http://www.ssireview.org/articles/entry/the_fight_against_human_trafficking?utm_source=Enews&utm_medium=email&utm_content=3&utm_campaign=From_Mag&goback=%2Egde_4165508_member_261215072
The knowledge, skill, and compassion of the health care community can help stop modern slavery.
(Illustration by AAD Goudappel)
Today, with the 150th anniversary of the signing of the Emancipation Proclamation upon us, Americans are renewing their commitment to the eradication of human trafficking. Modern slavery, or human trafficking as it is often called, occurs in a wide range of situations. But commonly it takes one of three forms: forced commercial sexual exploitation, illegal organ transplantation, and illegal labor exploitation.
The scale and scope of modern slavery are alarming. Although no definitive estimates of the number of US trafficking victims exist, the National Human Trafficking Resource Center hotline fielded 19,427 calls in 2011. And a 2004 US State Department report estimated that 14,500 to 17,500 people are trafficked into the United States each year.
Americans have responded by implementing new laws that reflect current practices in trafficking. For instance, in November 2012, California voters overwhelmingly approved a proposition that requires stronger criminal penalties for sex traffickers. Nearly every US state now has a human trafficking statute in place. Enslavement crimes are also receiving renewed attention nationally.
Although trafficking in the United States today is common, global trafficking is even more alarming. The International Labor Organization’s 2012 Global Estimate of Forced Labour concluded that nearly 21 million trafficking victims exist worldwide. Reliable statistics are difficult to obtain in part because trafficked persons resist being classified as victims. In other words, some victims may not be able or willing to reveal themselves to authorities, thereby unwittingly becoming complicit in the process of trafficking.
What is being done to combat trafficking globally? Despite the passage of criminalization laws in more than 125 countries, only a small number of prosecutions for human trafficking have been reported worldwide, and fewer than 50,000 victims have been identified—a tiny fraction of the total. The ineffectiveness of these efforts suggests a heightened need for international law enforcement efforts, but it also suggests that solely focusing on the capture and prosecution of suspected traffickers is insufficient to eradicate the problem. More victims need to be located and cared for.
Furthermore, eliminating global human trafficking requires societies to confront the underlying social and economic causes of modern slavery (such as familial poverty and gender discrimination) to prevent subsequent generations of trafficking. To that end, the US Department of State has advocated a tripartite approach to addressing global trafficking: “prevention, criminal prosecution, and victim protection.”
A New Kind of Partner
The anti-trafficking field needs to enlist a new kind of partner to accomplish prevention and victim protection and to prosecute crimes in light of the psychological, physical, and social processes of trafficking: health care workers. Why are health care workers in a prime position to help? First, they may be the first professionals to come into contact with trafficking victims—that is, traffickers may bring victims into hospitals and clinics for medical treatment, and trafficked persons may present themselves for care. From decades of experience working with domestic violence victims, health care workers have honed specialized skills and knowledge to handle a trafficking situation. They are familiar with treating victims’ injuries and illnesses, building trust, and taking account of the psychological challenges associated with trafficking. A second reason relates to the nature of trafficking itself: violence is a well-established medical and public health issue as well as a legal issue. Remediating trafficking requires its prevention, early diagnosis, and comprehensive treatment—all facets of health care delivery.
Strategically, anti-trafficking work and health care are a natural fit. As President Barack Obama said in a 2012 speech before the Clinton Global Initiative, “[Human trafficking] ought to concern every nation, because it endangers public health and fuels violence and organized crime.” The physical and mental health issues that trafficking victims face range from missing organs to psychological trauma to stunted growth to pelvic injury from sexual abuse. A 2010 American Journal of Public Health study, led by Cathy Zimmerman, of sex trafficking survivors in Europe revealed an association between trafficking and various mental health problems, specifically post-traumatic stress disorder.
Sex trafficking poses special concerns for population health, too. A 2007 Journal of the American Medical Association study, led by Jay Silverman, of nearly 300 Nepalese sex-trafficked women and girls revealed that 38 percent were HIV positive—in other words, trafficking contributes to the spread of HIV. Organ trafficking victims may suffer a host of chronic illnesses related to a lack of access to follow-up health care after organ removal. And labor trafficking victims may face numerous physical, biological, and chemical hazards due to unsafe working conditions.
The scars of trafficking may be durable. The process of trafficking often escalates through stages of psychological trauma that may initially render a trafficking victim unable to conceive of alternatives to enslavement. As Nicholas Kristof has reported in the New York Times, released slaves may return to enslavement because of stigmatization. Permanent disengagement requires redefinition of alternatives, the construction of psychological safety, and the recouping of identity. Thus liberation from enslavement is a complex medical and non-medical challenge.
Engaging Providers
What can be done to better engage members of the health care community? We at the Massachusetts General Hospital (MGH) Division of Global Health and Human Rights (in the Department of Emergency Medicine) have interviewed hundreds of antitrafficking experts in Brazil, India, the Philippines, the United Kingdom, and the United States as part of the Human Trafficking Initiative, which investigates the potential role of local health systems in combating trafficking.
Over the past four years, we have found that several steps must be taken to deepen the engagement of health care providers on the trafficking issue. Foremost, more efforts to raise awareness among health care providers about trafficking are desperately needed. Currently, knowledge about human trafficking is very low among physicians, nurses, and other health care workers in the United States. Given that trafficking victims may frequent hospitals and clinics, it is imperative that health care workers understand both the warning signs of trafficking and how to respond if they encounter a trafficking case. This means training not only physicians and nurses, but also hospital security personnel, administrators, and anyone else who might witness a trafficking situation.
Fortunately, several major US health stakeholder groups have recently taken action. For example, the US Department of Health and Human Services provides educational materials on victim identification and treatment for health professionals through its Campaign to Rescue & Restore Victims of Human Trafficking. It has developed simple screening questions that health care workers can ask, such as “Can you leave your job or situation if you want?” and “Has your identification or documentation been taken from you?”
Likewise, the Florida Medical Association recently developed a mandatory continuing medical education supplement on domestic violence and human trafficking for its physician members. At MGH, we have developed a rigorous curriculum and training program on trafficking for health care workers. In 2011 and 2012 we conducted more than 30 lectures and training sessions. Participants tell us they wish they had had our training years ago, because they can recall certain patients who, in retrospect, fit the profile of a trafficking victim. We have plans to scale up training in hospitals, medical schools, and allied health schools throughout the United States in 2013. In collaboration with the Massachusetts Medical Society, we are developing a manual on human trafficking for physicians. Raising awareness among practicing health professionals and trainees is an important first step in bringing recognition of human trafficking into the medical mainstream.
The larger public health community can draw on its rich history in violence prevention to develop evidence-based, durable strategies to combat human trafficking. The fields of epidemiology and biostatistics should harness their expertise in studying “hidden” populations to develop novel methods to determine trafficking prevalence and identify potential risk factors. In addition, health researchers should conduct more research on the short- and long-term health consequences of all types of human trafficking, to increase our knowledge base and develop appropriate systems of care for victims. These activities will accelerate the public health community’s understanding of human trafficking and inform evidence-based prevention and intervention strategies.
Health care remains one of the few settings in which a trafficking victim may interact on her own with people from the outside world. As one service provider in Los Angeles told us, training health care workers is vital to combating trafficking, “because really, when women are in these situations, it’s kind of the last stop. . . . She may be in a place where she’s going to actually die.” This observation serves as a sobering reminder of the knowledge, skill, and compassion the health care community can and must bring to bear on a hidden issue that deserves full exposure—and the unique opportunity for new partnerships within the anti-trafficking field that could spawn effective strategies to attack this awful crime against humanity.
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