Identifying Victims of Human Trafficking in the Clinical Setting
Takeaways
Any patient can be a victim of human trafficking, but there are some indicators that may alert healthcare providers to a potential victim.
Vulnerable populations, such as those living in poverty or experience unstable living conditions, are most at risk for exploitation.
The National Human Trafficking Hotline (1-888-373-7888) or 9-1-1 should be alerted when there is a suspected human trafficking situatoin.
A non-English speaking male presents for an injury that was sustained at work and has evidence of old bruising. A young woman that works as an au pair presents to Urgent Care with recurring UTI’s and is underweight. A female teenager presents to the Emergency Department with abdominal pain. She acts nervous/anxious during her exam and is unable to identify where she is living. An elderly foreign-born male presents to the walk-in clinic with a severe, infected laceration, clearly days old, obtained while washing dishes. A homeschooled child with ear pain states they are not allowed to play outside. Each of these patients is a potential victim of human trafficking.
The U.S. Department of Health & Human Services [HHS] defines human trafficking as “a form of modern day slavery in which victims are subjected to force, fraud or coercion for the purpose of commercial sex, debt bondage, or involuntary labor” (2012). Any patient could be a potential victim of human trafficking. Victims can be permanent residents, foreign nationals, or even U.S. citizens (HHS, 2012). No age, race, gender, socioeconomic status is spared (Shandro et al., 2020). Victims can be any patient.
Human trafficking is found in multiple industries like domestic labor, the hospitality industry, pornography, massage parlors, agriculural or ranch work, or factory work (HHS, 2012). However, there are some populations who are at greater risk. These include vulnerable persons such as those with language barriers, living in poverty, and/or with unstable living conditions (Shandro et al., 2020). Limited support and a lack of resources makes one especially vulnerable to exploitation and trafficking.
Identification of a Victim in a Clinical Setting
Identification of human trafficking victims can be difficult as patients do not often self-identify as a victim or report abuse (Shandro et al., 2020). Besides identification of vulnerable populations, certain complaints can be suspect of human trafficking. However, victims can present to any clinical setting with any complaint. Chief complaints vary in trafficking studies but include injuries from the labor, suicide attempts and other mental health conditions associated with trauma, substance abuse, untreated chronic medical conditions, malnutrition, and injuries related to assault. However, any chief complaint may accompany a human trafficked victim (Shandro et al., 2020).
Other clinical warning signs presenting on exam may be indicative of human trafficking. These include inconsistent or a scripted story, hesitancy to answer questions, evidence of a controlling partner or dominating relationship, inability to provide an address, lack of awareness of current location or date/time, lack of identification documents, resistance to assistance, and/or demonstration of hostile or fearful/nervous behavior (National Human Trafficking Resource Center [NHTRC], 2010). Red flags during physical exams include old bruising, unhealed wounds, scars, malnutrition, dehydration, or physical exhaustion (NHTRC, 2010). A tattoo of a man’s name or a nickname in an unusual place (inner thigh, breast, back of neck) may suggest branding and should be taken as a warning sign (Shandro et al., 2020). Frequent sexually transmitted diseases and multilple abortions are common amoung sexually trafficked individuals (Shandro et al., 2020). Among agricultural, construction, or manufacturing workers, chronic back, visual, or hearing problems can be common presentations (Shandro et al., 2020). Uncommon infectious diseases such as tuberculosis and hepatitis are common among overcrowded living conditions and drug abuse (HHS, 2012).
Unfortunately, human trafficking may present without a clear red flag and only a feeling of inconsistency during the visit. Health care providers should explore situations with a patient-centered approach, working to build trust and learn more information.
How to Help
If in a human trafficking situation, do not attempt to “save the victim” or keep them in the office. This may cause more harm to the victim or provider. The goal of the visit should be to establish a place of safety and provide resources if able – not to “disclose or rescue” (Shandro et al., 2020). While difficult, allowing the victim to leave the office may be the safest and best way to help.
The first step should be to alert law enforcement at the National Human Trafficking Hotline (1-888-373-7888) (U.S Department of State [USDS], 2017). This is a national 24-hour, toll-free, multilingual anti-trafficking number that can take tips and provide information on local community resources. The hotline can also provide general anti-trafficking education and information.
If a patient has escaped a trafficking situation, alert law enforcement immediately. Calling 9-1-1 is appropriate, especially in an urgent situation such as a recently escaped victim. The National Human Trafficking Hotline can also provide immediate information and further direction on how to help the victim, including information about shelters, legal assistance, and other critical resources.
Shandro, J., Chisolm-Straker, M., Duber, H. C., Findlay, S. L., Munoz, J., Schmitz, G., . . . Wingkun, N. (2016). Human Trafficking: A Guide to Identification and Approach for the Emergency Physician. Annals of Emergency Medicine,68(4). doi:10.1016/j.annemergmed.2016.03.049
Identifying Victims of Human Trafficking in the Clinical Setting
Takeaways
A non-English speaking male presents for an injury that was sustained at work and has evidence of old bruising. A young woman that works as an au pair presents to Urgent Care with recurring UTI’s and is underweight. A female teenager presents to the Emergency Department with abdominal pain. She acts nervous/anxious during her exam and is unable to identify where she is living. An elderly foreign-born male presents to the walk-in clinic with a severe, infected laceration, clearly days old, obtained while washing dishes. A homeschooled child with ear pain states they are not allowed to play outside. Each of these patients is a potential victim of human trafficking.
The U.S. Department of Health & Human Services [HHS] defines human trafficking as “a form of modern day slavery in which victims are subjected to force, fraud or coercion for the purpose of commercial sex, debt bondage, or involuntary labor” (2012). Any patient could be a potential victim of human trafficking. Victims can be permanent residents, foreign nationals, or even U.S. citizens (HHS, 2012). No age, race, gender, socioeconomic status is spared (Shandro et al., 2020). Victims can be any patient.
Human trafficking is found in multiple industries like domestic labor, the hospitality industry, pornography, massage parlors, agriculural or ranch work, or factory work (HHS, 2012). However, there are some populations who are at greater risk. These include vulnerable persons such as those with language barriers, living in poverty, and/or with unstable living conditions (Shandro et al., 2020). Limited support and a lack of resources makes one especially vulnerable to exploitation and trafficking.
Identification of a Victim in a Clinical Setting
Identification of human trafficking victims can be difficult as patients do not often self-identify as a victim or report abuse (Shandro et al., 2020). Besides identification of vulnerable populations, certain complaints can be suspect of human trafficking. However, victims can present to any clinical setting with any complaint. Chief complaints vary in trafficking studies but include injuries from the labor, suicide attempts and other mental health conditions associated with trauma, substance abuse, untreated chronic medical conditions, malnutrition, and injuries related to assault. However, any chief complaint may accompany a human trafficked victim (Shandro et al., 2020).
Other clinical warning signs presenting on exam may be indicative of human trafficking. These include inconsistent or a scripted story, hesitancy to answer questions, evidence of a controlling partner or dominating relationship, inability to provide an address, lack of awareness of current location or date/time, lack of identification documents, resistance to assistance, and/or demonstration of hostile or fearful/nervous behavior (National Human Trafficking Resource Center [NHTRC], 2010). Red flags during physical exams include old bruising, unhealed wounds, scars, malnutrition, dehydration, or physical exhaustion (NHTRC, 2010). A tattoo of a man’s name or a nickname in an unusual place (inner thigh, breast, back of neck) may suggest branding and should be taken as a warning sign (Shandro et al., 2020). Frequent sexually transmitted diseases and multilple abortions are common amoung sexually trafficked individuals (Shandro et al., 2020). Among agricultural, construction, or manufacturing workers, chronic back, visual, or hearing problems can be common presentations (Shandro et al., 2020). Uncommon infectious diseases such as tuberculosis and hepatitis are common among overcrowded living conditions and drug abuse (HHS, 2012).
Unfortunately, human trafficking may present without a clear red flag and only a feeling of inconsistency during the visit. Health care providers should explore situations with a patient-centered approach, working to build trust and learn more information.
How to Help
If in a human trafficking situation, do not attempt to “save the victim” or keep them in the office. This may cause more harm to the victim or provider. The goal of the visit should be to establish a place of safety and provide resources if able – not to “disclose or rescue” (Shandro et al., 2020). While difficult, allowing the victim to leave the office may be the safest and best way to help.
The first step should be to alert law enforcement at the National Human Trafficking Hotline (1-888-373-7888) (U.S Department of State [USDS], 2017). This is a national 24-hour, toll-free, multilingual anti-trafficking number that can take tips and provide information on local community resources. The hotline can also provide general anti-trafficking education and information.
If a patient has escaped a trafficking situation, alert law enforcement immediately. Calling 9-1-1 is appropriate, especially in an urgent situation such as a recently escaped victim. The National Human Trafficking Hotline can also provide immediate information and further direction on how to help the victim, including information about shelters, legal assistance, and other critical resources.
Interested in learning more?
Human Trafficking
Indicators of Human Trafficking
Caring for Trafficked Persons: Guidance for Health Providers – | IOM Online Bookstore
The Role of the Nurse in Combating Human Trafficking : AJN The American Journal of Nursing
References
National Human Trafficking Resource Center (NHTRC). Identifying Victims of Human Trafficking: What to Look for in a Healthcare Setting. (2010, January 03). Retrieved December 09, 2020, from https://humantraffickinghotline.org/sites/default/files/What%20to%20Look%20for%20during%20a%20Medical%20Exam%20-%20FINAL%20-%202-16-16_0.pdf
Shandro, J., Chisolm-Straker, M., Duber, H. C., Findlay, S. L., Munoz, J., Schmitz, G., . . . Wingkun, N. (2016). Human Trafficking: A Guide to Identification and Approach for the Emergency Physician. Annals of Emergency Medicine, 68(4). doi:10.1016/j.annemergmed.2016.03.049
U.S. Department of Health & Human Services. FACT SHEET: IDENTIFYING VICTIMS OF HUMAN TRAFFICKING. (2012, August 08). Retrieved December 09, 2020, from https://www.acf.hhs.gov/archive/otip/resource/fact-sheet-identifying-victims-of-human-trafficking
U.S. Department of Homeland Security. (2020, March 25).Indicators of Human Trafficking. Blue Campaign. Retrieved December 09, 2020, from https://www.dhs.gov/blue-campaign/indicators-human-trafficking
U.S. Department of State. (2017, December 13). Identify and Assist a Trafficking Victim – United States Department of State. Retrieved December 9, 2020, from https://www.state.gov/identify-and-assist-a-trafficking-victim/
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