Recognizing Human Trafficking:
Guidelines for Health Care
Providers
by Safe Horizon
This training tool was developed for and in collaboration
with the New York City Mayor’s Office
Survivors of Human Exploitation Working Group.
Note to the Audience
•
Human Trafficking is modern day slavery. The impact on the health and wellbeing of
the men, women and children who are the victims of this crime is serious and long
lasting. Developing a public health response to this issue is a critical step to ensure
that survivors are identified and receive proper care and support.
•
“Recognizing Human Trafficking: Guidelines for Health Care Providers” is a power
point presentation intended to be used as an introduction for medical professionals
who may come into contact with victims of human trafficking in the context of their
daily practice. The slides describe numerous trafficking indicators which will help the
professional both to identify and appropriately respond to the victims they may
encounter.
•
Victims of human trafficking have often been subjected to severe and complex forms
of interpersonal trauma that can have an effect on the way that victims interact with
medical professionals. The trafficking information set out in this presentation has
been put together with the health professional in mind. However it is by no means
exhaustive. To make the best use of this presentation, we recommend that health
care providers meet with an anti-trafficking service provider or expert to tailor and
facilitate trainings that address the specialized needs of the staff.
Human Trafficking
• Trafficking is the practice of exploiting adults and
children for use as commodities in conditions of sexual
and labor servitude.
• Tactics used by recruiters, traffickers and their
associates are often the same tactics used by batterers
and can mirror dynamics of domestic violence.
• Trafficking is not limited to formal work sectors. It can
occur wherever there is work.
People are trafficked for many kinds
of work and sexual exploitation
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Debt Bondage
Sex Industry
Domestic Labor
Agricultural Work
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Restaurant Work
Factory Labor
Commercial Sex Acts
Construction
Traffickers often accompany victims
at all times and can be:
• Friends/Family/Romantic
partners
• Sex industry managers and
“Pimps”
• US and International
government employers
– e.g. Diplomats
• Legitimate employers
– e.g. Households with
domestic workers
Photo: Kay Chernush for U.S.
State Department
Trafficked persons are:
Labor Trafficked
Female
Adults
Youth/minors
US Citizens
Foreign nationals
Sex Trafficked
Transgender
Male
Elements of human trafficking
1
PROCESS
Recruiting
OR
Harboring
OR
Moving
OR
Obtaining
2
3
MEANS
by
Force
OR
Fraud
OR
Coercion*
END
For the purposes of
Involuntary Servitude
OR
Debt Bondage
OR
Slavery
OR
Commercial Sex Acts
*Minors involved in commercial sex do not need to prove
force, fraud, or coercion.
Source: Freedom Network Training Institute
Common red flags
in health care settings
Environmental/ Situational
• Suspicious employment situation
• Dependence on “friend” or co-worker to answer questions
• Abusive relationships
Verbal/Emotional/ Psychological
• Providing health provider with contradictory information
• Suicidality, depression
• Fearfulness, anxiety, trauma symptoms
Physical
• Untreated injuries, explanations inconsistent with injuries
• Multiple STIs or abortions
• Evidence of sexual abuse
Common red flags in
health care settings (continued…)
Medical Indicators:
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Delayed medical care
Headaches
Fatigue
Abdominal Pain
Back pain
Severe/untreated dental problems
High blood pressure
Malnourishment
Drug or alcohol addiction
Common red flags in
health care settings (continued…)
Trauma Indicators:
• Unusual reactions to gynecological or breast exam
(appearing fearful, screaming, sobbing, tensing up as if
expecting intense pain, hyper-ventilating, fainting, going
totally limp)
• Unusual reactions to disrobing in doctor’s office
(trembling, sweating, stomach upset)
• Sexualized behavior or seductiveness, particularly in a child
(seeking inappropriate proximity to nurse or doctor)
Common red flags in
health care settings (continued…)
Trauma Indicators:
• Flinching or jerking away from contact
• Lack of responsiveness (appearing checked out as if in
another place, not responding to verbal prompts or name)
• Confused, having difficulty paying attention
Common red flags (continued…)
Special Considerations for Minors:
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Involved in commercial sex industry
Runaway/ homeless youth
Abusive relationships
Survivors’ trauma and situation
impacts medical assessment
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Fears consequences of identifying as victim:
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retaliation by trafficker - especially common are threats made against
family members or loved ones
deportation (foreign national)
social services interventions (especially for youth who previously
experienced abuse or harassment in foster care placements)
In crisis mode
Trouble recounting history/details
May not self-identify as victim
Loyalty to trafficker(s)
Cultural/language barriers
Mistrust of health professionals
Limited understanding of rights
Best practices when interviewing a
trafficked person
• Use the same words the patient is using and don’t correct
them, especially as it refers to their relationships and
situation.
• Be open to unfamiliar narratives and stories.
• Use your authority to create a safe space for talking:
Always speak with your patient privately.
• Always use professional interpreter services when a language
barrier exists.
• DO NOT rely on a friend or associate of the patient if
interpretation services are required.
• Use a trauma-informed, non-judgmental approach when
interviewing patients.
Recommended line of inquiry
Excerpted from Caring for Trafficked Persons Handbook, IOM, July 2009 and Domestic Violence Assessment Guide, Family Violence
Prevention Fund, 2008.
Traffickers often prevent trafficked persons from receiving regular
medical care. However, trafficked persons commonly find
themselves in the Emergency Room when injury or illness escalates
to the point of becoming life-threatening.
Ask simple, direct questions such as:
• Are you in a personal or work relationship with a person who
physically harms or threatens you?
• You seem to be in a hurry to leave. We are here to help you
and it is important that you remain for treatment. What is
making you feel anxious to leave right now?
• Have you been hurt while working on the job either by
someone you work for or with?
If you think your patient is a victim
of human trafficking
Communicate messages of hope:
• You have rights.
• You are not alone and not to blame.
• You are entitled to services and help.
Assess safety:
• Are you afraid to go home?
• Do you have a safe place to stay?
• What would happen if you didn’t return to your work
site/residence this evening?
Make referrals:
• Connect your patient with the hospital social worker, or
• Connect your patient directly with an appropriate service
provider
If an identified patient is not ready to
accept your help…
Validate/normalize their feelings:
• Reassure them that they have the choice not to accept your
help at that time.
Provide information:
• Many trafficked persons will seek assistance for their situation
when they feel safe and able to do so.
• Tell your patient where they can go for help in the future
(i.e. return to the clinic).
• Make sure to communicate options verbally since traffickers
are likely to destroy written instructions if they are found.
If you think your patient is a victim
continued…
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Do not try to rescue the patient.
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Do not ask about the patient’s immigration status.
•
Do not contact authorities without patient’s permission
(unless mandated to do so).
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Do not make promises you can’t keep.
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Provide the patient with contact information for a social
service agency or call 311.
Safe Horizon services for trafficked
persons
• Social Services
– Access basic needs and benefits, health care, housing,
education
– Safety Planning
– Interpretation
• Legal Services
– Rights-based education
– Immigration assistance (where non U.S. Citizen)
– Criminal Justice Advocacy and Support
Services for trafficked youth available through
Safe Horizon’s Streetwork Project
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Street outreach
Drop-in centers
Emergency shelter
Drug counseling & referrals
On-site medical help
On-site psychiatric help
Computer access
Meals & food pantry
Showers & laundry
• Wellness counseling &
services
• Syringe exchange
• Overdose prevention training
• Low-threshold buprenorphine
assessment & treatment
• Hygiene supplies
• Safer sex supplies
• HIV testing and counseling
• Groups
Referrals
Safe Horizon
Adults:
Anti-Trafficking Program
718-943-8631
Youth:
Streetwork Project
646-214-3817
Comprehensive Provider Directory
http://www.nyc.gov/html/endht/downloads/pdf/
human_trafficking_services_resource_directory.pdf
References
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Human Trafficking Services Resource Directory.
http://www.nyc.gov/html/endht/downloads/pdf/human_trafficki
ng_services_resource_directory.pdf
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Caring for Trafficked Persons Handbook, IOM, July 2009.
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Toolkit to Combat Trafficking in Persons, Global Programme
against Trafficking in Human Beings United Nations Office on
Drugs and Crime, 2008.
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First Aid Kit for Use by Law Enforcement First Responders in
Addressing Human Trafficking, UN GIFT Global Initiative to
Fight Human Trafficking.
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Domestic Violence Assessment Guide, Family Violence
Prevention Fund, 2008.