Advice and guidance on the health needs of migrant patients for healthcare practitioners.
Human trafficking involves the recruitment or movement of people for exploitation by the use of threat, force, fraud, or the abuse of vulnerability.
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.
Individuals who have been trafficked 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:
- support GP registration, which does not require proof of address or immigration status
- use professional language interpreting services and not family members, friends, children or accompanying person (for safeguarding reasons and to minimise risk of coercion)
- obtain a detailed medical history and sexual history from survivors or suspected victims of trafficking
- identify and report suspected human trafficking and modern slavery
- refer individuals to relevant services and specialist health services where needed (physical and mental health)
- apply trauma-informed approaches to service provision
- collaborate with agencies outside of the health and social care sector to identify and coordinate good prevention and response mechanisms, as part of a broader multi-system and public health approach
Trafficking is a process comprising various stages, starting with recruitment and followed by travel and transit, destination and exploitation. 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
- occupational injuries and disease, such as bacterial and other infections, chemical burns, injury, musculoskeletal injury, exhaustion and poor nutrition
- marginalisation and social exclusion
Individuals who have experienced human trafficking encounter many barriers to primary care both during and after exploitation.
Identifying human trafficking
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.
Refer to the HEAL Trafficking and Hope for Justice’s Protocol Toolkit for Developing a Response to Victims of Human Trafficking in Health Care Settings for more information on how to conduct interviews with patients.
Healthcare professionals can report suspected human trafficking in a number of ways.
Caring for people who have been trafficked
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. 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 family, friends or children for language interpreting interpretation (the perpetrator may pose as a relative or friend, and may accompanying a patient to their appointments)
- 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 people who have been trafficked, you should also:
- apply trauma-informed approaches to service provision
- use a patient-centred approach, which makes the patient central to the decision-making process and helps prevent disempowering or re-traumatising individuals who have been trafficked
- draw on approaches used for other vulnerable populations, such as victims of violence or torture, other migrants, sex workers (if relevant)
- consider age- and gender-related needs
A multi-agency and public health approach is needed for modern slavery and human trafficking prevention and response. In some regions, the health sector is involved in anti-slavery partnerships, but it is currently more common for NHS Trusts, CCGs/ICSs, national and local public health teams to be absent from the system-wide response. Healthcare professionals should collaborate with agencies outside of the health and social care sector to identify and coordinate good prevention and response mechanisms.
National Referral Mechanism referrals
The UK has implemented a National Referral Mechanism (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 for 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 contains guidance from the Department of Health and Social Care for health staff who suspect that a patient may be a victim of human trafficking and slavery.
The Home Office’s modern slavery training resources contains basic awareness raising materials and provides examples of training products available to public sector professionals and other individuals that might come across victims to help raise awareness, better spot the signs and increase confidence in reporting modern slavery when potential cases are encountered.
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 was 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) provides 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.
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.
The University of Sheffield, Public Health England and the Office of the Independent Anti-Slavery Commissioner developed ‘A public health approach to modern slavery’, which is an evidence-based approach to developing a strategy for action on modern slavery in the UK. It includes:
- an interactive framework
- a guide for policy, strategy and local partnerships
- a full report
The VITA Network connects individuals and organisations involved in modern slavery and human trafficking prevention, intervention and aftercare. They promote a whole-person health and public health-informed approach.