DANIEL
ASEKHAME FOUNDATION------STEP AGAINST HUMAN TRAFFICKING
Human Trafficking
ABSTRACT: Human trafficking is a widespread problem with
estimates ranging from 14,000 to 50,000 individuals trafficked into the United States American College
Background
Human
trafficking 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" (1). Largely
unrecognized, annual trafficking estimates have ranged from 14,000 to 50,000
individuals in the United
States Canada
and Mexico United States
Trafficked individuals fear identification. In addition, the
networks responsible for trafficking are adept at eluding law enforcement.
Traffickers and those being trafficked have complex relationships with each
other. In some cases those trafficked may be related to their captors, fear for
their safety, or feel they would not survive without the assistance of the
trafficker.
Federal legislation, passed in 2000 and reauthorized in 2003,
2005, and 2008, aimed to punish traffickers, protect and free victims, and
eliminate human trafficking, is not well known or well enforced, and few
trafficked individuals can afford legal representation (1, 3). From 2001 to
2009 only 2,076 foreign national victims of human trafficking have been
certified by the Department of Health and Human Services (4). This significant
lack of victim identification underscores the need to better educate the public
and governmental officials about this ubiquitous problem.
Characteristics
of Individuals Being Trafficked
Individuals who are trafficked have many faces. No racial or
ethnic group is spared; however, vulnerable people, such as those of war-torn
areas or economically poor areas are more commonly subjected to human
trafficking. Some are unwittingly ensnared by human traffickers, whereas others
are desperate to escape their circumstances and then find themselves enslaved
in a worse situation. No community is immune to this problem. Eighty percent of
trafficked individuals are female and 50% of victims are minors (2, 5). Many
are paid little or nothing for their services and fear deportation because they
often do not have any identification papers. Rates of sexually transmitted
infections and human immunodeficiency virus (HIV) infection are prevalent among
these victims (6).
One million children, most of whom are girls, are exploited in
the global commercial sex trade every year (7). Many of these children are
violated by sexual acts 100-1,500 times per year (8). The United States has
federal laws against individuals engaging in sexual acts with individuals
younger than 18 years, which are the Mann Act, the Child Sexual Abuse
Prevention Act of 1994, and the PROTECT Act of 2003. States vary in their
definition of underaged sex as well as their definition of a minor regarding
prostitution laws. In addition, the Department of Homeland Security and U.S.
Immigration and Customs Enforcement have a program called Operation Predator,
which aims to identify and prevent child predators from traveling in and out of
the United States
Forms
of Human Trafficking
Trafficking involves the commercial sex industry, agriculture,
factories, hotel and restaurant businesses, domestic help, marriage brokers,
and some adoption firms. Any form of human trafficking may be operated by
organized crime, individuals, or both. Forced bondage involves placing the
victim at the mercy of their employer as can be seen in migrant workers.
Migrant workers are separated from their social support and their families at
home who often are counting on their wages and are forced to tolerate inhumane
working and living conditions, usually earning less than what was originally
promised. Involuntary servitude poses a unique challenge because it is
especially difficult to identify these cases, most of which occur in private
homes. Many of these victims, mostly women, are abused physically, emotionally,
and sexually (9).
Challenges
of Human Trafficking
The most challenging aspect of addressing human trafficking is
identifying the victims, which is problematic for several reasons. Victims may
not perceive themselves as trafficked individuals. They may fear retaliation by
the trafficker; lack knowledge of resources to help themselves; and face many
cultural, social, and language barriers. Some of these aspects are analogous to
the difficulties in identifying victims of domestic violence or prostitution.
Identifying victims is the first step in an effective strategy to combat
trafficking.
Although recognizing trafficked individuals is difficult, having
some knowledge of its existence allows for the possibility of recognition. Many
service providers and community members are on the frontline of contact with
victims of human trafficking. Health clinics, hospitals, social welfare
offices, and police frequently and unknowingly experience face-to-face contact
with trafficked individuals. Obstetrician-gynecologists may be key to the
identification of trafficked individuals. Because 80% of trafficked people are
women and girls who may be at risk of gynecologic and obstetric issues due to
their circumstances, they may go to practitioners' offices or emergency departments
for their first medical contact. The Polaris Project, a national organization
working to address human trafficking by advocating for stronger federal and
state laws, operating the National Human Trafficking Resource Center hotline
and providing services to help victims of human trafficking (see Resources),
provides a set of general and health indicators that can alert a health care
practitioner to the signs of a patient who is a possible victim of human
trafficking. Following are some of these indicators:
·
Lack of any official identification papers or cards (driver's
license, passport, green card)
·
Vague answers about their situation ("I'm just
visiting" but has no passport)
·
Many inconsistencies to their stories
·
No eye contact
·
No control of their money (someone else pays cash for their
health care visit)
·
Malnourishment
·
Signs of physical abuse (bruises, burns, cuts, broken bones or
teeth)
·
Signs of depression or posttraumatic stress disorder
·
Drug or alcohol addiction
Signs of being a victim of sex industry trafficking may include
the following:
·
Known age younger than 18 years (along with some combination of
the following signs)
·
Multiple sexual partners reported
·
Multiple episodes of sexually transmitted infections
·
Inappropriate attire for a health care visit (eg, lingerie)
·
Tattoos or other types of branding for which the patient offers
a vague explanation
·
Evidence of sexual abuse or trauma
Asking
open-ended questions of the patient regarding mental and physical health can
sometimes reveal abusive situations. Being alert to an unusual dynamic between
the patient and her partner often can lead a health care provider to suspect
abuse. Finding a way to speak to the patient in the presence of a chaperone and
away from the partner is extremely important. If the patient relates a history
of abuse in addition to being the victim of human trafficking, the National
Human Trafficking Resource Center Hotline (1-888-373-7888) can be contacted to
help determine the next steps to help the victim. It is useful to have a list of
local shelters, safe homes for abused women and children, and contact
information ready to give to women in need. Literature such as posters,
brochures, or small pocket cards (translated as necessary) can be left in
bathrooms or waiting areas where women can more discreetly obtain information
and resources. If a child is suspected of being involved in abuse, Child
Protective Services should be contacted as well as the National Center
If you think you have a victim of human trafficking in your
office, the following is important:
·
Be sensitive (every situation is different)
·
Make sure you are not putting yourself or your staff in danger
(10)
·
Contact the police if you suspect immediate danger to the victim
or yourself
·
Offer assistance—Give the patient outreach information, hotline
numbers, or both for local services (only when patient is alone)
·
Give the patient the National Human Trafficking Resource Center
(NHTRC) hotline number (only when the patient is alone): 1-888-373-7888
·
Call the NHTRC to report the incident or to locate local
victims' services: 1-888-373-7888
Only when enough victims are assured of safety can another great
challenge be met: identifying and prosecuting the traffickers. Although
organized crime is significantly involved in human trafficking, there are
plenty of individuals, sometimes family members of the victims, and small
groups running their own exploitation enterprises. Human traffickers are very
adept at using modern technology to operate their enterprises—cell phones, web
sites, and other electronic devices (eg, personal digital assistants and
smartphones). It is often very difficult to keep track of the intended use of
myriad web sites on the Internet.
Eliminating
Human Trafficking
One solution to address human trafficking is eliminating the
demand for trafficked individuals. Strategies in the United States
Costs
of Human Trafficking
Human trafficking takes an immense toll on the quality of human
life as well as costs to society. This includes degradation of human rights,
poor public health, disrupted families and communities, decreased governance,
and diminished social and economic development (3). Victims of human trafficking
require rescue, rehabilitation, and reintegration into society.
Safety
for Health Care Providers
Because traffickers may be involved in organized crime, local
gangs, or other trafficking networks, protecting health care providers and
staff working with victims is imperative. See the following suggestions for
enhancing the safety practices of physicians, staff, and patients (10) (please
note the following list includes some general safety measures along with
measures that apply to health care providers who may frequently help victims of
abuse or human trafficking):
·
Establish a relationship with the local police force and other
security personnel.
·
Obtain a security audit of the office or institution.
·
Review emergency plans periodically.
·
Restrict after-hours access.
·
Improve lighting at entrances and in parking areas.
·
Install security cameras, mirrors, and panic buzzers.
·
Install deadbolt or electronic locks.
·
Restrict access to all doors except the main entrance.
·
Preprogram 911 (emergency telephone number) into all telephones.
·
Enclose and secure reception areas.
·
Develop an emergency notification system.
Conclusion
The exploitation of people of any race, gender, sexual
orientation, or ethnicity is unacceptable at any time, in any place. It is
costly both to the people and the nation and will take the concerted efforts of
government agencies, nongovernmental agencies, law enforcement, and the public
to defeat this problem. Barriers to accurately assess the scope of the problem
include the hidden nature of the problem, fear and cultural barriers, lack of
awareness on the part of the public and public officials, the limited legal
language related specifically to human trafficking, and the lack of adequate
funding and training for those capable of identifying and assisting victims of
human trafficking (3). As health care providers to women and girls, the members
of the American College
