Human Trafficking Definitions and Legal Considerations: Difference between revisions


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Trafficked persons are often tricked or misled into trafficking by (1) false romantic intentions, (2) promises of good employment or pay, and (3) a stable life.<ref name=”:9″ /> They can be of any gender or age, and come from any educational, socio-economic, ethnicity or nationality, or religious background. However, women and girls are at a higher risk of being trafficked for sexual exploitation.  Refugees are also often victimised due to dire living situations in refugee encampments.<ref name=”:8″ />

Trafficked persons are often tricked or misled into trafficking by (1) false romantic intentions, (2) promises of good employment or pay, and (3) a stable life.<ref name=”:9″ /> They can be of any gender or age, and come from any educational, socio-economic, ethnicity or nationality, or religious background. However, women and girls are at a higher risk of being trafficked for sexual exploitation.  Refugees are also often victimised due to dire living situations in refugee encampments.<ref name=”:8″ />

== Red Flags and the Health Impact of Human Trafficking ==

<blockquote>””’Polyvictimization”’, also known as complex trauma, describes the experience of multiple victimizations of different types, such as sexual abuse, physical abuse, bullying, exposure to family violence, and more. This definition emphasizes different kinds of victimization, rather than just multiple episodes of the same kind of victimization, because it signals a generalized vulnerability. Research shows that the impact of polyvictimization is much more powerful than even multiple events of a single type of victimization.”

”- National Children’s Advocacy Center”<ref name=”:10″>Office of Justice Programs. Mental Health Needs. Available from:,narcotics)%2C%20and%20eating%20disorders. (accessed 28/April/2023).</ref></blockquote>Survivors of human trafficking suffer physical, mental, emotional, and psychological injuries. They lose their independence and autonomy. Their quality of life is hugely and devastatingly affected. A study by Hossain et al.<ref name=”:28″ /> interviewed more than 200 survivors of sex trafficking and assessed for mental health and quality of life. They found 55% had high levels of depression symptoms, 48% had high levels of anxiety symptoms, and 77% were potentially suffering from PTSD.<ref name=”:28″>Hossain M, Zimmerman C, Abas M, Light M, Watts C. [,44&scillfp=15131976926524121165&oi=lle The relationship of trauma to mental disorders among trafficked and sexually exploited girls and women]. American journal of public health. 2010 Dec;100(12):2442-9.</ref>

”’The following table is a summary of red flags for human trafficking.”’

{| class=”wikitable”


|”’Physical Health”’


*Reproductive/sexual health: frequent treatment of sexually transmitted infections or injuries, multiple unwanted pregnancies,<ref name=”:11″>Texas Health and Human Services. Texas Human Trafficking Resource Center. Available from: (accessed 28/April/2023).</ref> lack of sexual desire or over-sexualised behaviours<ref name=”:10″ />

* Signs of physical abuse: fractures or burns,<ref name=”:11″ /><ref name=”:12″>Attorney General of Texas. Red Flags for Sex Trafficking. Available from: (accessed 28/April/2023).</ref> bruising,<ref name=”:11″ /> signs of concussion, traumatic brain injuries or unexplained memory loss<ref name=”:11″ />

* Gastrointestinal problems<ref name=”:11″ />

* Malnutrition<ref name=”:11″ />

* Changes in sleep: sleeplessness, sleep disturbances, nightmares, and/or insomnia<ref name=”:10″ />

* Fatigue<ref name=”:10″ />

* Skin or respiratory problems caused by exposure to agricultural or other chemicals<ref name=”:11″ />

* Communicable and non-communicable diseases<ref name=”:11″ />

* Oral health issues, including broken teeth<ref name=”:11″ />

* Chronic pain<ref name=”:11″ />

* Tattoos or branding of ownership<ref name=”:11″ /><ref name=”:12″ />


|”’Emotional/Psychological Health”’


*Unable to concentrate or provide basic information including age, address or time<ref name=”:11″ />

* Substance abuse<ref name=”:11″ />

* Self-harm and suicidal ideation<ref name=”:10″ />

* Depression, anxiety,<ref name=”:11″ /> panic attacks<ref name=”:10″ />

* Fear of being alone, distrust, and fear of strangers<ref name=”:10″ />

* Guilt, shame, and/or self-blame <ref name=”:10″ />

* Post-traumatic stress disorder<ref name=”:11″ /><ref name=”:25″>Chambers R, Gibson M, Chaffin S, Takagi T, Nguyen N, Mears-Clark T. [ Trauma-coerced attachment and complex PTSD: informed care for survivors of human trafficking]. Journal of Human Trafficking. 2022 Apr 18:1-0.</ref>

* Eating disorders<ref name=”:10″ />

* Suspicious behaviour: appears nervous or avoids eye contact;<ref name=”:11″ /> seems overly fearful, submissive, tense, or paranoid<ref name=”:12″ />

* Has a lack of autonomy or independence. Person will defer to another before giving information,<ref name=”:12″ /> no control over identification documents<ref name=”:12″ />

* Cultural, linguistic barriers and isolation<ref name=”:10″ />

* Withholds information. The person can be unwilling to answer questions about their health, and gives confusing or contradicting information<ref name=”:11″ />


””’Optional” in-depth reading:”’

* ”’Please read here for a list of [ Red Flags of Labour Trafficking] provided by the State of Texas, USA.”’

* ”’Please read here for a list of [ Red Flags of Sex Trafficking] provided by the State of Texas, USA.”’

”’The following table lists population-specific healthcare needs for survivors of human trafficking.”'<ref name=”:22″>REST. Population-specific health needs. Available from: (accessed 14 June 2023).</ref>

{| class=”wikitable”


|”’Immediate and short-term needs”’


* Chronic pain

* Complications from unsafe abortions

* Oral health problems

* Headaches

* Vaginal and anal health concerns

* Anxiety, depression, suicidal ideation

* Post-Traumatic Stress Disorder (PTSD)

* Somatic disorders

* Substance abuse-related health issues: abscess, HIV+, Chronic Venous Disorders


|”’Long-term needs”’


* Physical abuse counselling

* Head/neck/spine injuries

* Fractures

* Burns

* Wound care

* Sleep deprivation

* Psychosis

* Dehydration/malnutrition

* Gastrointestinal problems

* Ingestion of poisons and drug use

* Vaginal/anal pain and lacerations

* Unintended pregnancy

* Sexually transmitted infections (STIs),

* HIV exposure

* Contraception


== Interaction and Assessment of a Trafficked Person ==

Healthcare professionals can affect human trafficking with accurate identification of trafficked persons. Proper identification requires healthcare professionals to be familiar with vulnerabilities and red flags of human trafficking that may be revealed during routine assessments, especially when taking a detailed social history. A small number of human trafficking screening tools are available for use in the clinic.<ref name=”:14″>Greenbaum VJ, Titchen K, Walker-Descartes I, et al. Multi-level prevention of human trafficking: the role of health care professionals. Prev Med. 2018;114:164-167.</ref> Unfortunately, there are only a handful of validated screening tools available for clinician use.  Many of the tools would be of limited practical use in the health care environment because they (1) lack evidence-based support, especially for the health care environment, (2) have long administration times which may be difficult to utilise in the fast-paced medical setting, (3) require the administrator to have expertise in human trafficking, and (4) are only available and/or validated in the English language.<ref name=”:15″ /> Please see the resource section at the end of this article for downloadable options. 

Once a trafficked person has been identified, the healthcare professional should interact with them in the following ways:

=== ”’1) With respect for their autonomy”’ ===

* Use the term “trafficked person” or “trafficking survivor” rather than “trafficking victim” to change the misconception that persons who have endured this form of trauma are “helpless victims.”<ref name=”:16″>Macias-Konstantopoulos WL. [ Caring for the trafficked patient: ethical challenges and recommendations for health care professionals]. AMA journal of ethics. 2017 Jan 1;19(1):80-90.</ref>

* Treat trafficked persons as moral agents who have retained or can regain capacities for self-determination and decision-making power.<ref name=”:16″ />

* Trafficked persons deserve dignified respectful healthcare, which includes rights enjoyed by all patients such as: privacy in their care, and use of a professional medical interpreter. This also includes an explanation of the legal limitations of medical confidentiality due to the mandatory reporting requirements of human trafficking to the proper authorities.<ref name=”:16″ />

<blockquote>”’Special Topic: Professional medical interpreters”'<ref>Juckett G, Unger K. [ Appropriate use of medical interpreters]. American family physician. 2014 Oct 1;90(7):476-80.</ref>

It is best practice, and federal law ([ Title VI of the Civil Rights Act] requires interpreter services for all patients who are receiving federal financial assistance) for medical and rehabilitation professionals to use a professional medical interpreter when interacting with a person with limited English proficiency. 

Benefits of using a professional medical interpreter include:

* Fewer communication errors

* Interpreter can act as a “cultural liaison” and provide clarification and context to the healthcare professional

* Interpreter can clarify patient meaning beyond language

* Interpreter can function as a link between a trafficked person and the healthcare system

While there are times when a professional medical interpreter is not available and the use of an “ad hoc” interpreter such as a family member (including children) or friend are the only option.  However, use of such an interpreter can lead to the following issues:

* Non-professional interpreters may provide unsolicited advice or input

* There is no guarantee of confidentiality around topics discussed

* The medical professional may lose control of the interview due to off-topic conversations 

* Scope of inquiry may be limited by embarrassment or discomfort around about intimate or sexual issues

* Unfamiliarity with medical terminology can lead to misunderstanding and errors in interpretation

* ”Children should not be used as interpreters except in emergencies due to limited understanding of adult issues”</blockquote>

=== ”’2) With nonmaleficence and beneficence”’ ===

* All healthcare professionals have an obligation to first do no harm (”’nonmaleficence”’) and to act in the best interests (”’beneficence”’) of our patients. Examples of positive interactions between patients and healthcare providers include (1) the removal of harm, (2) the prevention of harm, and (3) the promotion of good.<ref name=”:16″ />

* The principle of ”nonmaleficence” cautions against pressuring for a disclosure that they are being trafficked, especially in the presence of the trafficker. Aggressive attempts can be psychologically harmful to the trafficked person, and can potentially trigger intense stress, anxiety, fear, and retraumatising the individual.<ref name=”:16″ />

* A trafficked person’s decision over disclosing their situation and whether to accept clinical assistance are based on the individual person’s firsthand experience and knowledge of the potential trafficker repercussions. For this reason, the patient’s decisions must be respected to the extent possible when mandatory reporting laws do not apply.<ref name=”:16″ />

=== ”’3) Considering justice”’ ===

* The unique circumstances surrounding the care of trafficked persons often challenge the concept of ”’justice”’ (the fair distribution of resources) by limiting trafficked persons’ ability to access appropriate and affordable health care outside of acute injuries and illnesses.<ref name=”:16″ />

* Many healthcare professionals do not receive appropriate education and training to recognise the signs and symptoms of human trafficking. This is significant as it leaves healthcare professionals unable to comprehensively assess and respond to the complex and challenging healthcare needs of trafficked persons.<ref name=”:16″ />

* Healthcare professionals must make treatment decisions for trafficked persons while considering the possibility of non-adherence and limited ability to follow through with long-term treatment plans, often for reasons outside of their control. Examples of pressing treatment needs for this population can include communicable diseases, substance use disorders, and mental illnesses. A healthcare professional’s decision to not test or initiate interventions due to assumptions about medical adherence must be carefully weighed against potential trafficker repercussions. At times, it may be necessary to make referrals to known and trusted organisations or other providers to find alternative options to manage the unique challenges and circumstances of trafficked persons.<ref name=”:16″ /> 

<blockquote>”’Special Topic: Mandatory Reporting Laws to Address Human Trafficking”'<ref>English A. [ Mandatory reporting of human trafficking: potential benefits and risks of harm.] AMA journal of ethics. 2017 Jan 1;19(1):54-62.</ref>

These laws include (1) mandatory child abuse reporting laws, (2) domestic violence reporting laws, and (3) laws requiring reports of knife or gunshot wounds.

”’Texas Mandatory Reporting Law”’. 

* According to Texas Family Code Section  261.101: “healthcare professionals are required to submit a report about suspected child abuse to law enforcement or the Department of Family and Protective Services (DFPS) within 48-hours of learning about the abuse.”  The duty of reporting the abuse cannot be delegated to another individual. Failure to do so is a criminal offense (Texas Family Code, Section 261.109).<ref>Texas Department of Family and Protective Services. When and How to Report Child Abuse. Available from: [,Family%20Code%2C%20Section%20261.101).,Family%20Code%2C%20Section%20261.101).] (accessed 07/September/2023).</ref>

* According to Texas Human Resources Code Section 48.051: “anyone with knowledge about the suspected abuse of a person  65 or older or an adult with a disability must submit a report immediately to law enforcement or the DFPS.” <ref>Texas Constitution and Statutes. INVESTIGATIONS AND PROTECTIVE SERVICES FOR ELDERLY PERSONS AND PERSONS WITH DISABILITIES. Available from: (accessed 07/September/2023).</ref>

”’Benefits of these laws”’: Healthcare professionals are incentivised to report human trafficking under these laws, which should increase the overall awareness of human trafficking and improve education and assessment skills within the healthcare community. Triggering an appropriate investigation can result in protective measures for trafficked persons and prosecution of the traffickers. A growing number of states have created “safe harbor” laws where trafficked persons are not treated as criminals but as survivors needing trauma-informed care and supportive services.

”’Risks of these laws”’: While mandatory reporting laws can protect and benefit trafficked persons, they also invoke vulnerability risks of trafficked persons related to their mistrust of authorities and fear of their traffickers. These reporting requirements also override the confidentiality protections that normally apply in healthcare settings. This has the potential for trafficked persons to lose trust in the healthcare system due to their fear of reprisal by their traffickers, prosecution by law enforcement, or deportation.

To ensure the protection and safety of trafficked persons, healthcare and law enforcement professionals must be properly trained in human trafficking and their roles as part of a multidisciplinary team. Trafficked persons must have access to trauma-informed care, and support systems must have the necessary resources to provide meaningful prevention and protection. With measures in place to ensure that the risks of mandatory reporting laws are limited, healthcare professionals can assume the role of mandatory reporters of human trafficking while meeting their ethical obligations. </blockquote>

=== 4) Considering how you interact ===

<big>”’The following table lists provider strategies when interacting with a trafficked person”’.<ref name=”:23″>REST. Do’s and don’ts for taking a health history and conducting a physical exam for individuals in the sex trade. Available from: (accessed 14 June 2023).</ref></big>

{| class=”wikitable”


|”’Physical posturing”’


* Maintain open and accepting body language

* Maintain relaxed body posture, neutral positions with hands at side, and be mindful to keep legs together

* Ask permission to make physical contact every time, and explain the procedure before making contact




* Don’t stigmatise, victimise, or ask unrelated questions

* Normalise the experience for the patient

* Believe and validate the patient, confront any biases, and empathise



|”’Provide empathetic and empowering statements:”’

* “It is normal to feel this way”

* “Thank you for sharing with me”

* “You are very brave to tell me”

* “I am so sorry that this happened to you. No one deserves that”

Use ”’non-judgmental language”’ such as “sex without a condom” vs “risky sex”

Use the term “survivor” vs “victim”

Encourage patient ”’autonomy”’ by saying “Is it okay if I?” instead of “I need to”

Ask “What is the most important thing you need right now?


”The information in this table is modified from the Healthcare Provider Toolkit by REST.<ref name=”:23″ />”

””’Optional”: to learn more about interacting with suspected trafficked persons, please read this [ manual] supported by the US Department of Justice.”’

== Create and Maintain a Safe Healthcare Environment ==

In addition to building trust and rapport at an individual healthcare provider level, safety can also be enhanced at a facility and/or organisational level for survivors of human trafficking. Strategies can include:

* installation of a systemwide policy to see patients alone for at least a part of every visit. Examples of policy change can include: (1) posting signage that outlines this policy in plain view in common areas, (2) staff education, (3) completing assessments and interventions only when alone with the patient.

* creation of a separation protocol to allow healthcare providers to examine or question the individual they believe is a trafficked person in a private, safe environment when there is suspicion that they are with a trafficker. The protocol should include: (1) who will carry out the physical separation process, (2) the steps to follow if the suspected trafficker refuses to comply, and (3) having a plan in place with hospital security and/or local law enforcement in case the trafficker becomes dangerous.

* It is important to document that informed consent was obtained when working with adults and to contact local child protective services when working with a minor.<ref>National Human Trafficking Training and Technical Assistance Center. Create and Maintain Safety. Available from: (accessed 15 June 2023).</ref>

== Intervention and Response ==

Healthcare providers can impact human trafficking using a multi-level approach, advocating for change from bedside care to society level.<ref name=”:14″ /> Within a clinical setting, healthcare professionals can come into contact with trafficked persons in any practice setting, including primary care settings, reproductive health clinics, medical specialities,<ref name=”:26″>Polaris Project. Human Trafficking and the Health care Industry. Available from: [,or%20most%20often%2C%20emergency%20departments.,or%20most%20often%2C%20emergency%20departments.] (accessed 26 June 2023).</ref> or most commonly, emergency departments.<ref name=”:26″ /><ref name=”:11″ />

The use of an ecological framework will provide the most holistic and wide-reaching response to human trafficking. The levels of responsibility within this framework include: (1) individual-level healthcare provider training, (2) health facility–level screening policies and response protocols, (3) community-level multidisciplinary resources and response teams, and (4) society-level awareness campaigns, funding allocation, and data collection.<ref name=”:15″ />

{| class=”wikitable”


!”’Framework level”’

!”’Examples of Interventions”’




* Training related to human trafficking, including case studies with real-life examples

* Trauma-informed care training


|”’Health facility–level”’


* Creation and use of screening policies and response protocols

* Have facility-level resources available in the electronic medical record




* 24-hour hotline

* Multidisciplinary response teams to coordinate care across the service continuum beyond the hospital or clinic through established, trusted and vetted professional relationships




* Improving awareness within the healthcare setting and greater community of human trafficking

* Provide funding for training/education opportunities

* Collect data to create and add to the profile of human trafficking


| colspan=”2″ |”The information in the table is based on data from Munro-Kramer et al. 2022.<ref name=”:15″ />”


Healthcare professionals can provide individualised ”’interventions”’ to trafficked persons to address human trafficking vulnerability factors and red flags within the safety of the health care setting. This can include:

* the initiation of established organisational protocols

* referral to trusted and vetted providers or outside organisations

* utilisation of trauma-informed and people-centred screening processes

* education on communicable diseases, substance use disorders, and mental illnesses within your scope of practice

”’Documentation”’ of human trafficking by a healthcare professional of attempted and successful assessment, care and interventions provided, and referrals made. Examples of documentation include:<ref>Human Trafficking Collaborative. Documentation. Available from: (accessed 26 June 2023).</ref>

* if human trafficking screening has/has not been completed. If screening has not occurred, document the reason why.

* if abuse, neglect, or other signs of trafficking are suspected, even if the patient denies these concerns. It is important to objectively document why trafficking is suspected.

* photographs with the patient’s written and verbal consent. It is important to explain that the photographs will become part of their medical record, which is protected by HIPAA (Health Insurance Portability and Accountability Act) and any applicable state or local medical record privacy laws.  If a situation arises where the medical record of the trafficked person is needed, legal counsel should be consulted to assist with the release of information.

””’Optional” reading: please review [ this document] by the University of Michigan Human Trafficking Collaborative for more information on healthcare documentation.”’

=== Trauma-Informed Care ===

<blockquote>”’Special Topic: Trauma-Informed of Care”’

The ”’trauma-informed”’ approach to care is strongly recommended as a beneficial framework for caring for survivors of physical and psychological trauma, which includes persons who have experienced human trafficking. For these patients, effective care requires a sensitive, compassionate, measured approach with attention to healthcare practices to limit the triggering of fear, stress, shame, and stigmatisation.<ref name=”:16″ /><ref name=”:25″ /> 

Trauma-informed care shares many principles with patient-centered care and is influenced by a healthcare provider’s understanding of the impact of interpersonal violence and victimisation on an individual’s life and development.<ref>REST. What is trauma-informed care?. Available from: (accessed 14 June 2023).</ref><ref name=”:25″ />

Examples include mindful sensitive wordage and proper verbal cues when requesting a patient disrobe for examination and assessment, and nonjudgement education on the use of contraception.

According to the US Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration, the trauma-informed approach:<ref name=”:16″ />

# ”Realises” the widespread impact of trauma

# ”Recognises” the signs and symptoms of trauma

# ”Responds” by fully integrating knowledge about trauma into policies, procedures, and practices

# Seeks to actively resist ”re-traumatisation”

</blockquote>””’Optional”: to learn more about trauma-informed care, please read this [ link] to The Healthcare Provider’s Toolkit created by REST.”’

== Multidisciplinary Team and Referral Network ==

Each survivor of human trafficking is unique and requires a different mix of services and support during their recovery journey. A strong multidisciplinary approach within the medical system and in community-based organisations and services will establish a safety net for safe return to the community. Building a comprehensive referral network will better meet the needs of survivors of human trafficking and their family members.<ref name=”:24″>National Human Trafficking Training and Technical Assistance Center. Multidisciplinary Treatment and Referral Team. Available from: (accessed 15 June 2023).</ref>

A referral network should include interactions between:

{| class=”wikitable”



|Provides collaboration with various healthcare professionals to identify and respond to human trafficking including:

* short and long-term medical treatment

* dental needs

* sexual assault forensic examination

* substance use treatment

* malnutrition and/or dehydration treatment and education


|”’Legal Aid”’


* provide information regarding legal options and advocates

* assistance with visa application

* assistance with orders of protection

* provide legal representation against their traffickers

* assist with the documentation needed for eviction and housing issues

* obtain proper legal documentation, such as proof of age and name at birth

* assist expungement relief for trafficked persons with a criminal history as a result of their trafficking

* provide family court services


|”’Community-based Organisations”’

|Often are the leaders in the development of a protocol and serve as a primary referral for a variety of services:

* housing

* interpretation/translation services

* childcare

* vocational training


|”’Social Services”’


* access to benefits for those with incomes to include: cash, food, or energy assistance

* childcare

* Head Start programmes

* child support offices

* vocational assistance programmes for individuals with disabilities


|”’Public Health Sector”’

|Can assist in preventing and identifying trafficking in a variety of ways, including:

* health safety inspectors identifying potential indicators of trafficking in businesses or homes

* community health workers monitoring the spread of disease and infection among at-risk populations

* researchers identifying methods for preventing trafficking

* incidence of trafficking and community surveillance


|”’Law Enforcement”’


* function as part of the criminal justice system

* provide referrals to local service providers

* creation of a human trafficking task force

* provide certification to assist in applying for immigration relief


|”’Behavioural Health”’

|Guide survivors to address trauma through:

* counselling and therapy services

* treatment for substance use

* sexual assault trauma services

* school-based counsellors

* medication management


|”’School-based services”’


* school-based health centres

* counselling and therapy services

* Head Start programming

* literacy programmes

* mentoring programmes

* childcare

* parental support activities such as before/after school childcare, parenting classes, GED prep classes

* accommodations for those struggling with school

* free or reduced meal programmes

* referrals to community resources


|”’Connection to other survivors of human trafficking”'<ref>Lockyer S. [ Beyond inclusion: Survivor-leader voice in anti-human trafficking organizations]. Journal of human trafficking. 2022 Apr 3;8(2):135-56.</ref>

|Survivor engagement allows networks to better serve clients by providing mentorship, identifying challenges and opportunities, and achieving agency missions and mandates.


”The information provided in this table was adapted from data given by the National Human Trafficking Training and Technical Assistance Center.”<ref name=”:24″ /><blockquote>”’Special Topic: Law Enforcement and Human Trafficking”'<ref>Police Executive Research Forum. How Local Police Can Combat the Global Problem of Human Trafficking. Available from: (accessed 26 June 2023).</ref>

As mentioned above, human trafficking is often underreported due to a lack of awareness of the crime. It is also important to note that trafficked persons are either unable or hesitant to come forward to law enforcement because of the control their trafficker has over their life. This control can include withholding of documents or identification, fear for themselves and for their family, or emotional or psychological manipulation. Trafficked persons may feel ashamed or fearful that they will be blamed for their situation. They may also fear deportation or other legal repercussions, such as losing their children or imprisonment, related to their circumstances.

Education, patience, and understanding are needed to help a trafficked person feel safe to disclose and report their situation to law enforcement. 

””’Optional” reading: for more information on law enforcement’s law in human trafficking, please read [ this report].”'</blockquote>

Trafficked persons may feel ashamed and embarrassed about their situation or think that they are to blame for their circumstances. Trauma-coerced bonding, where the survivor forms an emotional attachment to their trafficker despite repeated abuse, can occur. This can prevent the survivor from wanting to leave their trafficker or report them to authorities.

Healthcare professionals also have a wider responsibility to their greater community. As specialised educators and advocates, healthcare professionals can collaborate with community and society-level stakeholders and lawmakers to help bring about change and support for trafficked persons. This can include:<ref name=”:14″ />

* increasing awareness of human trafficking through healthcare facilities and community-level education programmes

* advocating for local and national policies which promote community health and wellness

* combating social or cultural norms that contribute to human trafficking

* creating and maintaining an evidence-based guide and training programme to prevent future human trafficking

== Resources  ==

== Resources  ==

Trigger warning. This page contains information about Human Trafficking, including physical abuse, sexual assault and abuse.

Human Trafficking is the recruitment, transportation, transfer, harbouring, or receipt of people through force, fraud or deception, with the aim of exploiting them for profit. Men, women, and children of all ages and from all backgrounds can become victims of this crime, which occurs in every region of the world.”
-United Nations, Office of Drugs and Crime[1]

The United States Department of State describes “trafficking in persons” “human trafficking” and “modern slavery” as interchangeable terms.[2]

Human trafficking is a global issue. It affects all races, genders, ages, and socio-economic groups. Recently, researchers, policymakers, and survivors of human trafficking are pushing to change the perception of human trafficking from a purely law enforcement issue to a public health issue.[3]

These crimes are widespread and occur in every segment of society. However, human trafficking is often hard to identify and remains hidden from view. Gallo et al.[3] have suggested that regular screening and monitoring for trafficked persons at locations they are likely to visit could improve the possibility of identifying and assisting more trafficked people. An estimated 22-88% of trafficked persons will come into contact with a healthcare professional during their exploitation.[4] Due to the nature of rehabilitation medicine assessment, documentation, and surveillance, healthcare professionals are well-suited to identify and assist trafficked persons.[3]

This article will provide an overview of key definitions and concepts, and the different types and dynamics of human trafficking. It will also discuss how healthcare providers can identify, assess, and assist survivors of human trafficking.

Trafficking Victims Protection Act of 2000 (TVPA) – United States Federal Law[edit | edit source]

Signed into law on October 28, 2000 by President Clinton, the Trafficking Victims Protection Act of 2000 (TVPA), amended (22 U.S.C. §7102) was created to “ensure just and effective punishment of traffickers, and to protect their victims.” The 2000 Act had three main components, commonly referred to as the three P’s.

A summary of the TVPA as quoted by the Alliance to End Slavery and Trafficking:[5]

“Protection: The TVPA increased the U.S. Government’s efforts to protect trafficked foreign national victims including, but not limited to:

  • Providing assistance to victims of trafficking, many of whom were previously ineligible for government assistance; and
  • Establishing non-immigrant status for victims of trafficking if they cooperated in the investigation and prosecution of traffickers (T-Visas, as well as providing other mechanisms to ensure the continued presence of victims to assist in such investigations and prosecutions).

Prosecution: The TVPA authorized the U.S. Government to strengthen efforts to prosecute traffickers including, but not limited to:

  • Creating a series of new crimes on trafficking, forced labor, and document servitude that supplemented existing limited crimes related to modern slavery and involuntary servitude; and
  • Recognizing that modern slavery takes place in the context of force, fraud, or coercion and is based on new clear definitions for both trafficking into commercial sexual exploitation and labor exploitation

Prevention: The TVPA allowed for increased prevention measures including, but not limited to:

  • Authorizing the U.S. Government to assist foreign countries with their efforts to combat trafficking, as well as address trafficking within the United States, including through research and awareness-raising; and
  • Providing foreign countries with assistance in drafting laws to prosecute trafficking, creating programs for trafficking victims, and assistance with implementing effective means of investigation”

In 2009, then Secretary of State Hillary Rodham Clinton identified a fourth P, “Partnership,” to serve as a “pathway to progress in the effort against modern-day slavery.” [5]

Below is a list of definitions and concepts within the context of human trafficking. Please refer to this list as needed throughout the Rehabilitation’s Role in Human Trafficking Awareness course.

  • Coercion is a means of control. It is the act of persuading another person into action by means of threats or force. According to the TVPA (22 U.S.C. §7102), coercion “may be understood as threats of serious harm to or physical restraint against any person; any scheme, plan, or pattern intended to cause a person to believe that failure to perform an act would result in serious harm to or physical restraint against any person; or the abuse or threatened abuse of the legal process.”[6]
  • Commercial Sex Act, according to the TVPA (22 U.S.C. §7102) is “any sex act on account of which anything of value is given to or received by any person.”[6]
  • Debt Bondage (also known as debt slavery, bonded labour, or peonage), according to the TVPA (22 U.S.C. §7102), is “the status or condition of a debtor arising from a pledge by the debtor of his or her personal services or of those of a person under his or her control as a security for a debt, if the value of those services as reasonably assessed is not applied toward the liquidation of the debt or the length and nature of those services are not respectively limited and defined.”[6]
  • Force, in the context of human trafficking, is a means of control over trafficked persons. The use of monitoring and/or confinement is often used during the early stages of victimisation to erode the trafficked person’s resistance. Physical forms of force used in human trafficking can include physical restraint, and physical and sexual assault. This is related to harbouring of a trafficked persons which involves isolation, confinement, and monitoring.[7]
  • Fraud, according to the TVPA (22 U.S.C. § 7101(b4)), “consists of some deceitful practice or willful device, resorted to with intent to deprive another of his right, or in some manner to do him an injury. In the context of human trafficking, fraud often involves false promises of jobs or other opportunities.” [6]
  • Human Smuggling is the exchange of fees or services to gain transportation or fraudulent documentation to illegally cross a border into a foreign country.[8]
  • Involuntary Servitude (also known as involuntary slavery), according to the TVPA (22 U.S.C. §7102), “includes a condition of servitude induced by means of (A) any scheme, plan, or pattern intended to cause a person to believe that, if the person did not enter into or continue in such condition, that person or another person would suffer serious harm or physical restraint; or (B) the abuse or threatened abuse of the legal process.”[6]
  • Labour trafficking (also known as forced labour), according to the TVPA, is defined as, “the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.”[9]
  • Obtaining, in the context of human trafficking, is the forced taking or exchange of something to gain control over another person.[7]
  • Patronising, in the context of sex trafficking, is receiving a sexual act or sexually explicit performance.[7]
  • Recruiting is the proactive targeting of vulnerable persons and the grooming of wanted behaviours by means of fraud and coercion by human traffickers.[7]
  • Sex trafficking, according to the TVPA (22 U.S.C. §7102(12)), is defined as, “the recruitment, harboring,  transportation, provision, obtaining, patronizing, or soliciting of a person  for the purpose of a commercial sex act.”[9]
  • Slavery, in the context of human trafficking, is when a controlled person is forced to provide labour and/or services against their will.[7]
  • Soliciting, in the context of sex trafficking, involves the offering a sexual act or sexually explicit performance.[7]
  • Transporting includes the movement and arrangement of travel for persons being trafficked.[7]

Human Trafficking versus Human Smuggling[edit | edit source]

Human Trafficking Human Smuggling
  • Trafficked persons are forced, defrauded, or coerced into trafficking
  • If consent was initially offered it is rendered null by exploiting labour, services, or commercial sex
  • Individuals give consent to being illegally smuggled and are involved a transaction of some sort
  • The transaction is mutual and ends at the arrival at the agreed-upon destination
Victim of the crime Committed against an individual Committed against a country
Domestic or Transnational
  • Victimisation can be transnational or domestic
  • Trafficking does not require crossing international or state borders
Smuggling is transnational by definition
Information in the above table is adapted from the Human Trafficking Fact Sheet created by the US Department of Health and Human Services Office on Trafficking in Person.[7]

Human trafficking is involuntary[edit | edit source]

The individuals are trafficked by force, fraud, and/or coercion to provide labour or services against their will. Trafficked persons do not have to be moved, relocated, or transported in any way.[7][8] It can occur in the trafficked person’s own town or home. In the United States, any person under the age of 18 who is a victim of sex for profit is automatically considered a trafficked person.[8]

The crime of human trafficking is defined by three core elements: the act, the means, the purpose.[10] This is also known as the Action-Means-Purpose (AMP) Model. This model illustrates the federal definition of a “victim of severe forms of trafficking in persons,” contained in 22 USC §7102.[11]

According to the Polaris Project: “Human trafficking occurs when a perpetrator, often referred to as a trafficker, takes any one of the enumerated Actions, and then employs the Means of force, fraud or coercion for the Purpose of compelling the trafficked person to provide commercial sex acts or labor or services.”[11]

This image is adapted from information provided by the United Nations Office on Drugs and Crime.[10]

Human smuggling is voluntary[edit | edit source]

It is the exchange of fees or services to gain transportation or fraudulent documentation to illegally cross a border into a foreign country.[12][8] Human smuggling does not involve coercion, most people seeking out these services are fleeing violence or poverty.[8]

To further your understanding of the differences between human trafficking and human smuggling, please view the following optional 9-minute video.


Consensual Commercial Sex versus Sex Trafficking[edit | edit source]

Sex work is consensual. Human trafficking is not. When you conflate the two, and you label all sex workers as victims of human trafficking, it totally takes away from the folks who are being trafficked” [14]
-Julia Baumann, founder and coordinator of Safe Space

Consensual Commercial Sex Sex Trafficking
  • All involved individuals give consent
  • Not a violation of the sex worker’s human rights[15]
  • Trafficked individual does not give consent, but is coerced into the sexual act or performance
  • Sex trafficking is a violation of the trafficked person’s human rights[15]
Person involved Sex workers are consenting adults Survivors of sex trafficking can include men, women, and children
Payment for Services Sex workers earn and keep income All income or services go to the trafficker, not the trafficked person

Consensual Commercial Sex (also known as sex work) is when a person willingly takes part in the sale of a consensual sexual act or conduct.[15]

Sex Trafficking (also known as Sexual Exploitation) is the sale of nonconsensual sexual acts or conduct through force or coercion.[15] Survivors of sex trafficking include all races, genders, ages, socioeconomic backgrounds, and nationalities.

Human Trafficking by the Numbers[edit | edit source]

It is difficult to find reliable statistics regarding human trafficking. Quality data collection is hampered by the hidden nature of trafficking, challenges of survivor identification, gaps in data accuracy, and safety and privacy concerns of sharing survivor information. Data and statistics on human trafficking may not reflect the full scope of the problem due to these reasons.[16]

The extent of human trafficking is difficult to establish and the tracking of trafficking is challenging for many complex reasons: (1) navigating legal definitions, (2) trafficker movement restrictions and isolation of trafficked persons, (3) the fear and stigma of trafficked persons self-reporting, and (4) the lack of frontline professionals trained in identification and monitoring of human trafficking.[3]

The International Labour Organization (ILO) and the Walk Free Foundation, in partnership with the International Organization for Migration (IOM) attempted to document the extent of human trafficking worldwide. They released a report on the norm/—ipec/documents/publication/wcms 854733.pdf Global Estimates of Modern Slavery in September 2022. This report estimates that, in 2021, approximately 27.6 million people were in forced labour. Of these, “17.3 million are exploited in the private sector, 6.3 million in forced commercial sexual exploitation, and 3.9 million in forced labour imposed by state.” The report also estimates that in 2021 approximately 49.6 million people were in “modern slavery.” This figure includes both the estimate for forced labour and forced marriage.[16]

Types of Human Trafficking[edit | edit source]

The US State Department recognises two types of human trafficking and classifies them as federal crimes:[2]

  1. Labour trafficking (also known as forced labour) involves the use of force, fraud, and/or coercion to obtain labour from the trafficked person. Labour trafficking can occur within any industry or sector: agriculture and meat farming, factory work, hospitality industry such as restaurants, hotels, or massage parlours; retail, mines, private homes, or drug trafficking operations.
    Two widespread forms of labour trafficking include:[2]
    • Domestic servitude involves a trafficked person performing forced labour in a private residence.[2]
    • Forced child labour involves children being forced or coerced to work. Unfortunately, forms of slavery including the sale of children, and debt bondage of children continue to exist across the world. Forced child labour is different from children who are able and choose to legally seek employment and work.
      • Some indicators of forced child labour include (1) when the child appears to be in the custody of a non-family member and their work benefits that person, (2) withholding food, rest, or schooling to a child who is working.[2]
  2. Sex trafficking involves the use of force, fraud, and/or coercion to perform a commercial sex act or conduct. The trafficked person can suffer threats of serious physical or psychological harm, threats to friends or family, or debt bondage. Sex trafficking can occur in any location including physical locations and on the internet.[2] Examples of sexual exploitation can include prostitution, escort agencies, phone sex lines, stripping on a webcam or internet chat rooms, and pornography.[17]
    • Child sex trafficking involves sex trafficking with a person under the age of 18 years. The use of force, fraud, or coercion is irrelevant, children engaging in commercial sex is illegal in most countries around the world.[2]

The United Nations, private and not-for-profit organisations, such as Stop the Traffick, acknowledge other types of human trafficking, including:

  1. Forced marriage[2][18] occurs when a person is forced into marriage under threats of force, fraud or through coercion. Situations where forced marriage may occur include: as access into a country or access to benefits.[17]
  2. Forced criminal activity[2][18] involves a person carrying out a criminal activity under threats of force, fraud or through coercion. Forced criminality can include drug distribution, cannabis cultivation, begging, pickpocketing or bag snatching, ATM theft, or the selling of counterfeit goods.[17]
  3. Child soldiers[2] involves a child serving as a soldier or committing a crime to the benefit of the trafficker under threats of force, fraud or through coercion.[18]
  4. Organ harvesting[2][18]and trafficking involves the removal of an organ or body part to sell on the black market. The trafficked person can be cheated out of an agreeable price for the organ, have an organ removed without their knowledge during treatment for another medical condition, or be kidnapped and have an organ removed without their consent.[17]

Dynamics of Human Trafficking – Trafficker and Trafficked Person[edit | edit source]

Trafficker[edit | edit source]

People who deal in human trafficking do so for monetary and financial gain. These crimes go undercounted and unrecognised because they are often difficult to detect.

Trafficker Profiles[edit | edit source]

Both US and international law state that human traffickers can be classified as corporations or other legal entities, or private persons.[19] An extensive review of federal human trafficking prosecution in the United States since the TVPA was enacted in 2000 found that the vast majority of prosecuted human traffickers were private persons. The review found that in 2020, the average defendant was a 36-year-old man, and 81% of all human trafficking case defendants were male. When comparing sex and labour trafficking cases from 2020, men made up 82% of defendants in sex trafficking cases and women made 43% of defendants in labour trafficking cases. This data was found to track with global trends.[20] However, there is no one human trafficker’s profile type and they could come from any segment of the population. Human traffickers can be foreign nationals or local citizens, family members, spouses/partners, friends, acquaintances, or strangers. They can be individual actors or part of a larger organisation. They can be pimps, gang members, diplomats, or business owners.[21]

The review went on to say that traffickers often know and have a trusting relationship with the trafficked persons. Data on sex trafficking cases from 2020, shows that approximately 43% of defendants previously knew the trafficked persons. Of these cases: 31% were social media contacts, 21% were spouses or intimate partners, 13% knew the survivor of trafficking as a human smuggler, and 10% were a friend or classmate. Data on labour trafficking cases found approximately 57% of defendants previously knew the trafficked persons.[20]

At what point a person transitions to a trafficker can be difficult to identify. The review points to the fact that the nature of the coercion used by the trafficker is highly personalised.[20]

Trafficker Recruitment Techniques[edit | edit source]

Human trafficking recruitment is often based on the deception of innocent, unsuspecting persons. Recruitment techniques commonly used by traffickers include:

  • Threats or use of violence[22]
  • Manipulation[20][22]
  • Seduction and romance[20][22][23]
  • Forced pregnancy[23]
  • False employment promises[22][23]
  • False promises about education or travel[23]
  • Sale by family[23]
  • Recruitment of formerly enslaved persons[23]
  • Abuse of religious beliefs[20][23]
  • Abduction[23] or kidnapping

In some cases, a survivor of human trafficking will become a trafficker themselves. This is most commonly the case of female trafficked person of sex trafficking.[20] This speaks to the grooming and psychological manipulation survivors of human trafficking suffer and endure.

The Trafficked Person[edit | edit source]

Trafficked persons can come from any segment of the population. However, traffickers tend to prey upon people with the following vulnerabilities:

  • poverty/economic hardship[22][21]
  • limited proficiency in local primary spoken language (English in the US)[21]
  • lack of lawful immigration status[21]
  • lack of stable safe housing[21]
  • lack of a social safety net[22]
  • following a natural disaster, war or political instability[22]
  • limited economic and educational opportunities[21]
  • psychological or emotional vulnerability[22]

Trafficked persons are often tricked or misled into trafficking by (1) false romantic intentions, (2) promises of good employment or pay, and (3) a stable life.[21] They can be of any gender or age, and come from any educational, socio-economic, ethnicity or nationality, or religious background. However, women and girls are at a higher risk of being trafficked for sexual exploitation. Refugees are also often victimised due to dire living situations in refugee encampments.[23]

North American Resources:[edit | edit source]

Texas, USA[edit | edit source]
Michigan, USA[edit | edit source]
Ontario, Canada[edit | edit source]

Clinical Tools and Resources:[edit | edit source]

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