Advice and guidance on the health needs of migrant patients for healthcare practitioners.
Human trafficking involves the recruitment or movement of people, by the use of threat, force, fraud, or the abuse of vulnerability, for exploitation.
Trafficking is a crime that can occur across international borders or within a country. It often crosses multiple geographic and legal boundaries.
Men, women and children may be trafficked for various purposes, including labour sectors (for example, agriculture, food processing, manufacturing, services), domestic servitude, forced begging and petty theft and sexual exploitation.
Trafficked people are likely to experience multiple physical and mental health risks prior to, during and after their trafficking experiences, and many suffer acute and long-term health problems.
Health consequences of human trafficking may include injuries, physical pain and illnesses, sexual health problems and mental health problems, such as depression, anxiety, psychosis and post-traumatic stress disorder.
High levels of sexual violence are reported among women trafficked for sexual exploitation and domestic servitude, with high levels of symptoms of sexually transmitted infections reported by men and women. Healthcare professionals should obtain a sexual history from trafficked people who access health services.
UK healthcare professionals play an essential role in the identification, referral to further services (shelter, legal aid, law enforcement) and clinical care of trafficked people.
Trafficked people experience many barriers to primary care both while they are trafficked and following their escape. Registration should be made as simple as possible and need not rely on providing proof of address. Interpretation should not be provided by a person accompanying a patient suspected of having been trafficked.
A healthcare provider’s role in cases of human trafficking may be either to treat, help identify and refer a possible trafficked person to other services, or to treat a trafficked person who has already been identified and referred for medical care. Recent research has found that up to 1 in 8 NHS professionals report previous contact with a person they knew or suspected had been trafficked.
Health problems commonly experienced by trafficked people
Trafficking can be thought of as a process comprising various stages, starting with the recruitment stage and followed by travel and transit, destination and exploitation stages. The exploitation stage may also be followed by periods of detention or re-trafficking, and later by integration (if remaining at destination) or re-integration (if returned home). Each stage poses different risks to a trafficked person’s health and wellbeing. They may be at risk of psychological, physical and sexual abuse, forced and coerced substance abuse, social restrictions and manipulation, economic exploitation and debt bondage, legal insecurity, occupational hazards and abusive working and living conditions.
- mental health issues such as anxiety, depression, psychosis, PTSD, suicide ideation, self-harm, somatic complaints, aggressive behaviour, memory loss and cognitive problems
- poor physical health such as acute injuries, chronic physical pain, fatigue, exhaustion, poor nutrition, sexually transmitted infections, other sexual and reproductive health complications and unwanted pregnancy
- substance use or misuse such as drug or alcohol addiction, overdose, self-harm, needle-introduced infection, and sleep problems
- social health consequences such as feelings of isolation, loneliness, shame, guilt, social withdrawal and risk of re-trafficking
- finance-related problems such as inability to afford basic hygiene, medical care, nutrition and housing
- legal and security problems such as long periods in immigration detention centres or prisons, denial of health treatment from public clinics and services, traumatic reactions to experiences and risk of re-trafficking
- occupational injuries and disease such as bacterial and other infections, chemical burns, injury, musculoskeletal injury, exhaustion and poor nutrition
Underlying these risk categories is the added difficulty of being a member of a marginalised group.
Detecting and responding to a person who may have been trafficked
Trafficking is a hidden crime and it is rarely obvious that an individual has been trafficked. However, ‘red flags’ might include a combination of being a migrant in work commonly associated with trafficking (such as labour industries), signs and symptoms of abuse or trauma, appearing fearful and untrusting and presence of a minder.
Caring for trafficked people
How people respond to traumatic experiences can vary widely and can be influenced by cultural norms, age, education, gender and personal histories. As a result, there is no simple ‘right way’ to approach and care for all trafficked persons. However, there are some ABCs of caring for people who have been trafficked to consider (Gender Violence and Health Centre). You should:
- assure patient and provider safety by consulting with the patient before contacting other support services (such as the police) to be sure this is what they want
- avoid using possible trafficked person’s ‘friends’ or ‘relatives’ for interpretation and do not give out personal contact details
- be prepared with good referral options and procedures by having contact details for the main agencies to hand, so no time is wasted looking these up. Try to make referral as easy as possible by providing the trafficked person with contact names or referral letters
- create a clinical safe space for disclosure, discussion and decision-making by learning about the effects of traumatic events, acknowledging and addressing abuse in informed and sensitive ways and doing your best to make the time and private space for individuals to disclose and describe events and concerns
When caring for trafficked people, draw on approaches used for other vulnerable populations, such as victims of violence or torture, other migrants, sex workers (if relevant) and consider age- and gender-related needs. Using a patient-centred approach, which makes the patient central to the decision-making process, can help prevent disempowering or re-traumatising individuals who have been trafficked. Care for trafficked people requires a multi-agency approach, so it is important to learn about collaborating agencies and identify good coordination mechanisms.
Referral options – adults
National Referral Mechanism referrals
The UK has implemented an NRM, a process by which potential victims of trafficking are formally identified and offered temporary government funding in the UK. After receiving support, a person who has no other rights to live in the UK, or who wants to leave the UK, will be supported to return to their country of origin. If a referred person is determined not to be a victim of trafficking and there are no other circumstances that would give them a right to live in the UK, they will be supported to return to their country of origin.
NHS professionals cannot refer directly into the NRM, but with the patient’s consent may contact the Salvation Army’s referral helpline.
Other referral options
A small number of charities provide support to victims of trafficking who have not been referred into the NRM. The Modern Slavery Helpline takes calls from potential victims and statutory professionals concerned about trafficking and can advise on relevant services and referral options.
Referral options – children
NHS professionals concerned that a child or young person may have been trafficked have a legal obligation to follow all child protection guidelines and speak to their designated Child Protection Lead. Out of hours, contact your Local Children’s Social Services or police service, specifically highlighting your concern about child trafficking.
Modern slavery: identifying and supporting victims: guidance from the Department of Health for health staff who suspect that a patient may be a victim of human trafficking and slavery.
The Modern Slavery Helpline can be contacted on 08000 121 700 by potential victims or statutory professionals concerned about trafficking and provides advice on relevant services and referral options.
Caring for Trafficked Persons: Guidance for Health Providers – developed jointly by the International Organization for Migration and the London School of Hygiene and Tropical Medicine.
The Salvation Army provides accommodation, care and support to victims of trafficking. They can provide assistance with referral via their helpline: 0300 303 8151.
The NSPCC Child Trafficking Advice Centre can provide further advice for professionals worried that a young person may be a victim of trafficking via their helpline: 0808 800 5000.
The Helen Bamber Foundation is a human rights organisation working with survivors of cruelty.
unseen(UK) aims to provide safety, hope and choice to women who have been trafficked for sexual exploitation.
Protecting Children and uniting Families Across Borders (CFAB): information for practitioners, including a free national advice and information helpline.
The PROTECT project (Provider Responses, Treatment and Care for Trafficked People) conducted by King’s College London and the London School of Hygiene & Tropical Medicine provides evidence about the healthcare needs and experiences of trafficked adults and children and documents NHS knowledge and experience of responding to the health needs of trafficked people. The full research report is available online.
NHS Health Education England provides e-learning courses for general practice (e-GP) on promoting equality and valuing diversity, safeguarding children and young people and women’s health.
Freedom from Torture (FfT) provides training and capacity building for frontline healthcare, social and legal workers to address the needs and rights of survivors of torture.
A Quick Guide to Modern Slavery/Human Trafficking for GPs is available from the Royal College of General Practitioners in their safeguarding adults toolkit.