Table 1. Health Problems Associated with Human Trafficking
|Physical Health Outcomes||Reproductive Health Outcomes||Mental Health Outcomes|
|Violence-related injuries (burns, fractures, traumatic brain injuries)||Violence-related injuries to the perineum||Affective disorder, depression, major depressive disorder|
|Occupational injuries due to lack of personal protective equipment and lack of machinery/safety training (chemical inhalational injury, digit amputations, strain injuries)||Forced insertions of foreign bodies into body orifices||Posttraumatic stress disorder due to witnessed/experienced violence, threats of punishment, demeaning treatment, social isolation, intimidation, and loss of agency|
|Poor oral health, dental infections, broken/avulsed teeth||Recurrent sexually transmitted infections (STIs)||Appetite, sleep, concentration, and memory disturbances|
|Progression and exacerbations of untreated chronic diseases||Progression of STIs to chronic disease states||Anxiety, generalized anxiety disorder, panic attacks|
|Dermatological conditions||Unwanted pregnancies||Dissociation, dissociative disorder|
|Communicable diseases due to unsanitary, crowded living/working conditions (tuberculosis, diarrheal disease)||Miscarriages and pregnancy complications related to lack of prenatal care||Self-loathing, self-blame, and self-injurious behavior|
|Substance use (potentially forced) and complications||Medical and clandestine abortions and complications||Suicide attempts, suicide|
Adapted from Ann Intern Med. 2016;165(8):582-588.
Explore This IssueACEP Now: Vol 37 – No 07 – July 2018
For patients who are accompanied to the emergency department, potential red flags include accompanying persons who appear overbearing, attempt to answer all questions, insist on translating, and seem to want to control access to the patient. As accompanying persons can be traffickers or their associates, clinicians should be aware that these individuals can either pose as or be the patient’s parent, legal guardian, family member, family friend, spouse, romantic partner, roommate, friend, coworker, or manager/boss. To avoid missed opportunities, clinicians should always use professional language-interpretation services when needed and should always evaluate the patient in private at some point during the visit without seeking the patient’s permission to do so in the presence of the accompanying person and potentially placing the patient in a precarious position. Clinicians can accomplish this by simply stating it’s their policy to involve professional interpreters and/or evaluate the patient alone for a certain portion of the exam, or by resorting to less conspicuous, more creative ways to separate them or meet with the patient alone. Other potential indicators include patient responses that seem rehearsed or restricted, explanations that don’t match injury patterns, apparent and stated age discrepancies, patients who appear subordinate or fearful of an accompanying person, and patients who do not know their whereabouts (city) or their own address but are otherwise oriented and unaltered.
Trafficking survivors are threatened, coerced, and forced into submission and silence. Rarely will survivors volunteer any information or want to answer questions about their exploitation for fear of retribution, harm to loved ones (including children), deportation, or criminal charges. As with intimate partner violence, the person being trafficked is in the best position to determine the risk behind attempting an escape or seeking or receiving help. They possess firsthand knowledge of the threats made, the ease with which they or their loved ones can be harmed, and the degree of violence and lethality displayed by the trafficker. Trafficking survivors who believe their silence is protecting loved ones from harm may fear “losing control” of the situation by the involvement of immigration or police officers and the ensuing cascade of events. If, given the circumstances of the situation, the maximum response allowed by law is not definitive or forceful enough and cannot guarantee their protection, then victims may end up in potentially worse or even lethal situations. Clinicians should also be aware that victims may end up punished under the same anti-trafficking laws designed to protect them if they were forced or coerced to engage in recruitment or other trafficking activities.