It’s been two years since hell paid Haiti a visit, but for countless women, terror still stalks the ruins. The scars of the January 2010 earthquake are etched on their bodies, in an ever-widening pattern of sexual exploitation.

A crisis of gender-based violence and exploitation is festering–and foreign aid efforts are still failing to protect survivor communities from harm, or to make the criminal justice system more accountable.

Sexual violence and women’s oppression in Haiti predated the disaster. Prior to the quake, surveys showed that gender-based and sexual violence was widespread, and women and children had long bore the brunt of poverty stoked by neoliberal economic policies and political instability. But post-quake conditions have posed unique threats to survivor communities: the lack of safety patrols in camps, the breakdown of an already tattered government structure, and the erosion of social networks that leave women at greater risk. In a recent study of conditions surrounding four internally displaced people’s camps, researchers with the Global Justice Center and Center for Human Rights and Global Justice (CHRGJ) estimate that “14 percent of households reported that at least one member of the household had been a victim of sexual violence since the earthquake.” Victims were typically young, female, and deprived of access to food, water and sanitation.

While Haiti’s recovery plods on amid promises of aid and reforms under the new government, the scourge of sexual abuse seems to have been eclipsed by other priorities. “With so little money going to community-based Haitian organizations that know best the problems they face and the solutions to crises, foreign aid has largely failed to address this crisis,” said MADRE’s Executive Director Yifat Susskind.

Authorities talk of reconstruction and repairing a broken infrastructure. Yet a large portion of donated aid remains unspent, and the economy is still crippled. The overarching social breakdown leaves women even more vulnerable to victimization.

Another report by researchers with CHRGJ, Center for Gender & Refugee Studies, City University of New York, along with the advocacy groups MADRE and Haiti-based Commission of Women Victims for Victims (KOFAVIV), examines how sexual exploitation weaves into everyday life in the ravaged communities of Port-au-Prince.

“Survival sex” (referring to the trading of sex for basic resources) has become a common way to get by in an economy that traffics in desperation. Last November and December a research team found that many women and girls had “exchanged sex for food, education or other necessities for themselves and their families.” Unable to secure decent work or housing, women and girls often turn to selling sex for precious resources like “coupons for aid distributions, access to direct aid distributions, cash for work programs, money, or even a single meal,” according to the study. Though many women surveyed said they used survival sex to meet individual needs, some women bartered sex to support their children or pay for schooling. Investigators noted, “Many of the women noted that they would not engage in survival sex if they could find work in either the formal or informal sector.”

The report documents the experience of eighteen year-old “Kettlyne,” who relied on survival sex for subsistence since losing her husband in the disaster:

[Men] sometimes refuse to pay her and often beat her after sex. Occasionally, they recommend her to other men and beat her if she refuses these men as well. As a result of one exchange, Kettlyne became pregnant and was forced to get an illegal abortion.

Kettlyne had hoped to somehow make enough money so she and her three-year-old daughter could go to school, but day-to-day needs took priority. She told researchers, “if my baby is crying for food, I am obligated to do anything.”

Investigators found that gay men engaging in survival sex were especially marginalized, both from the formal economy and their own families and communities.

Countless incidents of assault and exploitation go unreported, as women fear retaliation. Those who dare come forward, according to advocates, run up against unresponsive police and judicial systems that tend to ignore, or even blame victims. Inequities embedded in the aid system lead some women to use survival sex to navigate channels for humanitarian assistance. Researchers observed, “The men who solicit sex are often in positions of power, by virtue of their employment (administering a cash-for-work program, for example) or position on the camp committee [that organizes aid distributions].”

Alongside deep poverty, women in the survival sex trade face severe gaps in the social infrastructure. The earthquake’s aftermath underscored longstanding deficits in resources for reproductive healthcare, and for parallel crises like HIV/AIDS and the post-quake cholera epidemic.

According to CHRGJ, the post-quake housing crisis has aggravated brutality against women; hundreds of thousands of Haitians remain cramped in makeshift camps, where women are often extremely vulnerable to violence and abuse. The group has called for a moratorium on evictions from camps and shelters until authorities take essential measures to provide survivors with stable housing and safety protection.

Some international organizations like Oxfam have supported programs serving populations vulnerable to abuse and exploitation. Nonetheless, aid programs are generally hindered by chronic underfunding and haphazard coordination with Haiti’s numerous indigenous service groups. Following the disaster, aid agencies tried to coordinate programs to address gender and sexual violence issues. But Sheila Laplanche, a spokesperson for U.N. Women, told The Nation that two years on, funding has waned, and while recovery efforts led by the Haitian government and international groups “are primarily focused on reconstruction and access to housing,” acute needs of women and girls remain unmet. UN Women says it is working with state and civil society organizations to target resources toward gender issues, including programs to promote women’s economic self-sufficiency and comprehensive social services for survivors. But Laplanche acknowledged “an ongoing need to increase financing for gender equality programs within the context of reconstruction, not only to address the protection needs of women, but also to recognize and support their important contributions to reconstruction and economic development.”

Many advocates say bureaucracy and shortsighted planning are major obstacles to sustainable rebuilding, with established agencies often failing to collaborate with community-based organizations. Late last year, a U.N. analysis of funds promised in the March 2010 international donors conference revealed massive gaps between allocated funding and the amount actually disbursed for “social rebuilding” activities, such as education and health. Over one third of the money planned for women and children’s needs had not yet been disbursed.

Though foreign aid has lagged, activists on the ground struggle on their own to support women. KOFAVIV, MADRE’s Haitian partner organization, runs programs focused on community-based rehabilitation, providing both emergency assistance for traumatized women and youth, and advocacy for victims dealing with law enforcement. Outreach teams for women and men run community workshops on gender-based violence and reproductive health. Another aim is to connect women to financial supports like microcredit programs and educational funds, though such resources are severely strained.

Despite recent efforts by Haiti’s government to strengthen policies against gender-based and sexual violence through legislation, KOFAVIV co-founder Marie Eramithe Delva told The Nation that interaction with authorities has been “minimal.” She added that recovery efforts would be advanced by closer collaboration between officials and grassroots organizations. KOFAVIV remains a rare voice speaking out about the often hidden struggles of Haitian women. Delva said the staff at the KOFAVIV center make it “a point of refuge and shelter,” offering peer support so “the survivors learn that they are not alone. They are taught that they have a value and a purpose in society.”

While the shock of the quake still pulses through Haiti’s social landscape, it steels the foundational idea of self-reliance that drives groups like KOFAVIV: When institutions collapse, women lean on each other for survival.