Running head: HUMAN TRAFFICKING 1

Nurses and Human Trafficking

Kathleen Bucad

214279434

HH/NURS 4546 A

Sandra Skerratt

November 9, 2018
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Nurses and Human Trafficking

Human trafficking is a global health issue that claims an estimated twenty-one million

victims (Ochab, 2018) and US$ 44 billion of profit for traffickers every year (Edmonson,

McCarthy, Trent-Adams, McCain, & Marshall, 2017). Human trafficking is described as

recruiting, harbouring, transporting, luring, receiving or controlling a person by using force,

threats, or other forms of coercion for exploitation, forced labour, domestic servitude or forced

marriage (City of Toronto, 2018). Although considered a global issue, individuals often assume

it only happens in developing countries. However, it can happen anywhere in plain sight (Peters,

2013). Extreme poverty fuels the supply for this “market-driven industry”, where people are

deceived through false promises of love, a better life or security and demand increases with weak

laws, ignorance, and greed for cheap labour (Ahn et al., 2013; Peters, 2013). Although girls and

women make up majority of the victims, the number of males being trafficked is increasing

(Ochab, 2018). Not only does it violate basic human rights (World Health Organization, 2018); it

leads to several negative health outcomes related to physical, mental, sexual and reproductive

problems (Oram et al., 2016). With many victims suffering from PTSD, most, especially

children, turn to substance abuse to cope with pain (Peters, 2013). As the individuals more likely

to encounter victims of human trafficking, nurses have an obligation to identify its signs, take the

proper steps to secure the client’s safety and advocate for collaborative work and lacking

education, tools or training.

Human trafficking takes place worldwide. As described by Peters (2013), it is a modern-

day slavery that is hidden in plain sight. She states that according to statistics, 800,000 men,

women, and children are internationally trafficked each year. Human trafficking is common in

Europe (over 60%), East Asia and the Pacific (61%) South America (57%) and Sub-Saharan
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Africa (53%) (Ochab, 2018). In Toronto alone, 90% of cases happen within the country while

10% are over-the-border trafficking (City of Toronto, 2018). In fact, Peters (2013) argues human

trafficking is preferred in developed countries due to the higher profit gained by traffickers. She

also states that it is a result of the economic crisis and an increased desire for cheap goods and

labour. With the rise of globalization, goods and people can be easily transported from and to

anywhere (Canadian Federation of Medical Students 2015). Therefore, human trafficking is

more likely to happen due to an increased demand and less difficulty. Furthermore, although the

United Nations General Assembly adopted the Convention against Transnational Organized

Crime and other anti-human trafficking strategies, the focus is on legal solutions rather than

preventative measures (Canadian Federation of Medical Students, 2015). Thus, while human

trafficking is considered a crime and efforts are being made to punish traffickers, less priority is

placed on preventing the factors that increase people’s susceptibility to become victims and

traffickers, especially since most traffickers were victims in the past (Ochab, 2018). As evident

by the statistics and lack of intervention, human trafficking may just continue to spread further

worldwide, claiming even more victims.

Anyone can be a victim of human trafficking, with the majority comprising of vulnerable

groups. 79% of victims (mostly women and girls) are sexually exploited (Peters, 2013), while

most children and males are forced into labour (Oram et al., 2016). Migrants and refugees are

also vulnerable (UNICEF, 2018) due to lack of knowledge regarding the country’s language,

laws, etc. (Peters, 2013). This means the social determinants of health play a role in human

trafficking such as gender, culture, income and social status, physical environment, education

and literacy and employment and working conditions (Government of Canada, 2018). One-third

of all victims are children (UNICEF, 2018), which has various implications on the social
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determinant of healthy child development (Government of Canada, 2018), especially with the

abuse, use of force, deception and manipulation (Peters, 2013) that leads to health deprivation in

a stage of life where support and guidance are most needed by children for optimal development.

In a study by Chisolm-Straker, Sze, Einbond, White, & Stoklosa (2018), it is determined that

homeless youth lacking a supportive adult in their lives are more vulnerable to human trafficking

than those who are homeless but have an adult they rely on and trust. Thus, social support and a

healthy environment play key roles in the prevention of human trafficking in children. Clearly,

the social determinants of health can contribute to or prevent vulnerabilities to human trafficking.

Human trafficking requires awareness, attention and action due to its various negative

health outcomes. Victims suffer from “acute injuries, sexually transmitted infections,

complications from forced or poorly performed abortion, anxiety, depression, traumatic and post-

traumatic stress, and suicide” (Ahn et al., 2013, p. 284). However, these are just the health

effects of sexual exploitation on girls and women; research is lacking on men and long-term

health needs of people involved in other forms of exploitation in high-income settings (Oram et

al., 2016). A study by Oram et al., (2016) suggest violence, poor support and unmet needs result

in continuous pain and fear of traffickers post-trafficking. The authors learn that their study with

victims in high-income countries are consistent with past findings in low and middle-income

countries: victims also report severe physical symptoms like headaches, fatigue, back pain and

memory problems, chronic medical conditions, STIs (7.7% in men and 22.5% in women), mental

health issues (69.5%) and suicidal ideation (38%). Access to healthcare is often lacking or

limited despite being clearly needed; what is even worse is the fact that they are not identified as

human trafficking victims (Peters, 2013). In addition, many continue to experience financial

struggles and ostracization post-trafficking. Thus, the social determinant of access to health
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services (Government of Canada, 2018) is not met as victims fail to receive the help they need to

prevent such health problems. In addition, victims are more isolated without contact from family

and are fearful of law enforcers and service providers (Curran, Naidoo, & Mchunu, 2017).

Compared to victims of domestic abuse, they are more likely to suffer from malnutrition and

substance abuse, in which alcohol and drugs may be forced by traffickers as means of control

(Casey, 2017). After constant abuse, they believe there is no way out (Peters, 2013). It is evident

that health is compromised for individuals who become victims to human trafficking, and proper

action is needed.

Human trafficking is related to numerous Sustainable Development Goals. It includes no

poverty, good health and well-being, decent work and economic growth, reduced inequality,

peace and justice strong institutions and partnerships to achieve goal (United Nations, 2018).

Human trafficking is a crime of exploitation that inhibits peace and requires justice. As

mentioned previously, poverty fuels the problem of human trafficking along with an economic

crisis and inequality. Good health and well-being are impaired since victims suffer from various

health problems. Finally, partnerships are necessary to tackle human trafficking, such as between

healthcare providers and law enforcers to secure a client’s safety.

Nurses play a key role in the fight against human trafficking. Their main role is assessing,

identifying, caring for and safeguarding victims. According to Peters (2013), nurses identify

victims of human trafficking, carry out the proper interventions and work with other agencies to

secure safety of victims’ safety. Victims may be hesitant to share information, unaware of their

location or provide inconsistent explanations for injuries; these are warning signs that alert the

nurse of possible abuse and prompts separation of the client from the possible trafficker

(Manton, 2016). Golby, Tsuei, & Zacharias (2015) state 28% to 50% of victims report entering
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the healthcare system while still being held captive. Thus, often being the first people to

encounter victims of human trafficking, there is an urgent and unique opportunity for nurses to

engage with and provide safe spaces for victims. According to Manton (2016), client’s injuries or

symptoms necessitating care are treated after identification and the situation is reported if the

client is younger than 18. Meanwhile, adults are offered safety options and their decisions are

respected since they are the only ones aware of the results of escaping their traffickers; nurses

must then share the resources available should they decide to seek help, such as safe houses,

shelters for victims of violence, social services, and help hotlines (Egyud, Stephens, Swanson-

Bierman, DiCuccio, & Whiteman, 2017; Manton, 2016). In Ontario, a human trafficking helpline

provides support while protecting confidentiality (City of Toronto, 2018). Lastly, the nurse

identifies possible traffickers. He/she must be observant to signs of control, whether it be

possession of identification documents or insisting to answer for the client while being cautious

for his/her own safety due to the violent nature of the trafficker (Ahn et al., 2013). Through their

direct contact with victims, human trafficking can be detected.

A major role of nurses in relation to human trafficking is advocacy. The responsibility to

advocate for victims lies on the nurses, because victims are not able to stand up for themselves

(Casey, 2017). One way is to help people unaware of being exploited to realize they are victims

of human trafficking. This is essential since some do not consider their traffickers as exploiters;

instead, they consider them family, friends or lovers (Peters, 2013). If the victims themselves do

not recognize they are being exploited, then they may not attempt to escape their situation while

continuing to suffer from health problems. Nurses also spread awareness through interest groups.

One example is the Pennsylvania State Nurses Association which has published a position

statement regarding the duty of nurses to identify human trafficking victims (Human Trafficking
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PSNA Position Paper, 2013). As mentioned by Ahn et al., (2013), awareness combats human

trafficking. Nurses also care for victims by educating health care professionals in various clinical

and community settings: although most victims only seek medical aid during emergencies, they

may access physicians, dentists, urgent care clinics, maternal-child units and HIV or AIDS

clinics (Peters, 2013). Thus, the healthcare staff in other settings can also recognize human

trafficking. Vulnerable groups controlled by human traffickers require a voice to stand up for

them without discrimination. It is the nurse’s responsibility to bring awareness to the global

health issue of human trafficking and advocate for the victims.

I believe some changes by nurses are needed to combat human trafficking. I recommend

a nursing curriculum that includes training on how to screen for human trafficking, so

individuals are prepared to assess and raise alarm when it is suspected. According to Peters

(2013), the number of identified human trafficking cases is far too small compared to the actual

number of cases occurring; this reflects the need to train individuals more likely to encounter

victims. Moreover, Ahn et al. (2013) state even though law enforcers receive trainings, in-

services and educational tools regarding human trafficking, most healthcare providers have

minimal knowledge and awareness about it and few opportunities to receive training tailored to

how a healthcare provider should respond to human trafficking. They claim that as the frontline

staff to clients, nurses must be able to recognize the warning signs of human trafficking,

especially since victims may be threatened, distrustful, unable to speak up for themselves, or

angry, so it is important to know how to handle it, which can be learned and honed through the

proper training. Another intervention that can be fulfilled by nurses is collaborating with law

enforcers and victim services to develop a multidisciplinary approach in identifying, rescuing

and providing care to victims of human trafficking while targeting risk factors. This is necessary
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since victims need support to deal with the trauma and associated issues they experience while

ensuring risk assessments and safety planning (Oram et al., 2016). Thus, victims of human

trafficking need various services, which can be better implemented with a collaborative team that

builds trust with the client. For example, recalling information multiple times may be too

traumatic for the client, but with a more collaborative care, the team can ensure the trauma is not

experienced repeatedly. However, the collaborative team should also address the social

determinants of health contributing to human trafficking as a method of prevention and

incorporate them in advocating for the creation of specific guidelines. It is important because

best practice guidelines have yet to be established focusing on screenings, interventions and

clinical considerations specifically for victims of trafficking (Golby et al., 2015). Victims of

human trafficking need compassion and cultural-sensitivity from someone knowledgeable,

collaborates well with law enforcers, case managers and advocacy partners, prioritizes their

needs, advocates for their rights and promotes their health and safety (Ahn et al., 2013; Casey,

2017). This defines the crucial need for nursing care and leadership in victims of trafficking.

With millions of victims suffering from numerous injuries, illnesses and trauma due to

human trafficking, greater awareness and prompt interventions are vital to combat its spread

worldwide. Nurses play a crucial role in the identification of both victims and traffickers, which

then requires collaboration with law enforcement and other agencies to safeguard and support the

client. Thus, an improved nursing curriculum that involves training on how to screen for and act

against human trafficking can further support and propel the role of nurses in tackling the issue.

However, prevention is still lacking, which is why nurses must continue to raise awareness and

advocate for the victims of human trafficking. Despite being a crime that demands legal action,
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the client-centred care that prioritizes the individual needs of each person can only be met

through nurses.
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References

Ahn, R., Alpert, E. J., Purcell, G., Konstantopoulos, W. M., McGahan, A., Cafferty, E., …

Burke, T. F. (2013). Human trafficking: Review of educational resources for health

professionals. American Journal of Preventive Medicine, 44(3), 283-289.

https://doi.org/10.1016/j.amepre.2012.10.025

Canadian Federation of Medical Students. (2015). CFMS position paper on human trafficking in

Canada. Retrieved from https://www.cfms.org/files/meetings/sgm-2016/resolutions/18-

_Human_Trafficking_in_Canada_Proposal.pdf

Casey, D. (2017). From the ethics inbox: Identifying and advocating for human

trafficking victims. American Nurse Today, 12(12).

Chisolm-Straker, M., Sze, J., Einbond, J., White, J., & Stoklosa, H. (2018). A supportive adult

may be the difference in homeless youth not being trafficked. Children & Youth Services

Review, 91, 115-120. https://doi.org/10.1016/j.childyouth.2018.06.003

City of Toronto. (2018). End trafficking TO. Retrieved from https://www.toronto.ca/city-

government/accountability-operations-customer-service/long-term-vision-plans-and-

strategies/end-trafficking-to/

Curran, R. L., Naidoo, J. R., & Mchunu, G. (2017). A theory for aftercare of human trafficking

survivors for nursing practice in low resource settings. Applied Nursing Research, 35, 82-

85. https://doi.org/10.1016/j.apnr.2017.03.002

Edmonson, C., McCarthy, C., Trent-Adams, S., McCain, C., & Marshall, J. (2017). Emerging

global health issues: A Nurse’s role. Online Journal of Issues in Nursing, 22(1), 13-.

doi:http://dx.doi.org.ezproxy.library.yorku.ca/10.3912/OJIN.Vol22No01Man02
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Egyud, A., Stephens, K., Swanson-Bierman, B., DiCuccio, M., & Whiteman, K. (2017).

Implementation of human trafficking education and treatment algorithm in the emergency

department. Journal of Emergency Nursing, 43(6), 526-531.

doi:http://dx.doi.org.ezproxy.library.yorku.ca/10.1016/j.jen.2017.01.008

Golby, R., Tsuei, S. H., Zacharias, A. (2015). An introduction to health professionals’ role in

addressing human trafficking. UBCMJ, 6(2), 28-30.

Government of Canada. (2018). Social determinants of health and health inequalities. Retrieved

from https://www.canada.ca/en/public-health/services/health-promotion/population-

health/what-determines-health.html

Human trafficking PSNA Position Paper. (2013). South Carolina Nurse, 20(4) 5.

Manton, A. (2016). Human trafficking and the emergency nurse. Journal of Emergency Nursing,

42(2), 99-100. https://doi.org/10.1016/j.jen.2016.02.010

Ochab, E. U. (2018, July 26). Human trafficking is a pandemic of the 21st century. Forbes.

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trafficking-is-a-pandemic-of-the-21st-century/#5397cd096195

Oram, S., Abas, M., Bick, D., Boyle, A., French, R., Jakobowitz, S., … Zimmerman, C. (2016).

Human trafficking and health: A survey of male and female survivors in England.

American Journal of Public Health 106(6), 1073-1078. doi: 10.2105/AJPH.2016.303095

Peters, K. (2013). The growing business of human trafficking and the power of emergency

nurses to stop it. Journal of Emergency Nursing, 39(3), 280-288.

https://doi.org/10.1016/j.jen.2012.03.017
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UNICEF. (2018). Children make up almost one-third of all human trafficking victims worldwide.

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human-trafficking-victims-worldwide

United Nations. (2018). Sustainable development goals. Retrieved from

https://sustainabledevelopment.un.org/sdgs

World Health Organization. (2018). Sexual and reproductive health. Retrieved from

http://www.who.int/reproductivehealth/topics/violence/vaw_series/en/