Each year about 17,500 individuals are brought into the United States and held against their will as victims of human trafficking.
Some estimate the number is as high as 60,000 annually. These numbers do not include those who are here from previous years, migrants already in the US, runaways, displaced persons, and those from oppressed/marginalized groups and the poor. Combating human trafficking is a daunting task and emergency healthcare providers have a critical role to play.
Medical providers are a frontline of defense for victims - especially providers in an emergency department setting. Victims present here, often with their traffickers, and receive medical attention but not the further help they need to remove them from the environment that places their lives at risk daily. Emergency healthcare providers often miss the signs of human trafficking, mistake the signs for intimate partner violence, and are rarely aware of how to help. Instead victims are sent back "home" with their traffickers. This situation can change and it must.
Emergency care providers must identify these victims and provide the opportunity for appropriate treatment. This website contains information to give practitioners a basic introduction to what human trafficking is, the clinical presentation of such patients, and the unique treatment needs of this patient population. Click on the "Educational Tools" tab for helpful instruments in educating providers at your institution. Click on the "In the ED" tab if you suspect you are caring for a trafficked person.
the recruitment, transportation, transfer, harboring or receipt of persons:
by the threat or use of kidnapping, force, fraud, deception or coercion, or by the giving or receiving of unlawful payments or benefits to achieve the consent of a person having control over another person, and for the purpose of sexual exploitation or forced labor.1
- The recruitment, transportation, transfer, harboring or receipt of persons:
Trafficking does not require transnational movement of persons; anyone can be a victim of human trafficking: documented and undocumented immigrants, migrant workers, US citizens and residents.
- By the threat or use of kidnapping, force, fraud, deception or coercion:
Trafficking can result from a real or a perceived threat; a person only has to believe that they or loved ones are in danger, they do not actually have to be in danger. The victimized believes that if they do not do what the trafficker demands, regardless of the traffickers actual ability to follow through with said threat(s), there will be dire (physical, financial, legal, or other) consequences. Traffickers use a variety of techniques to control those they victimze. A hallmark of the criminal industry is the sophisticated use of psychological and financial control mechanisms, often minimizing or precluding the need for physical violence or confinement.2
Or the trafficker actually does a harmful thing, causing the trafficked person to reasonably believe they have no other choice but to do as the trafficker says.
- Or by the giving or receiving of unlawful payments or benefits to achieve the consent of a person having control over another person:
This means that the trafficker has given another person payment, of some kind, for the use of the trafficked person. For example, a trafficker may pay an impoverished parent for their child or a smuggler may sell a person to a trafficker.
- For the purpose of sexual exploitation or forced labor:
means that the trafficker uses the trafficked person for his/her
personal monetary, or other, gain.
- Given the criminal nature of trafficking, the fear of those trafficked, the stigma and shame experienced by those who come forward, prevalence estimates are riddled with inaccuracies. Many estimates are derived via unclear methods and are not reproducible. Still, convivence sample data indicate that trafficking often impacts those from vulnerable populations, including migrants, oppressed or marginalized groups, runaways or displaced persons, people of color, and the poor.4
Trafficking affects both people from the US and not from the US. Sometimes the person came, of their own accord, to the country and then fell into trouble; sometimes they are duped from the very beginning; sometimes they are from the US. A trafficked person does not speak a particular language or have a particular race; a trafficked person can be and look like anyone.
- People of all genders can be trafficked.
Men are more likely to be identified as trafficked for labor (e.g.: day laborers, construction or restaurant workers, etc), while womyn and children are often exploited for commercial. But people can be trafficked in any form of trafficking, and in more than one trafficking type.
They may operate as individuals, families, or more organized groups of criminals, and are facilitated by other indirect beneficiaries, such as advertising, distribution, or retail companies and consumers. People of any gender can act as traffickers in labor and sex trafficking operations.5
Traffickers may have survived abuse and exploitation themselves and may also have socially acceptable relationships with the people they exploit (e.g.: parents, romantic partners, employers, family friends, etc). Trafficking is appealing because it is so lucrative: People can be reused for commercial value, whereas drugs and weapons, once sold must be restocked. Read more about traffickers at www.HumanTrafficking.com.
are often hard to come by in this field. Trafficking is an illegal industry so finding out just how
many are victimized there are annually is difficult. Estimates about how many are
trafficked vary, and methodologies that rely on law enforcement are naturally
undercounts of the problem. However, it is reasonable to say that whatever the number,
one is too many. Finding local statistics may also be difficult, but local organizations are
better equipped to tell you more about problem at the local level. States with some the
greatest number of calls to the National Human trafficking Hotline are New York,
California, and Florida; Washington DC also has a large trafficked population. Some
organizations to contact for more info in this, and in all areas regarding trafficking are:
|Girls Education and Mentoring Service||212-926-8089|
|The Sex Workers Project||646-602-5617|
|CA||Coalition to Abolish Slavery & Trafficking
|Boat People SOS||703-538-2191, 2190|
|Tahirih Justice Center||703-575-0070|
|FL||Florida Coalition Against Human Trafficking||1-866-446-5600|
|Florida Freedom Partnership||1-866-443-0106|
|Shelter for Abused Women & Children||239-775-1101|
|DC||Break the Chain Campaign||202-234-9382|
|Ayuda||202-387-2870 ext 10|
- As with statistics, laws also vary state to state, but the federal law protects trafficked persons and prosecutes traffickers.Trafficking Victims Protection Act is an important document with which to be generally familiar.
- State and federal law are very clear that minors constitute a special population that requires special protection. While the trafficking of an adult can only be reported to authorities if the adult consents, if a minor presents to a healthcare facility and there is concern for human trafficking, CAPTA requires reporting as well. Practitioner compliance with these laws should be performed transparently with patients, who have the right to leave clinical care institutions at any time.
After a trafficked person is recognized there are a few things that can happen, all of which depend on what the adult survivor wants. In an emergency setting if the patient discloses a trafficking situation and the provider can call a local or national help hotline or a social worker (who should contact an appropriate local service provider). The patient should be allowed to speak with the person from the hotline if they want to. Then,
- if the patient decides to leave their situation, the hotline or service agency will help plan the safest course of action (e.g.: a local advocate may come to the healthcare facility);
- free shelter, clothing, food, healthcare, etc will be provided, if those resources are available
- TVPA 2005 protects all trafficking victims and allows special visas (T-visas) for international victims (not-US born) if they want to stay
- the survivor can choose not to press charges against their trafficker at all, can choose to press charges immediately, or at a later date; free legal aid is provided, if those resources are available
- if a patient decides not to leave their situation, their wishes must be respected; clinicians do NOT have the right to detain patients. It is possible that a trafficked person may have another opportunity to leave, so the clinician must create an environment and relationship that offers the patient every opportunity to receive help and instills the trust that healthcare can be sought in the future.
This is an unfortunate but real phenomenon of our communities. It is especially unfortunate in circumstances like those that surround human trafficking because the very people who ought to aid trafficked persons cannot always be counted on to help. Sometimes trafficked persons have already had prior negative experience(s)7 with law enforcement (e.g.: being arrested for activities performed while being trafficked), which makes them scared of police and, in general, mistrustful of institutions and people that are supposed to help. Because some police receive pay- offs from traffickers to look the other way, providers are not always aware of who can be trusted in their local police departments. Note that this does not mean all law enforcement are corrupt, but that those few have tainted the reputation of the institution and the result is that trafficked persons, in general, do not trust law enforcement officials. Thusly, providers should not call the police when they identify a trafficked person; local anti-trafficking institutions will know what to do and whom to trust in law enforcement. When it is true, clinicians should remind patients that the police will not be called without patient permission (unless there is an imminent threat of danger in the ED (e.g., someone is wielding a weapon)).
It takes a great deal of time and effort to rebuild that trust and local anti-trafficking advocates are qualified to help rebuild that trust. All over the U.S., law enforcement officials are receiving training about human trafficking and in serving trafficked persons, but because of survivors’ pre- and sometimes misconceptions about police, local anti-trafficking institutions and/or the National Human Trafficking Hotline should be called not police.
The standards that apply to a person victimized by rape can be applied to a those victimized by trafficking, regardless of whether they were sexually exploited. Documentation is important not
only in the event that the patient decides to involve the justice system, but also because if they do
not choose to leave at the time, a note in a patient's chart will give the next providers an
important heads up about the situation (assuming the patient presents to the same healthcare
facility again, using the same name). Read more about forensic documentation here:
Doctors of the World-USA, Kosovo, 2005
that educators need not adhere to the dosages and medications listed in
this document; use your institutions standards and this document as a
Anti-trafficking non-governmental organizations may offer trafficked persons a safe place to recover with the support of survivors and advocates. Depending on the agency, temporary housing, clothing, food, healthcare, counseling, food stamps, and legal aid may be provided, and/or educational (GED and ESL classes, for example) and job opportunities may be offered (at no cost to the survivor). Anti-trafficking NGOs can also help foreign-born survivors apply for relevant visas if they wish to stay in the United States.
Anti-trafficking NGOs are the experts in helping trafficked persons survive beyond their
trafficking situation. As advocates they are committed to the well-being of this population and
some are survivors who know the population implicitly. They can answer the questions that
providers have about laws, local population demographics, prominent types of trafficking in the
area, and so on. These types of NGOs are the best resources from which to get information about
and for trafficked patients. Note that all NGOs are not familiar with the needs of human
trafficking; you can use section 4 of this document to help determine which groups are
knowledgeable about the needs of trafficked persons; also, review the Office of Trafficking in
Persons list of grantees deemed qualified to provide anti-trafficking services.
Key to understanding the emergency clinician’s role in the anti-trafficking movement and in
treating a trafficked patient is understanding that the emergent issue, which causes the patient to
present, may only a symptom of a disease: human trafficking is a disease. The same way that
survivors of intimate partner violence live in a dangerous living environment, trafficked people
are surviving a trauma that may be making them sick. Just as clinicians understand that fatigue,
mental confusion, shortness of breath, and pruritis may be symptoms of kidney disease, we must
also acknowledge that cigarette burns, ligature marks, depression, back pain, and malnutrition
may be symptoms of human trafficking. Merely treating the symptoms of kidney disease does
not serve the best interests of the patient, nor does merely treating the symptoms of human
trafficking. Human trafficking, as a disease, must be considered as a differential when a patient
presents to the ED with certain red flags.8
Read the stories of "Jill Leighton", "Ashek Hamid", and "Ricardo Veisaga". There are different kinds of trafficking and these stories only illustrate three. All three of these people could (or did) present as trafficking patients in an ED and all of them would demonstrate signs or symptoms of trafficking; think about who would present in what way(s).
The stories of Leighton, Hamid and Veisaga are true and give names to the millions that are counted as nameless. Emergency healthcare practitioners have a significant role to play in learning the names of these people but first providers must be made aware.
1 International Protocol to Prevent, Suppress, and Punish Trafficking in Persons, especially Women and Children
2 http://www.humantrafficking.com/humantrafficking/trafficking_ht3/what_is_ht.htm (October 2006)
3 http://www.polarisproject.org/polarisproject/trafficking_p3/trafficking.htm (October 2006)
4 http://www.humantrafficking.com/humantrafficking/trafficking_ht3/what_is_ht.htm (October 2006)
5 http://www.humantrafficking.com/humantrafficking/trafficking_ht3/who_traffickers.htm (October 2006)
6 Polaris Project can also be used as an avenue to find non-governmental organizations in your area that do anti-trafficking work.
7 E.g.: Officers are sometimes the very johns that exploit sexual workers or sex trafficking victims may have been harassed or arrested for prostitution.
8 Refer to 'educational tools' tab, PowerPoint slides 12 and 13.