The Hidden Risk in Every Emergency
Preventing sexual exploitation and abuse in crisis response
Bujumbura, Burundi - When Mpox emerged in Burundi in July 2024, the government and partners acted to contain the outbreak, though not without challenges. Treatment centres were eventually established, humanitarian actors mobilized, and civil society organisations supported prevention, surveillance, and care. While the number of deaths remained lower than in other outbreaks, the impact went far beyond mortality, disrupting livelihoods, straining the health system, and deepening fear and stigma in affected communities.
Emergencies don’t just spread viruses. They can also deepen hidden risks, including the risk of sexual exploitation and abuse. In moments of crisis, when power imbalances grow sharper, the most vulnerable are often left with the fewest protections.
Listening First
To understand these risks, we knew we had to start with the voices that matter most. Together with our partners, Common Thread and Social Action for Development (SAD), we traveled to Buterere to sit with women across the community: Mpox survivors, mothers, young women, and women engaged in commercial sex work.
Talking about sexual exploitation and abuse is never easy, particularly in a society where conversations about sexuality are considered taboo. So we used participatory tools like vignette stories and scenario ranking to create safe space for dialogue. Bit by bit, women began to share.
The conversations revealed important gaps. Many had little awareness of what actually counts as sexual exploitation and abuse or misconduct, especially non-physical abuses like harassment or abuse of authority. Posters about reporting mechanisms hung unnoticed in clinics, suggestion boxes sat empty in corners with no privacy. And the fear of retaliation or judgment kept most women silent, leaving those who might experience abuse without safe pathways to seek help.
From Insights to Action
The question became: how do we design something that women will actually notice, trust, and use?
Our approach drew on human-centered design. We wanted to move beyond forgotten posters on clinic walls and instead create something that was clear, visible, and memorable. The result was a comic-style tool: colorful, direct, and designed to make the risk of sexual exploitation and abuse more visible.
The tool highlights not only physical abuse, but also subtle, non-physical forms; explains what the hotline is and why it’s confidential; sets expectations for reporting; and strengthens young women’s confidence to speak up. It was designed to be used flexibly: as a handout for communities, a discussion aid in facilitated dialogues, or a training tool to help frontline workers better understand sexual exploitation and abuse and reporting mechanisms.
Iterating with Women
With support from the Centre d’Information, d’Éducation et de Communication en matière de Population et Développement (CIEP), we took the comic back to the community to test early drafts. Women were quick to tell us what landed, and what fell flat.
The first version was often read as a general story about gender-based violence, not sexual exploitation and abuse. We had to be more explicit about abuse of power in the context of aid and services. Our softened language, meant to reduce sensitivity and discomfort, had missed the mark. Women wanted plain talk: what sexual exploitation and abuse looks like, who can commit it, and what steps to take.
They also flagged the visuals. We had drawn a group of women in open discussion with a community volunteer, but they told us that in Burundi, sensitive issues like this are rarely addressed in public. A one-to-one conversation with a volunteer felt far more authentic.
So we reworked it. The final version speaks directly, depicts scenarios women recognize, and uses trusted local voices. Because it was shaped with them, it carries their voice — and, we hope, their trust.
Planting Seeds for Change
This may look like a simple poster, but it’s more than that. It’s a conversation starter, a signal of accountability, and a bridge to safer reporting. Already, there are plans for the tool to be adapted into interactive theatre for less literate audiences, and to equip community volunteers and social workers with it as a discussion aid to spark dialogues on sexual exploitation and abuse in communities. Versions exist in Kirundi, French, and English, making it useful far beyond Burundi’s borders.
What We Learned
The Burundi experience underscores a vital truth: prevention of sexual exploitation and abuse cannot be an afterthought in emergencies. Safeguards must be built in from the start: visible, practical, and trusted by the people they’re meant to protect.
By listening first, and by iterating openly, we built more than a tool. We built a foundation for awareness, dialogue, and change. And we set the stage for scaling an approach that is as much about dignity, respect and trust as it is about prevention.
Because protecting people in crisis means more than fighting a virus. It means tackling the hidden risks that crises magnify, together.
Common Thread is a behavioural design company that aims to support people to make better decisions about their health. Want to know more? Reach out to us at [email protected].
