How to detect if the patient is a victim of human trafficking

Know the signs to help some of your most vulnerable patients.

What you might imagine human trafficking victims to look like can be a completely different picture than the reality of the patient in front of you.

Although human trafficking often brings to mind sex workers, did you know 68% involves the exploitation of forced labor, according to the International Labour Organization?

Although in the U.S. human trafficking is outlawed under The Trafficking Victims Protection Act, 75% to 80% of trafficking victims in America are involved in the sex trade.

Recognizing the warning signs a patient is a victim of trafficking is crucial in the ED and other healthcare settings.

For many victims, the opportunity to escape and receive help comes when they visit a healthcare provider, according to our recent continuing education webinar on human trafficking.

10 facts that could help you treat a patient victimized by human trafficking:

1. Patients who are victims of sex trafficking might exhibit a reluctance or inability to speak, with the possibility of a companion present who does all the talking or refuses to leave. The patient might provide answers to questions that seem scripted or rehearsed.
2. Sex trafficking indicators include frequent pregnancies and/or forced abortions, frequent sexually transmitted diseases, an excessive number of sex partners. For underage victims, it also could be a history of truancy or running away.
3. Most labor trafficking in the U.S. involves foreign nationals. More than 71% entered the U.S. on lawful visas.
4. Many labor trafficking victims are indebted to someone who charged the victims “finding fees” for jobs or charged fees for transport. The fees and interest continue to accrue and the workers are unable to retire the debt and escape. One study showed 31% of Spanish-speaking laborers in Southern California had been victims of human trafficking.
5. Some trafficking victims might not be aware they are victims. Traffickers use charm and coercion tactics — preying upon vulnerable, at-risk people. Tactics can involve promises of stability.
6. Human trafficking victims under U.S. law could include children younger than 18 induced into commercial sex; adults 18 years or older; adults 18 years or older induced into commercial sex through force, fraud or coercion; and children and adults induced to perform labor or services through force, fraud or coercion.
7. Human trafficking is low risk, high reward for perpetrators, with more than 20 million victims worldwide and an economic impact globally of more than $150 billion.
8. Of the 67% of forced labor victims, 25% are children. Labor traffickers can include recruiters, contractors and employers.
9. Victims are moved often to prevent friendships, and communication with family and friends is restricted or prohibited. Some do not understand English, may be unfamiliar with cultural and legal norms and are afraid to ask for help.
10. Traffickers often target runaway and homeless youth, as well as victims of domestic violence, sexual assault, war or conflict, or social discrimination. Patients involved in trafficking may not even be aware they are victims.

What can you do to help?

Medical histories of victims are admissible in court. Document your patient’s medical history in an unbiased manner and make sure findings of “suspected human trafficking” are noted, along with unaltered direct quotes from the patient.

If you suspect human trafficking, questions you could ask include: “Did anyone you worked for or lived with trick or force you into doing anything you did not want to do?” for sex trafficking. “Have you ever worked without getting the payment you thought you would get?” for labor trafficking.

Should a patient disclose he or she is a victim of human trafficking, contact and consult with a forensic nurse and/or social worker/mental health professional.

Try to build a rapport with the patient. Offer victims information and support through the process of connecting with service providers when they are ready to report what’s happened to them.

Not all victims will be ready to seek assistance. Try to partner with the patient in making the decision to contact law enforcement.

Hospitals and health systems should have a plan in place for assessing trafficking victims, with a response process among ED residents, attending physicians, triage staff, nurses, forensic nurses and social workers to work together to care for and assist suspected trafficking victims.