In the last 20 years, human trafficking has become a global problem of unforeseen proportions.
Human trafficking affects every country in the world, regardless of socioeconomic status,
history, or political structure and most countries are a source, transit, and destination for victims
of human trafficking. In fact, the profits from human trafficking are immense and the United
Nations Office of Drugs and Crime places human trafficking as the fastest growing and second
most profitable form of transnational crime (Chong & Clark, 2014).
Due to the complex nature of trafficking in person, data available on the number of people
trafficked are indiscriminate. Conservative estimates suggest that at least 2.5 million women,
children, and men are lured or forced across international borders (transnational
human trafficking) every year and a significant amount are trafficked within borders (internal
human trafficking)and forced to work against their will often in unsafe deplorable conditions
(Chong & Clark, 2014).
How can we define this phenomenon? Article 3a of the protocol to prevent, suppress and
punish trafficking in persons defines human trafficking as:
The recruitment, transportation, transfer, harboring or receipt of persons, by means of 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. Exploitation shall include, at a minimum, the exploitation of prostitution or other
forms of sexual exploitation, forced labor or services, slavery or practice similar to slavery,
servitude or the removal of organs (UNHCR, 2000).
Internationally, trafficking in persons has been identified as a serious threat to human security
and development by governments and the UN. It is one of the greatest human rights challenges
of our time and is, as the International Labour Organisation (ILO) points out, the “underside of
globalisation.”
This report aims to explore the role of healthcare practitioners in the practical solution of this
conundrum. Victims of trafficking in person will benefit from a holistic approach of care which
takes into account their physical, mental, emotional, and social wellbeing.
Drivers of Trafficking in Persons
• Globalization
Globalization, with its accelerating flow of products, and people within an expanding world economy have been
a huge impetus for human trafficking. The economic and demographic disparities between the developing and
developed nations caused by globalization, free trade, greater economic competition, and a decline of state
intervention in the economy have all contributed to the marginalization and impoverishment of countless
numbers of people. Structural poverty has resulted in increased movements across borders and increased
internal migration from rural areas to urban centers
.
• Medical Tourism
Medical tourism is a growing phenomenon and one of the manifestations of globalization. It can be
defined as the movement of patients across borders in pursuit of medical treatment and health.
Despite the economic advantages ranging from revenues in not just the healthcare sector, but the
tourism sector as well, this industry is posed with challenges associated with trafficking in person
which is more specifically the issue of organ trafficking particularly in countries like Thailand and India
where organ transplantation is rampant. While it is true that organ transplantation can be a lifesaving
intervention when patients go down with end stage organ failure, illegal sale of organs is still a
challenge in the aforementioned countries. According to Shimazono (2007) ‘Although the number of
foreign recipients seems to have decreased after the enactment of a law banning the organ trade
(the Human Organ Transplantation Act of 1994), the underground organ market is still existent and
resurging in India’. This illegal sale poses a great risk in the society.
• Gender inequality
Patriarchal societies that reinforce the subjugation of women and deeply entrenched socio cultural
norms leave women and girls disproportionately more vulnerable to fall victim to traffickers.
• Political instability/ Civil unrest
The destabilization and displacement of populations increase their vulnerability to exploitation and
abuse through trafficking and forced labor. War and civil strife may lead to massive displacements of
populations, leaving orphans and street children extremely vulnerable to trafficking. In conflict zones
and wars, some rebel or military groups will use child soldiers and keep sex slaves. Additionally, both
conflict and natural disaster can lead people to migrate out of their hometowns and home countries,
making them more vulnerable to traffickers, especially if they are looking for work or paying
smugglers to get where they want to go. On top of that, with the increased economic instability,
traffickers have opportunities to offer false job offers to people, leading them into trafficking
situations.
• Social media
Traffickers have expanded their reach through the misuse of internet and communication
technology to advertise, recruit and exploit persons, and especially lure children whom they groom
for sexual online exploitation.
COUNTRY ANALYSIS AND TRENDS
1)USA
According to the State Department, the U.S. recognizes 2 primary forms of human trafficking:
b) Sex trafficking is defined as "the range of
activities involved when a trafficker uses
force, fraud, or coercion to compel another
person to engage in a commercial sex act or
causes a child to engage in a commercial sex
act." Examples of where sex trafficking can
occur include prostitution, escort agencies,
strip clubs, massage spas, internet chat
rooms, pornography, mail order brides and
sex tourism.
In addition to these federally recognized crimes, other forms types of trafficking in persons exists.
In a report published by Polaris (2018), 25 distinct types of human trafficking business models exist in
the United States, see appendix 1. Similarly, there is a growing body of evidence which suggests that
organ trafficking is not a myth in the country. Trafficking of human organs occur when parts of a
person's body are removed, commonly the kidneys and liver, and sold on the illegal (black) market.
Extortion and misdiagnosis of false ailments are common tactics for harvesting organs. So what is the
origin of this problem and what is driving the organ trafficking trade? As of September 2014, in the
United States alone there were 123,175 people waiting for lifesaving organ transplants and
approximately 101,170 of these people were waiting for kidney transplants. To put this further into
perspective, in 2013 only 16,896 kidney transplants took place in the United States and 4,453 people
died while waiting for a kidney transplant. It is little wonder then that according to the World Health
Organization (WHO) in 2010 approximately ten percent of all transplanted kidneys worldwide were
illegally obtained and approximately 10,000 black market operations involving purchased organs take
place annually. For example, in 2011, Levy Izhak Rosenbaum, an Israeli citizen who lived in
New York, admitted to brokering black market sales of kidneys to three Americans and making
approximately $410,000 in the process. Interestingly, none of the Americans who received the
trafficked organs were prosecuted. While it is true that the sale of organs may be illegal in the United
States, very little has been done to stop organ trafficking under its current laws (Wagner, 2014).
2) Sub-Saharan Africa
Although human trafficking is common in different continents of the world, it is endemic in Africa. At
the moment, two types have been identified namely internal (within a country’s territory) and
external trafficking (cross border trafficking). Countries in West Africa tend to detect more
victims than other countries in Sub-Saharan Africa, mainly sex workers, children and for the
purpose of forced labor.
Trafficking features in West Africa is complex, so are its routes. Countries like Nigeria, Ghana,
Cameroon and Senegal are source, transit, and destination countries for trafficked women and
children. Trafficking of young girls from rural areas in countries such as Mali, Benin, Burkina Faso,
Togo, and Ghana to work in Cocoa plantations in Urban Cote D’Ivoire are also documented in
literature. Trafficking from and through eastern Nigeria to Gabon have increased in recent years.
According to United Nations International Children’s Emergency Fund (UNICEF) 2017 report, children
made up over a quarter of detected trafficking victims in the world, and out of this, 64% are from
sub-Saharan Africa. The trafficking of women to Europe for commercial sexual exploitation also is
more prevalent in West Africa than elsewhere. At least 60% of foreign prostitutes in Italy hail from
African countries, the majority from Nigeria. Nigerian and Italian authorities estimate that there are
10,000 to 15,000 Nigerian prostitutes in Italy. Out of 4799 victims detected in 26 Sub-Saharan
Africa countries, 3336 were in West Africa including 2553 children. UNODC data suggests that
close to 80% of victims in West Africa were trafficked for forced labour, which remains the
major form of exploitation in the region. Similar to the experience in West Africa, human
trafficking is prevalent in Southern Africa. Countries such as South Africa, Mozambique,
Zambia, and Lesotho are source, transit and destination countries for human trafficking.
Key Actors involved in Combating this Challenge
The fight against human trafficking requires not just passive support but actual, active commitment and
effort of these actors. Government, NGOs, Academics as well as Healthcare practitioners are at the
proverbial tip of the spear, essential to the fight against trafficking in persons.
Ways to combat this Global Challenge
Training and awareness raising on trafficking
Training is essential in order to raise awareness about the specificities of trafficking in person’s
exploitation and its modalities, and to equip relevant practitioners with the right tools to prevent,
identify and combat the phenomenon.
Training should be systematically integrated in the regular training curricula of different professional
groups, and an impact assessment should be carried out at regular intervals. Asides the
aforementioned actors actively involved in fighting this challenge, the professionals targeted for such
training should include tax and customs authorities, police officers, prosecutors, judges, border
guards, migration officials, consular staff, local/municipal government officials, trade unions, private
employment agencies and companies.
Multi-institutional and multi-disciplinary training provides additional benefits. When training includes
professionals from different agencies, the conditions are optimal to exchange experiences, create
trust and build networks for addressing trafficking in a coordinated manner. Training can also include
simulation-based training exercises to enhance countries’ capacities to identify and assist trafficked
persons.
Similarly, raising awareness on trafficking and the rights of trafficked persons is important, as many
people still lack knowledge of this phenomenon. Awareness campaigns and events can target the
general public, businesses, stakeholders in specific sectors considered to be at risk. Awareness raising
remains a crucial prevention tool, in particular when it is targeted and directly engages groups at risk,
e.g. in schools, communities, employment agencies, drop-in centers and work premises.
Role of Healthcare Practitioners in this challenge
Health care providers are among the few professionals likely to encounter human trafficking victims and
are a key element in the identification of human trafficking victims. These individuals commonly enter
the health care system during periods of transportation, detainment, or exploitation. Studies have
shown that approximately 50% of trafficking victims saw a health professional while in captivity.
However, healthcare workers, and particularly physicians, are rarely engaged or trained to recognize
these patients, despite their potential opportunity to intervene. According to U.S. Department of Health
and Human Services (2020) a recent study with Emergency Department personnel indicated that only
3% of Emergency Department personnel received training specific to human trafficking victims. Thus,
many human trafficking victims who encounter a health professional are not identified, recognized, and
referred to appropriate resources.
While human trafficking is believed to disproportionately affect women and girls, human trafficking
crosses all racial, gender, class, sexual orientation, age, ability, and socio-economic boundaries. In a
health care setting, acute medical complaints seen in these patients are varied. Lack of nutrition, sleep
deprivation, physical violence and injury, and mental health complaints due to extreme stresses are
commonly seen. As with many of our disadvantaged members of society, they may also present with
chronic diseases at advanced stages as they are systematically denied access to medical care by
traffickers.
Given the fact that victims often present to healthcare facilities, the role of healthcare practitioners
cannot be overemphasized. For this reason, it is very important to seek their active involvement in
identifying and fighting this phenomenon. Medical Doctors for example should be equipped with
resources that are necessary to help them identify these victims at their various facilities. To increase
victim identification in healthcare settings, providers need to be educated about the issue of trafficking
and its clinical presentations in an interactive format that maximizes learning and ultimately patient-
centered outcomes.
At the core of the victim’s physical, mental, emotional, and social wellbeing is a healthcare
practitioner. It is important to design action frameworks in order to integrate these victims back into the
society.
Conclusion
Trafficking in persons affects every country in the world, regardless of socioeconomic status, history, or
political structure as discussed earlier. It has gone beyond the commonly identified types and have cut
across the healthcare industry to give birth to a booming business known as organ trafficking. With
respect to combating this conundrum, we have seen various actors involved in this fight. This report
concludes that healthcare workers play a very important part in not just identifying trafficked victims,
but also in helping them integrate back into the society.
- Miriambeth Asika
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