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How Nurses Can Recognize and Report Human Trafficking

Gayle Morris, BSN, MSN
Updated March 3, 2023
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    Human trafficking is a public health emergency. Nurses can take these steps to identify and help people caught in human trafficking.

    In Summary:

    • Nurses should be aware of warning signs, recognize situations that need investigation, and must be trained on how to interview possible victims. Nurses should watch for general signs that an adult or child is held captive by human traffickers.
    • Nurses working in urgent care, emergency departments, and public health or the community are more likely to encounter people held in captivity.
    • COVID-19 lockdown measures have made it more difficult for state authorities to arrest and prosecute offenders. Aid agencies are challenged to provide services to victims and survivors.
    • Nursing research supports using trauma-informed care (TIC) to avoid or reduce retraumatization of trafficked individuals who are accessing healthcare.
    • Institutions must develop plans to identify and care for people who are abused and trafficked. They must also educate staff.

    Human trafficking is a crime against humanity, modern-day slavery, and a serious public health emergency. It affects up to 30 million people, including 5 million children. People are bought, sold, and smuggled. They are often beaten, starved, and forced into sex work or jobs in factories, restaurants, or agriculture.

    Nurses are in an ideal position to screen, identify, and support victims and survivors of human trafficking. On this page, we identify the role nurses play, how to recognize the signs of human trafficking, and how to report it.

    The Role of Nurses in Identifying Human Trafficking

    Human trafficking is a global problem. Victims in the U.S. may come from around the world, but many are U.S. citizens. In America, sex trafficking is more common than labor trafficking.

    One of the most challenging issues is identifying human trafficking victims. Those from outside the U.S. may be unaware of their rights. They are often kept isolated, and contact with the outside world is controlled and limited by traffickers.

    Victims are brought for emergency care only to treat major physical injuries or illnesses. In one survey, 28% of survivors of human trafficking said they had come into contact with a healthcare worker but were not identified as a victim.

    Nurses are one of the few healthcare providers who interact with human trafficking victims consistently. They are also trusted professionals, so victims may see them as safe. Nurses should be aware of the warning signs and recognize situations that require investigation.

    Nurses must be trained in the safety needs of this population and how to interview possible victims. Because the interview can be dangerous for the victim, those closest to them, and the interviewer, training should include:

    • checkHow to phrase the conversation
    • checkKnowledge of immediate resources
    • checkFollow-up care to ensure the safety of those involved

    Additionally, nurses should be educated on how to establish and maintain personal boundaries. It is not unusual for nurses and other healthcare providers to experience emotional distress from these situations. Professional resources for counseling should be made available.

    How Nurses Recognize Signs of Human Trafficking

    Human traffickers seek people who are vulnerable. While anyone is at risk, evidence shows that people of color, people who are part of the LGBTQ+ community, and people who are both are more likely to be exploited. Traffickers also look for people in unstable living situations or who have experienced violence.

    Traffickers target children and teens who run away. They also target those involved in the juvenile justice system or child welfare. Children who have a caregiver with a substance use issue or facing poverty may be sold.

    Nurses working in urgent care, emergency departments, and public health or the community are more likely to encounter people held in captivity.

    Nurses should watch for general signs that an adult or child is held captive by human traffickers. According to the International Council of Nurses, these signs can include:

    • The patient appears to have suspicious documentation.
    • They are not registered with the local schools.
    • The patient seems to have traveled to the U.S. without understanding the process involved.
    • The patient does not have control of their money, identification, or passport.
    • Their real name or personal details appear to have changed.
    • They seem to have a limited understanding of time.
    • The patient might tell you they are visiting the area but cannot offer details about arrival or departure dates, an address, or a phone number.
    • They may have difficulty speaking with healthcare staff because they are not allowed to speak for themselves or because of a language barrier.
    • They look neglected, malnourished, and lack self-esteem.
    • The patient has few personal possessions.
    • There are signs of physical abuse.
    • The patient has poor eye contact.
    • They display closed body language; they are withdrawn and submissive.
    • The patient might be nervous, anxious, fearful, and depressed.
    • They display post-traumatic stress disorder, suicidal ideation, or mood swings.
    • The patient has old or untreated injuries and history of the injuries is not believable.
    • Numerous inconsistencies are present in their story.
    • They are vague about their address or where they live.

    The National Human Trafficking Resource Center has a checklist for healthcare professionals to help identify victims. Included are general red flag indicators and specific ones for labor or sex trafficking victims.

    Nurses should also consider physical and mental health indicators that may help them identify victims.

    Health Indicators of Human Trafficking

    Nurses may also see health indicators in trafficking. These include:

    • Malnourishment
    • Sexually transmitted diseases
    • Mental health concerns
    • Addictions
    • People who don’t know when they last saw a doctor
    • Paying the bill in cash

    Healthcare professionals should also be on the lookout for patients with signs of physical abuse, including:

    • Burns
    • Bruises
    • Multiple old injuries
    • Unexplained injuries
    • Black eyes
    • Cuts
    • Broken bones
    • Broken teeth
    • Multiple scars
    • Evidence of prolonged infections

    There are also specific signs that an adult or child is being sexually exploitated, including:

    • Any involvement in sex work while underage
    • Multiple or frequent pregnancies
    • Physical evidence of sexual, vaginal, and rectal trauma
    • Evidence of untreated or treated sexually transmitted disease
    • Inappropriate interest or relationship with older men
    • Controlling relationship from a partner or another person
    • Unusual tattoos on the neck or lower back, or other types of branding
    • Suspicion the person is under 18 years old despite claiming they are older
    • Lack of engagement with healthcare services related to fear
    • Large number of sexual partners
    • Inappropriate language can indicate working in prostitution
    • Inappropriate clothing for the age or time of day
    • Urinary tract infections
    • Bald patches where the hair was pulled out
    • Chronic back pain, muscle strains, and sprains
    • Cardiovascular or respiratory conditions
    • Dehydration and exhaustion
    • Infectious diseases, such as tuberculosis
    • Infertility

    Types of Human Trafficking

    There are several types of human trafficking. The traffickers exert power and control over their victims. They use coercion, threats, intimidation, isolation, and physical and emotional abuse.

    New victims may be indoctrinated with physical and sexual abuse or the abuse may be used as a “punishment.”

    Human traffickers use mental, emotional, and physical power to force their victims into one or more forms of trafficking.

    •  Sex trafficking:Individuals may be forced into prostitution in residential or commercial front brothels, truck stops, hotels, or at major sporting events. Sex trafficking also includes forced online exploitation, including pornography and stripping.
    •  Labor trafficking:Adults may be forced to work to pay debts that can never be paid off because of poor wages and excessive interest rates. This may include domestic work, begging or peddling, construction, factory or fishing industry labor, car washes, restaurants, nail salons, or other unskilled work.
    •  Criminal activity:Adults and children may be forced into street crime, begging, benefit fraud, or cultivating cannabis or other drug activity. Young adults and some children may be forced into marriages.
    •  Organ harvesting:The demand for organs is growing faster than the supply, which opened the door to illegal trade and trafficking. Organized crime groups and individual organ brokers have expanded to a worldwide market. Migrants are particularly vulnerable, and governments are not always willing to prosecute traffickers.

    COVID-19’s Impact on Identifying Human Trafficking

    The lockdown measures to “flatten the infection curve” of SARS-CoV-2 has driven the human trafficking trade further underground. It has also made it more difficult for state authorities to arrest and prosecute offenders. Aid agencies are challenged to provide services to victims.

    During the pandemic, human traffickers adjusted their business model and took greater advantage of digital communication. The economic consequences of COVID-19 have also made the inequalities at the root of human trafficking worse.

    Additionally, school closures have meant many children didn’t have access to education, shelter, and nourishment. It also increased the risk of domestic violence and child abuse, affecting the vulnerability of this population.

    Lockdowns likely contributed to the isolation and controlled movements that are a common part of human trafficking.

    The United Nations Office on Drugs and Crime calls for safeguarding access to justice, remaining flexible and adaptable to meet the needs of the community. It advises remaining vigilant to address new crime patterns. It also recommends systematic data collection and analysis on the impact that COVID-19 has had on human trafficking.

    The Importance of Providing Trauma-informed Care to Suspected Trafficking Victims

    Suspected victims of human trafficking can present with post-traumatic stress disorder, suicidal ideation, and mood swings due to the trauma inflicted on them. Nursing research supports using TIC to reduce or avoid retraumatizing individuals accessing healthcare.

    TIC is a patient-centered approach that guides care to prevent retraumatization. Nurses should use TIC with all patients.

    It is important to note that a history of trauma is not usually immediately evident. Patients may present with past trauma from other events, such as domestic violence, assault, or abuse, as well as the conditions of their society and cultures.

    The framework requires healthcare professionals to be aware of trauma survivors’ experiences and allow this to inform the development of policies and practices. For example, patients who have survived trauma often face barriers to transportation. This may help inform cancellation policies.

    Additionally, research finds that people exposed to trauma may seek care but do not consistently stick with the prescribed treatments.

    A small study demonstrated that providing care through a trauma-informed lens could increase patients feeling safe and respected. This also increases the likelihood they would feel confident enough to live independently.

    How Nurses Report Identified Human Trafficking

    Legal requirements mandating reporting differ from state to state. Not all situations require mandatory reporting. It is important to be aware of how HIPAA regulations impact reporting and confidentiality.

    Every situation is unique, which requires a victim-centered approach. Not all victims are comfortable talking about their situation. Additionally, not all are ready to seek help. In many instances, seeking help and sharing information may put the victim, their family, or the healthcare professional at risk from the trafficker.

    Nurses have options to help patients who have disclosed they are victims of human trafficking. Nurses may give the individual the number to the National Human Trafficking Resource Center (NHTRC).

    The organization maintains a hotline (1-888-373-7888) for victims to help connect them as survivors with services and support. The patient may feel it is dangerous to have the number written down. In this case, ask them to memorize the number.

    Patients in immediate and life-threatening danger must be protected. Follow your organization’s policy for reporting.

    Whenever it is possible, involve the patient in the decision to report to law enforcement. This reduces the chance of retraumatization from healthcare professionals interfering with or removing control of their own decision-making.

    For example, offer options for services, resources, or reporting that would ensure their safety rather than making those contacts without the patient’s permission.

    However, if the patient is a minor and you do not follow mandatory state reporting laws and your organization’s policies for child abuse, you may face the consequences of your noncompliance. All information about the patient’s injuries, illness, and treatment must be accurately documented in the patient chart.

    Nurses are in a position to make a difference in the lives of people who are victims of human trafficking. Regardless of the setting, it is crucial to have a personal and organizational plan for handling a difficult trafficking situation.

    Nurses can help encourage their institution to address the issue through education and training. There are several resources that nurses and their institutions may use to learn more and develop a plan, including:

    Standing Up for the Rights of Women and Girls
    Activities include assisting women worldwide who are victims of sex trafficking through stronger laws, public awareness, and survivor leadership
    Stop Violence Against Women – Tools and Reports
    Resources help you have an impact, including toolkits, education, training, and contacts
    Strategic Plan 2021-2031
    Resources and targeted actions aimed at combating all forms of trafficking worldwide
    Polaris Project
    Projects provides the NHTRC hotline and the Action Center offers a list of films on human trafficking
    Creating a World of Dignity
    Campaign to stop global slave trade and end human trafficking
    Resources – Sex Workers Outreach Project
    National social justice network dedicated to the human rights of people involved in the sex trade and their communites
    Abolish Prostitution and Provide Real Alternatives
    Nonprofit organization researches prostitution, pornography, and trafficking
    Administration for Children and Families
    Campaign to Rescue & Restore Victims of Human Trafficking
    Resources include toolkits for healthcare providers
    Freedom Partner
    Global organization that partners with local justice systems to rescue victims and bring criminals to justice
    Anti-Human Trafficking Initiatives
    Programs to oppose and prevent sex trafficking in women and children worldwide

    Ways Nurses Can Take Action Against Human Trafficking

    Nurses have ranked as the most trusted profession for 19 consecutive years. They are in an excellent position to identify people held captive in human trafficking and provide resources to help them escape.

    The situation can be dangerous for the patient and the healthcare professionals, yet there are strategies that organizations can take to address the issue while maintaining safety.

    • check-circle

      Institutions Must Plan and Educate Staff Accordingly

      The role of healthcare is to improve access and provide quality healthcare to the community. Protecting the physical and mental health of patients falls under this definition.

      Institutions must develop plans to identify and care for abused and trafficked people. They must also educate and care for the staff.

    • check-circle

      Stay Educated

      Nurses can be educated and stay updated through reading, conferences, and pursuing continuing education credits in human trafficking. The education helps nurses understand the process for identifying and intervening in cases where their patients’ lives are in danger.

      Armed with knowledge, nurses can impact the development of policies, procedures, and in-house education to address these issues across the institution. Skilled assessments are a key role nurses play in identifying signs of human trafficking and carrying out proper treatment.

      Nurses can become strong advocates for victims and survivors by staying informed about local and national efforts and providing the same information to other staff.

    • check-circle

      Practice Trauma-informed Care

      It is important to question patients who have indicators of trafficking. However, remember to speak with them while alone and out of earshot of anyone who came with them.

      In some cases, you may need a translator. Use one who has no connection to the people who brought in the patient. You can also use MediBabble to translate yourself.

    • check-circle

      Safely Provide Resources to Victims

      It may be dangerous to give the NHTRC’s toll-free number to the patient. You can memorize it and help your patient to memorize it. Posters with the information and number can be hung in the examination rooms and bathrooms. These help victims to get the information and memorize the number.

      As you’re in the community, consider what is happening in the stores you visit and the services you use. Are there children who don’t seem to go to school? Are there men coming and going throughout the day and night at a nearby house?

      Remember that traffickers are violent people. Do not confront them directly. Instead, contact the local authorities and the NHTRC, as they are trained to help. These small steps can significantly impact the people who are suffering at the hands of their captors.

    Page last reviewed January 7, 2022