Physicians Need to Know About Human Trafficking and What to Look For. 

By T. JANN CAISON-SOREY, MD, MBA 

The United Nations on Drugs and Crime defines Human Trafficking as a “serious crime and a grave violation of human rights.” Every year, thousands of men, women and children fall into the hands of traffickers, in their own countries and abroad. Almost every country in the world is affected by Human trafficking. Here are some facts that bring to light the enormity of this global current day human tragedy: 

• Approximately 75-80% of human trafficking is for sex.  
• Researchers note that sex trafficking plays a major role in the spread of diseases.  
• There are more human slaves in the world today than ever before in history.  
• There are an estimated 27 million adults and 13 million children around the world who are victims of human trafficking.  
• Human trafficking not only involves sex and labor, but people are also trafficked for organ harvesting.  
• Human traffickers often send “broken-in girls” to recruit younger girls into the sex trade. Sex traffickers often train the girls they acquire themselves by repeatedly taking advantage of them then teaching them what they want them to do.  
• An estimated 30,000 victims of sex trafficking die each year from abuse, disease, torture, and neglect. Eighty percent of those sold into sexual slavery are under 24 years of age, and some are as young as 6 years old 

Although human trafficking is often a hidden crime and accurate statistics are difficult to obtain, researchers estimate that more than 80% of trafficking victims are female. Over 50% of human trafficking victims are children. 

Labor Trafficking is another form of human victimization where people are forced into indentured servitude. In this form of Human Trafficking victims can be found in:  

• Sweatshops (where they work long hours under abusive labor standards)  
• Commercial agricultural situations (working in large fields where crops are grown, factories/processing plants, canneries, etc.)  
• Domestic situations (maids, nannies. “live-ins”)  
• Construction sites (particularly if public access is actively prohibited)  
• Restaurant industry and custodial work  
• Debt bondage - enormous financial obligations or undefined/increasing debt  
• Isolation from the public - limiting contact with outsiders and making sure that any contact is monitored or superficial in nature  
• Isolation from family members and members of their ethnic and religious community
• Confiscation of passports, visas and/or identification documents 

So, how is it that ordinary young people in the United States can get trapped into the Sex or Labor Trafficking underworld? First understand that they are not volunteering to be exploited. Traffickers frequently recruit people through fraudulent advertisements promising legitimate careers, jobs as models, hostesses, domestics, or work in the agricultural industry. Those who answer these ads are looking for an opportunity get work as part of an upscale opportunity being offered, others are young people who want to be photographed, so they can get a shot at becoming famous by becoming an actress/actor, model, etc. only to discover much too late that there was another plan that they never saw coming. Trafficking victims of all kinds come from rural, suburban and urban settings. 

Often overlooked and Under Reported: Does it happen in Michigan? 

According to a news article by CBS-Detroit, new measures have been put into place in Michigan that include longer prison terms for involuntary servitude involving a minor and sex related activities and obtaining labor or services by force, fraud or coercion. 

Bridgette Carr, who directs the University of Michigan Law School’s Human Trafficking Clinic, said the practice is happening all over the state of Michigan, and tougher enforcement is needed to deal with the growing problem.

"In Michigan, we have seen victims in the U.P., in Detroit, in rural areas. We haven’t found a community yet that we haven’t seen a victim come from," Carr said. "So, what I often tell people is: 'Find a community that doesn't have a drug problem, and I can say perhaps your community doesn't have a human trafficking problem.' That’s how prevalent it is."

Many situations are common to circumstances seen on a national/international level:

Physicians/Clinicians Must Be Observant: 

As a physician it may be prudent to ask yourself, does the story given or circumstance provided fit what you are seeing? 

While it is quite understandable that a physician is not a detective, it is however imperative that physicians, whether they are Primary Care, Emergency Medicine Specialists or other Subspecialists [including Dentists/Oral Surgeons], ensure that they are comfortable that the story given fits the shape, extent and nature of injury/trauma they are seeing. Keep in mind that many scars can be psychological/emotional and not visible to the naked eye but carry a great potential for being uncovered if the right questions are asked and the victim is alone and away from The Trafficker or their representative. Additionally, physicians may wish to establish who is accompanying the young person they are seeing in their clinical setting if there are some suspicions, concerns or other red flags raised. 

According to the website HumanTrafficking.org, most trafficking victims will not readily volunteer information about their status because of fear and abuse they have suffered at the hands of their trafficker. They may also be reluctant to come forward with information due to despair, discouragement, and a sense that there are no viable options to escape their situation. 

The website goes on to state that "even if pressed, victims may not identify themselves as someone held in bondage for fear of retribution to themselves or family members." However, there may be indicators that may raise a red flag that an individual may be held in a human Trafficking situation. 

Health Characteristics of a Trafficked Person: 

Trafficked individuals may be treated as disposable possessions without much attention given to their physical and/or mental health. Accordingly, some of the health problems that may be evident in a victim include: 

• Malnutrition, dehydration or poor personal hygiene 
• Sexually Transmitted Infections 
• Signs of sexual assault- sexual abuse  
• Bruising, broken bones, lacerations or other signs of untreated medical problems  
• Poorly treated chronic illnesses including diabetes, cancer or heart disease  
• Post-traumatic stress and/or other psychological disorders 

Other Important Signs: 

In addition to some of the obvious physical and mental indicators of trafficking, there are other signs that an individual is being controlled by someone else. Red flags should go up for physicians, law-enforcement or others who happen to notice any of the following during an encounter. The individual: 

• Often has poor eye contact/very low self esteem  
• Does not hold his/her own identity or travel documents  
• May suffer from verbal or psychological abuse designed to intimidate, degrade and frighten the individual  
• Has a trafficker / trafficker representative with them at all times. In clinical settings, this person/these persons may refuse to leave the individual alone. 

Michigan Legislative Efforts: 

Michigan’s lawmakers are also being proactive. Lawmakers have been prudent in drafting the Human Trafficking Laws, which is the result of an intensive process that started in March 2013 when Representative Kurt Heise, R-Plymouth co-chaired the first Michigan Commission on Human Trafficking with Attorney General, Bill Schuette. These in conjunction with other coordinated efforts give law enforcement new weapons to find and prosecute human traffickers while protecting the victims of these crimes. 

On October 16, 2014 at 12:03 PM, Jonathan Oosting (a Capitol reporter for MLive Media Group) wrote that Michigan Gov. Rick Snyder on Thursday signed more than 20 bills designed to strengthen human trafficking laws, crack down on offenders and protect victims. Other laws signed Thursday will strengthen penalties for human traffickers and "johns" who solicit teens for prostitution, who would be placed on the sex offender registry. 

What can be done if Human Trafficking is suspected? 

If a physician sees red flags and has strong concerns, there are ways to follow-up. Alert Hospital Security/Local Law Enforcement/ Call the Help line below. Remember, that anyone can report suspected trafficking cases. 

To report suspected human trafficking: Call 1-866-347-2423 or to get help from a non government organization: Call 1-888-373-7888. Victims can text HELP or INFO to: BeFree [233733] 

Submitted by,
T. Jann Caison-Sorey, MD, MBA
President, Wayne County Medical Society, Southeast Michigan