The International Labour Organisation (ILO) estimates a staggering 20.9 million victims of human trafficking globally. Of these, 68% of them are trapped in forced labour; 26% of them are children, and 55% are women and girls.

While human trafficking may seem more of a social than a health issue, the World Health Organisation (WHO) has recognised that there is no guidance offered on the type of health services that should be made available or when – and under which circumstances should such provision be made.

It also stated that the healthcare sector has a pivotal role to play in the prevention of human trafficking, and care and referral of trafficked people. After all, victims of human trafficking interact frequently with the healthcare system.

“Apart from being in the presence of their minder, doctors are always present as well,” highlighted Dr Sharuna Verghis, the co-Founder and Director of Health Equity Initiatives, a non-profit NGO and Community Based Organisation in Malaysia, at the 25th Congress of the Obstetrical and Gynaecological Society. She emphasised that doctors, especially, are in a very powerful position to identify trafficking victims.

However, many doctors and medical professionals lack the knowledge to identify the signs and consequently act. Experts also urge that the awareness should not be limited to healthcare professionals only – rather, to the administrative staff as well.

Defining human trafficking

“Definitions are important because they are like diagnoses. They help us to accurately and appropriately identify cases and to make the appropriate remedies,” explained Dr Verghis.

“When we talk about human trafficking, the definition of human trafficking is derived from the Protocol to Prevent, Suppress and Punish Trafficking in Persons, which is one of the three protocols related to the United Nations Convention against Transnational Organised Crime (UNTOC),” she elaborated.

The protocol is defined by three constituent elements: The Act, The Means and The Purpose. It is the first global legally binding instrument with an agreed definition on trafficking in persons.

The Protocol to Prevent, Suppress and Punish Trafficking in Persons is defined by three constituent elements: The Act, The Means and The Purpose. Photo credit: UNODC
The Protocol to Prevent, Suppress and Punish Trafficking in Persons is defined by three constituent elements: The Act, The Means and The Purpose. Photo credit: UNODC

The intention behind the definition is for global cooperation in investigating and prosecuting trafficking in persons cases. It also aims to protect and assist the victims of trafficking in persons with full respect for their human rights.

However, critics of this protocol have focused on the weaknesses of protection of trafficked persons; as it is not a human rights treaty or a convention – especially in terms of health. In addition, many legislation frameworks focus on the victim after the crime has been committed, instead of preventing the crime from being committed.

“The Malaysian legislation adopts this international definition of human trafficking, and that is both its strength and its weakness – in that it has aligned with international standards; but the weaknesses in the international law are also reflected in the national law,” said Dr Verghis.

The basic question of “Are you okay?

Many experts and scholars who have documented stories of trafficking victims have reported that victims were in the presence of at least one healthcare professional during the trafficking process.

“But never once were they asked “Are you okay?”” lamented Dr Verghis. “Even when they said they have had several abortions or they were servicing 30 – 40 clients a day; nobody actually asked them “Are you safe? Are you okay?””

She further urged healthcare professionals to study the emerging body of knowledge on the role of medical doctors in identifying persons who have been trafficked.

Initiatives have also begun all over the world. In the US, many institutions and organisations have created training videos, provided training for employees at the hospitals and implementing guidelines to identify and help trafficking victims.

“We’re looking for signs of abuse, signs of guarding, not wanting to answer questions in front of another person, and when we see that, it raises a red flag for us,” said Carlton Hall, a clinical coordinator at Dignity Health, a non-profit corporation that operates hospitals and ancillary care facilities in Arizona, California and Nevada in the US.

Addressing other issues such as domestic violence and sexual assault

By educating healthcare professionals to identify human trafficking victims, there is an indirect benefit of the identification of other forms of abuse, such as domestic violence and sexual assault.
By educating healthcare professionals to identify human trafficking victims, there is an indirect benefit of the identification of other forms of abuse, such as domestic violence and sexual assault.

These initiatives and guidelines do not just benefit the identification of human trafficking victims – as seen in pilot screening programmes introduced to select hospitals of Allegheny Health Network, in southwestern Pennsylvania. After five months in the pilot, 38 patients were identified as potential trafficking victims; but only one turned out to be trafficked.

“Interestingly, we found that not only were formal education and treatment methods the effective strategies to improve recognition and save human trafficking victims – but, they also increased the identification of other forms of abuse, such as domestic violence and sexual assault,” said Amber Egyud, R.N., chief nursing officer and vice president of patient care services at Allegheny Health Network’s Forbes Hospital.

As such, some institutions are introducing the importance of this topic much earlier. For example, the University of Massachusetts (UMass) College of Nursing at UMass Amherst is offering a new online course on human trafficking this coming fall.

“The course will introduce students to what human trafficking is, how to identify victims, the health problems commonly associated with this population, special considerations to be aware of when working with trafficking victims and how to access services for them,” stated the UMass press release by, explaining the course structure.

“I hope that they leave with a solid understanding of what human trafficking is, including the who, what, when, where, why and how—and what it is not—and how to identify and offer appropriate support to human trafficking victims,” concluded Donna Sabella, an expert in the field of human trafficking who will be teaching the course. MIMS

Read more:
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Police raid clinics, arrest doctor suspected to be involved in baby trafficking
Multi-agency approach to tackle illegal migrants avoiding health screenings, says Malaysia’s MOH

Sources:
http://dailycollegian.com/2017/09/11/umass-college-of-nursing-offers-new-course-on-human-trafficking/
http://sacramento.cbslocal.com/2017/04/28/fight-human-trafficking-hospitals/
https://polarisproject.org/facts
http://www.who.int/reproductivehealth/topics/violence/vaw_series/en/
http://www.fiercehealthcare.com/population-health/er-staff-should-be-trained-to-recognize-signs-human-trafficking
http://www.abc12.com/content/news/Training-doctors-and-nurses-to-identify-human-trafficking-victims-440402253.html
http://www.hhnmag.com/articles/8159-human-trafficking-how-americas-hospitals-can-help
https://www.unodc.org/unodc/en/treaties/CTOC/index.html
https://www.unodc.org/unodc/en/human-trafficking/what-is-human-trafficking.html