Individuals who experience human trafficking have a range of health consequences and many individuals with pervasive health concerns and disabilities are particularly vulnerable to traffickers. But despite up to 88% of trafficking victims accessing health care during their trafficking situation, not every health care professional may feel equipped to identify the signs or address a trafficking survivor’s needs.
Health Conditions & Recruitment
Traffickers prey on individuals with health vulnerabilities such as physical disabilities, mental health diagnoses, substance use concerns, or intellectual/developmental disabilities. These potential victims are targeted due to social discrimination and prejudice, and for their access to government benefits. Traffickers may even offer alleged therapeutic care, residential care, or substance use rehab services to entice individuals into exploitation. Recruiters may also target residential drug rehabilitation centers or behavioral and mental health clinics looking for these vulnerable populations. Substance use and existing drug debts and are also used to coerce victims into the sex trade or various forms of labor.
Victim's Access to Health Care
Most trafficking victims will have contact with health care during their exploitation including at primary care, reproductive health clinics, medical specialities, mental health, substance use disorder treatment, or most often, emergency departments. The health consequences of being trafficked can be wide ranging and unique to the type of exploitation. Increasingly, health care professionals are learning to look for signs of trafficking and to treat victims with the respect they deserve, but many interviewed survivors remember feeling judged or discriminated against when they sought treatment while being trafficked. These experiences can discourage the survivor from seeking health care later in life.
Health Care in Trafficking Operations
Labor trafficking victims are found not only among patients but within the health care workforce in residential care facilities, occupational therapy, or in-home caregiving. Foreign victims are often tricked with misleading visa contracts, indebted, and threatened if they speak up. Women from the Philippines are disproportionately affected. Human trafficking and the illicit drug economy fueling the public health issue of substance use can also go hand-in-hand. The National Hotline has documented cases of unaccompanied refugee children being forced to carry drugs across borders, adult intimate partners of drug dealers being coerced to sell drugs and sex, and runaway children trading sex for drugs at informal drug homes.
Health Care as a Means of Control
Many trafficking victims are in need of medical attention while being trafficked, however, some traffickers may fully deny or restrict access to health care like 47% of surveyed survivors reported. When victims are allowed to access health services, their trafficker may closely monitor them during health visits, preventing victims from speaking up about their circumstances or true health concerns. Sex trafficking victims are especially vulnerable to reproductive coercion from their traffickers such as denying condom use or birth control. Traffickers also tend to initiate or escalate a victim’s dependence on substances to make them more compliant or dependent.
Physical Indicators of Human Trafficking
While not all trafficking victims will show physical signs, some signs and symptoms should trigger further concern. Delayed care or an unexplained progression of an illness may be an indicator that a victim was denied access to care. Health care professionals may also note physical signs of long-term trauma, bruises in various stages of healing, signs of physical or sexual abuse, malnourishment, substance use, and poor hygiene. Labor trafficking victims, particularly those in high risk industries, may present with severe workplace injuries, prolonged and unprotected exposure to toxic chemicals, and exhaustion. Sex trafficking victims may report a high number of sexual partners, multiple STIs/STDs, multiple pregnancies, or request frequent STI/STD testing.
Behavioral Indicators of Human Trafficking
Some trafficking victims may not present many physical signs of exploitation, but will exhibit behavioral concerns. Some examples are scripted answers/stories, minimizing abuse or injuries, overly fearful or nervous behavior, being unaware of location or date/time, being unwilling or hesitant to answer questions about the injury or illness, or symptoms related to depression or PTSD. Victims may also leave against medical advice or refuse care due to a potential trafficker using threats or manipulation to pressure the victim to return to work quickly.
Environmental Indicators of Trafficking
Health care staff, particularly those in reception areas, may notice that the patient is accompanied by someone exhibiting controlling behavior over the patient. For example, the accompanying person may try to monitor or speak for the patient, become aggressive or verbally abusive, may be in possession of the patient’s ID or money, insist on filling out paperwork, or insist on being present during exams. They may also claim to be related to the patient despite not knowing critical details about their medical history or identity. At-risk patients may report high risk environmental factors such as living at work or in crowded living conditions or not have a fixed home address.
One recommendation is simply approaching every health care interaction from a trauma-informed perspective to reduce re-traumatization. Another, of course, is creating and implementing a training and response protocol for all health care professionals or adapting existing screening and response protocols from similar populations like domestic violence and child abuse. To help training efforts, we urge Congress to pass the SOAR to Health and Wellness Act to reauthorize and expand funding to ensure that health care professionals have access to comprehensive training and technical assistance. Polaris also recommends posting posting the National Hotline number where it can be discreetly accessed by at-risk patients.