Health and trafficking in persons

As discussed in Trafficking in persons and associated forms of exploitation and abuse, trafficking in persons is a gross violation of human rights that is often associated with physical and psychological harm. Trafficked persons often live and are forced to work in the margins of society where they frequently experience discrimination, neglect and limited access to health services. Health problems endured range from minor to severe and may be influenced by:

• Pre-existing chronic or genetic conditions, and chronic illnesses;
• Exposure to infectious diseases and other health risks linked to conditions of exploitation and poor living conditions;
• Persistent physical, sexual and psychological violence;
• Hazards related to specific forms of exploitation;
• Deterioration of health conditions resulting from lack of diagnosis and care.

Many trafficked persons experience a complex set of overlapping health problems that may include:

• Sexual and reproductive health problems, particularly for those who suffer sexual violence and sexual exploitation;
• Physical health problems;
• Mental health problems;
• Psychosomatic illnesses;
• Natural reactions to trauma and related problems of recovery;
• Psychoactive substance misuse and dependence;
• Social reactions such as rejection by family and community.

Trafficked persons often suffer repeated and multiple physical or psychological injuries and illnesses. These can lead to health problems that are debilitating, long term and/or cumulative. Exposure to health risks can continue even after the period of exploitation. Beyond physical harm, trafficked persons often experience psychological trauma and stress following persistent life-threatening trafficking situations. Lack of control over often unpredictable traumatic events associated with trafficking in persons can result in natural reactions such as depression, anxiety, hostility or irritability. When women, men, girls, boys or gender non-conforming adults and children suffer from sexual abuse, sexually transmitted infections including HIV and other sexual and reproductive health problems may compound psychological trauma. Sexual violence is often used against men and boys as part of processes of torture. Boys, especially when travelling unaccompanied and/or who are victims of trafficking, are at particular risk of being targets of sexual violence. For women and girls, additional health risks of sexual abuse may include unwanted pregnancy, unsafe abortion, pelvic inflammatory disease, infertility, vaginal fistula, inability to have children and other reproductive health problems.

In addition to physical and sexual abuse, trafficked persons also face other risks that threaten their health such as:

• Economic exploitation;
• Confiscation of identity documents, which restricts access to health services where identification is required;
• Occupational hazards including dangerous and exploitative working and living conditions;
• Social exclusion due to structural and sociocultural barriers that prevent accessibility to health services.

Despite the widespread international dialogue and documentation of severe trafficking-related abuses and exploitation, there are very few evidence-based health sector strategies on health and human trafficking, and very few policy guides that can be used widely to inform the design of health services and referral systems to support people who have been trafficked.

Health providers may be more likely than other professionals to have private or semi-private clinical contact with people who are trafficked. If given appropriate training in safe identification and referral procedures, they can play a vital part in the design of relevant policy interventions and in helping people leave dangerous and exploitative situations (see Borland and Zimmerman, 2009; Zimmerman et al., 2014 ; Buller et al., 2015) . To institute health and safety measures within an informed and responsive policy environment, it is essential to include the health community, and develop instruments that focus on the health consequences of human trafficking in general and the health needs of trafficking survivors in particular. Considerations for the health of trafficked persons must be a critical component of the full range of intervention options to ensure that health services are integrated into post-trafficking referral mechanisms. In this way, the expertise of health professionals will be able to inform efforts by non-health counter-trafficking actors to identify potential victims of trafficking and to support survivors in their recovery.