Human Trafficking
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This powerpoint presentation offers an overview of the Human Trafficking problem and how medical professionals can intervene and become actively engaged.
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Human Trafficking
- 1. Trafficking in Persons September 2007
- 6. Sexual Trafficking War New Technologies Cultural Attitudes And Values Poverty Ethnic Minority Orphaned Abandonment/ Runaways Legal and Tolerated Sex Industries Corruption Prior Sexual Abuse Gender Demand for Commercial Sex Government Policies
- 7. Two Broad Categories of Human Trafficking Labor Trafficking: Domestic Service Sweat Shops/Factories Begging Agricultural Work Mining Brick Kilns Military Conscription Sexual Trafficking: Prostitution Pornography Stripping Lap Dancing Live-Sex Shows Mail-order Brides Child Brides (Sex is Not Labor/Work!)
- 14. Magnitude of Human Trafficking / USG estimates Numbers are for cross border trafficking and do NOT include internal trafficking in persons
- 15. Human Trafficking ANE Bureau – Strategic Review – Summer 2007 2004 2006 Labor Trafficking: Bonded Labor, Indentured Servitude, Debt Bondage, Child Soldiers
- 21. Teenage Prostitution… The most common form of human trafficking in the US today
- 26. Health risks and opportunities Destination Travel and transit Pre-departure Detention, deportation, criminal evidence Integration and reintegration STAGES OF THE TRAFFICKING PROCESS
- 27. ACCEPTS OFFER Vulnerabilities Hopes Strengths + = CREDIBILITY OF THE OFFER Timing of the offer Quality of the offer PUSH & PULL FACTORS DECIDING FACTORS Recruitment Equation
- 43. The Faces of Prostitution Courtney. The Denver Post . 2005. Melissa. Photos -Pinellas County Police Dept, Florida.
- 44. Violence women experienced prior to being trafficked
- 45. 81% headaches 71% dizzy spells 69% back pain 60-70% various sexual health problems 63% memory problems 82% fatigue The most common physical health symptoms reported by women at 0-14 days
- 46. Levels of psychological distress are high, with multiple presenting symptoms 0-14 days 28-56 days 90+ days
- 47. Trafficked women’s mental health compared to a general female population 0-14 days 28-56 days 90+ days
- 48. Examples of the HIV/TIP Intersection Soweto, South Africa Disaster / Armed Conflict Displaced People Vulnerability Conflict Rape/Sex Slavery HIV Tourism Prostitution/Sex Industry (Corruption) Vulnerability Poverty Gender Inequality (Apathy) Vulnerability Children Orphaned by AIDS Poverty Vulnerability
- 62. Physical comfort Comforted, comfortable individual More thoughtful, more reliable, accurate information Psychological comfort + Time + Of benefit to the victim = benefit to the case
- 67. STOLEN SMILES Physical and mental health consequences of women and adolescents trafficked in Europe Funding from the European Commission’s Daphne Programme, Sigrid Rausing Trust, International Organization for Migration
Notes de l'éditeur
- Case study and discussion
- It appears that TIP is NOT getting better, if anything the situation is worsening. With the Congressional appropriation being only $50 million worldwide annually which translates into $11 million worldwide for actually programs, its not hard too imagine why we are unable to make an impact. G/TIP says: We do not know for sure if TIP is getting worse or not, because as there has been increased attention to the issue, there have been more reports of TIP. This is the problem, we don’t know, in some places, anti-TIP prevention campaigns may be working, while in others, depressed economies may be making the situation worse. Also, I can’t confirm the appropriation figure above, so I would just note orally that the demand for anti-TIP resources has increased while funding has not.
- Perhaps the world’s (i.e. USG, UN other donor countries) attempt to address labor trafficking has help to make an impact on lessening labor trafficking but the off-setting increase in sexual exploitation is greater which points to the need to address this side of the problem to a greater extent.
- EXPLANATION This figure on the stages of the trafficking process highlights the cumulative nature of the health problems that may occur during the trafficking process. A trafficked woman’s health complications may result not only from the abuse and exploitation she experiences at the destination point, but also from the various dangers and abuses she faces before, during and after she is exploited. For example, prior to leaving home, a woman may have been sexually abused by her step-father, as many women in our study were, raped by an acquaintance or beaten by her husband. During the travel and transport stage, while travelling to a destination location, traffickers may have forced her to swim through freezing river currents to evade border controls, or survive in an airtight cargo hold of a lorry. After escaping the exploitative situation, she may be re-traumatised during a police or immigration interrogation or while providing court testimony. She may have been held in detention or forcefully deported. In other words, the multiplicity of symptoms women display are likely to be a result of numerous dangers and cumulative physical and psychological harm. This conceptual model also highlights the points at which it is possible to intervene.
- EXPLANATION The traditional explanation for recruitment generally includes push and pull factors. Push factors being those things that make a woman want to leave home. For example, poverty, unemployment, violence, political instability, gender inequalities, etc. Pull factors being those things that draw a woman to another place. For example, safety, job opportunities, ease of travel, media images of a better life elsewhere, greater freedoms, greater equality. However, based on women’s accounts, it seems that among the most decisive factors influencing a woman’s decision to leave, is the credibility of the offer. That is, is the offer made by someone the woman trusts, or a friend or acquaintance of someone she trusts. The timing of the offer is also important. Offers to leave may come at a time when women are particularly in need of escaping a dangerous situation, financially desperate, etc. And whether the offer seems good to her, e.g., money, type of work, etc. When considering push factors, there are also individual, character level factors that may have even greater influence than the structural factors, such as women’s vulnerabilities (distress, loneliness, etc.), their strengths (e.g., courage to take action to remedy her situation) and her hopes (for a better future for herself or her family). It is important to recall that for every woman who is offered a job and ends up trafficked, there are many more women who are offered a job and who are not trafficked. There is little reason for a woman to believe she will be the unlucky one, when other friends and acquaintances recount good experiences with jobs elsewhere (even ones who may have been trafficked and do not wish to disclose this).
- EXPLANATION Women were asked about their experiences of violence prior to being trafficked. Before leaving home, 60% reported that they had been physically and/or sexually abused. 50% were physically abused, 32% were sexually abused, and 22% reported both physical and sexual abuse, and one in seven said that they had been sexually abused before the age of 15, one-quarter of whom said they had been abused by more than one perpetrator. Often the perpetrator was a father of step-father. 60% is a high level of abuse, as national prevalence levels of intimate partner violence are generally between 23% and 49%. 39% of the women in the study had children, and 82% of these women were single mothers. INTERPRETATION These figures illustrate several key issues: these numbers suggest factors that may have contributed to women’s vulnerability to accepting dubious offers promising a better, safer life elsewhere. a history of violence has implications for women’s physical and psychological health, because multiple or chronic experiences of abuse are generally believed to cause greater health damage than single events. the prevalence of violence in women’s past suggests that security assessments must be carried out before returning women to their home.
- EXPLANATION The study documented a wide range of physical health symptoms, including neurological, gastro-intestinal, sexual and reproductive health symptoms, mental health symptoms, and injuries and infections. The most prevalent health symptoms were headaches, fatigue, dizzy spells, back pain, sexual and reproductive health problems, and memory problems. Over 80% of the women reported headaches and fatigue. Of the eight in ten women stating they had headaches, three-quarters of these women described the headaches as very, very painful. For many, they were excruciating beyond explanation. Approximately 70% reported dizzy spells and back pain, Between 60 and 70% reported sexual health problems, 63% reported memory problems. INTERPRETATION Look to see how many of these are neurological problems or those that potentially affect cognitive functioning. These findings are important for law enforcement personnel and immigration services who often evaluate a woman’s credibility based on the clarity and consistency of her story—which is likely to be affected by this pain and discomfort. Impaired cognitive functioning can significantly hinder a woman’s ability to recall and recount what happened to her, which may mistakenly be interpreted as a woman being uncooperative or untruthful. It is essential that police and immigration services begin to understand that trauma leads to dissociation and significant memory problems. Again, I ask you to try to imagine how you would feel with a massive headache, feeling exhausted, dizzy, with back pain, pelvic pain, and fearing that you have acquired infections that might mean that you could never hope to have a family. You can imagine that your thinking might be clouded, your interest in answering questions might be slim and your disposition would not be cheerful. You might not even have the energy to seem grateful. As you can see, the majority of these symptoms affect cognitive functioning—or women’s memory and thought processes. These findings on women’s physical health are important for health service providers assisting women who may have difficulty explaining each and every one of their symptoms, and speculating what may be the source of their problems. Although sexual and reproductive health problems are the most common health problem associated with trafficking, while they were prevalent, other symptoms were equally or more often reported.
- EXPLANATION This slide shows the changes in the number of poor MENTAL health symptoms that women reported over the course of the study. Within the first fourteen days, 71% of the women reported more than 12 symptoms of mental distress This did not reduce significantly even after 28 to 56 days, as over half were still reporting these symptom levels, with 52% reporting that they experienced more than 12 symptoms of psychological distress. It is not until approximately 90+ days in care, that a real reduction in symptom prevalence can be seen. Yet, even at this point, nearly one in five women (19%) were burdened with a long list of symptoms. IMPLICATIONS Mental health consequences appeared to be the most consistently problematic and enduring for the women in this study. Mental health symptoms take longer than physical health symptoms before a reduction can be observed. Psychological support is key to women feeling better. For some women, a professional psychiatric assessment may be necessary in order to provide them with appropriate medication, when needed. A period of reflection and recovery should be at least 90 days in order to give women time to regain a significant level of psychological functioning. Even at this point, however, many women are likely still be suffering numerous and severe trauma symptoms.
- EXPLANATION Here we have compared women’s depression, anxiety and hostility levels with the symptom levels of an average female population. The red line represents the norm for an average female population. The “norms” came from a sample of women in the U.S. What we see is that even at 90+ days, women who have been trafficked show symptom levels well above population norms. For example, trafficked women’s depression levels, the black line, still fall near the 90 th percentile. Further analysis is required to see if it is possible to understand what main factors may have contributed to these symptom levels, for example, history of abuse, level of abuse and intimidation during trafficking, physical health status, or even site-specific factors.
- HRW on women and children in Africa: children are often double victims of AIDS. First orphaned, then trafficked for sex, put at risk of HIV
- SCRIPT: So what can TSA do? Using existing programs as a base TSA can do outreach to prostituted and trafficked persons. It is very important though that outreach be coupled with serious offers of transitional assistance. Outreach to these populations without giving them the hope of a new life borders on the unethical. Report and Rescue simply means that cases of trafficked persons are reported and that rescue is attempted. (Some harm-reduction, health-based programs run by other NGOs only focus on certain health issues of people caught in obviously terribly exploitive and slavery conditions) Advocacy – contrary to popular belief TSA has and can engage in legal reform –the campaign to raise the legal age of consent in the UK in the 1880s is a perfect and dramatic example how powerful our voice (on behalf of others) can be.
- SCRIPT: Some more ideas of what can be done Foster parenting – potential parents would need extensive training Shelters – the problem is sustainability and “institutionalizing” the victims Job skills training – most job skills training (in foreign countries) involves handicrafts, sewing, hair dressing – more advanced skills training should be developed and provided to those with the capacity to develop Sally Ann − a program run by TSA Bangladesh. Sexually trafficked women learn skills to make handicrafts. A catalog of goods is available by writing the Bangladesh command. Special marketing initiatives – purchasing to support micro-credit programs – conference bags and ornaments are examples – NHQ purchased ornaments from Sally Ann to give to all NHQ employees at Christmas time. People could make special purchases for advisory board members, women’s auxiliaries, Home League projects, etc. NHQ has also purchased conference bags from a company that employees formerly prostituted/trafficked women. Working cross-borders/cross-territorially is important. For example lots of trafficking from Mexico and Canada to the U.S. – thus it would be great for the territories there to collaborate
- Empower most vulnerable through income generation projects and access to adequate health care Train clinic outreach workers and service providers on both HIV/AIDS and TIP so that they can properly recognize affected persons, treat them appropriately and refer them to appropriate services
- EXPLANATION While exploited, most women have been given few options, little to no control over their bodies or their movements, etc. It is important to begin to restore some control for her, to let her know that she is “free” and has a right to be informed, to make choices, to refuse. While trafficked a great deal of what happens to women on a moment to moment basis is unpredictable, beyond their control To restore a sense of control and predictability, one should offer clear explanations of what will happen, the purpose for questions, and a step-by-step explanation of what will take place. These are good first steps in letting women know that they are being treated with respect, and in allowing women to have a sense of their immediate future. Describe general subjects she will be asked about, warn her about subjects that may bring up bad memories, may be embarrassing or difficult. Explain clearly who will and will not have access to the information she describes. Offer that she may return to difficult questions later Tell her that if she does not understand something she should say so, then repeat slowly and clearly
- EXPLANATION As it turns out, that which benefits the victim, allays her symptoms, making her more physically comfortable, pain medication, sleep, psychologically comforted, security, sympathy, and time is likely to result in her being able to give more reliable information. I am going to try to offer some hints that may help creating a good environment and a more productive and trusting rapport.
- EXPLANATION Women have many reasons why they may not wish to disclose various aspects of the trafficking experience, or personal details. The most obvious barrier to disclosure is a woman’s fear of retaliation by traffickers. This may be exacerbated by their mistrust of authorities. She may feel guilty over any level of participation she had in the trafficking—perceived and actual. She may feel guilt over other criminal activities that occurred in conjunction with the trafficking, e.g., crossing borders illegally, taking money earned illegally. Sexual activities are of particular embarrassment for many women, and therefore it is important to recognise the difficulty women may have in discussing these and the possibility that they may not explain exactly what happened and how, if it is shameful or stigmatising to them.
- EXPLANATION Interpreters are not a ‘tool’ like a pencil or scissors. They are people with opinions, personalities, and backgrounds. It cannot be assumed that all interpreters are fit to translate for a trafficked person. Rule 1: do not use persons on the site where a person suspected of having been trafficked has been identified. For example, if a sex worker at the club ‘volunteers’ to interpret for the woman you want to speak with, this is not a good idea. She may be part of the trafficking network, or may report conversation to traffickers. Woman is unlikely to be certain that what she says will be held in confidence. Case in California: Police went into a brothel where they wanted to speak with a young Indian woman. Man says he is her uncle and volunteers to interpret. Two months later, police went back to venue with a real interpreter and found out he had trafficked her and was selling her. Rule 2: Interpreters have opinions and they may feel that, for example, sex workers are dirty, migrants are unacceptable, etc. and this impression is likely to affect their interpreting and is likely to be perceived by the women. Rule 3: ‘No Neighbours’: take the time to find out if the interpreter comes from the same area/village as the woman. She is likely to be very unwilling to discuss events if she thinks they will get back to her community and she will be ashamed and stigmatised. Rule 4: Some women may prefer talking to a woman, some to a man. Whenever possible, as a woman her preference. Rule 5: Warn interpreters against telling anyone about what they hear—no matter how interesting the information/experiences may seem. Communities are very small, and information travels very quickly and one never knows the tenuous connections individuals may have to those who are traffickers. Try to come up with a way to check the acceptability of an interpreter with the person who is being interviewed after about 10-20 minutes into the interview. It may be possible to have a paper prepared in the person’s language that asks them to circle yes and no questions about their impression and trust of the interpreter. It is of NO USE to employ interpreters that will not have the confidence of the person who has been trafficked. She will not share the important information. Be suspicious of interpreters who give very very short interpretations of long sentences, or vice versa.
- EXPLANATION: Purpose of presentation: to describe some of the findings from a multi-country study on the health of women who have been trafficked. This study was a collaborative project carried out by London School of Hygiene and Tropical Medicine, the Rehabilitation Centres of International Organization for Migration in Moldova and Ukraine, La Strada, Czech Republic and Bulgaria, the Poppy Project in London, On the Road in Italy, and Pag-Asa in Belgium. This research was funded by the European Commission’s Daphne programme, which specifically focuses on violence against women. The study was carried out between 2003 and 2006. INTERPRETATION Can be used for: training of law enforcement Social support workers Health professionals Policy advocacy-government Other