Human Trafficking: Identifying Potential Victims in a Healthcare Setting

Human trafficking has become one of the fastest-growing organized crimes in the world and the United States is one of the largest markets for these devastating crimes. Because of this, it’s more important than ever before that staff members at healthcare facilities understand how they can identify potential human trafficking victims and get help without putting them in further danger.

But what puts healthcare organizations in a position to be able to help human trafficking victims? Studies have shown that nearly 88% of human trafficking victims have needed to seek medical care at some point during trafficking. This puts healthcare workers in a unique position to help these individuals. Unfortunately, these opportunities to help are often lost because human trafficking is simply not on the radar of healthcare employees or they are not sure what actions to take in order to help the victim.

So how can we better identify potential victims and help them? According to Elizabeth Even, Associate Director of Clinical Standards Interpretation at the Joint Commission, the key is for healthcare leaders to develop the proper education and training to guide staff in how to care for victims. Even is a certified trauma nurse with more than 15 years of hands-on experience in trauma centers and emergency departments.

“If a staff member in your organization has not yet encountered a human trafficking victim, that will likely change very soon,” Even says. “This is an ever-growing problem, with data showing that 40,000 human trafficking cases were reported in the U.S. between 2007 and 2017.”

Know The Warning Signs

The basic definition of human trafficking is “one person having power over another person for the purpose of exploitation.” While the most common form is sex trafficking or forced prostitution, other victims are forced to do manual labor — essentially slave labor.

There are a number of warning signs that can alert staff to the possibility of a patient being a victim of human trafficking. One of the most common signs is poor mental health or abnormal behavior. These patients may appear to be fearful or anxious. Victims may be depressed, submissive, tense, nervous or paranoid. They commonly avoid eye contact and may refuse to change into a gown and/or cooperate with a full physical exam. Their behavior or demeanor may not align with the injury or complaint. For instance, they may act like it’s no big deal even though they’ve suffered serious injuries or they may simply seem disinterested in their own care. They may refuse treatment that does not take place during the current visit. For example, they may refuse to go see a specialist.

The other main warning sign is poor physical health. These patients may appear to be very malnourished. They may have signs of repeated exposure to harmful chemicals, signs of physical or sexual abuse, physical restraint, confinement or torture. Victims may also have symptoms or injuries such as burns, fractures, bruises, respiratory infections such as tuberculosis, sexually transmitted diseases, abnormal vaginal discharge, pelvic inflammatory disease or complications related to HIV, pregnancy or abortion.

Other warning signs may include the patient not being in control of their ID or passport. They may not appear to be allowed to speak for themselves. Perhaps a third party is insisting on being present or interpreting for them. They may say that they are just visiting the U.S. or be unable to clarify the address where they live. They may be unsure of their whereabouts or even unable to identify the name of the city they are in at the moment. They may appear to have a lost sense of time and/or inconsistencies in their story about how they got here.

“The most important thing is to always screen anyone with a red flag,” Even says. “Your organization needs to develop and utilize written criteria to identify those patients who may be victims of assault, sexual assault, sexual molestation, domestic abuse and any other form of abuse, including human trafficking.”

Compiling these criteria will take a team of individuals who have done a thorough assessment of the care, treatment and services offered by your healthcare facility, the community and population served, and current data and literature on the topic. The entire staff will then need to be educated to use the criteria and assure that it’s applied appropriately. In addition, professional interpreters must be used when needed for non-English speaking patients in suspected cases of abuse, including human trafficking.

Treating Trafficking Victims

When dealing with patients who are possible victims of human trafficking, it’s vital to understand that they will usually be scared and vulnerable. They may be under the influence of drugs or alcohol, could be experiencing significant pain and may also be suffering from sleep deprivation. As such, it could take a long time to get them to open up and even longer to get any information from them about their living circumstances.

By incorporating routine screening questions into patient intake, staff will be more likely to ask the important questions regarding possible abuse and they will also be more comfortable in responding to the answers that they may receive. It is extremely important to ensure that staff members know about local resources to help with suspected trafficking cases. For example, many U.S. metropolitan areas have human trafficking task forces. The National Human Trafficking Resource Center also provides helpful services.

Reporting Your Findings

What should staff do when they identify a potential human trafficking victim? Part of the criteria developed by your healthcare organization should include an action phase. If there is a local human trafficking task force, they should be notified. In addition, some local law enforcement agencies have authorities who are specially trained to respond to these situations. In some instances, local laws may also mandate that you report the suspected abuse. Just make sure that the criteria include a clear path of action for your staff to take in suspected human trafficking cases.

Many healthcare organizations now add human trafficking education as part of new employee orientation. It’s also a good idea to have an annual refresher and communicate updates about new resources, data and research when necessary.

It is up to healthcare leaders to educate, dispel myths, challenge stereotypes and develop a better understanding of human trafficking. As healthcare providers, we have a responsibility to help these patients.

“Trafficking can only exist in the atmosphere of public, professional and academic indifference,” Even says. “We all must be prepared to recognize, comfort, assist and teach.

Learn more about human trafficking and find additional resources in our toolkit.