This study examines the relationship between aid allocation by household headcount, population growth, and resource pressure in Nakivale Refugee Settlement, Uganda. Using qualitative methods, the research explores how humanitarian assistance structures shape household formation, reproductive decision-making, and livelihood strategies in a protracted displacement context. The findings reveal that population growth in Nakivale is not primarily driven by new refugee arrivals but by internal dynamics linked to hunger, insecurity, gendered survival strategies, and aid policies that tie assistance to household size. Drawing on Malthusian population theory, dependency theory, and the Sustainable Livelihoods Framework, the study demonstrates that headcount-based aid allocation unintentionally incentivizes household expansion as a survival strategy. Women are disproportionately affected, with limited livelihood opportunities, exposure to sexual violence, and inadequate reproductive health services contributing to unplanned pregnancies and population growth. Refugees exhibit agency through informal trade, agriculture, and integration with host communities, yet these strategies remain constrained by structural dependency and resource scarcity. The study contributes to refugee scholarship by highlighting how humanitarian governance systems shape demographic behaviour and resource pressure. It recommends rethinking aid allocation models to incorporate livelihood capacity, gendered vulnerability, and long-term sustainability in protracted refugee settlements.