THE HEALTH CONSEQUENCES OF HUMAN TRAFFICKING DR. SHANE ALEXIS HEALTH… A state of complete physical, mental and social well- being and not merely the absence of disease or infirmity”. TRAFFICKING… “The recruitment, transportation, transfer, harbouring or receipt of persons by means of 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 minimum, the exploitation of 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. 5 STAGES OF TRAFFICKING… 1. 2. 3. 4. 5. Pre-departure Stage Travel & Transit Stage Destination Stage Detention, Deportation, Criminal Evidence Stage Integration, Re-Trafficking & Re-Integration Stage It appears that most of the focus of policy makers has been towards the legal and immigration considerations and not the health concerns of Human Trafficking. PRE-DEPARTURE STAGE “The period before a woman enters the trafficking situation.” Personal history; chronic illness, violence, reproductive health Quality of health services & health promotion Epidemiological & Socioeconomic conditions TRAVEL & TRANSIT STAGE “The travel and transit stage begins at the time of recruitment when a woman agrees to, or is forced to depart with a trafficker (whether she is aware that she is being trafficked or not). This stage ends when she arrives at her work destination. It includes travel between work destinations and often involves one or numerous transit points.” DESTINATION STAGE “The period that a woman is in the location where she is put to work and subjected to coercion, violence, exploitation of her labour, debt-bondage or other forms of abuse associated with trafficking.” DETENTION, DEPORTATION & CRIMINAL EVIDENCE STAGE “The period when a woman is in the custody of police or immigration authorities for alleged violation of criminal or immigration law, or co-operating, voluntarily or under threat of prosecution or deportation, in legal proceedings against a trafficker, pimp or madamme, exploitative employer or other abuser.” INTEGRATION & RE-INTEGRATION STAGE “The period that consists of a long-term and multi- faceted process that is not completed until the individual becomes an active member of the economic, cultural and civil and political life of a country and perceives that she has oriented and is accepted.” PHYSICAL ABUSE Murder Physical Attacks – beatings, knifing etc Torture – ice baths, cigarette burns etc Physical Deprivation- sleep, food, light etc Physical Restraint – ropes, cuffs, chains etc Withholding Medical or Essential care CONSEQUENCES: PHYSICAL HEALTH Death Acute or Chronic Physical Injuries Acute or Chronic Physical Disabilities Fatigue Poor nutrition Deterioration of pre-existing conditions leading to illness or death SEXUAL ABUSE Forced vaginal, oral, or anal sex, gang rape, degrading sexual acts Forced prostitution, inability to control number or acceptance of clients Forced unprotected sex, and sex without lubricants Unwanted pregnancy, forced abortion, unsafe abortion Sexual humiliation, forced nakedness Coerced, missuse of oral contraceptives or other methods CONSEQUENCES: SEXUAL HEALTH CONSEQUENCES: SEXUAL HEALTH HIV/AIDS STI’s & related complications Amenorrhea & Dysmenorrhea Acute or chronic pain during sex Tearing & other damage to vaginal tract Negative outcomes from unsafe abortion Irritable bowel syndrome Inability to negotiate sexual encounter PSYCHOLOGICAL ABUSE Intimidation of and threats to women Lies, deception & blackmail to coerce women Emotional manipulation CONSEQUENCES: MENTAL HEALTH Suicidal thoughts, self harm and suicide Chronic Anxiety, sleep disturbances Memory loss, memory defects and dissociation Somatic complaints Depression, frequent crying, withdrawal Aggressiveness, violent outbursts etc Substance abuse, addiction Loss of trust Changes in self esteem, guilt, shame Difficulty maintaining intimate relationships SUBSTANCE ABUSE Non-consensual administration & Coercive use of alcohol or drugs in order to: 1. Abduct, rape, or prostitute women 2. Control activities 3. Coerced compliance 4. Decreased self protective defenses, increased compliance 5. Prevent women from leaving or escaping CONSEQUENCES: SUBSTANCE ABUSE Overdose, self-harm, death, suicide Participation in unwanted sexual acts Addiction Brain or liver damage Needle introduced infections Dependence on drugs, alcohol or cigarettes to cope SOCIAL RESTRICTION & MANIPULATION Restricted movement, time, activities Frequent relocation Absence of social support, denial Loss of contact with family, friends Emotional manipulation by boyfriend Denial of privacy CONSEQUENCES: SOCIAL WELL BEING Feelings of isolation, loneliness, exclusion Inability to maintain supportive relationships Poor overall health; lack of exercise Vulnerability to infection Difficulty with reintegration, shunned, rejected by family etc ECONOMIC EXPLOITATION & DEBT BONDAGE Re-Trafficked, enter into high risk relationships Economic exploitation and debt bondage Turning women over to immigration, police Forced to accept long hours, number of clients CONSEQUENCES: ECONOMIC WELL-BEING Inability to afford basic hygiene, nutrition, housing, condoms etc Pharmaceuticals Increased vulnerability to STI’s Punishment – retribution for escaping Rejection HARSH WORKING & LIVING CONDITIONS High Risk, Abusive Working & Living Conditions Long work hours Dangerous working & living conditions Punishment CONSEQUENCES: OCCUPATIONAL HEALTH Occupational & Environmental Health: Vulnerability to infection, parasites, communicable diseases Exhaustion Poor nutrition Injuries & anxiety GUIDING PRINCIPLES: HEALTH RIGHTS The right to health of trafficked women State authorities must ensure women’s health & well- being; negative impact of legal proceedings, physical security Appropriate collaboration of Government agencies, health professionals, & NGO’s Trafficked women should not be subject to mandatory medical inx, or procedures (eg. HIV) GUIDING PRINCIPLES CONT’D The right to privacy & confidentiality; interviews, tests, treatments etc The right of trafficked women to their Medical & Health Records The right to timely forensic exams & relevant reports to pursue cases of rape, physical violence GENERAL RECOMMENDATIONS Recognize trafficking as a health issue Recognize trafficked women & adolescents rights to health services Develop health & health related prevention & intervention strategies Increase awareness of health risks & consequences Fund, develop & implement training & education programs Strengthen public health promotion campaigns DISCUSSION REFERENCES “The Health Risks and Consequences of Trafficking in Women and Adolescents” (Cathy Zimmerman; 2003). THANK YOU.