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«IOM is committed to the principle that humane and orderly migration benefits migrants and society. As an intergovernmental organization, IOM acts ...»

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Suspicions about trafficking should increase if an individual discloses or is identified as having worked or currently working in a job sector commonly associated with trafficking; if he or she shows signs or symptoms of trauma reactions, injuries, illnesses or infections that suggest that abuse has occurred or that the individual has been working in exploitative conditions; or if the patients shows physical manifestations of poor nutrition, hygiene and lack of self-care (see chapters 1 and 2).

Trafficked persons may also appear fearful, mistrustful and anxious about their surroundings. They may have difficulties in articulating their medical complaints; sometimes they may not speak the local language. They may have legal problems that add to their fear and mistrust, including problems


related to immigration status or possibly criminal status. In the more obvious trafficking cases, a ‘minder’ will accompany the trafficked person to serve as a translator, monitor behaviour or provide transportation. Intimidation is not always evident – but often the signs of quiet coercion can be discerned.

Finally, it is not uncommon for a person who has been trafficked to be unaware that he or she is a victim of a crime. Many trafficked persons will not have heard of the crime of ‘trafficking’ and may consider the exploitation or abuse that occurred to be a matter of bad luck, or the result of poor judgment.

RequIRed ACTIonS Picking up on the red flags described above, you should consider the actions outlined below.

If you suspect or find out that your patient has been trafficked The most important part of the response to a suspected trafficking situation is the work you do before you react. Learn about the protection options available for trafficked persons or similar vulnerable groups in your country and local setting. Keep referral information in various languages if possible, including names and phone numbers of contact persons and know whether these referral options are competent to support the needs of trafficked persons – and specifically your patient (see action sheet 10).

Bear in mind that you may not be able to rescue your patient due to security risks to you and/or your patient, and that the responsibility is not yours alone. There are other options available to maximize the benefits

to your patient, even if you only have one single encounter. Consider the following important points:

• do not try to rescue your patient if you are not yet linked to the protection system available for trafficked persons in your country or area, and do not have proper information on existing referral networks and available services (see action sheet 10).

• Ensure the safety of your patient, yourself and your health facility first (see action sheet 7).

o Find ways to talk to the patient alone. do not inquire about trafficking-related circumstances in front of others, including your patient’s companion. To gain privacy with the patient, you could, for example, suggest that a private examination is required.


–  –  –

When referral is possible and you are aware of services available and who

to contact, consider the following (see action sheet 10):

• What protection services are available in your country or area for trafficked persons? Is there a specific agency appointed as first point of service? Are you compelled by local laws to report cases of trafficking and/or violence?

• What service(s) does your patient most need at the time of your encounter? Shelter and food? More comprehensive health and psychological care? Legal or immigration assistance?

Translation services? The trafficked person should have a voice in making this decision whenever possible (see action sheets 1 and 16).

• do not contact any support organization or the police without first explaining to your patient how this communication will affect him or her. Discuss available options, and explain how they work and what the benefits are. Act only with your patient’s consent.28 • Different contexts may apply to your patient in terms of his or her rights, depending on his or her immigration and legal status, presence of proper documents, and the type of work engaged in (whether legal or illegal). All of these circumstances may have an impact on the patient’s safety.

Explain the situation to your patient and help him or her make the best decision.

When you cannot refer your patient but feel confident about your patient’s compliance for follow-up assessment and treatment, consider the


• Maintain your professional role as health provider. Provide comprehensive management for your patient, including arranging follow-up care and visits.

• You may face different circumstances in your next encounter with your patient. Your patient may develop trust and request different assistance.

Please see action sheet 16 for special considerations related to competence, capacity, and guardianship.


–  –  –

RefeRenCeS And ReSouRCeS International Organization for Migration 2007 The IOM Handbook on Direct Assistance for Victims of Trafficking, IOM, Geneva, 2007.

2006 2004 The Mental Health Aspects of Trafficking in Human Beings: Training manual, IOM, Budapest, Hungary, 2004.

2004 The Mental Health Aspects of Trafficking in Human Beings: A set of minimum standards, IOM, Budapest, Hungary, 2004.

2001 Medical Manual, 2001 Edition, IOM, Geneva, 2001.

Pan American Health Organization, Women Health and Development Program and Organization for American States, Inter-American Commission on Women 2001 “Trafficking for Sexual Exploitation”, Fact Sheet of the Program on Women, Health and Development, Washington, DC, July 2001.

Zimmerman, C. and C. Watts, 2003 WHO Ethical and Safety Recommendations for Interviewing Trafficked Women, World Health Organization, Geneva 2003.

Zimmerman, C. et al.

2008 “The health of trafficked women: a survey of women entering posttrafficking services in Europe”, American Journal of Public Health, vol. 98, no. 1, January 2008, pp. 55–59.

AC Action Sheet 7:

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RATIonAle All trafficked persons have the right to physical safety and protection.

According to international standards, “States have a responsibility under international law to act with due diligence to prevent trafficking, to investigate and prosecute traffickers and to assist and protect trafficked persons.”29 Protection is one of the three ‘Ps’ of counter-trafficking activities – prevention, protection and prosecution – and is an essential element of an assistance package to a trafficked person. For a healthcare provider, ‘protection’ means meeting individuals’ health needs and helping to keep them safe from harm.30 Human trafficking is a criminal activity that frequently involves organized crime networks. The security and physical safety of trafficked persons—and of health care providers—must always be among the highest priorities. For traffickers, the loss of a trafficked person is the loss of income and a symbol of their loss of control. In some cases, individuals who have escaped traffickers may be pursued by them or their co-conspirators, especially if the trafficked person is participating in a criminal investigation against the trafficker.

Although health care providers are not ultimately responsible for the security of a trafficked person, they are obligated to contribute in every way United Nations Office of the High Commissioner for Human Rights, Recommended Principles and Guidelines 29 on Human Rights and Human Trafficking, Report of the United Nations High Commissioner for Human Rights to the Economic and Social Council (E/2002/68/Add.1), United Nations Economic and Social Council, New York, 20 May 2002. Article 2.

In a broader sense, protection also means creating a social, political and legal environment that fosters the protection of victims of trafficking. For states that receive persons trafficked internationally, this may mean offering special residence permits or visas to allow victims from other countries to remain in a country legally, for example. Protection may also involve assisting trafficking survivors to return to their country or region of origin in safe ways that respect their human rights. See: IOM Counter-Trafficking Training Modules.


possible to the health and safety of individuals in their care, and to refer them into services where they may be safe. And, while cases of trafficking do not always pose a threat to persons providing health care and support, health professionals should still be attentive to potential security risks to themselves and other staff members. This action sheet describes some of the measures that a health facility may take to ensure the safety of a trafficked person and of the staff.

RequIRed ACTIonS A key principle of providing assistance to trafficked persons is that actions and services should be conducted within what is known as a ‘sphere of protection’.31 This means prioritising safety and security during the assistance and referral process, including making an effort to protect victims from harm, threats or intimidation by traffickers or their associates.32 Maintaining strict confidentiality about trafficking cases is a basic security measure that health professionals can take. Staff of medical facilities that assist trafficked persons should have well-defined and wellcommunicated rules regarding confidentiality about trafficking cases (see action sheet 9). Information regarding a trafficked person’s identity, whereabouts and circumstances must be protected at all times (see action sheets 7, 9 and 10). This is essential not only to protect you and the trafficked person from reprisals by traffickers, but also to protect trafficked persons from potential stigma within their families or communities. Protection also includes shielding individuals from the attention or abuses, of the media.

Health professionals are strongly discouraged from facilitating journalist, filmmaking and other media interviews with trafficked persons. Health facilities must be viewed as safe and anonymous locations of care and support by individuals who are vulnerable. Clear policies on media should be established and communicated.

Careful listening is an essential security tool in cases of trafficking.

Health providers must take the time to learn about any security risks associated with their patient. Trafficked persons are often in the best position to know of and interpret any dangers they may face. However, providers must never coerce or pressure individuals to divulge details they are not ready to discuss. Information-gathering must happen in a non-coercive way. In cases where other service providers or police are involved, health International Organization for Migration, IOM Counter-Trafficking Training Modules: Return and reintegration, IOM, Geneva, 2005.

United Nations Office of the High Commissioner for Human Rights (2002). Article 2.


providers should enquire about potential safety risks to the trafficked person and to themselves. They should seek advice from competent individuals or agencies on how address possible risks.

Well-functioning referral networks and procedures are crucial (see action sheet 10). Health providers should be prepared, in advance, to know who to call in situations that feel unsafe. In some countries a special countertrafficking police unit exists; in some places, a counter-trafficking hotline can link a health provider to specialists who can help in a crisis situation (see action sheet 10).

Having in place a specific security protocol or code of conduct for dealing with patients who have been trafficked can help maintain a safe environment for staff and patients. Health facilities may wish to institute a special security plan for trafficking cases and to alert staff and patients about safety procedures and key contacts, if potential problems arise.

It is important to be aware that:

• Security is a priority in trafficking cases, but total security may not be possible.

• Personal security can be enhanced by assessing and managing risks, being aware of the immediate surroundings and situation and listening carefully to the patient’s assessments and concerns.

• Although there is the potential to cause staff anxiety by overstating potential risks, everyone who interacts with trafficked persons should be informed of possible risks.

Health structures

Conduct a risk assessment to identify potential security problems for trafficked persons and staff. Depending on the local context, a medical facility may want to take specific security precautions, such as alarms or, in extreme circumstances, security personnel, depending on the potential dangers associated with assisting trafficked persons.


Health providers

–  –  –

RefeRenCeS And ReSouRCeS International Organization for Migration 2007 The IOM Handbook on Direct Assistance for Victims of Trafficking, IOM, Geneva, 2007.

2005 IOM Counter-Trafficking Training Modules: Return and reintegration, IOM, Geneva, 2005.

United Nations Office of the High Commissioner for Human Rights 2002 Recommended Principles and Guidelines on Human Rights and Human Trafficking, Report of the United Nations High Commissioner for Human Rights to the Economic and Social Council (E/2002/68/Add.1), United Nations Economic and Social Council, New York, 20 May 2002.


Action Sheet 8:

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