By Dr. Jarrod Sadulski, Faculty Member, Criminal Justice
Medical facilities and their staff are in a unique position to identify and provide help to human trafficking victims. Healthcare providers are often the first to have contact with trafficked women and girls.
In fact, up to 88% of human trafficking victims access healthcare during their exploitation, according to surveys from the Polaris Project. Medical professionals are extremely important because they are more easily able to identify the indicators of human trafficking.
Emergency Departments: The Primary Venue for Identifying Human Trafficking Victims
The Polaris Project surveys discovered that emergency departments were the most common venue for medical care that are reported by human trafficking survivors. The surveys included these statements from victims:
- “I was only able to see health care providers on a dire basis. Even when I had broken bones, and I’ve had 85 broken bones that were documented, many more that were never documented because I couldn’t go.”
- “The only time I was ever admitted to the hospital, I had a UTI that got so bad that I had some type of e-coli strain. So I was actually like two days away from kidney failure by the time I went in.”
- “I was beat up in a hotel room, so I went to a hospital. My cheekbone was fractured and the nurse was awful to me, treated me less than human. It was because of the commercial sex lifestyle.”
- “I used to go every month to outpatient reproductive health clinics for testing. They would say, ‘No, you can’t get an HIV test every 30 days.’ I wouldn’t necessarily say that I was a sex worker, but that I had multiple partners. But somebody that’s getting tested so frequently, that should be a huge red flag.”
Delayed Medical Care Can Also Indicate That a Patient Is a Victim
For victims, interactions with medical care facilities can vary. For example, victim restrictions and control of medical access by human traffickers, coupled with a lack of access to regular preventative care, often results in minor infections or illnesses remaining untreated until they become an emergency. Therefore, delays in medical care or the unusual development of an injury or illness should be a red flag for medical personnel regarding potential human trafficking.
Healthcare Workers Have a Unique Opportunity to Identify Trafficking’s Warning Signs
Healthcare workers have a unique opportunity to recognize and provide help for human trafficking victims due to the confidential nature of healthcare settings. Indicators of trafficking can be recognized by professionals at different levels within the healthcare facility, including receptionists, nurses, medical technicians, or physicians.
Some of the potential indicators that medical personnel may observe include:
- Another person with the patient and who coaches the patient on what to say
- Unexplained origins of an illness or injury
- Physical signs of long-term trauma
- Bruises at various stages of healing or that are unusual, such as bruises that indicate someone was forcefully grabbed or struck
- Unprotected exposure to toxic chemicals
- Communicable diseases, malnourishment, poor hygiene, or substance abuse
- Suspicious tattoos or signs of branding that indicate a trafficker’s ownership. Branding tattoos are often located in inconspicuous places, such as on the inner lip of someone’s mouth or on the back of the neck that is covered with hair.
- Patients who are unwilling or unable to answer questions about their injury or illness
- An overt fear of someone who accompanies the patient
- Suicidal ideation, symptoms of Post-Traumatic Stress Disorder (PTSD), or nervous behavior
Patients who are victims may be accompanied by someone who is not a family member. There are several behavioral signs that are a red flag of human trafficking. These red flags include:
- Someone who refuses to let the patient be alone with a medical provider
- Someone in control of the patient’s identification or money
- Someone who claims to be related to the patient, but who does not know critical details about the patient’s medical history or other common information a family member would normally know
- Someone who attempts to fill out the patient’s paperwork without consulting the patient
- Someone who is verbally aggressive with the patient
Some Victims Are Often Too Terrified to Provide Information
Patients who are being trafficked are likely to not be immediately forthcoming about their situation. Often, they are too scared.
Traffickers frequently threaten violence toward their victims if they speak to anyone about their exploitation. That same threat of violence is often extended to the victim’s family or loved ones.
Healthcare Providers Must Be Proactive in Identifying Victims
While responses to potential indicators of human trafficking vary depending on the situation, it is important that healthcare facilities provide victims with an opportunity to seek help. Many victims may not even realize that they are human trafficking victims, what is occurring to them is illegal, or there are resources ready to support them.
Human empathy and sympathy are other factors in encouraging victims to seek help. The Polaris Project had a human trafficking victim explain that “I think that posters about sex work or trafficking might serve as an indicator to show that they at least know what that is. But I think the main thing is empathy and just asking the right questions.”
Medical professionals must be proactive in their approach and having discussions with patients when indicators of human trafficking are present. Since the presence of a trafficker with the patient may make this discussion challenging, there are strategies that can help.
One strategy, for instance, would be to have a communication system set up in advance. For example, when suspected human trafficking victims go to the restroom in a medical facility, the patients can either leave a note for medical staff that they are in danger or make a call on a house phone that connects a patient to a receptionist. In this scenario, it would be important for law enforcement to be immediately notified if people disclose that they are in danger.
Another strategy would be to create a space for honesty and voluntary disclosure when patients reveal that they are human trafficking. If patients disclose that they are human trafficking victims and are not in immediate danger, medical staff through their experience in trauma-informed care should follow established protocols to educate and provide resources to patients.
From their experience, human trafficking victims in the Polaris Project survey noted that protocols and assessments should not be solely focused on identifying a victim and promoting a disclosure. The aid should also include healthcare professionals engaging with victims on safety planning, assessing their needs, providing resources for support, and ultimately working with them as partners in determining the best way out of their unique circumstances.
Escape from human trafficking may include immediately contacting law enforcement or providing literature on human trafficking victim advocacy programs, depending on the situation. For medical facilities that wish to develop protocols to support human trafficking victims, one good option is the HEAL Trafficking and Hope for Justice’s Protocol Toolkit for Developing a Response to Victims of Human Trafficking in Health Care Settings.
It is essential that healthcare professionals continue to build their knowledge of human trafficking warning signs, as they are on the front lines and are in an important position to identify and help victims. I recommend that healthcare facilities require staff at all levels complete substantive training on recognizing and responding to human trafficking.
One of the most comprehensive training options available that is free of charge for medical staff is through SOAR Online. It is a series of self-paced online training modules that enable medical staff to earn Continuing Education Units or Continuing Medical Education. This training is specifically designed for medical staff.
Human trafficking continues to be a major problem in the United States and worldwide. But medical professionals serve as an important resource to recognize and combat this problem.