Imprisoned and held against their own will. In fear, alone, starved or abused into submission. These are people in our very own communities. Hidden behind closed doors, human slavery is a real deal.
The tragic accounts of victims forced into labour and captivity are made increasingly more public in the media and online. Human trafficking is the movement and exploitation of vulnerable individuals by means of coercion, fraud or deception. An estimated 27 million men, women and children are illegally traded for profit a year. Victims are from unstable homes, in search for a better life or employment opportunities. Instead, they are forced into myriad forms of enslavement – domestic servitude, sexual exploitation and bonded labour. This £105 billion-a-year industry flourishes from global socio-economic inequality.
This is not an issue confined to the developing world. The Home Office estimates 13,000 victims are working in the UK. According to UNICEF, at least 10 children are trafficked in the UK every week.
It is a modern day slave-trade that is epidemic on an international scale. In one year alone, up to 800,000 people are trafficked across international borders – half of which are children. Human trafficking is the second largest illegal trade in the world. The number and value of victims illicitly marketed are worse now than ever before. An enslaved fieldworker worth £28,000 in 1850 costs £70 today; the number of victims is double that of the African transatlantic slave-trade. Political disorder, corruption and economic malaise are catalysts for the expansion of this lucrative crime. Most certainly too, Europe’s escalating refugee crisis is a platform for this scourge.
Trafficking is a hidden and hushed agenda.
Only 1% of victims are ever rescued. Judiciary systems have failed to identify and persecute the perpetrators. Victims are trapped under inexorable debt to their traffickers. They fear they have no support, no legal rights from the state – and ultimately, no other choice. Furthermore, trafficking bears social, psychological and health implications. In countries where resources are already finite, there is a reluctance to accommodate and pay for the intervention these victims require.
In 2000, the United Nations adopted the Palermo protocol to ‘prevent, suppress and punish trafficking’. It was a universal forward movement in the recognition of contemporary slavery, paving the way for states to reform their own individual laws. However, the protocol only encourages, and does not demand, the provision of healthcare to identified victims of trafficking. 62 out of the 117 signatory states have yet to convict a single trafficker.
There is still much work to be done on both the international and local stage.
The Modern Slavery Bill passed by parliament last year introduces national measures to tackle human trafficking in the UK. Under the act, UK based-firms must publicise information to indicate none of their trading partners are involved in slave labour.
However, legislation cannot solve the issue of contemporary slavery alone. In conjunction, Unseen is an international Bristol-based charity, which supports the recovery and rehabilitation of trafficking survivors. As well as focused efforts on victim protection and the conviction of perpetrators, emphasis is important on the early identification of the victims of trafficking. Here lies the instrumental role of our healthcare professionals.
Up to a third of victims have encountered a healthcare professional whilst captive in the UK. 13% of healthcare workers have reported contact with a suspected victim of trafficking. A staggering majority, 86.8%, denied any confident understanding on how to recognise trafficking victims. The identification of victims in a healthcare setting necessitates clear understanding and awareness of the contemporary issue, which is currently lacking in postgraduate healthcare training. Even after a victim is identified and released, financial, social and counselling support is inadequate.
There is potential in healthcare for better engagement and intervention.
Rosie Riley, a final year medical student at Bristol University, established a training programme in 2013 that focuses on appropriate identification, referral and management of potential victims of trafficking. The scheme attracted the interest of 57 healthcare professionals from 9 GP practices across the UK. Healthcare providers are the first port of call for vulnerable victims, and appreciation of the typical warning signs are imperative in the campaign against contemporary slavery.
A noticeable element of the scheme is the acronym ‘TRAFFICKED’, which draws on the typical presentation of a potential victim: T- timid/terrified/tense; R – (not) registered with a GP/nursery/school; A – accompanied by a controlling individual; F – foreign language; F – frequently moving location; I – inconsistent clinical history; C – (no) control of documents; K – keep alert (and trust your instincts); E – evidence of injuries; D – DNA (does not attend future appointments). The acronym places emphasis on common attributes that raise suspicion of trafficking. Victims may also appear fearful and unaware of where they are.
The difficulty is that symptoms are often non-specific, such as fatigue, headaches, back pain and weight loss. One should also be concerned of recurrent STIs and sexual or reproductive health problems. Focus is also placed on training healthcare professionals on the appropriate questions to pose to suspected victims. Are you free to quit your job? Has anyone lied to you about the type of work you were to do? When you are not working can you come and go as you please?
Mental and physical health problems continue long after a victim is released from their trafficker. It is important that referral to appropriate support is provided post-trafficking. Although online resources are available, schemes such as Rosie’s may be integral for healthcare professionals to respond appropriately to victims presenting for care, and integrating them back into society. Healthcare workers are at the forefront of the battle against modern day slavery. As existing and future doctors, we are in a unique position to identify and protect the vulnerable and silenced victims of trafficking.
It is all too well expressing concern over the issue at hand. It is far better still to translate concern into a force for change.
It cannot be denied that the despicable trade of humans is a global injustice, and a violation of basic human rights. Contemporary slavery fuels violence and organised crime; it warps the economic market and debases the value of human life. The criminals who sustain it discredit common humanity. We all have the expertise to encourage the release and recovery of victims of trafficking. We can become better informed, promote and share awareness, support the abolition of slave-made products – and ultimately, contend against the covert nature of this illicit industry.
‘No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms’ – The Universal Declaration of Human Rights, 1948.
Human trafficking: identification and support of potential victims. Training Handout for Healthcare Professions. Rosie Riley; 2016 .
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United Nations Office on Drugs and Crime. Global Report on Trafficking in Persons. 2014.
Identifying and supporting victims of modern slavery: Guidance for health staff; Department of Health; 2015.
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Palermo Protocol: The First Ten Years after Adoption. Carol S. Brusca. Global Security Studies, Summer 2011, Volume 2, Issue 3