Each year about 17,500 individuals are brought into the United States and held against their will as victims of human trafficking. Some estimate the number is as high as 60,000 annually. These numbers do not include those who are here from previous years, migrants already in the US, runaways, displaced persons, and those from oppressed/marginalized groups and the poor. Combating human trafficking is a daunting task and emergency healthcare providers have a critical role to play. Medical providers are a frontline of defense for victims - especially providers in an emergency department setting. Victims present here, often with their traffickers, and receive medical attention but not the further help they need to remove them from the environment that places their lives at risk daily. Emergency healthcare providers often miss the signs of human trafficking, mistake the signs for intimate partner violence, and are rarely aware of how to help. Instead victims are sent back "home" with their traffickers. This situation can change and it must. Emergency care providers must identify these victims and provide the opportunity for appropriate treatment. This website contains information to give practitioners a basic introduction to what human trafficking is, the clinical presentation of such patients, and the unique treatment needs of this patient population. Click on the "Educational Tools" tab for helpful instruments in educating providers at your institution. Click on the "In the ED" tab if you suspect you are caring for a trafficked person.

Human Trafficking is

Trafficking can result from a real or a perceived threat; the victim only has to believe that he/she or loved ones are in danger, they do not actually have to be in danger. The victim believes that if s/he does not do what the trafficker demands, regardless of the traffickers actual ability to follow through with said threat(s), there will be dire (physical, financial, or other) consequences. Traffickers use a variety of techniques to control their victims. A hallmark of the criminal industry is the sophisticated use of psychological and financial control mechanisms, often minimizing or precluding the need for physical violence or confinement.

Human Trafficking targets

Trafficking affects both people from the US and not from the US. Sometimes the victim came, of her/his own accord, to the country and then fell into trouble; sometimes victims are duped from the very beginning; sometimes they are from the US. A victim of trafficking does not speak a particular language or have a particular race; a victim of trafficking can look like anyone

Who is a trafficker?

Traffickers may be professional or non-professional criminals because of the low-start up cost of creating a trafficking business. Trafficking is appealing because it is so lucrative: it is the third largest illegal industry worldwide.

Statistics

are often hard to come by in this field. Trafficking is an illegal industry so finding out just how many victims there are annually is difficult. Conservative estimates say that 15,000 people are trafficked into the U.S. annually, while others guess the number is high at 60,000. It is reasonable to say that whichever number or wherever in between the truth lay, the number is one too many. Finding local statistics may also be difficult, but local organizations are better equipped to tell you how big of a problem trafficking is in your area. Ideally, you need to know the number of persons trafficked locally, the number of victims presenting as emergency care patients, and the number of survivors who escaped because of hospital intervention. Also important to know are which facilities the referrals are coming from. States with the greatest concentration of trafficked persons are New York, California, and Florida; Washington DC also has a large trafficked population.

Laws

State and federal law are very clear that minors constitute a special population that requires special protection. While the trafficking of an adult can only be reported to authorities if the adult consents, if a minor presents to a healthcare facility and is identified as a victim of abuse, this abuse must be reported.

What happens next?

After a trafficking victim is identified there are a few things that can happen, all of which depend on what the adult survivor wants. In an emergency setting the patient is identified as a trafficking victim and then the provider calls a help hotline or a social worker (who should contact the help hotline. The patient should be allowed to speak with the person from the hotline if s/he wants to)

Police Corruption

This is an unfortunate but real phenomenon of our communities. It is especially unfortunate in circumstances like those that surround human trafficking because the very people who ought to aid trafficked persons cannot always be counted on to help. Sometimes victims have already had prior negative experience(s)7 with law enforcement, which makes them scared of police and, in general, mistrustful of institutions and people that are supposed to help. Because some police receive pay-offs from traffickers to look the other way, providers are not always aware of who can be trusted in their local police departments. Thusly, providers should not call the police when they identify a trafficked person; the help hotlines will know what to do and whom to trust in law enforcement. Furthermore, providers should assure the patient that the police will not be called without their permission. Note that this does not mean all law enforcement are corrupt, but that those few have tainted the reputation of the institution and the result is that trafficked persons, in general, do not trust law enforcement officials. It takes a great deal of time and effort to rebuild that trust and local anti-trafficking advocates are qualified to help rebuild that trust. Law enforcement is receiving training about and in dealing with human trafficking victims, but because of victims pre- and sometimes misconceptions about police, hotlines should be called not police.

Medical Documentation

The standards that apply to a rape victim can be applied to a trafficking victim, regardless of whether s/he was sexually exploited, as the patient is in a fragile emotional, mental and psychological state and this condition ought to be respected in the process of medical documentation. Documentation is important not only in the event that the patient decides to involve the justice system, but also because if s/he does not choose escape at the time, a note in a patient's chart will give the next providers an important heads up about the situation (assuming the patient presents to the same healthcare facility again, using the same name).

Medical Treatment (for sexually exploited patients), courtesy of Kathleen Morrow, CNM, MA;

NGOs and Trafficked Persons

Anti-trafficking non-governmental organizations offer trafficking victims a safe place to recover with the support of survivors and advocates. Temporary housing, clothing, food, healthcare, counseling, food stamps and legal aid are provided, and educational (GED and ESL classes, for example) and job opportunities are offered (all at no cost to the survivor). Anti-trafficking NGOs can also help international survivors get T-visas. Anti-trafficking NGOs are the experts in helping trafficked persons survive beyond their escape. As advocates they are committed to the well-being of this population and some are survivors who know the population implicitly. They can answer the questions that providers have about laws, the population make-up, prominent types of trafficking in the area, and anything else about trafficking. These types of NGOs are the best resources from which to get information about and for trafficked patients. Note that all NGOs are not familiar with the needs of human trafficking; you can use section 4 of this document to help determine which groups are knowledgeable about the needs of trafficked persons.

The Disease of Human Trafficking

Key to understanding the emergency provider's role in the anti-trafficking movement and in treating a trafficked patient is understanding that the emergent issue, which causes the patient to present, is only a symptom of a disease: human trafficking is the disease. The same way that victims of intimate partner violence need to be removed from a dangerous living environment, trafficking victims need to be separated from their trafficker. Just as providers understand that fatigue, mental confusion, shortness of breath and pruritis may be symptoms of kidney disease, we must also acknowledge that cigarette burns, ligature marks, depression, and malnutrition may be symptoms of human trafficking. Merely treating the symptoms of kidney disease does not serve the best interests of the patient, nor does treating the symptoms of human trafficking but sending the patient back home. Human trafficking, as a disease, must be considered as a differential when a patient presents to the ED with certain symptoms.

Illustrative Narratives

Read the stories of "Jill Leighton", "Ashek Hamid", and "Ricardo Veisaga". There are different kinds of trafficking and these stories only illustrate three. All three of these people could (or did) present as trafficking patients in an ED and all of them would demonstrate signs or symptoms of trafficking; think about who would present in what way(s).b