Human trafficking and exploitation: guidance for health workers

How human trafficking affects health

The health impact for those subjected to trafficking can be profound and enduring; both in the health risks associated with exploitation and abuse, and in the longer-term psychological impact of being enslaved. In many instances, it is akin to the experience of victims of torture – being in a situation characterised by a lack of autonomy and control often compounded by a sense of fear, hopelessness and despair.

Most of the research on the health of trafficked persons has been with women who have been sexually exploited. There is less evidence on the health consequences of other forms of trafficking. Nonetheless, the exploitative nature of trafficking, and the likelihood of working in hazardous conditions undoubtedly have cumulative health effects^[10].

Key influences on health include:

• Exposure to infectious diseases
• Repetitive physical, sexual and/or psychological abuse
• Chronic deprivation – e.g. food, sleep, shelter
• Hazards – e.g. poor ventilation, sanitation, exposure to chemicals, bacterial/airborne contaminants; dangerous machinery, lack of protective equipment etc
• Pre-existing health conditions – given the pathways into trafficking, some victims already have health issues that are exacerbated by trafficking

Mental Health

Poor mental health is common amongst victims of trafficking given the trauma and abuse they have experienced. Complex Post-Traumatic Stress Disorder (CPTSD) can often develop as a consequence of human trafficking. Core symptoms include re-experiencing of the traumatic event(s), avoidance of thoughts/memories/situations reminiscent of the event(s) and persistent perception of heightened threat. It also takes into account difficulties related to beliefs about self and others and problems in affect regulation^[11].

Studies have consistently shown high levels of psychological distress among survivors of trafficking. In a US study, 71% of people trafficked had high rates of depression and 61% had CPTSD^[12]. Research in England found that 78% of women and 40% of men who had been trafficked experienced high levels of depression, anxiety and post-traumatic stress symptoms^[13].

Given the circumstances which may have led to their trafficking, many victims have prior experience of violence and abuse. Studies on women trafficked for sexual exploitation found that 43%-60% had previously been physically and/or sexually abused, and that 12%-31% had experienced childhood sexual abuse^{[14, 15]}. This previous experience of trauma may contribute to the higher levels of PTSD and CPTSD found among females trafficked for sexual exploitation. The health impact recorded amongst women and girl victims is considerable: 63% had more than 10 concurrent health problems, while 39% had suicidal thoughts. High levels of anxiety and hostility, chronic pain and headaches were also recorded^{[16, 17]}.

For all victims of human trafficking the complexity of health needs has to be recognised and addressed. Since the unpredictability and uncontrollability of traumatic events are highly predictive of an intense or prolonged psychological reaction all health care responses should be trauma informed.