Also, many trafficking victims who are not forced into sex trafficking are still sexually abused by the people who are exploiting them for their labor.15
The following include some of the signs of trafficking to watch for when a patient comes to your office or emergency room for services:
The patient appears to be under the control of someone who never leaves them alone.
Someone else is speaking for the patient (this can be a cause for suspicion whether or not the patient can speak English)
The patient lacks identification, wallet, and/or spending money.
The patients shows signs of malnutrition, dehydration, drug abuse or addiction, poor general health, poor hygiene, physical abuse or neglect, untreated illnesses or injuries.
The patient appears frightened, anxious, or depressed.
The patient’s story about what s/he is doing on the job or in this country does not make sense.
Be observant about the dynamics between the patient and the person accompanying them. Watch for controlling behavior17 or a lack of concern for the patient that one would not expect from a family member or support person. Try to separate the patient from the accompanying person without raising suspicions, and talk with the patient alone.18 A nurse reported that routinely telling patients that hospital policy required her to question everyone individually was
often a successful way to do this.19 If there no staff members who speak the patient’s language, a translator should be used, but it is important to screen the translators to make sure that they do not know either the patient or the accompanying person or otherwise have a conflict of interest.20
Victims of human trafficking may not identify as victims.21 Some blame themselves for their situations or even develop positive feelings for their traffickers as coping mechanisms. 22 They may fear authorities because they fear deportation or because the authorities in their home country are corrupt.23 Victims are often unfamiliar with the local culture, and sometimes do not know what city or even country they are in because their traffickers move them often. 24 Traffickers will sometimes threaten victims and their families, so a trafficking victim might be extremely fearful about talking about their situation.25 Young victims who previously suffered abuse in foster care placements may also be fearful of interventions by social services organizations.26
For all of these reasons, you should not start a conversation with a patient by directly asking them whether they are a victim of human trafficking. Some questions recommend by the Department of Health and Human Services’ Campaign to Rescue and Restore Victims of Human Trafficking are:
Can you leave your job or situation if you want to?
Are there locks on the doors or windows where you live so that you cannot get out?
Do you have to ask permission to eat, sleep, or go to the bathroom?
Has anyone taken your documents or identification?
Has anyone threatened you or your family?27