The right to liberty is one of the essential human rights. Evidence, however, shows that slavery didn’t end with the Slavery Abolition Act in the 19th century. Modern slavery or human trafficking is a global problem affecting millions of people and societies across the world. In fact, data shows there are twice as many trafficked people today as during the African slave trade. While human traffickers do not legally “own” their victims, they use threats, physical violence, psychological abuse, and manipulation to control and force people to act against their will.
Human trafficking is a global health problem. Alarmingly, more than 600,000 to 800,000 people are being trafficked across borders every year. Developed countries are not immune to the impact of human trafficking, defined as the fastest growing criminal industry in the world. Any country can be a source, a place of transit, or a destination. Note that the US is one of the largest markets and destinations, second to Germany (Dovydaitis, 2010). Domestic trafficking is also exorbitant. For example, according to data provided by the US State Department, 50,000 victims are trafficked into the US, and more than 400,000 domestic children are involved in trafficking every year.
Human trafficking generates more than $150 billions of dollars in profits, with forced labor, debt bondage, and sexual exploitation being three of the most common and “profitable” forms of human trafficking. Human trafficking involves three elements: a) the act (e.g., recruitment, kidnapping, transfer); b) the means (e.g., force, kidnapping, fraud); c) the purpose of exploitation (e.g., sexual exploitation, forced labor, removal of organs). Additionally, human trafficking takes on many forms, including drug trafficking, forced marriages, and child soldiers.
Modern slavery affects people of all age, race, nationality, and gender. Research on human trafficking is crucial to identify and help victims who according to data, reach 40.3 million across the world. Data shows that 81% of all victims are trapped in forced labor, and 75% are women. More than 10 million victims are children, and approximately 15.4 million people are forced into marriage. As many cases go unreported or neglected, health research is the most promising way to provide evidence-based data with real-life implications.
- Sexual Exploitation
Sexual exploitation is one of the most extreme forms of modern slavery, with more than 54% of all victims being sexually exploited (UNODC, 2016). Human trafficking takes on different forms, including prostitution, Internet chat rooms, pornography, and sex tourism, and generates more than $99 billion in profits globally. Note that a large number of traffickers are women exploiting other women. While most of the trafficked individuals are females, men and boys also become victims of sexual exploitation.In the US alone, Polaris’ National Hotline and Be Free text line identified 7,255 of sex victims in 2017, and not a single state was excluded. To provide an example, in 2014, the sex criminal industry generated $39.9 million in Denver, Colorado, and $290 million in Atlanta, Georgia. The majority of cases accounted for escort services, followed by residential cases and outdoor solicitation.
Due to extreme stress, violence, hazardous conditions, and deprivation of food and sleep, victims suffer tremendous consequences. Trafficked individuals often suffer physical injuries (e.g., cigarette burns, loss of teeth, broken bones) and long-term disabilities (Acharya, 2019), as well as depression, anxiety, and posttraumatic stress disorder (Hossain et al., 2010). Additionally, forced and unsafe abortions put female victims at risk and strip them from their reproductive rights.
Therefore, medical professionals play a crucial role in identifying victims of human trafficking. Often health care providers are the only professionals to interact with the victims while still in captivity. To set an example, data shows that 28% of victims saw a medical professional during their captivity. As many cases go underreported, tattoo recognition also plays a vital role in prevention and recovery (Fang et al., 2018). Note that sex traffickers often “brand” their victims to indicate ownership. Due to the severe consequences of sexual exploitation, data shows that working with one trafficking victim can take the same amount of the health provider’s time as 20 other violence victims.
- Labor trafficking: Forced Labor, Depth Bondage, and Domestic Servitude
Labor trafficking is one of the most common forms of modern slavery, with more than 24.9 million people being victims of forced labor via human trafficking. Victims are often promised a high-paying job or better opportunities but are sent to horrendous working conditions. Victims are forced to work in inhumane conditions across various industries, such as domestic work, leather tanning, agriculture, construction work, factories, and even restaurants and massage businesses. Traffickers (including recruiters, contractors, and employers) exercise physical and psychological control to target vulnerable populations and ethnic communities. Factors, such as immigration status, recruitment debt, and weak labor protections policies, contribute to human trafficking. Women are highly affected by forced labor, accounting for 99% of victims in the sex industry and 58% in other industries. Many female victims of forced labor are often sexually exploited.Forced labor practices occur in every industry, including manufacturing, hospitality, fishing, agriculture, and construction. Some of the means of human trafficking include the use of violence, retention of documents, and threat to exposure to immigration services. Descent-based slavery, which refers to people born into slavery to slave-owning families, should also be tackled. Note that descent-based still occurs in the Sahel belt in Africa and other parts of the world. As many victims experience abuse and live in inhumane and hazardous conditions, enslaved individuals often suffer from infections, malnourishment, and depression, which require medical assistance. Note that 22% of trafficking survivors in Southeast Asia reported severe injuries, such as loss of limbs (Zimmerman & Kiss, 2017).
Bonded labor or debt bondage is a severe form of labor trafficking, which refers to the use of a bond to keep an individual under control. Bonded labor occurs when traffickers manipulate the victim via an initial debt considered part of the terms of employment, such as a significant amount paid for the “privilege” to work abroad. Abuse of contracts, inadequate local laws, and intentional impositions of illegal costs contribute to bonded labor, especially among migrant workers. Surprisingly, in the US, 71% of labor trafficking victims entered the US on lawful visas (Owens et al., 2014).
Domestic servitude is a specific form of forced labor. Given the fact that domestic servitude involves private properties, which are rarely inspected, many cases go underreported. Evidence shows that foreign workers from Asia, Africa, and Latin America often work as domestic servants in rich places, such as the Gulf States and the US. In fact, the International Labor Organization reports more than 67 million people working as domestic workers across the world. Many victims are on call 24/7, confined to a home without their travel documents or money and with no access to health services or social support. Alarmingly, if workers manage to escape from their abusive employers, they are often treated as criminals instead of victims.
- Organ Harvesting
Illegal organ trade is one of the most complex forms of human trafficking, which generates profits between $840 million and $1.7 billion per year, with more than 10% of all organ transplants being trafficked. Note that lungs, kidneys, livers, corneas, and hearts are the most trafficked organs. According to the World Health Organization, more than 10,000 kidneys are purchased on the black market across the globe, which equals more than one kidney every hour.
Organ harvesting is a global health problem as long waiting times for legal transplants are among the main contributing factors fueling today’s illegal organ trade. In Canada, for instance, the average wait time for a kidney is between 4 and 7 years.Victims are often forced or lured to sell their organs for a low price through a middleman. Other victims do not consent, and their organs are forcefully removed. To provide an example, a person may go to the hospital for an unrelated condition, after which their organs can be removed without their knowledge or consent. Victims of forced labor and sex exploitation often become victims of organ harvesting. Additionally, individuals can be kidnapped, sold, and killed for organs. Note that the Chinese government admitted to harvesting organs from prisoners between 1990 and 2000. Alarmingly, doctors, nurses, and other “respected” health professionals often get involved in organ trafficking.
To target traffickers, a multidisciplinary collaboration between health professionals, anti-laundering specialists, and law enforcement agents is essential. Note that wire transfers, payments between medical tourism sites, and first-line banking information for large amounts of money transferred by ill clients to medical companies can indicate organ harvesting.
- Forced Criminality
Trafficking for crime and forced begging refers to forced crimes, such as benefit fraud, ATM theft, pick-pocketing, and forced begging. In Europe, the Roma community is one of the main ethnic targets of human trafficking, with Romania being one of the major source countries. Romani women and children are particularly vulnerable to trafficking for various purposes, including sexual exploitation, labor exploitation, organ trafficking, illegal adoption, and forced begging. Identifying such victims is specifically complex due to social exclusion, poverty, illiteracy, and ethnic discrimination.
Research shows that the UK is one of the main destination countries for enslaved victims. In the UK, in particular, 2,555 victims of trafficking were identified in 2012, with 16% identified as trafficked for the purpose of criminal exploitation. Forcing people into cannabis production is also common, with 96% of victims being from Vietnam. Note that bond labor is a common means of controlling the victims who often turn to illegitimate lenders to pay off their “debt.” Additionally, trafficked victims are often treated as criminals. For example, statistics show that in the UK alone, 130 children have been arrested for crimes relating to the cultivation of cannabis since 2011 (Victim or Criminal? Trafficking for Forced Criminal Exploitation in Europe.).
In Central America, drug cartels also exploit people, including children, for the purpose of drug and sex trafficking. Some victims of human trafficking are used to transport drugs across borders. These victims are known as drug mules and go through hazardous procedures to swallow balloons with illicit drugs, which are then retrieved from their bodies. Victims suffer serious injuries, stress, prosecution, and death. Alarmingly, drug cartels are turning to sexual exploitation, and in some cities, such illicit sex trade is even encouraged. A survey showed that 16% of boys from San Miguel Tenacingo, Mexico, wanted to become a “pimp” and get involved in human trafficking.In fact, drug and human trafficking are interconnected; many victims suffer from drug addictions and mental illnesses. A survey showed that 84.3% of sex trafficking victims in the US used drugs during their exploitation; 55% used alcohol, marijuana, and cocaine; and 22.3% heroin (Stoklosa, MacGibbon & Stoklosa, 2017).
- Forced Marriages
Forced marriages are another severe form of human trafficking. Data shows that 15.4 million victims of human trafficking are in situations of forced marriage, and 84% are girls and women. Note that three types of forced marriages exist: the forced marriage of adults, child marriage, and trafficking for marriage. The means of trafficking, on the other hand, vary from fraud to abduction by an armed group. Other forms of forced marriage include a family member being involved in the trafficking network, confining and abusing the victim to obtain consent – sometimes defined as “honor”-based violence.
Child marriages, in particular, are a major health problem as they lead to numerous psychological and health issues, with risks stemming from early and multiple pregnancies. Data shows that 37% of people in forced marriage were children at the time of the marriage and were stripped from their right to education. Alarmingly, child marriages are integrated into various cultures throughout the world.
When it comes to the phenomenon of trafficking for marriage, 1.4% of victims of human trafficking were trafficked for marriage. According to data, due to the sex imbalance in China, men often purchase or lure foreign brides from countries such as Thailand, Vietnam, Laos, Cambodia, and North Korea. Forced marriage increases the risk of further abuse and enslavement with the inability to leave.
Forced marriages lead to a variety of health and emotional issues, including a high risk of self-harm and suicide. Family harassment, including harassment for dowry, also increases the risk of mental problems and premature death.
- Trafficking of Children and Child Soldiers
Trafficking of children spans across all forms of modern slavery, including sexual exploitation, forced labor, removal of organs, forced marriage, and forced criminality. Alarmingly, 20% of all victims are children. In some parts of Africa and Asia, these numbers reach up to 100%. Statistics show more than 1.2 million children are being trafficked annually. According to the Polaris Project database, there are 100,000 to 300,000 children prostituted in the US and more than two million children held in sexual bondage across the globe.
Runaways are at high risk of being trafficked, with 1/3 forced into prostitution within 48 hours of leaving their homes. Data shows there are more than 450,000 children runaways; in 2017, one out of seven reported runaways were child sex trafficking victims. Alarmingly, 88% were in the care of social services or foster care seeking escape from a bad environment.
A specific form of child trafficking is the exploitation of children by extremist groups (e.g., child soldiers in Colombia and Nigeria, the enslavement of Yazidi women by Islamic State). Child soldiers, in particular, is a global problem as child soldiers are used for frontline combat, informants, and other acts of crime. Although empirical research is lacking, health professionals report trafficked children to suffer emotional trauma, developmental problems, and degradation (Rafferty, 2008).
Last but not least, child selling is another severe form of trafficking in children. We should note that global surrogacy arrangements, particularly in India, have also risen concerned about human trafficking; human rights defenders claim that women in low-resource nations are particularly vulnerable to exploitation and discrimination.Human trafficking is a growing problem. According to data provided by the International Labor Organization, there were 12.3 million trafficking victims in 2005, 21 million victims in 2012, and 40.3 million victims in 2016. In contrast, evidence shows there were only 14,894 trafficking prosecutions and 9,071 convictions in 2016. Moreover, victims, especially homeless people, LGBT youth, and minorities, often experience revictimization by the police or medical professionals. To provide an example, American Indians who represent 2.2% of the population in Hennepin County, Minnesota, account for 24% of women arrested for prostitution (Martin & Rud, 2007).
Human trafficking is also a global health problem. As explained above, health professionals are sometimes the only people who are in contact with the victim while still in captivity. Careful examination and training are mandatory to identify victims and save lives. As explained above, victims suffer tremendous injuries and mental problems. Data collected from 207 trafficked women across 14 countries reported that 95% of women had experienced extreme physical violence and emotional abuse. Forced abortions are also common; 71% of sex trafficking victims reported at least one pregnancy, 21% more than five pregnancies, 55% at least one abortion, and 30% multiple abortions. Note that forced abortions can lead to scar tissue, infections, and hysterectomy. Additionally, victims suffer from serious illnesses and long-term disabilities. To provide an example, a study on trafficked Nepalese girls and women found that 23% of them tested positive for HIV.
Therefore, evidence-based research is crucial to help authorities and health professionals identify and combat human trafficking. A recent bibliometric analysis, however, showed there is a significant underrepresentation of health literature on human trafficking (Sweileh, 2018).
When it comes to human trafficking, raising social awareness is one of the essential steps to end modern slavery. From pornography to social stigma, human trafficking is closer than people think, with the demand and supply circle being a vicious aspect of it. Alarmingly, the U.S. Department of Labor has identified more than 148 goods from over 76 countries made by forced labor, so smart purchasing choices are essential.Human trafficking or modern slavery refers to the exploitation of people via violence, fraud, and threats. From forced labor and sex trafficking to domestic servitude and the use of child soldiers; trafficking represents horrendous violations of human rights. More than 40.3 million people across the globe become victims of human trafficking and suffer extreme physical, emotional, and social abuse. Alarmingly, victims who manage to escape are often treated as criminals and experience revictimization and discrimination.
Due to the covert nature of modern slavery, research and evidence-based information are mandatory to help authorities and health professionals identify and save victims who are often “hidden in plain sight.” Note that human trafficking is a global health concern as victims suffer from long-term disabilities and mental problems, and medical professionals are often the only people who can help the victim while in captivity.
While proper training and strict anti-trafficking legislation are mandatory, human trafficking is also a social concern. In demand for cheap products and accessible pornography, products of human trafficking are closer than people think. It’s no surprise trafficking is defined as the fastest growing criminal industry with more than $150 billion in profits annually.
Human trafficking, however, is not a business. Human trafficking is a crime against humanity – because people are not for sale.
- Acharya, A. (2019). Prevalence of violence against indigenous women victims of human trafficking and its implications on physical injuries and disabilities in Monterrey city, Mexico. Health Care for Women International.
- Dovydaitis, T. (2010). Human Trafficking: The Role of the Health Care Provider. Journal of Midwifery & Women’s Health, 55 (5), p. 462-467.
- Fang, S., Coverdale, J., Nguyen, P., & Gordon, M. (2018). Tattoo Recognition in Screening for Victims of Human Trafficking. The Journal of Nervous and Mental Disease, 206 (10), p. 824-827.
- Global Estimates of Modern Slavery: Forced Labour and Forced Marriage, Geneva, September 2017.
- Hossain, M., Zimmerman, C., Abas, M., Light, M., & Watts, C. (2010). The Relationship of Trauma to Mental Disorders Among Trafficked and Sexually Exploited Girls and Women. American Journal of Public Health.
- Martin, L, & Rud, J. (2007). Prostitution Research Report: Data Sharing to Establish Best Practices for Women in Prostitution. Minneapolis, MN: Prostitution Project, Hennepin County Corrections and the Folwell Center.
- Owens, C., Dank, M., Farrell, A., et al. (2014). Understanding the Organization, Operation, and Victimization Process of Labor Trafficking in the United States.
- Rafferty, Y. (2008). The Impact of Trafficking on Children: Psychological and Social Policy Perspectives. Child Development Perspectives.
- Stoklosa, H., MacGibbon, M., & Stoklosa, J. (2017). Human Trafficking, Mental Illness, and Addiction: Avoiding Diagnostic Overshadowing. AMA Journal of Ethics.
- Sweileh, W. (2018). Research trends on human trafficking: a bibliometric analysis using Scopus database, 14 (106).
- UNODC (2016). Global Report on Trafficking in Persons.
- Victim or Criminal? Trafficking for Forced Criminal Exploitation in Europe. Retrieved from https://www.antislavery.org/wp-content/uploads/2017/01/Criminal-or-victim-UK.pdf
- Zimmerman, C., & Kiss, L. (2017). Human trafficking and exploitation: A global health concern. PLOS.