Dr Sian Oram is currently working with Professor Louise M Howard and Kylee Trevillion on an NIHR study to inform the NHS response to human trafficking. For more information, see the PROTECT (Provider Responses, Treatment, and Care for Trafficked People) project

1. Human trafficking
Dr. Sian Oram
Section of Women’s Mental Health
Institute of Psychiatry
King’s College London

2. True or false?
1. Only women and children are victims of human trafficking
2. Only illegal immigrants are victims of human trafficking
3. Victims of human trafficking work mainly in the sex industry
4. Children who work for relatives in domestic situations are not considered to be
victims of trafficking
5. Calling the police if you suspect a patient has been trafficked could put them in
more danger
A quick quiz Page 1

3. What is human trafficking?
(a) the recruitment or movement of persons
(b) most often by force, fraud, coercion or
deception
(c) for the purposes of exploitation.

4. How are people exploited?
Forced sex work
Domestic servitude
Forced or exploitative labour in settings such as:
Agriculture
Construction
Food packaging and processing
Nail bars
Restaurant and hotel trade
Markets, street selling and shop work
Forced criminality, such as cannabis cultivation,
theft, and begging.

5. What is the UK picture?
In 2012: services encountered 2,255 potential victims
55% female
71% adult
35% sexually exploited, 23% exploited in labour settings, 16% exploited
through criminal activity, 4% exploited through domestic servitude.
78 different countries of origin were recorded. most frequently:
Romania (13%)
Poland (11%)
Nigeria (9%)
Vietnam (6%)
Hungary (6%)
86 (4%) of potential victims were UK nationals.
(SOCA Intelligence Assessment 2012).

6. https://www.youtube.com/watch?v=80AkgFFHVIc
“Mike was a personal trainer until the recession cost him his job. He ended
up homeless, and took up the offer of work with lodgings. Gradually, he
realised he was a victim of human trafficking. He was paid £20 a week
and he could not flee for fear of violence.”
(The Guardian, October 19th 2012)
“It can happen to anyone if you’re desperate” Page 5

7. • Government-funded support is available to potential victims of trafficking who
agree to be referred into the National Referral Mechanism (NRM).
• The NRM is a framework for identifying victims of human trafficking and
providing them with temporary accommodation and support.
• Referrals must be made by an authorised agency – the NHS is not an
authorised to make NRM referrals.
• With the patient’s consent, NHS professionals should contact the Salvation
Army confidential helpline for advice, support, and referral:
0300 303 8151 – 24 hours, 7 days per week.
What support is available for victims of human trafficking? Page 6

8. What health risks are associated with human trafficking?
Zimmerman et al Social Science & Medicine
2011

9. HEALTH RISKS
Physical abuse, deprivation
Threats, psychological
abuse
Sexual abuse
Substance misuse
Social restrictions and
manipulation
Economic exploitation and
debt-bondage
Legal insecurity
Occupational hazard
POTENTIAL CONSEQUENCES
Death, acute injuries, chronic physical pain, disability, fatigue, exhaustion,
malnutrition, starvation, deterioration of pre-existing conditions.
Suicidality, traumatic stress, depression, somatic complaints, sleep
disturbances, memory loss, dissociation, aggression and irritability.
STI including HIV/AIDS, UTI, damage to vaginal tract or anus, unwanted
pregnancy, forced or unwanted termination,
Addiction, overdose, self-harm, infection, brain/liver damage, sleep
problems
Isolation, shame, guilt, loss of self-esteem, social withdrawal
Inability to afford basic hygiene, nutrition, safe housing, medical care,
dangerous self-medication, rejection by family.
Acceptance of dangerous travel/work conditions, obedience to traffickers,
unhygienic/unsafe detention conditions, difficulty obtaining medical care,
traumatic reaction to interrogation, unsafe deportation/return.
Exhaustion, poor nutrition, communicable disease, injury, musculoskeletal
problems, hypothermia, heat exhaustion, dehydration, dermatological
infections, burns.
Zimmerman et al Social Science & Medicine
What health risks are associated with human trafficking?

10. When might NHS professionals encounter victims?
Staff suspect someone might
be a victim of trafficking in
persons
• Still in the trafficking
situation
• Just escaped from the
trafficking situation
Someone is referred for care
who is already recognized as
a trafficked person
•Just after the trafficking
experience
•Years later
Two situations

11. Scenario 1: When staff suspect
10
•A (trafficked) person has come alone for medical attention due
to injury or illness
•A (trafficked) person is brought by the trafficker for medical
attention due to injury or illness

12. Clues that a person may have been trafficked Page 11
Health
• Symptoms of trauma (physical, psychological)
• Illnesses or injuries associated with poor living and
working conditions
• Fearful, mistrusting
• Withdrawn, submissive
Context
• Sector or activity commonly associated with exploitation
or trafficking in this country
• Accompanied by a “minder”
• May have migrated locally or internationally (e.g. doesn’t
know the local language)
• Doesn’t know where they are or can’t explain how they
arrived

13. Scenario 1: When staff suspect
12
•Prioritize safety
•Try to find a way to talk to the person alone
•Apply a trauma-informed care approach
•Ask a few questions related to the symptoms to ascertain the
situation
e.g. You look very pale. Can you tell me about your
diet? What have you eaten this week? Over the last month?
You are coughing a lot. Can you tell me about where
you are living? Are you sharing a room with others?
Were you injured while working? Can you tell me about
your work and how you were injured?

14. And referral seems possible:
• Apply a trauma-informed care approach
• Offer to provide information or to refer the person (e.g.
hotline number)
• Be careful they are alone
• Communicate clearly
• Be mindful of traceable documentation; be discreet
• Act only with informed consent
Scenario 1: When staff suspect Page 13

15. And referral is not possible (the situation is unsafe or the
patient does not want referral):
• Provide as much information as possible
• Be careful they are alone!
• Communicate clearly
• Be mindful of traceable documentation; be discreet
• Provide as much treatment as possible
• Provide a complete regimen of prescribed medication and a medical
summary
• Use single dose therapy when possible
• Apply a trauma-informed care approach
• Try to arrange a follow-up visit if possible
Scenario 1: When staff suspect Page 14

16. 15
When urgent assistance is required:
• Ensure your own safety
• For emergency care, persuade by focusing on
health status and not the cause
• If person is alone and police contact is desired
or seems necessary, discuss slowly and clearly.
Make sure this is the person’s preferred course
of action.
• Apply the trauma-informed care approach
Scenario 1: When staff suspect

17. Scenario 2: Caring for a recognized
trafficked person
16
Person has been identified as trafficked (has been screened
and interviewed, and has most likely received some kind of
assistance)

18. Scenario 2: Caring for a recognized trafficked person
17
Whether receiving a referral or referring:
• Know how information and data will be transferred
• Know how the first contact will be arranged
• Know how trafficked person will be received
• Apply the trauma-informed care approach
• Inform patient and obtain consent
• Communicate (to the other agency) only information required
for care and security
• Assess risks with person and with experts in the field

19. An English man aged about 35, has been brought into your service by a
couple of men who register him with the receptionist. The men wait with
him in reception. The receptionist observes that something doesn’t feel
right about the patient and the men he is with. They don’t appear to be
acting as if he is their friend and they seem short-tempered with him,
although he is obviously in great pain.
The nurse who assesses the patient notes that both men insist on
accompanying him to the assessment as they say he has difficulty
speaking with his injury. She also notes that his general condition is
poor. He looks underweight; he obviously hasn’t washed for a while and
his clothes are dirty.
The consultant notes that the patient’s jaw has been broken for a while and
there is evidence of old injuries that have not healed.
(Taken from the e-learning for health trafficking module)
Case study Page 18

20. The Don’ts
19
•Do not try to rescue a patient yourself
•Do not inquire about trafficking-related circumstances in front of
others
•Do not disclose your personal address or attempt to shelter patient
in your own home
•Do not contact the authorities (e.g., police, immigration) without
explaining this option and gaining patient’s permission
•Do not ask anyone accompanying individual to assist with
interpreting or be present examination
•Do not make promises you can’t keep

21. The ‘Do’s’
20
•Do ensure safety of patient, yourself and health facility first
•Do find ways to talk to patient alone
•Do ask patients if they feel safe to speak openly
•Do make referrals to well-respected providers
•Do make certain patient has full information to make informed
decisions

22. National contacts
Salvation Army :
0300 308 8151
Accommodation and support for adult trafficked men
and women
Poppy Project:
020 7735 2062
Accommodation and support for trafficked women aged
>16
NSPCC National Child Trafficking Advice Centre
0808 800 5000 (Mon-Fri 9.30 a.m. – 4.30 p.m.)
Advice if you are worried about a child who may have
been trafficked.
Metropolitan Police/Stop the Traffik Helpline:
0800 783 2589 (Mon-Fri 9 a.m. – 5 p.m.)

23. Resources: leaflet and e-learning module Page 22
http://www.e-lfh.org.uk/programmes/human-trafficking-e-learning/

24. Resources: further reading
http://publications.iom.int/bookst
ore/index.php?main_page=produ
ct_info&products_id=510

25. • The PROTECT Research Programme (“Provider
Responses, Treatment and Care for Trafficked
People”)
• Funded by Department of Health Policy Research
Programme
• Started 1st July 2012, completion by 31st March 2015.
• Project steering group includes clinical and
academic expertise in psychiatry, sexual health,
emergency medicine, maternity care, primary care,
and social work.
• For information contact protect@kcl.ac.uk
• Visit http://tinyurl.com/oa8g92n
Current research Page 24

26. Objectives Method
1. Synthesise evidence on the number
of trafficked adults and children
identified in England, their
healthcare needs, and their
experiences and use of health and
social care
◦ Systematic review of the health risks and outcomes associated with
human trafficking.
◦ Analysis of case note data from South London and Maudsley NHS
Foundation Trust and post-trafficking support services.
◦ Cross sectional survey with trafficked adults and adolescents (n=150)
2. Document NHS experience,
knowledge and gaps about
trafficked people’s health care
needs and to explore healthcare
models in other European states
◦ NHS provider interviews (n=30).
◦ Non-NHS support provider interviews (n=30).
◦ Review of European health policy and health service responses to
human trafficking.
◦ Survey to assess NHS staff knowledge, experience and training needs
(n=750).
3. Provide recommendations,
materials and dissemination
strategies to support NHS staff to
identify, refer and care for trafficked
people and to become a strategic
partner within the UK NRM and with
other agencies
◦ ‘Strategy development workshop’ with health and non-health providers
to inform training materials, mode of delivery and NRM coordination;
◦ Development of content for training materials, pilot and evaluate in
sessions with health providers;
◦ Production of training material content and proposed dissemination
strategy.
The PROTECT Research Programme