Human trafficking – the recruitment and movement of people for exploitation by means such as coercion and deception – is believed to affect every country in the world. One estimate puts the number of victims worldwide at 2.5m people at any one point in time. The UK Home Office estimated in 2013 that there could have been 10,000 to 13,000 victims of trafficking in the UK.
Many victims of trafficking will suffer physical, mental, and sexual and reproductive health problems as a result of their experiences. The health problems experienced by victims of trafficking suggest that healthcare professionals could play a vital role in efforts to address human trafficking. But how often do they come into contact with victims of trafficking and would they know what to do if they did?
To answer this question, my colleagues at King’s College London and I surveyed National Health Service hospital staff attending mandatory training sessions on child protection and safeguarding vulnerable adults, plus staff attending meetings of the Royal College of Emergency Medicine. The study was conducted as part of the PROTECT research programme – which is independent research, funded and commissioned by the UK Department of Health Policy Research Programme.
Almost 800 NHS staff took part in the survey across 11 sites, including staff working in emergency medicine, maternity services, mental health, and paediatrics. The sites included hospitals in London, Manchester, Birmingham, Cambridge and Kent. We asked them whether they had ever been in contact with a victim of trafficking and also assessed their knowledge of what human trafficking was and how confident they felt to respond.
One in eight NHS staff who took part in the survey reported that they had previously been in contact with a patient they knew or suspected had been trafficked – and among maternity staff this figure rose to one in five. Yet, the overwhelming majority of participants (80%) reported that they had not had enough training to be able to assist victims of trafficking. In particular, participants felt that they lacked knowledge about how to make referrals to support agencies and how and when to contact the police. Although participants’ knowledge of the definition of human trafficking and the health problems experienced by victims of trafficking was generally good, more than 95% had no idea about the scale of human trafficking in the UK.
Importantly, more than 90% of participating NHS staff agreed that healthcare professionals had a responsibility to respond to suspected cases of trafficking and more than three-quarters reported that they would like to receive information and training on human trafficking in the future. Interest in future training was particularly high among mental health and emergency medicine professionals.
Identifying someone who may be trafficked
Findings from our study suggest that training programmes should focus firstly on how to identify and secondly on how respond to suspected cases. International guidance suggests that although no single set of signs can indicate definitively that a person has been trafficked, healthcare professionals can look out for red flags that taken together might suggest a person has been trafficked.
Trauma symptoms, injuries associated with abuse, and illnesses and injuries associated with poor living and working conditions might prompt healthcare professionals to suspect trafficking when, for example, the patient has migrated locally or internationally for work commonly associated with human trafficking and seems fearful or mistrusting, does not speak the local language, or is accompanied by a person who is reluctant for the patient to be seen alone.
Training on how to respond to suspected cases of human trafficking should include how and when to contact the police and how to make referrals to local and national support services. They should not make referrals or contact the police on behalf of adult patients without their patient’s consent and without first discussing with their patient what options are available to them.
Although the findings might not be generalised across the country (we chose hospitals in areas of England in which at least five victims had been identified by police in the previous year) they do suggest that healthcare professionals can play a critical role in efforts to tackle human trafficking. At the moment, however, they lack the confidence to do so. Targeted training for staff working in key clinical disciplines – including maternity services, mental health, paediatrics and emergency medicine – may help improve preparedness to identify and respond to potential victims of trafficking and improve the well-being and safety of this vulnerable group.