In 1992 I read a newspaper article about women from countries in the former Soviet Union being forced into sexual servitude around the globe. I was angered and shocked. I thought of my grandmothers, young Eastern European emigrants to the United States, traveling alone at great risk to begin new lives. They arrived safely, but today vulnerable people living in or fleeing from countries torn by war, disaster, and poverty are often targeted by traffickers. The more I learned, the more I wanted to help.
Human trafficking—"the acquisition of people by improper means such as force, fraud, or deception, with the aim of exploiting them," usually for forced labor or sex—is among the top three most profitable transnational crimes, according to the United Nations Office on Drugs and Crime. Traffickers manipulate, enslave, and dehumanize their victims—and they do so more often and much closer to home than you might think. According to the 2008 U.S. Department of State's Trafficking in Persons Report, an estimated 800,000 people are trafficked internationally each year: 80% are women and girls, and half are minors. And according to the Victims of Trafficking and Violence Protection Act of 2000, about 50,000 such victims arrive in the United States annually. It's quite possible that in your community people are being held against their will as sex slaves, domestic servants, or laborers. If one of them came to you for treatment, would you know how to help?
In 2002 I started volunteering with Project Kesher, the largest women's human rights organization operating in countries belonging to the Commonwealth of Independent States, an association of 12 former Soviet republics, including Russia. It works to educate women and youth at risk and to provide services to escaped victims. For example, recently we helped a woman who'd been held in sexual slavery for six years to reestablish her Russian citizenship, secure an apartment, find her child (who'd been taken to an orphanage), and begin vocational retraining.
My experiences with Project Kesher showed me firsthand that public awareness is critical to stopping traffickers. I started thinking about what I could do to identify and assist victims here. As a public health nurse, I knew that reaching out to nurses was the first step. In September 2007 I spoke about human trafficking at the annual convention of the New York State Nurses Association. Afterward, two maternal–child health nurses told me they might have cared for women who were victims of trafficking; the nurses' stories seemed plausible. Indeed, there are signs that U.S. nurses are growing more aware of this issue. In July the American Nurses Association passed a resolution stating that it will advocate legislation to reduce the incidence of human trafficking and will work to ensure that nurses know how to identify and assist victims.
Most victims have little or no access to health care. But some wind up in EDs for treatment of trauma or in community clinics for reproductive care. Usually the trafficker, often acting as interpreter, will closely monitor the victim's interactions with all providers. If you suspect a patient of being a trafficking victim, try to talk with her or him in a safe, private environment. If possible, enlist the help of a staff member who speaks the patient's language. Screening questions that might help in identifying a victim include "Can you come and go as you please?" and "Have you been threatened if you try to leave?"
Let me be frank: I hope that you will let what you read about human trafficking seep into your consciousness, that you will find its cruelty and injustice unacceptable. And I ask that you remain aware as you go about your daily practice. If and when you meet victims of trafficking, you might be able to recognize them and to help. If you think your patient may be a victim of trafficking, call the National Human Trafficking Resource Center: (888) 373-7888. More information, including a toolkit for health care providers, is available at www.acf.hhs.gov%2ftrafficking.