Can you identify the signs of human trafficking in the Emergency Room?

human trafficking

Definition and Importance

Human trafficking is a global problem enclosing the spheres of international law, human rights, organized crime, public health and medicine. It is best defined by the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons as “the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or a position of vulnerability or the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs.”

According to the Federal Bureau of Investigation (FBI), human trafficking is considered the third-largest criminal activity in the world. Despite issues regarding data collection, the US State Department was able to report that around 20,000 people per year are trafficked inside the United States. It is also estimated that up to 900,000 people per year are being transported across borders with the intention of slavery and exploitation.

Why should physicians care about it?

A 2014 study showed that 87.8% of human trafficking survivals had access to healthcare services during their trafficking situation and of this, 68.3% went to the emergency room. The data above highlights the importance of healthcare professionals, especially those at the emergency department, when it comes to the identification and help of trafficking victims. It also reinforces the role of the emergency doctors as front-line healthcare providers for those in vulnerable situations and/or who lack proper medical care.

What are the signs that can be marked as "red flags" to identify victims of human trafficking?

According to the guidelines provided by National Human Trafficking Resource Center (NHTRC) there are some indicators, and they are divided into General Indicators and Health Indicators or consequences of Human Trafficking. They can be physical and/or mental signs. It is important to say that not all the victims will have the same indicators and each sign isolated may not be a trafficking situation. However, if several “red flags” are detected, further assessment may be needed.

GENERAL INDICATORS

  • The patient may tell an inconsistent story or be reluctant to describe details and answer questions about the injury or illness.
  • The accompanying individual does not let the patient have privacy or even speak for themselves.
  • They are unable to provide his/her own address and/or are unaware of the current time and location.
  • The patients` document may not be in his/her possession, and rather held by the accompanying individual.
  • The patient may not have the appropriate clothing for the weather.
  •  The presence of tattoos or any branding form demonstrating possession or serial numbers and bar codes may be found in the patient’s body. 
PHYSICAL INDICATORS
  • Signs of abuse or inexplicable injuries such as bruises, burns, cuts, wounds, blunt force trauma, broken teeth, fractures or any other sign of torture such as restraint marks 
  • Neurological conditions such as unexplained memory loss or traumatic brain injury  
  • Dietary issues such as extreme weight loss or malnutrition
  • Signs of potentially forced substance abuse
  • Issues regarding the reproductive system such as Sexually Transmitted Diseases (STDs), genitourinary problems, forced abortions or several unwanted pregnancies. 
  • Effects of prolonged exposure to unhealthy environments such as extreme temperatures, industrial or agricultural chemicals 
  • Somatization symptoms 
  • Poor dental hygiene 
  • Untreated skin infections 
MENTAL HEALTH INDICATORS
  • Anxiety
  • Post Traumatic Stress Disorder
  • Depression with or without suicide thoughts
  • Nightmares and/or flashbacks
  • Hostile behavior 
  • The patient may present with a feeling of disorientation or an unrealistic perception of his/her surroundings.  
  • Stockholm syndrome
  • Paranoid or extreme fearful behavior 

It is important to keep in mind that the signs presented above are not exclusive to a trafficking situation and many other clinical conditions may cause the appearance of those groups of symptoms. That being said, if after spotting some “red flags” you are still unsure whether or not that patient is a potential victim, there are a few screening questions you can ask that might help to confirm your suspicions, such as: 

  • Are you in possession of your identification documents?
  • How is a normal day at your work? 
  • How is it like at the place where you work?
  • Describe the place where you sleep and eat.
  • Are you free to come and go whenever you please?
  • Do you get paid for your work?
  • Where is your family?
  • Is anyone threatening you?

What to do in case you come in contact with a victim?

Dealing with trafficking victims is a very sensitive matter which requires discretion and an approach centered on the victim. That means once it is confirmed that the situation is indeed about human trafficking, the doctor’s aim is to try to provide a safe environment and inform the person of his/her rights. In order to do that, you should try to meet the patient`s basic needs, always trying to build trust and rapport, avoiding any potential re-traumatization situation.

Some protocols will depend on the specific situation. It is also important to know that legal requirements regarding contacting the authorities will be different in each country. That said, it is your responsibility as an emergency doctor to be informed about the protocol regarding your geographic location.

In the US, there is a National Hotline (1-888-373-7888) that provides the victims with a safe and confidential space to talk and report the trafficking. This line is operational 24/7 and offers access in more than 200 languages.

In conclusion, doctors have a privileged position when it comes to recognizing and helping human trafficking victims. That is why it is very important to be attentive to spot possible “red flags” and be informed of the right protocols to follow in case you need to assist a victim.

References and Further Reading

Cite this article as: Brenda Feres, Brazil, "Can you identify the signs of human trafficking in the Emergency Room?," in International Emergency Medicine Education Project, December 20, 2021, https://iem-student.org/2021/12/20/human-trafficking-signs/, date accessed: January 17, 2022

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