Identification of Human Trafficking Victims in Health Care Settings

This is a long article that looked for patterns to better identify victims of child trafficking, when they receive medical care.

by Susie B. Baldwin, David P. Eisenman, Jennifer N. Sayles, Gery Ryan, Kenneth S. Chuang

Health & Human Rights Journal Vol 13, No 1 (2011)


An estimated 18,000 individuals are trafficked into the United States each year from all over the world, and are forced into hard labor or commercial sex work. Despite their invisibility, some victims are known to have received medical care while under traffickers’ control. Our project aimed to characterize trafficking victims’ encounters in US health care settings.


The study consisted of semi-structured interviews with six Key Informants who work closely with trafficking victims (Phase I) and 12 female trafficking survivors (Phase II). All survivors were recruited through the Coalition to Abolish Slavery and Trafficking, an NGO in Los Angeles, and all were trafficked into Los Angeles. Interviews were conducted in English and six other languages, with the assistance of professional interpreters. Using a framework analysis approach that focused on victims’ encounters in health care settings, we assessed interview transcript content and coded for themes. We used an exploratory pile-sorting technique to aggregate similar ideas and identify overarching domains.


The survivors came from 10 countries. Eight had experienced domestic servitude, three had survived sex trafficking, and one had experienced both. Half the survivors reported that they had visited a physician while in their traffickers’ control, and another worked in a health care facility. All Key Informants described other victims who had received medical care. For domestic servants, medical visits were triggered by injury and respiratory or systemic illness, while sex trafficking victims were seen by health professionals for sexually transmitted infections and abortion. Trafficking victims were prevented from disclosing their status to health care providers by fear, shame, language barriers, and limited interaction with medical personnel, among other obstacles.


This exploration of survivors’ experiences in health care settings supports anecdotal reports that US health care providers may unwittingly encounter human trafficking victims. Increasing awareness of human trafficking, and modifying practice to facilitate disclosure, could improve victim identification.


Human trafficking is modern-day slavery, a global industry of exploitation that generates billions of dollars in international profits each year.1 The United Nations defines human trafficking as “the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.”2 In the US, the Trafficking Victims Protection Act (TVPA) of 2000 and subsequent TVPA reauthorizations codify human trafficking as a federal crime, create protections for victims, and strengthen the ability of the government to combat human trafficking internationally.

Though it is difficult to collect concrete data regarding the extent of human trafficking, the US is known to be a major trafficking destination.3 The State Department estimates that 18,000 women, men, and children are trafficked into the US each year from dozens of countries.4 Many victims arrive in the US through three main trafficking hubs: Los Angeles, New York City, and Miami, but as of 2004, forced labor victims had been identified in at least 90 US cities in 31 states.5, 6 In addition, thousands of US citizens, mostly women and children, are trafficked within US borders, primarily for sexual exploitation.

Once in the US, trafficked victims are absorbed into underground, unregulated sectors of the economy, where wage, health, and safety law violations routinely occur.5 In addition, thousands of US citizens, mostly women and children, are trafficked within US borders, primarily for sexual exploitation. Often, trafficking victims work as enslaved domestic servants or as forced laborers in the restaurant, agricultural, or manufacturing sectors. Trafficking victims are also coerced into prostitution, pornography, and other sectors of the commercial sex industry. Regardless of the form of their exploitation, people who are trafficked suffer intense abuse that often results in physical and mental illness.7

Encounters in the health care setting may offer opportunities for identification of trafficking victims. Based on a sample of 21 victims from San Francisco, Los Angeles, and Atlanta, The Family Violence Prevention Fund reported in 2005 that 28% received medical care while in their trafficker’s control.8 The US Department of Health and Human Services (HHS), the federal agency responsible for assisting trafficking victims, supports the notion that health care providers can facilitate the identification and rescue of trafficking victims. In 2004, HHS initiated a campaign to increase awareness of human trafficking among professionals, including health care workers, who may unknowingly interact with trafficking victims in their daily work.9 According to subsequent HHS reporting based on information from law enforcement and service providers, health and dental clinic workers and emergency room personnel have served as sources of victim referrals.10

Despite such reports, few empirical data exist regarding trafficking victims’ interactions within US health care settings, and key questions require further examination. Are there certain settings, patient presentations and behaviors, or perpetrator characteristics that together may help identify a patient as a victim of human trafficking? What barriers prevent health care professionals from identifying trafficking victims? To better understand trafficking victims’ use of health services, this qualitative study explores and characterizes encounters in health care settings, as reported by trafficking survivors living in Los Angeles.

(Read the rest of the article and resources cited at the attached link)

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