The Significant Role of Healthcare Providers in Human Trafficking Identification

A 2014 study reported 88/100 of sex trafficking victims came into contact with a healthcare department during their exploitation
A 2014 study reported 88/100 of sex trafficking victims came into contact with a healthcare department during their exploitation

There is growing awareness of the key role that the healthcare sector plays in identifying and supporting victims of human trafficking. Due to the vast forms of exploitation, many dangerous scenarios lead to numerous physical injuries from STD’s of sex workers, to injury operating  heavy machinery on mine sites, and exposure to hazardous chemicals,  malnourishment and osteoporosis. Furthermore, trafficking victims often suffer from significant mental health and physical trauma as a result of their exploitation. Currently, in hospitals around the world, systems of identification exist for child abuse and domestic violence, yet limited procedures exist to identify and support trafficking and modern slavery survivors. Both the UK and the US are implementing policy to work with healthcare professionals to provide the necessary care and support for trafficking victims.

According to reports by trafficking survivors, many entered the healthcare system at some point during their process of exploitation. A survey in 2014 suggested 88/100 of the sex trafficking victims came into contact with an emergency healthcare department. These scenarios are critical opportunities that are missed if healthcare staff are not trained to identify victims of trafficking. However, this is not a simple or obvious process, as many of victims face difficult situations. They may not be open with the professionals if they have self doubt or are not yet aware they are being exploited, they are afraid of the repercussions of giving information regarding their situation, or they are accompanied by a supervisor to prevent details being communicated to authorities.

To deal with such situations, training is given to doctors, nurses but also a wider circle of healthcare providers that have come into contact with victims, including social workers, security guards and receptionists. These employees have the capacity to intercept victims, spot the important indicators, such as if the healthcare needed has been put off for several weeks, to spot inconsistencies in information or repeat injuries. They will then ask a number of leading questions to encourage victims to receive help. These questions may entail whether the patient “has ever had sex for money” or “whether they give someone else part of what they earn”.

Dignity Health has human trafficking program in over 40 hospitals in the USA, in which the core goals “are to ensure that trafficked persons are identified in the health care setting and that they are appropriately assisted with victim-centered, trauma-informed care and services”. They are “implemented first in Dignity Health emergency departments, followed by labour & delivery and postpartum departments”. In particular, there is a new diagnostic tool that can be used to identify and record umbers of trafficking against other abuse victims.

The UK are also developing systems to address the role of healthcare in trafficking survivors. The NHS Human Trafficking e-Learning Tool assists in identification and care of trafficking victims. It is aimed to train healthcare staff by outlining various scenarios of trafficking and how to appropriately cover the legal rights to medical care of trafficking victims. The aim is to inform and prepare front line staff to provide thorough support when confronted with cases of human trafficking.

In terms of victim support for survivors of human trafficking in the UK, the healthcare system is only available to victims within the 45 day reflection and recovery period of the National Referral Mechanism, after which governmental and healthcare assistance ends and survivors are vulnerable to re-trafficking and exploitation. In a report by Dr. Carole Murphy, she explains that the “system and its processes and procedures are not fit for purpose and have the potential to cause harm to survivors through re-traumatisation, falling through gaps in service provision and potential re-exploitation.”

The International Organisation for Migration and UN Global Initiative to Fight Human Trafficking also provide guidance on recommendations for victim care within all jurisdictions. They provide the report Caring for Trafficked Persons: A Guide for Health Providers in which they suggest careful treatment from healthcare providers can be fundamental in the recovery of abused and traumatised victims. It aims to provide guidance in recognising the common health problems and diagnosis associated with trafficking and the most safe and appropriate way to undergo treatments.

It is clear that the healthcare system plays a fundamental role in both human trafficking identification, as well as on going survivor support. The issue is unfortunately, if victims are not willing to give up information then there’s little support healthcare providers can give, hence, the way in which victims are spoken to and dealt with must be in careful and diligent manor after going through specialist training.

Further information and official reports on medical resources for professionals working with trafficking victims, see our eLearning resource.

World Day against Trafficking in Persons 2018: Join the HTMSE Directory in the Fight Against Human Trafficking

World Day against Trafficking in Persons 2018

The United Nations has allocated the World Day against Trafficking in Persons, occurring for the 5th year on July 30th, in order to raise awareness for the heinous crime that plagues every country globally, whether a place of origin, transit or final destination.

Behind drug trafficking, human trafficking is one of the most profitable criminal networks where millions of vulnerable people are forced, manipulated or coerced into moving to a foreign destination, whereby they will endure exploitation at some point along their path. This may take the form of hard labour, sexual exploitation, forced begging, forced criminality, organ removal or ever developing forms of exploitation, for example skin removal, online pornography, and exploitation in the sports industry.

The International Labour Organisation reports that 21 million people are subject to forced labour globally, of which a large proportion have been trafficked. Women and girls make up around 70%, and children or minors make up 30% of all trafficking victims. Hence, the focus for World Day against Trafficking in Persons 2018 is on ‘responding to the trafficking of children and young people’ as announced by the UNODC. The aim is on prevention, education, support and justice for the child victims of trafficking.

In order for this movement to be most effective, professionals within the fields of human trafficking and modern slavery need to work together, pool resources, expertise and specialism. The HTMSE directory is a global platform that lists professionals in the fields of law, trafficking and country experts, medical experts, counsellors and therapists, specialist organisations and researchers who are working towards the same goal of eradicating exploitation, trafficking and slavery. On this World Day against Trafficking in Persons 2018, we welcome you to join our initiative or use the resource in your fight against human trafficking alongside our professional network, to achieve support and justice for victims of trafficking.

For further information on World Day against Trafficking in Persons 2018, see here.

Accountability Needed for Internet Service Providers: Sex Trafficking and the Case of

Backpage’s involvement is reported in 73% of all child trafficking cases received from the US National Centre for Missing and Exploited ChildrenIn an exponentially expanding era of cyber activity, new channels for criminal activity are being facilitated. A particular area of concern is within the use of the Internet for human trafficking and in particular sexual exploitation, in which the US case of has received much international attention.

Earlier this year the notorious website was shutdown by the US Department of Justice. is the world’s second largest classified ad marketplace where 90% of the websites’ revenue is generated from ‘ads’ relating to sexual promotion, including child sexual exploitation and forced prostitution. Based in its Dallas Texas HQ with global operations out of 97 countries with 943 locations, the last reported value of was over half a billion US dollars. It has been the subject of on going concern for US authorities, as Backpage’s involvement is reported in 73% of all child trafficking cases received from the US National Centre for Missing and Exploited Children (NCMEC).

The United States Senate’s report’s Knowing Facilitation of Online Sex Trafficking following the 2 year investigation indicates three major findings:

  1. Backpage has concealed evidence of criminality by systematically editing its ‘adult’ ads. Over the last 10 years and as recently as 2014, Backpage executives have had several methods of formalised ‘deletion of incriminating words and phrases, primarily through a feature called the “Strip Term From Ad Filter.”’ Words removed by both manual and automatic systems included “lolita,” “teenage,” “rape,” “young,” “amber alert,” “little girl,” “teen,” “fresh,” “innocent,” and “school girl.” Through rewording advertisements, the client could submit the ad with the same criminal intention and usage, yet presented with ‘legal’ content.
  2. Backpage is fully aware of the fact that it facilitates illegal prostitution and child sex trafficking. It has refused to respond to complaints and manipulated information sent to NCMEC.
  3. Despite the sale of the website to an anonymous foreign company in 2014, the real owners are James Larkin, Michael Lacey, and Carl Ferrer.

Bradley Myles CEO of Polaris Project made a statement on this case, in which he commented that “shutting down the largest online U.S. marketplace for sex trafficking will dramatically reduce the profitability of forcing people into the commercial sex trade, at least in the short term. Traffickers will have to rethink their business models and sex buyers will face greater risk.” He highlighted the fact that the multimillion-dollar industry leader cannot claim ‘ignorance’ as to the human trafficking they are facilitating and must be held personally liable.

This response relates to previous attempts to shutdown For example in 2016, the CEO, Carl Ferrer and fellow executives were arrested on ‘pimping related charges’. However, this attempt at prosecution was unsuccessful, protected under the US Constitution and legislation that deemed having no liability for the speech of third parties who posted the ads on their site. The US Communications Decency Act (CDA) 1996 was implemented as an attempt to regulate internet pornography, but under Section 230 has been interpreted to shield operators of Internet services, and thus they are not legally or criminally liable for the content of third parties who use their services. This defence has been used several times to leave operating, despite the obvious facilitation of sex trafficking. To overcome this on going loophole, the Trump administration has amended this legislation through their Stop Enabling Sex Traffickers Act of 2017 to put the onus of responsibility onto the website host for information relating to sex trafficking.

The concern over this legislation has primarily been voiced by free speech and internet advocates including the Silicon Valley Internet Association who are lobbying against it, as it has wider implications for their own accountability for illicit content created by users. The CDA legislation is seen as a primal statute for Internet development, which has put pressure on large ‘legitimate’ tech companies including as Google, Amazon, Facebook, and Twitter. Google has put forward a number of solutions they are contributing, including blocking advertising from their remit and developing technology to help scan for rouge sites. Ultimately, however, these technologies have not been successful in stopping the operation of sex promotion that is currently ‘protected’ by the US constitution, and therefore legal measures need to be adjusted.

In analysis, the core of the issue is transferring the onus of responsibility onto the owner/s of websites that may be used for illegal activity, as they are ultimately benefitting from the exploitation facilitated by their website (whether within or out of their knowledge).  Although the issue is complex and there are no tangible supply chains in an online system, the legislation ruling cyber security must mimic the template of recent Modern Slavery Legislation (e.g. in the UK), where the benefiters (i.e. corporations) must be responsible for human rights abuses in their supply chain in the same way that website facilitators must be held accountable for abuses that are associated with their website’s network.

For the full report United States Senate’s report’s Knowing Facilitation of Online Sex Trafficking, read here.  

Long-Term Support Lacking for Human Trafficking Victims in the UK

Long-Term Support Lacking for Modern Slavery and Human Trafficking Victims in the UK

The report A Game of Chance? Long-term support for survivors of Modern Slavery by Dr. Carole Murphy at The Centre for the Study of Modern Slavery offers a comprehensive analysis into the UK’s current approach to support for victims of human trafficking and modern slavery. It highlights the significant gaps in survivor care, most notably in long-term support. There is little done beyond the 45 day reflection and recovery period of the National Referral Mechanism, after which financial assistance ends and survivors are vulnerable to re-trafficking and exploitation. Hence, the report suggests the “system and its processes and procedures are not fit for purpose and have the potential to cause harm to survivors through re-traumatisation, falling through gaps in service provision and potential re-exploitation.

The key recommendations are:

  • Resource services to work with complexity of survivors’ needs relevant statutory and voluntary sector
  • A positive Conclusive Grounds (CG) decision must carry status and resources (see Lord Mc Coll’s (Victim Support) Bill)
  • Trafficking Survivor Care Standards (HTF) should be implemented as standard model of best practice and should consider introduction of independent advocates
  • Statutory guidelines should be introduced and monitored and include compulsory and embedded training for all First Responders and other statutory services
  • Personnel conducting CG interviews should be properly trained
  • Undertake consistent monitoring of the NRM drawing on evidence based research about what works
  • Document evidence of what works by conducting a cost benefit analysis to establish the social return on investment of longer-term support provision
  • Consider evidence and best practice from other jurisdictions to inform changes


For the full report on A Game of Chance? Long-term support for survivors of Modern Slavery by Dr. Carole Murphy The Centre for the Study of Modern Slavery, read here. 

Labour Abuses in the Jewellery Industry

Over 1 million children between the ages of 5 -17 are working in artisanal mining operations on less than $2 per day or receiving food as payment
Over 1 million children between the ages of 5 -17 are working in artisanal mining operations on less than $2 per day or receiving food as payment

In the wake of the development of modern slavery compliance legislation, there is a movement towards transferring the onus of responsibility onto large corporations to ensure their own supply chain is clean. Some of the worlds largest companies are in the jewellery business, with a notorious reputation for human rights abuses, yet some of the world’s highest revenue. According to Human Rights Watch (HRW), specifically gold and diamonds generate over $300 Billion revenue annually, from 90 million carats of diamonds and 1,600 tones of gold. 

There has been an upraise in media on ethical supply chains in agricultural industries such as fishing, cocoa & coffee production, yet there are significant issues to be addressed in supply chain compliance and ethical sourcing compliance for the jewellery business – here addressing labour exploitation, child labour and human trafficking.

Examples of Human Rights abuses

 Specifically in relation to child labour, estimates suggest over 1 million children work in artisanal or small-scale mining operations, despite being illegal at both the domestic level and by international law. Statistics from the African Centre For Economic Transformation suggest these children between 5 -17 are working on less than $2 per day, or receiving food as payment. Child labour has been reported in Ghana, Mali, Nigeria, the Philippines, Tanzania, and Zimbabwe, Burkina Faso, Uganda, the Democratic Republic of Congo, and Indonesia. However, regulation is lacking and children are continuously working in extremely dangerous and inhumane conditions, including exposure to toxic and explosive chemicals potentially causing brain damage, respiratory diseases from the dust, heavy strenuous lifting and exposure to dangerous machinery.

Concerning forced labour, it has been reported in Peru, Democratic Republic of Congo, Eritrea and in Zimbabwe where the military physically forced workers into diamond mining between 2008-2014. In the harsh conditions of the mining industry, workers are prevented from leaving either by blackmail or violence. In other cases, workers are trafficked to mines, by deception or force, in order to be exploited for mining work.

Wider rights abuses are continually taking place in the extraction industry, including land rights violations whereby indigenous populations have been displaced, armed conflict violations including money laundering to fund civil wars and violence by arming militias. Sexual violence, including abuse and torture by occupying mine workers, security guards and soldiers controlling mines has been reported, such as in Porgera mine, Papua New Guinea. Furthermore, environmental rights have been violated by disrupting 1000s of people and defecating habitats with toxic mine runoff, as in Nigeria 400 were children killed by artisanal mine toxic lead poisoning.

What are the current standards?  

Alongside prominent Modern Slavery legislation, as seen developed in the UK, USA and developing in Australia, that holds businesses accountable for their own supply chain regulation, there are several international standards for human rights compliance yet none that are prominent enough to control this issue.

The United Nations Guiding Principles on Business and Human Rights declares that companies are by law required to undertake “human rights due diligence” within their entire supply chain. Furthermore, they must have systems in place to identify and remediate human rights abuses immediately. However, when it comes to implementation this only document offers only ‘guidance’.

The OECD Due Diligence Guidance for Responsible Supply Chains of Minerals from Conflict-Affected and High-Risk Areas provides an industry-targeted outline for mine operators. The major issue with this, however, is that it is voluntary and therefore not officially regulated.

Furthermore the Kimberley Process Certification Scheme (KPCS) is a significant international standard relating specifically to diamond extraction, to eradicate “blood diamonds” or “conflict diamonds”. However, again this proves too narrow, as it does not cover human rights abuses outside of active conflict zones.

The Responsible Jewellery Council (RJC) provides a certification system for all stakeholders in the jewellery supply chain. However, as this is an industry led program, it fails to have the legal and regulatory weight to ensure due diligence is done. Instead, according to findings by HRW it has flawed governance systems in which most companies assign their whole credibility for human rights compliance.

Are jewellery companies adhering to Modern Slavery compliance regulation?

HRW released a report in February this year focusing on the policies and practices of 13 major jewellery brands that generate over $30 Billion per year. Many reporters and researchers fail to receive any comment from major bands as to their slavery and trafficking risks associated with gold mining.  HRW concluded that clear majority of jewellery companies are not meeting human rights standards within their supply chains. There are little hands on investigations, and too much reliance is put on verbal ‘assurances’ from their suppliers that the gems, minerals, products are ethically and sustainably sourced.

Two mining companies have monopoly over the global diamond industry, and account for over half of all diamond sales. De Beers, working from South Africa, Botswana, Canada, Namibia, and Russian company ALROSA. However, according to HRW, both of these fail to be transparent with the mines in which their diamonds are sourced.

Issue in difficulty for companies to trace their supply chains

With parallels to technology companies who source small parts from many locations, the jewellery industry has very complex supply chains, as oppose to fishing or agriculture where the total product (e.g. a fish) has one source of origin. For example diamond jewellery is handled by many actors, making it difficult for companies to trace their full supply chain. From the mines, diamonds are firstly sent to be cut and polished, whereby 70% of the global diamond supply is done in India and 20% in China, reflecting their low labour costs. The next stage in a generic supply chain is to jewellery manufacturers where the products are pooled and constructed. Finally they reach the end retailers, where the US has the largest market of 40% of global sales.

A crux of the issue is in the sale after the raw extraction process because as soon as the minerals go through the first process of trade or export, batches from many sites are often mixed up. This makes the sustainably and ethically sourced gems or metals untraceable from those that are product of exploitative labour. This is ultimately caused by negligence of the mine operators in dealing with and processing their products in a way in which they can be accounted for.

Some companies have CSR programs used to give back to the community and in exchange for their land use, build major infrastructure like schools, roads, and hospitals. (Harvard) However, there is speculation around using these methods as a way to be presented as human rights compliant, as these initiatives are undercut by their lack of transparency in their daily business operations and supply chain mechanisms. Analysis of the global extraction business points to the conclusions that this industry is fuelled by profit and capital gain, whereby there is a large disconnect between those that are receiving the benefits of the jewellery business and those that are suffering. This issue is on-going because perpetrators will not have interests in alleviating the abuses from their supply chains, unless legally forced to, or compelled by their customers through suspended of business.


Although the majority of companies are lacking in their supply chain compliance, HRW points out that some positive initiatives are blooming. For example a number of jewellers are exclusively working with artisanal mines that comply with the Fairtrade or Fairmined gold standard coming from Latin America, driven by consumers demanding ethical sourcing. In order to be most effective, successful domestic legislation such as the UK Modern Slavery Act should be used as a blueprint to regulate national supply chains. For countries that are less likely to adopt such policies, the international literature should become involuntary, binding and regulated, to cut out any internal corruption facilitating the mining industry. Furthermore, a percentage of the capital that is gained from mines should be redirected to the local communities through education and infrastructure to deal with the long term problem of child labour in the extraction sector.

Statistics drawn from Human Rights Watch Report February 2018: The Hidden Cost of Jewelry: Human Rights in Supply Chains and the Responsibility of Jewelry Companies


Migrant Crisis Reinforced by Large Death Toll Crossing the Mediterranean

Photo Credit: UNHCR/Alfredo D’Amato. An overloaded boat of refugees and migrants trying to reach Europe, as seen from the deck of an Italian Coastguard ship, in the Mediterranean Sea.
Photo Credit: UNHCR/Alfredo D’Amato. An overloaded boat of refugees and migrants trying to reach Europe, as seen from the deck of an Italian Coastguard ship, in the Mediterranean Sea.

The crossing between North Africa and Southern Europe has proved to be the most dangerous refugee passage. Concern has been raised by international agencies including the IOM and UNHCR by two fatal sunken boats over three days at the beginning of July 2018.

On the first boat around 103 people drowned off the coast of Libya, where the coast guard had limited capacity to rescue only 16 men. The mode of transport in which they were crossing was an “unseaworthy and overcrowded” rubber boat marking an example of the dangerous methods that migrant smugglers are using. Shortly following, a second boat capsized with 100 people still missing, 41 saved. This toll contributes to the statistics of over 1000 drowning on the Mediterranean crossing of this year alone.

The Libyan Coast Guard is continually intercepting boats with smuggled migrants who are attempting to cross the Mediterranean and turning them back to be held in detention centres. Although numbers arriving at EU shores are 5 times lower than it’s peak in 2016, over 10,000 people have been returned to shore so far this year, representing another significant increase in numbers. There is also concern over the human rights conditions in the detention centres, where women and children put at high risk of violation and exploitation.

On analysis, although this points to urgent need for action by the EU, this situation needs to be addressed carefully. Bureaucracy between Geneva and the Libyan government led to the 2018 EU backed anti-smuggling operations in Libya including tightening regulation of volunteer boats arriving on European shores, which inadvertently has impacted the increased death toll. The concern of agencies is regarding higher sanctions on boats already in transit, which will bread further desperation and in turn fatal impact if distress calls are not seen to.  Hence, emphasis should be made on reinforcing search and rescue operations, assist the Libyan coast guard and a careful and collaborative approach needs to be made with the international community to curb migrant smuggling and the cause of more deaths during this crossing.

​ It is also important to highlight the ​increase of displaced and vulnerable migrants who are at risk of exploitation, given the complexities of the migrants’ journey, it is a frequent occurrence that the definitions of trafficking and smuggling become obscured. Often victims will believe they are being smuggled but become trafficked through transit or at their destination country. Factors such as political instability, economic pressures and environmental issues are often the catalysts for migrants seeking to come to Europe. Illegal migrants often rely on organised criminal networks to facilitate their passage to Europe, leading to higher risk of exploitation and further blurring of the distinction between trafficking and smuggling. The migrant crisis in Libya provides a unique yet unfortunate opportunity for clarification: the controls aimed at ending the smuggling of migrants to Europe has been the catalyst of human trafficking inland.

For Untitled Nations reporting on the migrant crisis see here:

Immigration Policy Impacts Trafficking Statistics

Image Credit: Polaris Project Human Trafficking on Temporary Work Visas: A Data Analysis 2015-2017
Image Credit: Polaris Project Human Trafficking on Temporary Work Visas: A Data Analysis 2015-2017

Polaris has recently investigated a structural cause into the increased trafficking statistics within the USA. From 2015-2017, around 50% of all victims who reported labour trafficking to the National Human Trafficking Hotline had legal employment visas, of whom 797 had specifically Temporary Work Visas (H-2A, H-2B). From their research, 75% of the victims were recruited for valid job offers within a variety of industries including agriculture, domestic work, landscaping, hospitality, restaurants, and construction.

This suggests that there is a disconnection between the legal framework that a temporary visa provides and the reality of employment, where a grey area allows employers to exploit their foreign workers. Indeed, Polaris’ latest report details how firstly, labour recruiters for the USA demand an array of complex fees and hidden costs often amounting to disproportionate debt for the victim. Furthermore, many of the visa holders are vulnerable to exploitation because they are legally bound to a single employer to uphold their right to remain in the USA. This often leads to a form of debt bondage to their employer because by loosing their job they are imminently subject to deportation, which can be used to blackmail and demand on-going labour.

Instead of the cause of this trafficking being rooted in the recruitment process that usually occurs abroad, the issue posed takes place at the next stage once employment is confirmed within a domestic situation. This must be looked at within the context of the USA border policy, which tends to be outward focused in an attempt to control inward trafficking of drugs, weapons and humans. However, these statistics suggest there is an oversight made domestically, with a need for regulation of labour policies for immigrants. Polaris suggests the need for transparency and supports the proposed Visa Transparency Anti-Trafficking (VTAT) bill to address this issue.

For the full Polaris Report on Human Trafficking on Temporary Work Visas, read here.