GLOBAL: Helping health providers treat trafficking victims

Wednesday, November 5, 2008

Health providers – frequently the first professional a trafficking victim consults for help – are often thrust into the fight against organised crime without adequate preparation, according to the International Organization for Migration (IOM). The agency says there is an urgent need to ensure care for trafficking victims and hopes to fill the gap with its soon-to-be released guidelines for health workers.

Expected by the end of December, the global guidelines are intended to help health providers identify and treat victims of trafficking. A panel of experts in health and human trafficking has been collaborating on ways to instruct health providers about the dangers of treating victims of trafficking – persons who are recruited or transported to work under coercive, abusive conditions, according to the UN.

Cathy Zimmerman, the guidelines’ lead researcher who specialises in health and human trafficking at the London School for Hygiene and Tropical Medicine, told IRIN that prosecuting traffickers has had a higher priority than treating their victims. “The focus has been on training police [and] immigration officials and lost in the mix has been health care for the victims. There are all sorts of global manuals for law enforcement, but nothing on the basics of care and treatment of trafficking victims.”

Zimmerman said this is a “huge gap” because health providers’ instincts might put them and their patients at danger: “What do you do if you are working in an emergency room setting and a girl comes in because of haemorrhaging? She has had a miscarriage, shows signs of being abused, is under age and you suspect she is being held captive. Your first instinct might be to sneak in the back and call the police. But what if the police are complicit and part of the [smuggling] network? What if it was the police who brought her over the border?”


One of 17 information sheets that make up a draft of the manual is “Actions if you suspect trafficking”; for the above scenario it instructs the provider to talk to the girl and call an aid agency.

Topics covered in the information sheets include health risks and consequences, communication and working with interpreters, physical protection and security, safe referrals, mental health care, urgent care, and interactions with law enforcement.

Trafficking expert Zimmerman said health workers should be cautious about whom they trust when treating trafficking victims: “Someone’s uncle may be translating. The health provider must consider the possibility that he is both the trafficker and the uncle.”

Geneva-based IOM officer Rosilyne Borland told IRIN some patients are brought to the hospital by people who do not have their best interests in mind. “A trafficking victim for sexual exploitation is less profitable for their trafficker if they have a sexually-transmitted infection. The trafficker will bring them in for treatment, which can be a dangerous situation.”

Borland added that even when victims escape and seek care on their own, they may not be out of danger: “Even if they are taken out of immediate danger, there is still the element of organised crime that threatens them. They may be followed. People who say they are officials or the media may seek information. The risks are higher for violating patient confidentiality [than in regular patient care settings]. The impact of disclosure would be disastrous, not just unethical.”

Whose truth?

Zimmerman and her expert panel team describe in the soon-to-be-released guidelines how much more difficult it is to pry the truth about someone’s condition when they have been subjected to coercion and physical and psychological abuse.

Abdoulaye Diop, a physician who works with street children in Dakar through the NGO Samusocial Senegal, told IRIN children working in forced labour have learned how to protect themselves: “Children tell the truth, but at first it is their truth, their reality. They are in denial and they fear telling the [real] truth. But if you are patient, the truth will come out one day, but you cannot push them against a wall and force it out.”


ILO estimates more than 12 million people are in forced labour worldwide; around 43 percent of human-trafficking victims are commercial sex workers, while about one-third are exploited in agriculture, private households and sweatshops. Most cases of forced labour involve exploitation by private agents. But researcher Zimmerman warned against getting caught up in the legal definition of trafficking: “How exploited do you have to be to be considered trafficked? Trafficking as a label can be exclusive and cut out people who need help.”

Rather, she said, it is more urgent to restore dignity to patients who have been abused: “When you have been held captive, tortured, you lose control of what happens from one moment to the next. You simply have no idea what happens next. We [health providers] can start restoring that sense of control in the clinic setting.”