ Kleber and TTM Mooren, ‘War Trauma Lingers On: Associations Between Maternal
Posttraumatic Stress Disorder, Parent-Child Interaction, And Child Development’ (2012) 33
62
Infant Mental Health Journal 459; K Anderson and E Van Ee, ‘Reflective Functioning of Refugee
Mothers with Children Born of Sexual Violence’ (2020) 17 International Journal of Environ-
mental Research & Public Health 2873; Bihabwa Mahano, Amalini and Moro (n 55).
Mauwa et al (n 48).
63
Neenan (n 3).
64
Les Enfants de Panzi et d’Ailleurs (n 49).
65
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-172
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER

In Eastern DRC, some rape survivors, their husbands, and siblings described
their experiences with children born of CRSV as positive.66 Indeed, love of
neighbour, forgiveness, etc. are among the religious virtues they put forward
as a reason for accepting children born of CRSV. In addition, raising a child
born of CRSV during a conflict or post-conflict period also has a therapeutic’
dimension.67 Indeed, in a study of 44 survivors’ experiences of genocidal rape
in Rwanda, the therapeutic dimension of rape is reflected in developing a deep
bond with the child as a result of shared trauma and marginalisation.68
3.3. Medical Care
3 academic articles and 8 organisational reports and interna-
tional guidelines touched on experiences in the medical area. Sexual violence
is often accompanied by physical injury including obstetric fistulae, sexually
transmitted infections, including HIV/AIDS; and genital injury.69 Norwegian
Church Aid70 has developed an international guideline for the clinical manage-
ment of rape and intimate partner violence and, as well as teaching about
medical examination in vulnerable populations, encourage practitioners to
consider the social and cultural implications for the mother upon having a child
born of CRSV. Including what options are available in places where abortion
is not permitted (and/or wanted by the mother). As secondary victims of CRSV,
no medical interventions were recommended specifically for children born of
CRSV, though a small body of evidence suggests a link between health of the
mother and outcomes for the physical development of the foetus. This may be
due to difficulties accessing pre-natal care services for fear of discrimination,
which significantly contributes to poor new-born health.71 Being in captivity
and/or wanting to hide their pregnancy, some survivors of sexual violence give
birth without assistance.72 New-borns are particularly at risk during the birthing
process if the mothers have experienced nutritional deprivation or lack of ma-
SA Rouhani, J Scott, A Greiner, K Albutt, MR Hacker, O Kuwert, S Bartels, ‘Stigma and Par-
enting Children Conceived from Sexual Violence’ (2015) 136 Pediatrics e1195.
66
Carpenter (n 11).
67
L Woolner, M Denov and S Kahn, “I Asked Myself If I Would Ever Love My Baby”: Mothering
Children Born of Genocidal Rape in Rwanda’ (2019)25 Violence Against Women 703.
68
S Koshin Wang and E Rowley, ‘Rape: How Women, The Community and The Health Sector
Respond’ (2007) Geneva, Switzerland: World Health Organisation/Sexual Violence Research
69
Initiative; DM Mukwege and C Nangini, ‘Rape with Extreme Violence: The New Pathology In
South Kivu, Democratic Republic Of Congo’ (2009) 6 PLoS Med 1.
Norwegian Church Aid ‘Clinical Management of Rape and Intimate Partner Violence - Training
Manual’ (2020) <https://www.kirkensnodhjelp.no/globalassets/gbv/nca-clinical-managment-
of-rape-and-intimate-partner-violence-training-manual.pdf> accessed 4 February 2023.
70
Mitchell (n 10).
71
World Health Organisation, ‘Reproductive Health During Conflict and Displacement: A Guide
for Program Managers’ (2021) WHO Doc. WHO_RHR_00.13 2012.
72
73JHEC vol. 4, nr. 1, 73-82,©2023 Paris Legal Publishers
CHILDREN BORN OF CONFLICT-RELATED SEXUAL VIOLENCE

ternal care during their pregnancy.73 In addition to the possibility of death, they
are at risk of disability following premature delivery, which can have significant
physical consequences for the new-borns, especially if there is no support
nearby.74
In many instances where rape is committed by one or more soldiers,
HIV/AIDS is often transmitted during the act of aggression. There are, sub-
sequently, reports of HIV/AIDS transmission from some mothers who are
already infected to their newborns.75 Other women choose to seek abortion
services where possible or resort to abortion using less safe traditional meth-
ods.76 In addition, cultural beliefs and traditions about sexual violence influence
the health of children born of CRSV. One belief is that the breast milk of a
woman who has been raped is contaminated and therefore cannot feed the new-
born77 (Mitchell, 2005). This exposes the new-born to starvation and malnutri-
tion. Access to health care by children born of CRSV can be fraught with legal
and other obstacles (see below in the legal and protection domain).
The issue of abortion and abandonment are pertinent and sensitive topics.
In many instances, children born of CRSV are rejected by their mother, family,
and/or community, which leads to deprivation and destitution.78 Historically,
facilities for termination of pregnancy or adoption exist for women in emergency
settings,79 including safe houses where babies have been dropped after birth80
for fear that they would be rejected if they returned to their community with
an ‘enemy’s baby’ (p 41).
Center for Reproductive Law and Policy, ‘Rape And Forced Pregnancy Have Historically Been
a Part of War That Has Not Been Recognized as a Human Rights Abuse’ (1996) <https://healthe-
73
ducationresources.unesco.org/organizations/center-reproductive-law-and-policy-crlp> accessed
9 February 2023.
A Muhayisa, J Mutabaruka, I Mukarusanga and I Duret, ‘Héritage Traumatique chez les Enfants
Nés du Viol Pendant le Génocide Perpétré contre les Tutsis au Rwanda en 1994’ (2018)19
L’Autre, Volume 197.
74
J Uram, ‘Enfants de Mauvais Souvenir: Conceived Through Violence, Born as Outcasts, Living
in Danger. Why Parentless and Orphaned Children of Rape Should Receive Refugee or Asylum
Status’ (2008) 26 Penn State International Law Review 935.
75
Human Rights Watch, ‘Shattered Lives. Sexual Violence during the Rwandan Genocide and
its Aftermath’ (1996) Human Rights Watch: USA.
76
Mitchell (n 10).
77
UNDPO, ‘The Handbook for United Nations Field Missions on Preventing and Responding
to Conflict-Related Sexual Violence’ (2020) < https://www.un.org/sexualviolenceinconflict/wp-
content/uploads/2020/06/2020.08-UN-CRSV-Handbook.pdf> accessed 4 February 2023.
78
International Rescue Committee, ‘A Safe Space Created By and For Women Sexual and Gender-
Based Violence Program’ (1998) <https://www.cawtarclearinghouse.org/storage/Attachement-
79
Gender/A%20Safe%20Space%20Created%20By%20and%20For%20Women-IRC.pdf> ac-
cessed: 4 February 2023.
Dr Denis Mukwege Foundation (n 45).
80
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-174
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER

3.4. Legal and Protection Assistance
5 academic articles and 16 organisational reports noted some
experiences in the legal and justice arena, although predominantly with recom-
mendation, as opposed to direct experiences.
It is well understood that children born of CRSV face invisibility and lack
of attention in policy, practice and research unlike other populations who have
experienced war trauma and abuse.81 Their right to an identity, to protection
and to a family is often violated in accordance with the 1989 Convention on the
Rights of the Child.82 This is particularly the case in circumstances where
children born of CRSV are denied citizenship by the countries in which they
were born, often owing to patrilineal understands of ethnicity.83 This can mean
little access to medical care, education, or other social benefits such as access
to religious sacraments.84 A lack of citizenship may also have implications for
land and birth rights,85 and may further impact freedom of movement, ability
to receive asylum, chance of being formally adopted and vulnerability to human
trafficking.86 The nexus between social stigmatisation of children born of CRSV
that may lead to ostracisation/abandonment from their mother, and therefore
vulnerability to trafficking is not something that receives as much attention as
it should. Vulnerable children are known to be at risk from armed groups of
mass abduction87 and being recruited as child soldiers or as sex slaves,88 and
key actors in the legal and protection sectors should be aware that children born
of CRSV might fall victim to these additional crimes.
When applying for refugee status, children born of CRSV face many obstacles
to completing the process. If they are accepted into refugee camps, they may
be risk of abuse given the lack of an adult to protect them (Uram, 2008). For
some women with children conceived or born from CRSV, navigating the
asylum process can be long and arduous and they may face challenges in telling
their story. It can also act as a barrier to recovering from the trauma of CRSV,
which is likely to impact on their capacity as a parent, and means they are not
Denov (n 4).
81
UN General Assembly, ‘Convention on the Rights of the Child’ (1989) <https://www.oh-
chr.org/sites/default/files/crc.pdf> accessed 4 February 2023.
82
ME Hamel, ‘Ethnic Belonging of the Children Born out of Rape in Post conflict Bosnia-
Herzegovina and Rwanda’ (2016) 22 Nations and Nationalism 287.
83
Bihabwa Mahano et al (n 56).
84
Neenan (n 3).
85
Carpenter (n 11).
86
European Parliament Briefing, ‘Russia’s war on Ukraine, Forcibly Displaced Ukrainian Children’
<https://www.europarl.europa.eu/RegData/et-
udes/BRIE/2023/747093/EPRS_BRI(2023)747093_EN.pdf> accessed 15 June 2023.
87
J Tan, ‘Sexual Violence Against Children on the Battlefield as a Crime of Using Child Soldiers:
Square Pegs in Round Holes and Missed Opportunities in Lubanga’ in TD Gill et al (eds)
Yearbook of International Humanitarian Law (Asser Press 2012) 117–151.
88
75JHEC vol. 4, nr. 1, 75-82,©2023 Paris Legal Publishers
CHILDREN BORN OF CONFLICT-RELATED SEXUAL VIOLENCE

able to engage with their children in the way they would like.89 Despite the wide
acknowledgement of harm in this regard, guidance and recommendations on
how to address this domain were less frequently mentioned, though several
studies suggest that, as a first step, mothers and children need safe physical
spaces, where they can be open and talk about their experiences.90
In a report by the Dr Denis Mukwege Foundation91 on understanding CRSV
in Ethiopia, this organisation recommends ‘that children born to mothers of
all ethnic groups enjoy equal rights as Ethiopian citizens. As the circumstances
of conception or abandonment may not be known, all children who are aban-
doned during the conflict should be provided access to shelter, care and educa-
tion without discrimination’. This goes for other conflicts as well, that specific
recognition of these children at the national level as citizens of the country they
were born, regardless of their father, should be encouraged. Furthermore, the
PSVI Principles for Global Action, preventing and addressing stigma associated
with CRSV,92 also advocate for legal recognition for these children, in a non-
stigmatising way. Notably, however, there exists a paucity of documentation as
to the implementation of these policies, if/where they were adopted and their
successes/obstacles.
4. Discussion
4.1. Summary of Findings
This review identified 68 documents (scientific articles, book
chapters, organisational reports and international guidelines). Importantly, this
review found both researchers and international organisations to be forthcoming
in recommendations, but there remains a gap in implementation and docu-
mentation of the effectiveness of these recommendations. It is therefore imper-
ative that practices are implemented and tested to ensure a robust evidence
base that can be used by practitioners in the field.
Findings of this review most often fall into the socioeconomic domain but
given that experiences of mothers with children born of CRSV are multiple and
pervasive, many of these become intertwined with other domains. Based on
Anderson and van Ee (n 61).
89
UNICEF and International Alert, ‘Bad Blood: Perceptions of Children Born of Conflict-related
Sexual Violence and Women and Girls Associated with Boko Haram in Northeast Nigeria 2016
<https://www.international-alert.org/publications/bad-blood/> accessed 4 February 2023.
90
Dr Denis Mukwege Foundation (n 45), 64.
91
Preventing Sexual Violence Initiative, ‘Principles for Global Action. Preventing And Addressing
Stigma Associated With Conflict-Related Sexual Violence’ (2017) <https://assets.publishing.ser-
92
vice.gov.uk/government/uploads/system/uploads/attachment_data/file/645636/PSVI_Prin-
ciples_for_Global_Action.pdf> accessed 4 February 2023.
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-176
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER

the findings of this review, the authors have formulated recommendations that
can guide professionals and decision-makers in improving existing responses
for the holistic care of CRSV but also in implementing suggested interventions
and assessing their effectiveness. Furthermore, we posit to take current termi-
nology regarding children born of CRSV a step further and refer to the forth-
coming publication of Loning,93 who calls for a re-thinking of the language
used globally to perceive children ‘born’ of war. Loning argues that current
discourse emphasises a violent birth, as opposed to a violent conception. Given
that many children do not enter the world in violence, but often surrounded by
love, this could be a universal avenue for the future.
4.2. Implementation of Responses/Interventions for Children
Born Of CRSV
From results of this review, there is a disconnect between
practice and theory, which is otherwise rich in suggestions and recommenda-
tions. Indeed, children born of CRSV face many diverse problems across the
lifespan, but the results of this review clearly show a lack of implementation in
most countries. Notably, the search of organisational reports and international
guidelines revealed two discussions as to why they felt as an organisation they
were not able to address the needs of children born of CRSV. Reasons included
a hesitation to label these children as particularly vulnerable persons, and almost
no effective mainstreaming of humanitarian advocacy and programming for
them, compared to other vulnerable children. For example, interviewees in a
report from Iraq outlined a need to protect the reputation of these children in
the local community due to fearmongering from authorities that children born
of CRSV could pose a security risk. They also expressed a fear of being attacked
(again) if they try to integrate these children into existing programmes.94
It is worth noting the relevance of the four domains on which the manage-
ment of children born of CRSV is based and their interconnection. Indeed, the
legal and medical domains, which are less well covered in this review in terms
of content related to CRSV care, are equally important for the well-being of
children born of CRSV. Bihabwa Mahano et al,95 for example, demonstrate the
link between the denial of citizenship to these children and their economic
status, which restricts their access to health care, education, and other benefits
only available to citizens of a country. As important as it is to use holistic theory
in addressing CRSV, it is also essential that children themselves (those above
18) lead the discussion on how to make responses effective and efficient. The
Loning (n 40).
93
Amnesty International, Legacy of Terror: The Plight of Yezidi Child Survivors of ISIS (2020)
<https://www.amnesty.org/en/documents/mde14/2759/2020/en/> accessed: 4 February 2023.
94
Bihabwa Mahano et al (n 56).
95
77JHEC vol. 4, nr. 1, 77-82,©2023 Paris Legal Publishers
CHILDREN BORN OF CONFLICT-RELATED SEXUAL VIOLENCE

recommendations proposed in this review are directed at four key actors,
namely researchers, public authorities, competent judicial bodies, and human-
itarian agencies.
4.3. Recommendations to Researchers
Carpenter suggested that empirical evidence should be collec-
ted to enable governments to understand that the rights of children born of
CRSV need to be specific. And while the empirical evidence base has expanded
in the last 15 years, this call is supported more recently by the PSVI Platform
for Action,96 with an urge to research groups to build and share evidence on
their needs. Furthermore, adult children born of CRSV should also be included
as peer researchers in the co-creation of projects, and we should collectively
work towards the development of survivor-centred, holistic, trauma-informed
proposals for interventions. Children born of CRSV should be included from
the start of the process, until the publication of results.
Viewed from a gender perspective, the issue of rape refers to power relation-
ships and the dynamics they can engender both in the experiences of children
born of sexual violence97 and potentially in care thereafter. A gender-sensitive
approach to research would make it possible to develop a gender-sensitive
methodology that would later lead to appropriate recommendations for care.
Research should take age groups into account in order to understand the tra-
jectory of CRSV over time, and the resilience they might face. For younger
children, whose data could be collected in particular through the perception of
parents/guardians or third parties, it is necessary to collect the points of view
of more than one adult (parent or guardian) in a comparative perspective. Indeed,
views may be influenced by the status that CRSV occupy within the family98 or
the community. Given the intergenerational transmission trauma99 from which
they suffer, particular emphasis should be placed on the choice of data collection
tools and strategies for gathering data from CRSV. The Murad Code, a global
code for documenting and investigating CRSV, should be used as key guidance
in the research process from collection to dissemination100 (Murad Code, 2020).
PSVI Platform for Action (n 34).
96
Foussiakda et al (n 8).
97
Denov and Lakhor (n 37).
98
Kahn and Denov (n 55).
99
Murad Code, Background Paper & Draft Global Code of Conduct for Documenting & Investigating
Conict-Related Sexual Violence(“The Murad Code”)’ (2020) <https://static1.squarespace.com/stat-
100
ic/5eba1018487928493de323e7/t/5efa1554a8553428c9395936/1593447765159/English+Draft-
MuradCode%2BBackgroundPaper+June2020+Website.pdf> accessed 11 June 2023.
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-178
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER

4.4. Recommendations to Public Authorities
The development of policies that legally/formally recognise
children born of CRSV would be a first step towards their access to citizenship.
These need to be tailored according to individual states, and should be inclusive,
making children born of CRSV eligible for similar benefits granted to conflict
survivors (Denov et al, 2020). Views of children born of CRSV should also be
prioritised in policy development and implementation as they often have a clear
understanding of their own situation and needs and how they would like them
to be addressed. There is, therefore, a need to challenge the traditional ap-
proaches considered participatory so far. New approaches should not consider
children born of CRSV and their mother as mere beneficiaries but rather as
actors, as they are the people who hold valid solutions to their problems. They
may also have different needs and wishes and should be involved in policy for-
mulation in the areas of education, health, social and legal services. Gender
differences should be taken into account in this exercise.101 Even if the (military)
perpetrators are untraceable, they work for the state, and as such, their states
should pay compensation to women who have been raped by their soldiers, as
well as their children.102
Children born of CRSV require regular and long-term access to mental
health and social services that are designed to meet their unique needs. In ad-
dition, these services should take into account gender differentiation and the
ways in which girls and boys are particularly affected.103 Training of peacekeepers
and military personnel on how to meet the needs of citizens should be a priority
for the government to ensure that they understand the vulnerability of local
populations in their host countries. In addition, they should also be trained in
sexual and reproductive education for women and girls.104
4.5. Recommendations to Relevant Judicial Bodies
Relevant judicial bodies are asked to become involved in en-
abling children born of CRSV to have citizenship status in accordance with the
Convention on the Rights of the Child which gives them the right to know their
parents105 to document and to share their experiences. Finding alternative
Carpenter (n 11).
101
Grieg (n 1).
102
Denov (n 4).
103
K Wagner, H Glaesmer, SA Bartels and S Lee, ‘If I Was with my Father Such Discrimination
Wouldn’t Exist, I Could Be Happy like Other People: A Qualitative Analysis of Stigma among
104
Peacekeeper Fathered Children in the Democratic Republic Of Congo’ (2020) 14 Conflict and
Health 1.
Grieg (n 1).
105
79JHEC vol. 4, nr. 1, 79-82,©2023 Paris Legal Publishers
CHILDREN BORN OF CONFLICT-RELATED SEXUAL VIOLENCE

solutions for mothers who choose not to raise their children would also provide
relief for many of them. Denov et al have proposed the creation of laws to
prevent stigmatisation and abuse. It would also be useful for key actors in the
judicial system to have training in trauma-informed interview techniques,
specifically to understand the impact that CRSV can have on memory, witness
testimony and the ability to share their stories. Often women are too afraid to
speak out about their experiences, but when they do, they are penalised for
speaking too late and it thus having a negative impact on their asylum claim.106
4.6. Recommendations to Humanitarian Agencies
A useful first step would be for large humanitarian organisa-
tions and their donors to conduct or commission impact assessments of existing
field guidelines on children born of CRSV, or support those currently ongoing.
Some specific guidance should be developed in the existing guidelines to ensure
humanitarian personnel knows how to effectively respond to children and their
mothers and community, and this, with the involvement of survivors and chil-
dren born of CRSV. Humanitarian organisations should encourage governments
to maintain statistics on CRSV and make use of gender and child rights sensitive
approaches in their use.
On the issue of their mental health, for children born of CRSV mental health
and psychosocial support services should be culturally and contextually sensitive
so as not to exacerbate symptoms of trauma. Indeed, the approaches usually
used tend to focus on individual risk factors, psychopathology, and psychother-
apy, which have shown their limitations.107 The mother-child relationship is to
be strengthened as it plays a vital role in the lives of children born of CRSV and
has a unique importance.108 Many learn what their mothers have gone through
and can eventually feel empathy for their suffering.109 The increase in focus
groups with peers is an encouraging element and promotes exchange and social
integration in the community. On the other hand, children born of CRSV need
advocacy to highlight their particular persistent difficulties.110
Socioeconomically, in Rwanda, some programmes were proposed that could
help children born of CRSV with livestock rearing, agricultural projects, voca-
K Anderson and E Van Ee, ‘Refugee Mothers Raising Children Born of Sexual Violence in
Dutch Society’ in K Zaleski, A Enrile, L Eugenia, Weiss and X Wang (eds), Women’s Journey
106
to Empowerment in the 21st Century a Transnational Feminist Analysis of Women’s Lives in Modern
Times (Oxford University Press, 2019).
Denov (n 4).
107
K Anderson, ‘Supporting Mothers and Children Born of Sexual Violence: The Importance Of
Community-Based Approaches’ in B Stelzl-Marx, S Lee and H Glaesmer (eds), Children Born
of War in the 20th Century (Taylor & Francis 2021).
108
Roupetz et al (n 57).
109
Denov et al (n 29).
110
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-180
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER

tional training, and other income-generating activities to feed their families,
attend school, rent land, and access health care. In Uganda, recommendations
were made to focus on discussions on living together, education and awareness
raising for school administrators, teachers, fellow students, family, community
members and community leaders. They suggested the increase of talk-show
radios to inform more about the difficulties and strengths of children born of
CRSV. Psychosocial support to themselves and their families was raised in
terms of home visits, psychosocial counselling, psycho-educational workshops
on the concerns, needs and challenges faced by children, parents, and caregivers
etc.111
The need for community awareness is to be considered as well as projects
that can share collective experiences of marginalisation and move towards
greater unity within the respective families and communities.112 Individual and
group support could be provided through comprehensive community-based
HIV/AIDS treatment and care. Effective practices for children born of CRSV
and their mothers should necessarily include families and communities to
promote acceptance and inclusion beyond individual and group support. Chil-
dren born of CRSV during the genocide against the Tutsi in Rwanda have re-
quested to be included as beneficiaries of the Rwanda Genocide Survivors in
Need (RGIS) fund in the same way as other genocide survivors born in 1994.113
5. Conclusion
Children born of conflict-related sexual violence are a special
category, because of the context in which they were born and their experiences
across the lifespan, including psychological, economic, medical, and legal/pro-
tection hardships. These children are very often stigmatised, traumatised, live
in poverty, lack citizenship status in the country of their birth and some suffer
from health problems related to the conditions of their conception and birth.
Some responses are provided by some humanitarian agencies, the com-
munity, and governmental organisations to alleviate the suffering of children
born of CRSV. These responses include food aid, medical care, housing assis-
tance, home visits, financial support for the mothers of children born of CRSV,
and therapeutic games and counselling. Nonetheless, the results of the review
show that there remains a gap between what is recommended and what is im-
plemented in practice. With this in mind, this review summarizes requirements
of researchers, humanitarian agencies, the relevant judicial bodies, and public
Denov and Lakhor (n 37).
111
Denov et al (n 29).
112
Khan and Denov (n 55).
113
81JHEC vol. 4, nr. 1, 81-82,©2023 Paris Legal Publishers
CHILDREN BORN OF CONFLICT-RELATED SEXUAL VIOLENCE

authorities to improve responses to children born of CRSV and thereby enable
their effective integration into the community of their mother.
Journal of Human Trafficking, Enslavement and Conflict-Related Sexual Violence 2023-182
FOUSSIAKDA, ANDERSON, PASQUERO AND BLAVIER