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Human Trafficking – a Health Perspective. Sue Gwyer - CSWP COMB AT Engagement Specialist. UK Government Strategy on Human Trafficking [July 2011 p.29].

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Human trafficking a health perspective

Human Trafficking – a Health Perspective


Engagement Specialist

Uk government strategy on human trafficking july 2011 p 29
UK Government Strategy on Human Trafficking [July 2011 p.29]

  • The Department of Health (DH) will work with the UKHTC and others, to improve the response from health services to victims of trafficking

  • This will include equipping more health services and professionals with the training and skills to become first responders

  • DH is working with the Women’s Health and Equality Consortium on the trafficking and health project to agree specific actions to promote greater awareness of human trafficking and provide health professionals with guidance on how to respond to victims appropriately

  • The DH has also recognised the need for better understanding of the issues around health and trafficking and has therefore invited bids for a piece of research in this area which is due to commence in 2011

Training objectives

Raise awareness of the issue of Human Trafficking, specifically the trafficking of children and young women

Outline the Legislative Framework

Identify discreet issues for health professionals

Identify how we can COMBAT human trafficking through prevention, protection and prosecution

Outline the procedures to follow when we suspect that someone is the victim of trafficking

Signpost to appropriate support agencies and resources

Human trafficking the context
Human Trafficking - the context…

“Trafficking in persons shall mean the recruitment, transportation, transfer, harbouring or receipt of persons, by means of threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having the control of another person, for the purpose of exploitation.

Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs.”

Protocol to the 2000 UN Convention

Against Transnational Organised Crime – ‘Palermo Protocol’

Trafficking vs smuggling
Trafficking VS Smuggling

  • The two most common terms used for the illegal movement of people have very different meanings

  • In human smuggling immigrants and asylum seekers pay people to help them enter a country illegally, after which there is no longer a relationship

  • Trafficked victims are coerced or deceived by the person arranging their relocation and forced into exploitation by their trafficker or person into whose control they are delivered or sold

Uk legislation and guidance
UK Legislation and Guidance

The Nationality, Immigration and Asylum Act 2002: Made the trafficking of people for prostitution illegal

The Proceeds of Crime Act 2002: Enabled the criminal assets of traffickers to be confiscated

The Sexual Offences Act 2003: Introduced legislation making all forms of sexual exploitation illegal – including trafficking into, out of and within the UK

[s.53a amended by s.14 of the Policing & Crime Act 2009]

The Asylum and Immigration (Treatment of Claimants) Act 2004: Extended definitions of illegal offences of human trafficking, including forced labour and human organ transplants

The Gangmasters Licensing Act 2004: Established the Gangmasters Licensing Authority and deals with forced labour

The Nationality, Immigration and Asylum Act 2006: Brought in civil penalties and criminal sentencing for employers who employ illegal immigrants

The Coroners and Justice Act 2009: Made it a criminal offence for individuals to force others into labour, particularly highlighting aspects of slavery and servitude

Safeguarding Children who may have been Trafficked 2011: Addendum to Working Together to Safeguard Children 2006

The problem
The Problem…

UNGIFT {United Nations Global Initiative to Fight Trafficking} estimates that there are 2.5 million people in forced labour (including sexual exploitation) at any given time worldwide as a result of trafficking

18.8% of this number are estimated to be in industrialised countries and countries in transition

In emerging democracies and post-conflict states across Europe, the convergence of corruption of officialdom and emergence of organised crime has provided fertile ground for the growth in human trafficking

Trafficking – modern day slavery – occurs both within and across borders and affects economies, political stability, law enforcement and public health

The trafficking of children ungift united nations global initiative to fight human trafficking
The Trafficking of ChildrenUNGIFT – United Nations Global Initiative to Fight Human Trafficking

An estimated 1.2 million children are trafficked each year worldwide

95% of victims experience physical or sexual violence

43% of victims are used for forced commercial sexual exploitation

98% of this number are women and children

32% are used for forced economic exploitation

56% of this number are women and children

Child trafficking the uk
Child Trafficking & the UK

  • CEOP recorded 325 children trafficked into the UK between March ‘07 and Feb ’08 – of these approx. 180 went missing from Local Authority care

  • In 2008-09 ‘Operation Glover’, directed against the internal trafficking of teenage girls for sexual exploitation, rescued 33 trafficking victims

Operation golf
‘Operation Golf’

  • In 2010 ‘Operation Golf’ picked up 103 Roma children from 13 addresses in East London. 52 adults were arrested. The trafficking ring was operating from one town in Romania.

  • Between 01.04.09 and 31.03.11 the UKHTC received 1481 referrals – 390 of which were minors

    But why are people trafficked?

    For what purpose?

Human trafficking a health perspective

In the UK children are trafficked for:ECPAT – End Child Prostitution, Child Pornography and the Trafficking of Children for Sexual Purposes

Sexual exploitation

Forced labour (including restaurant and catering work)

Domestic servitude

Cultivation of cannabis

Drug trafficking

Begging & Petty theft

Blood rituals

Benefit fraud

Selling counterfeit goods such as DVD’s

Illegal adoption / private fostering

In the uk ecpat
In the UK… [ECPAT]

There is also evidence that children are brought to and removed from the UK for forced marriage

There is no current evidence that children are being trafficked into the UK for organ removal although there are documented cases elsewhere in the world including both East and West Europe

But why is trafficking possible? What do you think makes ‘some’ people more vulnerable to trafficking – both from abroad and here in the UK?

Human trafficking a health perspective

Poverty – the root cause of vulnerability to exploitation

Lack of education – attendance at school has been a key means of protecting children from all forms of exploitation

Discrimination – this can be based on gender and ethnicity

Cultural attitudes – traditional cultural attitudes can mean that some children are more vulnerable to trafficking than others

Grooming – children are sometimes trafficked out of their country of origin after having been groomed for purposes of sexual exploitation

Dysfunctional families – children may choose to leave home as a result of domestic abuse and / or neglect or they may have parents / guardians with substance dependency issues

Political conflict and economic transition – often lead to movements of large numbers of people and the erosion of economic and social protection mechanisms

Natural disasters – Earthquakes, Tsunami’s etc – displacement leads to separated children and vulnerable adults

Inadequate local laws and regulations – trafficking involves many different events and processes and legislation in some countries has been slow to keep pace. Even where there is appropriate legislation enforcement is often hampered by lack of prioritisation, corruption and ignorance of the law

A barbaric trade in human misery right on our doorsteps grahame maxwell ukhtc
“A barbaric trade in human miseryright on our doorsteps” –Grahame Maxwell - UKHTC

"One of the first victims we helped in the UK was a 15 year-old Lithuanian girl who found herself in Sheffield where she managed to escape her trafficker and turned up at a police station.

Her case shows how unsuspecting young victims are lured from their homes into a nightmare world of brutality and rape. She was phoned up by someone and asked if she would like to sell ice cream for the summer in London and was told she would earn about £300.

The traffickers signed a consent form and her parents, believing it was a good opportunity, approved the trip.

She was flown to Gatwick and sold in a coffee shop from one trafficker to another for £3,000.

Her passport was taken off her and sold for £4,000. Later the same night, she was taken to a flat brutalised and raped, and from that moment on she was forced to act as a prostitute.”

The girl was sold six times in six different cities in the UK before finally escaping and helping the police catch her traffickers.

Human trafficking a health perspective

Behind the Smile on Vimeo

8000 women work in off-street prostitution in London

80% of these are foreign nationals

Over 1000 trafficked women have been referred to the Poppy Project since March 2003

“You can't get away from them. You just want to kill yourself”


Identifying victims of trafficking health indicators harrow lscb
Identifying Victims of TraffickingHealth Indicators [Harrow LSCB]

  • Untreated injury / medical condition [unexplained delay in seeking treatment]

  • Indications of abuse / neglect

  • Not registered with GP

  • Use of different doctors / A&E Departments

  • Evidence of substance misuse

  • STI / unwanted pregnancy [possibly numerous] – lack of medical attention during pregnancy

  • May have tatoo’s or other marks indicating ‘ownership’

Human trafficking a health perspective

Physical Health SymptomsStolen Smiles – a summary report on the physical and psychological health consequences of women and children trafficked in Europe

  • Fatigue & Weight Loss – easily tired, loss of appetite

  • Neurological – headaches, dizzy spells, difficulty remembering, fainting

  • Gastrointestinal – stomach or abdominal pain, upset stomach, vomiting, diarrhoea, constipation

  • Sexual & Reproductive Health – urination pain, pelvic pain, vaginal discharge, vaginal pain, vaginal bleeding [not menstruation], gynaecological infection

  • Cardiovascular – chest / heart pain, breathing difficulty

  • Musculoskeletal – back pain, fractures / sprains, joint or muscular pain, facial injuries

  • Eyes – vision problems, eye pain

  • ENT - ear pain, colds, flu & sinus infections

  • Dermatological – rashes, itching, sores

The nhs charges to overseas visitors regulations 1989 s i 1989 306
The NHS (Charges to Overseas Visitors) Regulations 1989 (S.I. 1989/306)

  • Amended to provide a new exemption from charge category for anyone who the ‘Competent Authorities’ of the UK have identified as a victim of human trafficking

  • Or consider that there are reasonable grounds to believe is a victim of human trafficking for whom a ‘recovery and reflection’ period has not yet expired

  • This will extend to their spouse/civil partner or dependent child

  • As of 1 April 2009 trusts must not charge those patients who are identified as actual or suspected victims

Human trafficking a health perspective

Trafficking for Domestic Servitude (S.I. 1989/306)


Domestic servitude s 71 coroners justice act 2009

‘Domestic Servitude’ (S.I. 1989/306)(S.71 Coroners & Justice Act 2009)

Holding another person in slavery or servitude or requiring another person to perform forced or compulsory labour.

The circumstances must be such that the defendant knows or ought to know that the person is being so held, or required to perform such labour.

The offence applies to legal persons e.g. Companies as it applies to natural persons.

Human trafficking a health perspective
A young Chinese woman, forced into domestic servitude in a UK takeaway restaurant, was confined to live in this outhouse

Human trafficking a health perspective

This was her bed – the post mortem on her body indicated that she had died of hypothermia. There was evidence of severe physical abuse on her body

Ecpat missing out
ECPAT – ‘Missing Out’ that she had died of hypothermia. There was evidence of severe physical abuse on her body

  • In September 2005 six Chinese girls, aged 16-17 were stopped at Birmingham Airport boarding a plane for Toronto – it is believed that they had been in the UK for two years

  • Immigration services identified one of the adults with whom they were travelling was wanted for human trafficking offences in Singapore

  • The girls were accommodated in the care of two separate local authorities – three of the girls went missing within 72 hours

  • Another of the girls, suffering mental health problems, could not be found appropriate foster care – she went missing shortly after being placed in residential housing

  • The two other girls remained in foster care for nine months until the younger of the two went missing - she subsequently returned but would not disclose where she had been

  • No information about the missing four girls was ever forthcoming

The traffickers
The Traffickers... that she had died of hypothermia. There was evidence of severe physical abuse on her body

52% of traffickers are men, 42% are women and 6% work in joint enterprise

In 54% of cases recruiters are strangers to victims whilst 46% of victims know their recruiters

The global annual profit made from the exploitation of all trafficked forced labour is conservatively estimated to be US$31.6 Billion {UNGIFT}

This illicit commercialisation of humanity is the fastest growing global crime and is today one of the largest criminal industries in the world second only to the trade in arms

The 21 st century slave trade
The 21 that she had died of hypothermia. There was evidence of severe physical abuse on her bodyst Century Slave Trade

“Human trafficking is a crime that demeans the value of human life and is a form of modern day slavery”

UK Action Plan on Human Trafficking - CHP 2

“There are more slaves in the world today than were seized from Africa in the four centuries of the trans-Atlantic slave trade”

‘Free the Slaves’ – Kevin Bales

“The trafficking of women and children is an egregious violation of human rights”

Anti-Slavery International

“ Anyone can report suspected trafficking – as a public service professional it is your duty

Geoff Feavyour – Chief Constable - Leicestershire Police

How do we combat human trafficking
How do we COMBAT that she had died of hypothermia. There was evidence of severe physical abuse on her bodyHuman Trafficking?

Countries of origin, transit and destination share a mutual interest and responsibility in combating human trafficking - we must work across borders

Human trafficking has a destabilising effect on democratic institutions, the rule of law and respect for human rights BUT…

“Liberation is not just about knocking down doors and dragging people to freedom. Permanent freedom requires survivors to ‘own’ their freedom and to change the systems that support slavery” –

All agencies agree that initiatives designed to combat human trafficking have to concentrate on the three P’s: Prevention, Protection and Prosecution

Prevention… that she had died of hypothermia. There was evidence of severe physical abuse on her body

In the year 2000 the United Nations adopted the ‘Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children

The Palermo Protocol entered into force on 25th December 2003 and had been signed and ratified by 117 countries worldwide, including the UK, by June 2010

CET 197 – The Council of Europe Convention on Action Against Trafficking in Human Beings [Warsaw 2005] entered into force on 1st February 2008 and had been signed and ratified by 34 European countries, including the UK, by July 2010. It came into force in the UK on 1st April 2009

The UK Government directed SOCA {Serious and Organised Crime Agency} to take governance of the UK’s anti-trafficking strategy

In October 2006 SOCA launched the UKHTC {United Kingdom Human Trafficking Centre} as a multi-agency decision making body with responsibility for enforcing the UK Action plan on Tackling Human Trafficking

The UK Action Plan tasks the public, private and voluntary sectors to work together in a co-ordinated and directed manner to combat the trafficking of human beings

Prevention protection
Prevention > Protection… that she had died of hypothermia. There was evidence of severe physical abuse on her body

Much work has been done over the last decade, since Palermo, to get legislation in place worldwide to back the fight against human trafficking

It is now key that all agencies involved in the safeguarding of children and young people adopt best practice regards dealing with ‘trafficking situations’ to ensure compliance with both the UN & UK Action Plan

Both safeguarding & non-safeguarding professionals, who may come across victims of trafficking in their everyday working lives are directed to ‘Working Together to Safeguard Children’ and more specifically the addendum publication ‘Safeguarding Children Who May Have Been Trafficked’

Professionals working in the children’’s workforce should familiarise themselves with the LSCB’s ‘Trafficked Children Toolkit’ now accepted by the UKHTC as the most appropriate guidance and assessment matrix for identifying victims of human trafficking - (

Protection prosecution
Protection > Prosecution… that she had died of hypothermia. There was evidence of severe physical abuse on her body

The UKHTC is the nominated ‘Competent Authority’ (along with the UKBA). They have responsibility for making decisions as to whether a referred person is a victim of trafficking

Any First Responder that wishes to refer a potential victim of human trafficking to the National Referral Mechanism (NRM) is required to fill out a standard referral form

First Responders are the only people entitled to fill out this form and currently they are; Police, UK Border Agency (UKBA), Serious Organised Crime Agency (SOCA), Local Authorities / Social Services, Gangmasters Licensing Authority (GLA) plus a range of NGO’s and charities working with victims of trafficking

The Competent Authority assesses whether there is ‘reasonable’ or ‘conclusive’ grounds to decide if a referred person is indeed a victim of trafficking.

Victims are given a 45 day reflection period (extendable) to decide whether they wish to pursue prosecution and / or be repatriated

Prosecution… that she had died of hypothermia. There was evidence of severe physical abuse on her body

In 2006 there were just 5,808 prosecutions and 3,160 convictions throughout the world for human trafficking

Put into perspective, this means that for every 800 people trafficked just one person was convicted in 2006

In the UK between 2006 and 2010 109 people were sentenced for trafficking offences receiving an average custodial sentence of 4yrs 2mths

In the same period 254,980 people were sentenced for drugs offences receiving an average custodial sentence of 2yrs 8mths

This is organised crime on a global scale and if we are to tackle it we need to be equally well organised in our strategies and responses to this ‘egregious violation of human rights’

There are no black and white answers to tackling trafficking – we need to look at a multi-agency 3P approach differentiated according to the needs of each individual situation

The human trafficking venn
The Human Trafficking Venn: that she had died of hypothermia. There was evidence of severe physical abuse on her body


  • Education – tailored packages for professionals and non - professionals

  • Cross border cooperation – countries of origin, transit & destination

  • Campaigning – ASI, Stop the Traffik, ECPAT, MTV Exit, Blue Blindfold, ATA, Unchosen, Unseen, CROP, Just Whistle…

  • Social Cohesion – involve communities

  • Reduce demand




  • Improve victim identification

  • Support victim service development & provision

  • Enshrine rights-based approach in policies & programme planning

  • Engage public, private and voluntary sectors


  • Liaise over necessary use of CP procedures

  • Enact Palermo / simplify laws

  • Collaborate with law enforcement agencies: Police / UKBA / IA

  • Confiscation Orders / tougher sentencing

  • Share intelligence: UKHTC / CEOP / Crimestoppers

  • Use contacts and intelligence in custodial estate – work with perpetrators?

  • Collaborate with & use


Signposting: that she had died of hypothermia. There was evidence of severe physical abuse on her body

UKHTC - 0844 778 2406 -

London LSCB -

ECPAT - 020 7233 9887 -

NSPCC / CTAIL – 0800 107 7057

CEOP - 020 7238 2320 / 2307 –

Children’s Legal Centre - 01206 872 466

CFAB – Children & Families Across Borders (ISS) – 020 7735 8941

CRIMESTOPPERS - 0800 555 111