Human trafficking is a global issue that presents challenges to communities, governments, humanitarian organizations, the healthcare sector, and law enforcement. Organized crime figures largely in this worldwide scourge, and although sexual slavery is one aspect that receives attention, many other forms of trafficking exist and should be on the minds of professionals working in the healthcare sector.
What is Human Trafficking?
The United Nations Palermo Convention, also known as the Convention Against Transnational Organized Crime and the Protocols Thereto, was ratified in the year 2000. It includes three specific protocols: the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children; the Protocol against the Smuggling of Migrants by Land, Sea and Air; and the Protocol against the Illicit Manufacturing of and Trafficking in Firearms, their Parts and Components and Ammunition.
According to the International Labor Organization (ILO), in 2016 there were 5.4 victims of human trafficking out of every 1,000 people in the world; sadly, 25 percent of these victims were children.
The Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children contains a legally binding definition of trafficking in human persons:
“the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs.”
Human trafficking is universally viewed as a crime and a violation of human rights, and the above-mentioned Palermo Convention has been ratified by 177 countries.
Human Trafficking and Public Health
In the 21st century, human trafficking has become such a significant problem that it is now being viewed as a critical issue of public health. Problems arising from trafficking include, but are not limited to:
- Communicable diseases from crowded and unsanitary living conditions
- Isolation, stress-related illnesses, and mental health issues
- HIV, STDs, and STIs related to rape, prostitution, and sex trafficking
- Genital trauma and forced abortion
- Substance abuse and its sequelae
- The development of otherwise preventable medical and dental issues related to a lack of access to both urgent and primary care
- Missed immunizations and health screenings
Nurses, Human Trafficking, and Advocacy
Nurses must recognize that human trafficking does not discriminate when it comes to gender, age, sexual orientation, religion, or socioeconomic status. Immigrants, children, victims of natural disasters, the homeless, the mentally ill, and other populations are especially vulnerable.
When trapped in a trafficking situation, individuals may be abused physically, emotionally, psychologically, and/or sexually. A surprising number of trafficking victims are in bondage to family members, not strangers – this may make it more difficult to spot, even when the nurse has suspicion that something is amiss.
The American Association of Colleges of Nursing has identified five values that are essential to the role of the nurse and the nursing profession; they are altruism, autonomy, human dignity, integrity, and social justice. These values loom large as driving forces of nursing care and nurses’ interest in advocating for those who may not be able to advocate on their own behalf. (American Association of Colleges of Nursing. (2008). Professionalism and professional values in The essentials of nursing education for baccalaureate nursing practice (pp. 27-28).)
In terms of advocacy, the International Council of Nurses has defined the nature of nursing thus:
“Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings. Nursing includes the promotion of health; prevention of illness; and the care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.”
Meanwhile, the American Nurses Association (ANA) has defined nursing as “the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations.”
Indicators of Trafficking
The following represent some common indicators of human trafficking that may be observed during assessment:
- The person accompanying the patient refuses to leave the room. He or she may insist on serving as interpreter.
- The patient has no identification, does not know their address, and/or is unaware of the date, time, or current location.
- The patient does not make eye contact, and may display nervousness, fear, or hostility. He or she may be unwilling to respond to certain questions about their illness or injury, the story of which may seem inconsistent with findings from physical assessment.
- The presence of tattoos or branding such as “Daddy”, “Property Of”, or “For Sale”.
- Patient reports of a high number of sex partners, is dressed inappropriately, or uses language common to the sex industry.
Human Trafficking Screening Questions
The US Department of Health and Human Services Campaign to Rescue and Restore Victims of Human Trafficking has published assessment questions that can be used by healthcare staff attempting to ascertain if a patient may be a victim of trafficking. A sampling of these questions include the following:
- Can you leave your job or situation if you want?
- Can you come and go as you please?
- Have you been threatened if you try to leave?
- Have you been physically harmed?
- What are your living and working conditions like?
- Where do you eat and sleep?
- Do you sleep in a bed, cot or on the floor?
- Have you been deprived of food, water, sleep, or medical care?
- Do you have to ask permission to eat, sleep or go to the bathroom?
- Are there locks on your doors and windows so you cannot get out?
- Has anyone threatened your family?
- Has your identification or documentation been taken from you?
- Is anyone forcing you to do anything that you do not want to do?
- Where are you living now? Who else lives with you?
- Do you go to school?
- Do you have a girl/boyfriend? How old are they?
- Are you sexually active? How many partners in last 6 months?
- Has anyone offered to give you something you want in return for sex?
- Have you had sex with multiple men in one night?
- Do you need a certain amount of money before you can go home at night?
- Has anyone asked you to have sex with someone else in front of a camera or for posting on the Internet?
Human Trafficking Resources for Healthcare Providers
There are many resources available for healthcare providers who would like to more fully understand strategies related to screening for, and identifying human trafficking victims, as well as advocating for victims.
Polaris is a non-profit, non-governmental group dedicated to combating modern day slavery.Their website is.
The National Human Trafficking Resource Center (NHTRC) sponsors the National Human Trafficking Hotline (NHTH), which can be reached at 1-888-373-7888.Individuals can also text HELP to 233733 to request help or report suspected human trafficking, or email [email protected]. The website for the hotline is www.humantraffickinghotline.org.
The Human Trafficking Knowledge Portal was created by the United Nations (UNODC) to share information about the prevention, suppression, and punishment of trafficking in persons, especially women and children. The portal provides access to databases related to case law, legislation, and bibliographic materials.
The Blue Campaign is a program of the U.S. Department of Homeland Security (DHS) designed to combat human trafficking. The purpose of the campaign is to educate the public in hopes of increased awareness and reporting of suspected human trafficking.
The Trafficking Victims Assistance Program is run by The U.S. Conference of Catholic Bishops through an cagreement with the Department of Health and Human Services’ Office on Trafficking in Persons. It offers services including food and clothing, housing, safety planning, healthcare referrals, transportation, legal aid, employment training and guidance, language and educational programs, life skills and family support and immigration legal services.
HEAL (Health, Education, Advocacy, and Linkage) Trafficking is a not-for- profit organization composed of interdisciplinary professionals committed to using a public health approach in the effort to combat human trafficking. HEAL offers health care facilities the HEAL Trafficking and Hope for Justice’s Protocol Toolkit for Developing a Response to Victims of Human Trafficking in Health Care Settings to guide them in creating safe procedures and spaces for meeting the needs of trafficked patients.