Human trafficking is a form of modern slavery. It’s also a $150+ billion global industry that, by current estimates, entraps over 27 million people around the world. It is a global problem that will require collective action to address, and healthcare workers can play an essential role — provided they know what to look for.
That’s because healthcare workers are rarely trained to recognize the signs of trafficking. So, while many trafficking victims will eventually seek health care, workers may not recognize them as victims. By knowing what to look for and how to respond, healthcare workers can help current victims find the support they need and prevent continued victimization.
Here’s what you need to know to recognize and respond to human trafficking in a healthcare context.
The U.S. Department of State considers “human trafficking” and “trafficking in persons” as larger terms that can refer to either compelled labor or sex trafficking. Both are defined by the Trafficking Victims Protection Act of 2000 as:
Despite the term “trafficking,” human trafficking does not require movement. People who can be considered trafficking victims include those who:
Human traffickers prey on people of all ages, backgrounds, and nationalities, exploiting them for profit. There are an estimated 27.6 million victims worldwide1 and The U.S. Department of Health and Human Services’ Administration for Strategic Preparedness & Response (ASPR) reports that human trafficking affects every community in the United States across age, gender, ethnicity, and socio-economic backgrounds.
The U.S. Trafficking Victims Protection Act of 2000 officially made human trafficking a federal crime. The act not only defines the conditions of human trafficking, it also provides law enforcement and government officials the tools and authority to address and combat trafficking both worldwide and in the U.S.
Instances of human trafficking in health care environments are common, as traffickers tend to prey on individuals with health vulnerabilities. Potential victims can include those with physical or mental health disabilities, substance use concerns, or developmental disabilities.
These individuals make appealing targets to traffickers because they often have access to government benefits and may be isolated due to social discrimination and/or prejudice. Traffickers may offer alleged sources of health care, including therapeutic or residential care, to lure individuals into exploitation.
Human traffickers may also target drug rehabilitation centers or behavioral and mental health clinics to find vulnerable individuals. Traffickers will offer substance use rehab services to entrap individuals, and then use either the promise of further substance use or the threat of drug debts to coerce victims into the sex trade or forced labor.
Disasters can also also increase the risk of human trafficking,2 as they disrupt systems that are in place to protect people, creating chaotic conditions where human traffickers can exploit people in need — including individuals who require aid or children separated from their families.
Most trafficking victims will have contact with healthcare workers during their exploitation. According to a survey by the Polaris Project, 69% of respondents reported having had access to health services at some time while they were being trafficked. Trafficking victims will often seek medical care, as 85% of respondents also said they had received treatment for an illness or injury directly related to their forced work or exploitation.
Other studies have also found that a high percentage of human trafficking victims —anywhere between 50–88% — will access health care while being exploited. This often involves seeking services at emergency care departments but can also include requesting services at reproductive health clinics, mental health treatment facilities, substance use disorder treatment facilities, or healthcare specialists. As one of the largest areas of human trafficking in the world,3 every region of the United States has seen reports of human trafficking from healthcare professionals.
Heatmap of healthcare professionals who’ve contacted the National Human Trafficking Hotline from December 7, 2007 — December 31, 2017
While healthcare professionals are very likely to come into contact with trafficking victims, they may not possess the proper training to recognize and address their own implicit biases. Victims of human trafficking will likely fear authority figures and be reluctant to give out personal information1, and many interviewed survivors remember feeling judged or discriminated against when they sought treatment.
“I did [go to the hospital] one time because I was pretty beat up….I sat there for 6 hours and the nurses… they were talking back there and looking at me, and [saying] “You know, well she looks like she deserved it.”
— Anonymous survivor | Polaris Report
Any healthcare professional that wants to address human trafficking should learn how to look for signs of trafficking in health care and the ways they can treat victims with the respect they deserve.
“During the time I was on the street, I went to hospitals, urgent care clinics, women’s health clinics, and private doctors. No one ever asked me anything anytime I ever went to a clinic.”
– Lauren, survivor | National Human Trafficking Resource Center
Healthcare workers on the front lines are often the only professionals able to interact with trafficking victims who are still in captivity. Being trained in how to assess signs of tracking makes it easier to identify victims, while learning how to approach victims can increase the odds of interviewing and offering aid to them.
According to the AMA Journal of Ethics’ recommendations on education and training in human trafficking, “The medical education of healthcare professionals should be grounded in a victim-centered, culturally relevant, evidence-based, gender-sensitive, trauma-informed perspective and include the essential components of prevention and identification of trafficking and treatment of trafficking-related health conditions.”
Healthcare professionals who may be able to recognize victims of human trafficking, and so would benefits from medical education on human trafficking, include:
According to different authorities on human trafficking, including Polaris, The National Human Trafficking Resource Center, and the Administration for Strategic Preparedness & Response, the major signs of human trafficking include physical, behavioral, and environmental indicators.
As a healthcare worker, if you come across someone who may be a victim of human trafficking, call the National Human Trafficking Hotline (NHTH) at 1-888-373-7888. You should call the hotline if you notice the above indicators, even if you are not sure that your patient is a victim of human trafficking. Reporting human trafficking does not require divulging individually identifiable patient health information, and so does not risk violating the HIPAA privacy rule.
To effectively recognize victims and provide them the care they need, organizations that work against human trafficking recommend that healthcare facilities require staff at all levels — from receptionists and registration staff to physicians and nursing staff — complete substantive training on human trafficking.
If you want to build the skills and knowledge necessary to identify human and sex trafficking and learn how to provide safe and appropriate health care for trafficked persons, enroll in USD PCE’s course on Human Trafficking Training for Healthcare Professionals.
Graduates who fully participate in the program will be able to:
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