Addressing human trafficking through health systems: a scoping review

“There was never one time that anyone ever asked me: 'Are you okay?'”

Addressing human trafficking through health systems: a scoping review from WHO/Europe

8 May 2023

Jane Lasonder was trafficked for sexual exploitation as a child, at a very young age. “I didn’t even know that it was called trafficking, because that wasn’t a word that was used many years ago.”

“I can’t really put into words the terror. It was so horrific and traumatic. But what was even worse was that I often got injuries, like a fractured skull or broken arm; and I was underfed.”

She ended up in hospital many times during that period. As with so many other trafficked people, she did not receive the care she needed because she was never identified as a trafficked person. Looking back, she describes feeling left alone and invisible: “Not one doctor or one nurse ever came to me and said: ‘Why are you sitting here, terrified? Why have you got another injury?’”.

Feeling totally alone, Jane became scared of hospitals: “I remember being so scared I could hardly breathe. I was totally scared of doctors and hospitals and having all these injuries that weren’t normal and having to go through even an abortion at the age of 13. Not one doctor or nurse who saw me, and I looked about 10 then, even questioned why there was a terrified pregnant girl with injuries”.

Jane would have hoped for more support from the doctors and nurses she saw as a child. Every time she went to hospital was a missed opportunity.

Not an isolated story

Unfortunately, Jane’s story is not an isolated case. The latest data from the United Nations Office on Drugs and Crime (UNODC) shows that at least 20 000 people were trafficked in Europe and central Asia in 2020 alone. These numbers are on the rise in the WHO European Region and are most likely an underestimate as many trafficked people, still to this day, remain undetected.

Human trafficking is the recruitment, transportation, transfer, harbouring or receipt of people through force, fraud or deception, with the aim of exploiting them for profit. It is a lucrative crime that exploits men, women and children and can happen to anyone. It does not necessarily involve crossing a border; it can also happen within national boundaries.

A new WHO/Europe scoping review found that frontline health workers are often the only public employees to meet trafficked people during their ordeal. However, many trafficked people remain unidentified.

“The main problem is finding out that they are in a trafficking situation, because if they come with an acute condition, they have a broken arm or something, then you treat the broken arm – and if you don’t think about it, then you don’t see the problem with the person behind the broken arm,” says Charlotte Møller, Senior Consultant at Aarhus University Hospital in Denmark, who has treated trafficked individuals for years.

Trafficking affects people everywhere

Trafficking affects people in all WHO Member States, regardless of the national economy, rates of migration or gender equality legislation. WHO/Europe asked survivors of human trafficking to share their experiences.

Shandra Woworuntu, the Chair of the International Survivors of Trafficking Advisory Council, asks health workers to “look beneath the surface”. Describing a situation where she opened up to health workers about her dire situation, she felt let down: “The nurses were talking about me behind the curtain.… The psychiatrist laughed and told me that I wasn’t telling the truth. ‘Are you sure you experienced that?’ he asked”.

Wide-ranging impacts on people’s physical and mental health

Human trafficking has impacts on people’s health, with wide-ranging physical and psychological harms. To address these, trafficked individuals need a variety of physical and mental health-care services, including sexual health care, counselling and dentistry. During trafficking, individuals often experience traumas leading to mental health conditions such as post-traumatic stress disorder or depression.

Regina Lee Jones, a survivor of human trafficking, tells us: “When I think back, I think that if a doctor had taken the time to ask how I was, they would have realized that something was wrong. I wish doctors would talk more about trauma and mental health. Knowledge about it in recent times has helped me a lot. It can really help when you know what is wrong and why”.

Health systems can play a vital role in addressing trafficking

Health systems and health workers are uniquely positioned to identify, treat and protect trafficked people and those at risk of being trafficked. Speaking from his experience about how hard it was to access health services without a regular migration status, a male survivor based in Belgium points out: “I never had a connection with a doctor because I was illegal. I was afraid of doctors because I thought they would take me to the police. That’s what my boss told me”. He emphasizes that it is important that everyone, independent of migration status, is informed about their rights and how to access health services.

The scoping review puts forward the following policy considerations:

Those trafficked need universal, affordable access to health care – regardless of status or resources.
Addressing trafficking requires the involvement of multiple sectors. No country or sector can do it alone, but health systems play a vital role.
Health professionals need training on survivor-centred, trauma-informed care. A lack of training on trafficking leaves the health systems they work within unprepared.
Standardized protocols, and screening and reporting systems applied when indicators of trafficking are recognized help health workers to provide appropriate care.
Trauma and trauma responses need to be placed at the centre of standards of care for trafficked people and trafficking survivors.
Harm reduction policies should mitigate individual-level risk factors such as barriers to reporting abuse.
The goal of identifying trafficked people is quality of care, empowerment and a safe space, not disclosure.

Speaking up and raising awareness

Today, Jane uses her voice to speak up against trafficking. She raises awareness and provides training to medical students. “I can’t go out and save the world, but I can go out and save one person’s daughter or one person’s son. And if it was my daughter or my son, then I would do everything to help this one person.”

Links:

Addressing human trafficking through health systems. A scoping review

YouTube paylist: Human Trafficking