Learn the Signs of the Horrids of Human Trafficking

I have had an urge to pray for victims of human trafficking all day. As I have become more perceptive to the promptings of the Holy Spirit, I have sudden urges to pray for things that might come off as random. Human trafficking was one of those today. I invite you to learn more about the signs of human trafficking through this somewhat extensive essay I wrote back when I was in university.

This essay talks about the massive yet often ignored problem of human trafficking. The focus was on children since, unfortunately, that is often when the trafficking starts. I have a passion for advocating for children, and human trafficking is one of the things I hope no child ever goes through. Lamentably, it is quite the opposite.

Yet, our God is the God of the impossible and is love itself. I know that with my small prayer, someone in this situation is being helped. But in Matthew 18:20, Jesus says, “For where two or three are gathered in my name, I am there among them,” so I ask that you join me in prayer for the eradication of human trafficking!

While my essay focuses on people in the medical field needing to be more aware of potential signs, it is beneficial for ALL to know the signs since your neighbor could be a victim of human trafficking–it is that common yet unnoticed.

Please brace yourself for what you are about to read.

Child Trafficking: Finding Hope in Clinics

Out of the estimated 21 million trafficked humans per year worldwide, about 5.5 million are under 18 (International Labour Office, 2014). The literature on this topic, though limited, often uses the term human trafficking as an umbrella term, but it is important to dissect the different types of human trafficking. The United States Advisory Council on Human Trafficking distinguishes sex trafficking—”commercial sexual exploitation of a child or domestic minor sex trafficking, involves youth under the age of 18 years who are obtained, harbored, transported, advertised, recruited, solicited, or enticed to engage in commercial sexual exploitation(e.g., exotic dancing, massage parlors, escort services, prostitution, pornography, or any other sex-related work) for some form of payment, either in money or goods”—from labor trafficking—”forced labor acts through physical or psychological threats or debt bondage [such as in] service, domestic (i.e., hospitality industries, such as hotels), and agricultural industries.” Furthermore, it is important to note that child trafficking, unlike adult trafficking, is always considered a crime even when apparent force, fraud, or coercion is missing if the person is under 18-years-old. (USDS, 2019).

In 2012, it was estimated that human trafficking was an international illegal business worth over $150.2 billion US dollars (International Labour Office, 2014).). This growing, multi-billionaire crime fuels the existence of modern-day slavery. It does not discriminate against ethnicity, age, gender, religion, or physique, making anyone a potential victim. Its prevalence is beyond human comprehension due to its underreported and lack of awareness nature (UNICEF USA, n.d.). Despite misconceptions, it isn’t always the case that victims are chained or bruised; your favorite relative could be directly or indirectly affected by human trafficking. For these reasons and more, many governments have taken the initiative to implement protective programs emphasizing the most vulnerable population, children (NCTSN, n.d.). This paper will focus on the importance of having well-trained professionals up to date on the risk factors, proper protocol when in contact with potential victims, and resources available for trafficked children. 

It is estimated that, in the United States, more than 80% of trafficked children seek medical help; however, it often goes unnoticed due to omission from the child or physician’s lack of knowledge on prospective signs and symptoms (Greenbaum, 2017). Greenbaum’s study showed that about 60% of health care providers had never been given training on identifying human trafficking victims (2017). Symptoms vary between individuals, but it’s important to first look into what makes someone more vulnerable to becoming a victim. 

In Baauw and colleagues’ 2018 European study, it was estimated that about 4,000 to 5,000 children were presumable trafficked victims, its major contributor being the surge of migration in recent years. Since the study, the European Academy of Pediatrics has advised health care providers to look out for signs of abuse in migrating children—they typically travel to an unknown place by themselves, putting them at greater risk of being exploited due to reliance on anyone, good or bad, for essential needs (Baauw et al., 2018). In the United States, homeless children are often the ones recruited the most. A study analyzing 143 verified trafficked children found that 90% had a history of runaway, 40% had been in the foster care system, and 14% had been involved in juvenile crimes (Palines et al., 2020). Their lack of shelter and sense of belongingness puts them at high risk for victimization (Chisolm-Straker et Al., 2019). 

Furthermore, a survey of 913 survivors of child trafficking, sexual and labor, in Florida revealed that 47% were first trafficked between the ages of 13-14, 29% were 12 years old or younger, and 15% were 15 years old or older (Reid et al., 2018). And, while female children make up most of the trafficked victims, 94%, males and transgender are also at risk but are most often underreported (Greenbaum, 2017). All victims are often brainwashed from any hope of escaping through coercion in one or many of the following ways: 1) feeling guilt for things the child has been involved in, 2) denying being in a harmful environment after falling for a deceitful romantic partner(often much older than the victim), or 3) being threatened by trafficker if the victim attempts to leave the situation or tells someone (Greenbaum, 2017). Likewise, childhood trauma (i.e., having an abusive father, living in a toxic environment, or experiencing neglect) correlates with trafficking susceptibility; the high-stress levels prompted by trauma at a young age hinder neurological wellbeing, thus extinguishing a child’s sense of worth or good life potentiality early on (Zimmerman, Hossain, & Watts, 2011). 

These fear factors decrease the likelihood of children seeking help, making it harder for health providers to know when a child is being trafficked. However, there are some warning signs to consider as probable links to being trafficked. The National Association of Pediatric Nurse Practitioners (NAPNAP) for Vulnerable Youth says tattoos of barcodes, traffickers’ names, or money symbols can be potential signs of being a trafficked victim by getting marked as if they we someone’s property with a visual price tag(2019). Trafficked children are 66% more likely to experience severe psychological damage such as post-traumatic stress disorder, depression, anxiety, suicide idealization, substance abuse, and psychosis than non-trafficked homeless children (Palines et al., 2020). The agonizing experiences of being trafficked could lead to further health complications like sexual and reproductive problems (often due to premature sex or even forced abortions), poor dental care, or body injuries from sex or labor trafficking (Peck et al., 2020).

These factors are not easy to identify on a single visit, and the chances of doing so further decrease in fast-paced environments, such as ERs. Nevertheless, a sensitive, quick screening procedure has been developed. It is called the Quick Youth Indicators for Trafficking. Its benefits include being administrable by a non-traffic expert and being short enough to do in settings with limited time and resources (Chisolm-Straker et Al., 2019). The National Child, Traumatic Stress Network, requires healthcare providers to foster a trauma-informed approach when interacting with presumed victims of trafficking. This approach is designed to enable trafficked survivors to expand their contribution to care-related choices by having healthcare providers consider their wishes, reassure protection, and provide sincere and reliable care (Peck, 2019). It is also pivotal to use open-ended questions when screening children to allow the child to express their situation with as much information as possible without suggestions; with that said, healthcare providers should be patient and reassure patient that he or she can be helped, but he or she is not forced to answer (NCTSN, n.d.). Young children have difficulty regulating their emotions and thoughts; this can be amplified with trauma. This can lead children to become aggressive, fearful, noncompliant, or defensive when approached (Peck, 2019). These reactions could be warning signs of trafficking. Still, healthcare providers must be careful not to interrogate the child if with an accompanied adult, for he or she could be the trafficker or connected to the trafficker. It is also important to know that the child’s parents often could be the traffickers, so all patient-care facilities should have the proper protocols and adequately trained staff to act when faced with a presumable or confirmed victim (Greenbaum, 2017). The protocols should include multi-lingual and culturally sensitive staff for children who have been transported from another country and have good resources at hand (Peck, 2019). 

Helping trafficked children means going beyond mental and physical wellbeing since they usually need additional resources such as protection, shelter, and food. Many organizations have, such as the National Human Trafficking Resource Center, are great sources to find experts’ guidance on this matter. 

The Mount Sinai Adolescent Medical Center, established in New York in 1968, is another source available to all people, ages 10-24 and their children, who need free high-quality services. They welcome over 1,000 children each year, and all get screened for being trafficked or being at risk of being trafficked. 87% of the patients are African American and Latino, 10 % White, 2% Asian, and 1% Native American. Moreover, 98% of the patients are considered impoverished, so they rely on mostly professional volunteers, donations, and public insurances to achieve their biopsychosocial, cultural, spiritual, and youth-friendly approaches. (Diaz, 2020).  

Love 146 is also a good referral for children coming out of trafficking. In 2002, this largely federal-funded, international organization offers rapid response services to all referred children. They provide an hour-long interview to understand the child’s needs and give individuals backpacks full of essentials, books/journals, and emergency-only cell phones. They also keep in touch with the child even after he or she has transitioned to a better, independent lifestyle. (Williamson et al., 2020). 

Healthcare providers are often the only professional adults to contact a child presumably being trafficked, making it important for them to take action while they have the opportunity. Being aware of risk factors, having trained professionals, and knowing local organizations can ease the process and get those vulnerable children the proper help. But this kind of responsibility should not rest solely in the hands of healthcare providers. Governments should implement stricter laws and provide information to the public about the prevalence and risk factors associated with this sinister crime infesting the whole world. China has integrated the evolvement of technology to create policies that protect against child trafficking and for victims. One is the Anti-trafficking DNA Bank, in which parents of missing children can deposit their DNA in hopes that police will compare it to found victims; 5,000 children have been able to go back to their families using this system (Han, 2019). Another device mentioned in Han’s study is the Bao Bei Hui Jia; this is where families can post information about their missing child and wait for someone to find updates; however, over 400,000 users have submitted information, but only 2,592 children have found their families (2019). While this might be a good-intended innovation, the chances of it working are flimsy since both the child and the family are needed to have a match; families of low-income and poor education might never hear about the programs available; or, the parents can be the ones trafficking or the ones who sold their child, meaning no one is looking for the child. This last one is a limitation faced by all attempts to alleviate the world from human trafficking. It turns into an endless spiral where no one wanting the child to begin with, so then, the child doesn’t have a safe place to run to, leading the child to think their situation is the norm and any thought of hope in the world is destroyed. 

There is also an excruciatingly low percentage of thoroughly prepared professionals available to help trafficked children. And even if there was a push for more training, new forms of screening would need to be developed to account for busy environments often experienced in ERs. Additionally, there would have to be help available for those responding to the trafficking survivors because the horrors of living as a trafficked human being, especially when coming from a child, must be difficult to bear (Peck, 2019). 

Given the nature of the subject, the data is gathered mostly through a non-profit organization. There is no way to truly know the prevalence of the crime or who is involved. This unnoticed problem is often portrayed as a them problem, meaning it happens to those in a bad neighborhood, those looking for trouble, those following wrong paths, and those without a caring support group. However, the truth of the matter is that this can happen to anyone at any point in time (UNICEF USA, n.d.). This is an us problem; our community, family, friends, can be affected by it right now without anyone ever knowing. Bringing awareness into our schools and communities could help fight this crime, and some programs are doing just that. The Just Enough is an association that talks to 3RD-12th grade students about important topics, such as human trafficking, at appropriate educational levels (Just Enough, n.d.). This is a problem affecting everyone in the world. Yes, pediatric health providers should be getting trauma-informed training as part of their certifications. Still, anyone involved with children(i.e., parents, teachers, coaches, etc.) should be aware of the information to spread awareness and prevent these crimes. 

Saint Josephine Bakhita,

You know the hardships and injustices that come with the horrors of slavery, especially having been sold at the young age of seven by your kidnappers. Yet your steadfast faith upon knowing the Lord soon set you free. May your resilience inspire hope to those who suffer through slavery. Be at their side to remind them of the Father’s love. And may they, like you, find safety in the arms of Christ’s Holy Church. Amen.

St. Josephine Bakhita, pray for us!

References

Baauw, A., Rosiek, S., Slattery, B., Chin, M., Hensbroek, M., Goudoever, J., & Holthe, Joana. (2018). Pediatrician-experienced barriers in the medical care for refugee children in the Netherlands. European Journal of Pediatrics, 177. 10.1007/s00431-018-3141-y. 

Chisolm-Straker, M., Sze, J., Einbond, J., White, J., & Stoklosa, H. (2019). Screening for human trafficking among homeless young adults. Children and Youth Services Review, 98, 72–79. doi: 10.1016/j.childyouth.2018.12.014

Diaz, A., Arden, M., Blaustein, S., Nucci-Sack, A., Sanders, L., & Steever, J. (2020). Featured counter trafficking program: Mount Sinai Adolescent Health Center. Child Abuse & Neglect, 100, 104129. doi: 10.1016/j.chiabu.2019.104129

Greenbaum, V.J. (2017). Child sex trafficking in the United States: Challenges for the healthcare provider. PLoS Med, 14, 11. https://doi.org/10.1371/journal.pmed.1002439 

Han, L. (2019). New Technologies in Combating Child Trafficking in China: Opportunities and Challenges for Children’s Rights. Peace Human Rights Governance, 3 (3), 389-414. 

International Labour Office. (2014). Profits and Poverty: The Economics of Forced Labour. https://www.ilo.org/wcmsp5/groups/public/—ed_norm/—declaration/documents/publication/wcms_243391.pdf

Just Enough. (n.d.). Modern slavery — Just enough group. https://www.justenoughgroup.org/modern-slavery

NAPNAP Partners. (2019). Tattoos of human trafficking victims. https://www.napnappartners.org/tattoos-human-trafficking-victims

National Child Traumatic Stress Network (NCTSN). (n.d.). Understanding and addressing trauma and child sex trafficking. Policy Brief. https://www.nctsn.org/resources/understanding-and-addressing-trauma-and-child-sex-trafficking-policy-brief

National Conference of State Legislatures. (2018). Human trafficking overview. Retrieved from http://www.ncsl.org/research/civil-and-criminal-justice/human-trafficking.aspx

Palines, P. A., Rabbitt, A. L., Pan, A. Y., Nugent, M. L., & Ehrman, W. G. (2020). Comparing mental health disorders among sex-trafficked children and three youth groups at high-risk for trafficking: A dual retrospective cohort and scoping review. Child Abuse & Neglect, 100, 104196. DOI: 10.1016/j.chiabu.2019.104196

Peck, J.L. (2019). Human trafficking of children: Nurse practitioner knowledge, beliefs, and experience supporting the development of a practice guideline: Part two. Journal of Pediatric Health Care. Doi 10.1016/j.pedhc.2019.11.005 

Peck, J. L., Meadows-Oliver, M., Hays, S. M., & Maaks, D. G. (2020). White Paper: Recognizing Child Trafficking as a Critical Emerging Health Threat. Journal of Pediatric Health Care. DOI: 10.1016/j.pedhc.2020.01.005

Reid, J.A., Baglivio, M.T., Piquero, A.R., Greenwald M.A., & Epps, N. (2018). No youth left behind to human trafficking: Exploring profiles of risk. American Journal of Orthopsychiatry, 9, pp. 704-715. 

UNICEF USA. (n.d.). Child trafficking. https://www.unicefusa.org/mission/protect/trafficking

United States Department of State. (2019). United States Advisory Council on Human Trafficking: Annual Report 2019. Retrieved fromhttps://www.state.gov/wp-content/uploads/2019/05/US-Advisory-Council-2019-Report.pdf

Williamson, E., O’Brien, J., Jones, L., Mitchell, K., & Dunford, L. (2020). Featured counter-trafficking program: Love146. Child Abuse & Neglect, 100, 104131. DOI: 10.1016/j.chiabu.2019.104131

Zimmerman, C., Hossain, M., & Watts, C. (2011). Human trafficking and health: A conceptual model to inform policy, intervention, and research. Social Science & Medicine, 73(2), 327–335. DOI: 10.1016/j.socscimed.2011.05.028