HUMAN TRAFFICKING and Health Care - Stanford University

HUMAN TRAFFICKING
AND HEALTHCARE:
Modern-Day Slavery and
Its Effects on the Health of
Teens and Children in the U.S.
Kristin Collins, D.O.
Aimee Grace, M.D.
Morning Report
August 12, 2009, Stanford University

Shauna’s Story
(as told on the Today Show @ msnbc.com)
16 y/o female—Shauna Newell—in Florida, a
respectable, safe, careful teen
Fellow 16 y/o “Kathy” became a good “friend” and
invited her to sleep over
Shauna drank “water,” blacked out, woke up and
realized she was being raped over and over
She was sold on the Internet for $300,000, then found
by witnesses
No one has ever been charged in the kidnapping,
gang-rape, and torture of Shauna Newell
She is scarred emotionally for the rest of her life

What is Human Trafficking?
The recruitment, transportation, transfer, harboring,
or receipt of a person for the purposes of sexual or
labor exploitation, forced labor, or slavery.
27 million slaves in the world today.
Types include:
Sex trafficking
Forced labor
Child soldiering
Organ removal
War brides

Victim Recruitment
False-Front Agencies
Employment, modeling, marriage agencies that promise
better lives in rich nations, and create debt bondage
Local Sex Industries
Promise higher wages & better working conditions
Abduction/Kidnapping
“Push” factors:
Poverty—parents may sell children
Political instability, internal displacement, & civil wars

The Facts
800,000 people are trafficked annually across international
borders, and vulnerable people are targeted
80% are women and girls, and up to 50% are minors
Trafficked from Asia, former Soviet Union, Africa, Eastern Europe,
and Latin America
Primary destinations: Italy, U.S., Germany, Netherlands
14,500-17,500 people are trafficked into the U.S./year
According to the U.S. State Dept., CA is the primary U.S. destination
Attorneys from the U.S. Dept. of Justice have prosecuted slave-trade
activity in 91 cities and nearly every state in the U.S.

The Facts, cont.
Rivals drug trafficking and illegal arms for the
top criminal activity on the planet
Victims often “invisible”—may toil in the public
eye for long hours with no pay, deprived of
basic freedoms (i.e. play, school)
Generates ~$32 billion annually in revenue

Focus on Sexual Trafficking
An estimated 2.5 million children, the majority
of them girls, are sexually exploited in the
multibillion dollar commercial sex industry
Biggest child pornography market worldwide is
in the U.S.

Trafficking & Teens in the U.S.
Adolescents are a vulnerable group at risk!
Most common form of trafficking in the U.S. is
underage prostitution
Youth under 18 y/o cannot legally consent to
prostitution Congress has included it as a form of
severe trafficking
In a representative sample of over 13,000 U.S.
adolescents, 3.5% admitted to having exchanged
sex for drugs or money
400,000 American youth who are being prostituted
or are at risk for being prostituted in the next year

What can health care providers do?
Healthcare professionals play KEY roles for
victims
1) We are among the only professionals
likely to encounter the victims while they are
held by their trafficker
2) We can take care of their health needs

Victim Recognition by Physicians
In one study, 28% of trafficking victims encountered
a healthcare professional while still in captivity
None of these encounters resulted in the victim being
freed because of lack of training in recognizing victims
Suspicious signs:
Patient accompanied by controlling person, who may
insist on giving health information
Visible signs of physical abuse
Patient is unusually fearful or submissive, does not
speak English, is a recent immigrant, and lacks a
passport or other immigration/identification documents

Victim Recognition by Physicians, cont.
Separate the patient from the potential trafficker
Sensitively question the patient about the situation
Try to find a native speaker to establish rapport
Sample questions:
Can you leave your work if you want?
When not working, can you come and go as you wish?
Have you been threatened by harm if you try to quit?
Has anyone threatened your family?
What are you living or working conditions like?
Is there a lock on your door or windows so you can’t get out?

Victim Recognition by Physicians, cont.
If the patient may be a victim of human trafficking,
call the Health and Human Services hotline at
1-888-3737-888
Trained personnel will help determine whether the
person is truly a victim of trafficking and help get
them connected to local resources that can help

Victims of Trafficking and Violence
Protection Act of 2000
Allows victims to:
Remain in the US and receive federal and state
assistance
Seek witness protection
Increases prison terms for all slavery violations
from 10 years to 20 years
Adds life imprisonment where the violation
involves the death, kidnapping, or sexual abuse
of the victim
Greatest hindrance to revealing the truth is fear of
deportation and prosecution

Caring for Victims’ Health Needs
Infectious diseases, i.e. HIV/AIDS, STDs
Noninfectious diseases
Reproductive health problems
Unwanted pregnancies, forced/unsafe abortions
Substance abuse
Mental health problems
PTSD very common, also depression, anxiety, +SI
Physical trauma
Bruising, broken bones or teeth, mouth injuries, cuts, burns

Further Factors Affecting Health
Unsafe and unpredictable “work” conditions
Deprivation of food and sleep
Extreme stress
Hazards of travel
Somatic symptoms & other sequelae of abuse
Headaches, back & body aches, dizziness, nausea,
visual problems
Illegal activities very limited access to health care
Emotional manipulation, i.e., blackmail & threats
Inability to recuperate and integrate into society

What Can I Do?
Get educated
Movies: Trade, Born Into Brothels, Call and Response
Books: Not for Sale (David Batstone), Stolen Lives by
Sietske Altink
Websites:
National Human Trafficking Resource Center:
http://www.acf.hhs.gov/trafficking/index.html
Pacific Alliance to Stop Slavery:
http://www.traffickjamming.org

What Can I Do? cont.
Spread the word!
Host an awareness event/movie night
for your circle of friends/colleagues
Host a jewelry party to sell products
made by trafficked women
Contact your Congressional representatives
Public pressure political will!
Volunteer with organizations that help victims
Donate to good causes, i.e. International Justice
Mission

Take-Home Points
Modern-Day slavery = human trafficking.
Healthcare professionals are in the unique position to
find and free these victims, and have a role in restoring
the mental and physical health of those who survive
human trafficking.
To properly fulfill these roles, healthcare professionals
must be educated regarding the phenomenon of human
trafficking.

For Healthcare Professionals…
In ERs and other healthcare facilities (teen
clinics, health van, schools, cities), be AWARE of
patients who might be trafficking victims…
Then CALL the trafficking hotline at 1-888-
3737-888 if you have any suspicions!
ADVOCATE for victims of trafficking and
their healthcare needs
They are often seen as illegal immigrants, not victims
SPREAD THE WORD to your colleagues and
circle of influence!

Upcoming legislation…
Child Protection Compact Act of 2009
Co-sponsor: Congresswoman Anna Eshoo of Palo Alto
Provides $50 million over 3 years to select “focus
countries” through the U.S. Department of State’s Office
to Monitor and Combat Trafficking in Persons (G/TIP)
These focus countries will receive support in building
public justice systems that effectively investigate crimes
against children and prosecute perpetrators in numbers
sufficient to deter and eventually eliminate the crime.
The legislation also authorizes increased assistance for
care for survivors of trafficking.

Let’s take action today!
Sign letter to thank Congresswoman Eshoo for her
support of this bill
Stay tuned for more opportunities to advocate for
children and against trafficking!

Let Freedom Ring!
“Injustice anywhere is a threat to justice
everywhere.”
--Martin Luther King, Jr.
“You are today where the thoughts of yesterday
have brought you and you will be tomorrow where
the thoughts of today take you.”
--Blaise Pascal

References
Barrows et. al. “Human Trafficking and the Healthcare Professional.”
Southern Medical Journal, Volume 101, Number 5, May 2008.
Batstone, David. Not For Sale: The Return of the Global Slave Trade and
How We Can Fight It. HarperCollins 2008.
“Children as a saleable commodity.” The Lancet, Volume 358, December
22/29, 2001.
Hodge, David. “Sexual Trafficking in the United States: A Domestic Problem
with Transnational Dimensions.” National Assn. of Social Workers, 2008.
Beyrer, Chris. “Global child trafficking.” The Lancet, Volume 364, December
2004.
“Is trafficking a health issue?” The Lancet, Volume 363, February 14, 2004.
“Teen Sold as Sex Slave”:
http://www.msnbc.msn.com/id/21134540/vp/27098382#27098382
Stop Child Trafficking Now (www.sctnow.org)

Thank you!