Medicolegal assessment of human trafficking victims. Descriptive study of a series of forensic cases in Catalonia (Spain). / Valoración médico-legal de las víctimas de trata de seres humanos. Estudio descriptivo de una serie de casos forenses en Cataluña (España).

BACKGROUND AND OBJECTIVE: Human trafficking or contemporary slavery is the recruitment and transfer of people by force or deception for sexual, labour or other types of exploitation. Although the violence, abuse and deprivation that trafficking entails are a threat to the health of its victims, in Spain the clinical or forensic data available in this regard is scarce. At the Institute of Legal Medicine and Forensic Sciences of Catalonia (IMLCFC), a unit specialized in the forensic assessment of these victims was created. The objective of this work was to describe a series of forensic cases of trafficking victims. MATERIAL AND METHOD: Retrospective study of victims in judicial cases opened for an alleged crime of human trafficking registered in the IMLCFC until 06/30/2023. RESULTS: 57 different victims were registered. The majority were women (71.9%). The average age was 30.5 years (s.d. 10.31). All the victims were foreigners, mostly from Latin America (45.5%). The exploitation was mainly sexual (61.4%). There were some sociodemographic differences and in the conditions and consequences of trafficking between victims of sexual exploitation and the rest. Mental health problems were very common in all victims at the time of the assessment (87.5%). CONCLUSIONS: The consequences of trafficking on health, especially mental health, are notable and the forensic assessment of victims is valuable in judicial proceedings. It is necessary to deepen our knowledge of the phenomenon in our environment.

Detecting orphanage trafficking and exploitation.

BACKGROUND: There is growing awareness that a proportion of children in orphanages have been recruited or transferred into the facility for a purpose of exploitation and/or profit. These children are often falsely presented as orphans to evoke sympathy and solicit funding. This process is known as orphanage trafficking. Although orphanage trafficking can be prosecuted under legal frameworks in some jurisdictions, including Cambodia, there have been limited prosecutions to date. One factor that likely contributes to a lack of prosecution is poor detection, yet the indicators of orphanage trafficking have not been considered by extant research. OBJECTIVE: The current study was conducted as a first step towards providing evidence-based indicators of orphanage trafficking. PARTICIPANTS AND SETTING: Professionals who had identified or responded to cases of orphanage-based exploitation in Cambodia were interviewed. Participants included criminal justice professionals, investigators from civil society organisations, and child protection social workers. METHODS: Professionals' perspectives on how to identify orphanage trafficking were explored via in-depth interviews, and the data were analysed via thematic analysis. RESULTS: The analysis revealed a distinct set of indicators that may be used to detect orphanage trafficking, including the operation of an unauthorised facility, orphanage tourism and volunteering, and an overt focus on fundraising. CONCLUSION: The indicators revealed in this study point to the need for an effective and thorough monitoring system for orphanages, as well as adequate education and training of relevant personnel to aid in the detection of orphanage trafficking.

Child Labor Trafficking Essentials for Forensic Nurses.

Human trafficking is a form of modern-day slavery and is a significant pediatric healthcare problem in the United States. The term "human trafficking" encompasses both sex and labor trafficking. Sex trafficking, especially child sex trafficking, has received significant lay and professional attention. However, few efforts have focused on learning more about youth experiencing labor trafficking in the United States. Pediatric healthcare providers, including forensic nurses, are likely to encounter victims of child labor trafficking in their practice. A basic understanding of child labor trafficking will assist forensic nurses in timely identification of and appropriate intervention for victims. In this article child labor trafficking is discussed in terms of definition, epidemiology, history, risk factors, consequences, identification, and implications for practice.

Human Trafficking of Children.

Human trafficking has been increasingly recognized worldwide as a major public health problem. It is a crime based on exploitation of the most vulnerable and marginalized people of any community and is a violation of human rights. Children, especially immigrant and refugee children, are at risk of victimization and may experience considerable physical and mental health consequences. Adding these problems to pre-existing vulnerabilities and adversities makes human trafficking a complex health issue that needs to be addressed by a multidisciplinary team that includes health care providers. This article aims to provide an overview of human trafficking and the red flags that may alert the pediatrician to the possibility of exploitation, with a special focus on immigrant and refugee children. It describes a trauma-informed, rights-based approach and discusses ways in which pediatricians can contribute to a multidisciplinary response to human trafficking. [Pediatr Ann. 2020;49(5):e209-e214.].

A Public Health Approach to Global Child Sex Trafficking.

Human trafficking and child sex trafficking and sexual exploitation in particular are global public health issues with widespread, lasting impacts on children, families, and communities. Traditionally, human trafficking has been treated as a law enforcement problem with an emphasis on the arrest and prosecution of traffickers. However, use of a public health approach focuses efforts on those impacted by exploitation: trafficked persons, their families, and the population at large. It promotes strategies to build a solid scientific evidence base that allows development, implementation, and evaluation of prevention and intervention efforts, informs policy and program development, and guides international efforts at eradication. This article uses the public health approach to address human trafficking, with a focus on child sex trafficking and exploitation. Recommendations are made for public health professionals to contribute to antitrafficking efforts globally.

Review of Published Curriculum on Sex Trafficking for Undergraduate Medical Trainees.

Educational councils and medical societies recommend that medical students learn to recognize and care for victims of sex trafficking. Previous research has found that healthcare providers are one of the few professionals to interact with sex trafficking victims during exploitation. This review evaluates currently published curricular and extracurricular U.S. medical education resources. A literature review of MEDLINE, PubMed, Embase, MedEdPORTAL, Google Scholar, and Google was conducted in December 2018 to January 2019 using the search terms: human trafficking OR sex traffic OR sex violence OR sex work OR sex exploitation OR child prostitution AND education, medical, undergraduate OR students, medical OR medical student or medical education OR education, medical. The inclusion criteria included informational educational materials for medical students on sex trafficking. Studies were excluded for: non-English language, empirical research on sex trafficking, nonhealth or nonundergraduate medical students, and resources focused on other sexual health topics. The database literature search uncovered 64 scholarly articles. Inclusion criteria were met by 4 articles; 2 articles were added from a reference review, and an additional 5 articles were found from an Internet search. These 11 resources provided educational materials relevant to medical students on sex trafficking themes, including scope, consequences, identification, treatment, referral, legal, security, and prevention. The curricula demonstrated a wide variability in delivery method, length, and scope. A limited published sex trafficking curriculum exists for medical student learners. Future research evaluating unpublished curricula within U.S. medical schools is necessary to coordinate efforts for standardized and robust sex trafficking education.

Featured counter-trafficking program: Project intersect.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes Project Intersect, a program of mental health services and behavioral health professional training designed to address trauma-related psychological and behavioral problems experienced by adolescent survivors of commercial sexual exploitation and trafficking. The project is led by the Georgia Center for Child Advocacy in Atlanta, GA, USA. The primary goal of the program is to build a cadre of behavioral health specialists with skills to implement trauma-focused cognitive behavioral therapy to address the unique needs of trafficked/exploited youth. This involves intensive initial training, follow-up consultation, technical support, and program evaluation.

Featured counter trafficking program: The law enforcement first responder protocol.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficking children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes the Law Enforcement First Responder Protocol, which trained law enforcement to recognize youth engaged in sex work as survivors of commercial sexual exploitation, rather than as "prostitutes", and to connect these survivors immediately with social services, advocates, timely medical care and ongoing follow-up.

Featured Counter-Trafficking Program: The Minnesota Runaway Intervention Program.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes the Minnesota Runaway Intervention Program (RIP), a Minneapolis-St. Paul based program dedicated to supporting youth aged 12-17 who have run away and experienced sexual violence, including sexual assault and exploitation. It is a comprehensive, health care focused intervention, embedded within a hospital-based Child Advocacy Center. RIP is developed and led by nurse practitioners who provide services tailored to participants' diverse needs, including health care, case management services, and a therapeutic empowerment group.

Post-implementation of a Safe Harbor law in the U.S.: Review of state administrative data.

BACKGROUND: Safe harbor laws have been implemented to change the way systems of care respond to juveniles exploited in commercial sex in the U.S., yet there is little research on the way these laws have impacted the identification and rehabilitation of juveniles. OBJECTIVE: Using administrative data, this study investigates the impact of a safe harbor law enacted in one state in the U.S. PARTICIPANTS AND SETTING: This study examines secondary data on juveniles with prostitution-related charges from 2007 to 2017 (n = 17); juveniles who were screened for human trafficking by juvenile court personnel (n = 56,937); (3) screenings for human trafficking with juveniles in the juvenile justice system (n = 12,223); and (4) juveniles who were reported to the child welfare agency as possible victims of human trafficking (n = 697). The number of criminal cases of human trafficking involving victims under the age of 18 years old from 2007 to 2017 were analyzed by calendar year (n = 61). METHODS: Aggregate, administrative data was accessed and analyzed. RESULTS: Findings show that juvenile justice and juvenile court personnel are screening for trafficking at an increasing rate and making referrals to the child welfare system as mandated by law. However, a relatively low percentage of these cases are substantiated, confirmed and/or result in criminal charges to the trafficker. Despite safe harbor mandates that prohibit the charging of juveniles with prostitution offenses, there is evidence that this is still occurring in small numbers. CONCLUSIONS: Based on these findings, researchers have identified next steps to facilitate future investigations of safe harbor laws.

Evidence-Based Human Trafficking Policy: Opportunities to Invest in Trauma-Informed Strategies.

Human trafficking is a critical social issue characterized by chronic trauma among victims, and frequently preceded by traumatic experiences that contribute to risk of victimization. Therefore, the research-based practice of trauma-informed care is a highly appropriate lens for both prevention and intervention. This work examines federal legislation in the United States related to human trafficking for references to trauma, as well as how the use of research could implicitly direct public policy responses toward trauma-informed approaches. Legislation on human trafficking has risen substantially since 1989, and the use of research and trauma language within these policies has also observed substantial increases. While the use of trauma language was associated with limited progression in the policy process, legislation using research language was more likely to pass out of Committee and become enacted. Moreover, legislation may leverage research in ways that have the potential to bolster trauma-informed practice among human trafficking victims. Specifically, research can be used to describe the problem and causal mechanisms (e.g., impact of trauma), guide "best practice" for service delivery, and generate knowledge through studies and evaluations that guide future policy. Therefore, human trafficking legislation that implicitly guides trauma-informed practice via the use of research may be particularly promising for the field.

Children at Work, Child Labor and Modern Slavery in India: An Overview.

There is a large child work force in India reported to be about 40 million. Child labor is being regarded as a form of modern slavery, as children are forced to work or have no choice to refuse work. Children are employed in a variety of occupations, many of which are hazardous. Exposure to machinery, pesticides, dust in agricultural work and fumes, chemicals, acids, cotton and wool fiber in other forms of work is detrimental to health. A large number are held in bonded servitude. In urban areas, children are employed as domestic helpers and engaged in eateries and auto-repair work. Trafficking and trading of children for work and sexual slavery are also major concerns. Poverty and illiteracy are root causes of child labor, but iniquitous societal attitudes are responsible for abuse and exploitation. Working children are deprived of proper health care and education, and lose their childhood and dignity. Several legal measures exist to prevent child labor and protect them from harm, but are thwarted by the distressing socioeconomic conditions. Although child labor would be difficult to abolish, exploitation can be prevented with concerted efforts of the government agencies, professional bodies and the civil society.

The Disease Outbreak-Human Trafficking Connection: A Missed Opportunity.

This article examines the connection between disease outbreaks and human trafficking. A central challenge in combating trafficking is poor data on its nature and scope. One way to deal with these gaps in knowledge and still target resources effectively is to identify key "push and pull" factors that increase the likelihood of trafficking from origin countries and to destination countries. One under-examined push factor is the outbreak of disease. Outbreaks are associated with several well-documented trafficking risk factors, from the breakdown of rule of law and increase in criminal activity to competition for resources and diminished economic opportunity. Disease outbreaks can also disrupt family ties. For example, the 2014 Ebola outbreak in West Africa left thousands of orphans at increased risk of exploitation. The article outlines possible mechanisms through which outbreaks could increase trafficking risk and, using data on disease outbreaks and trafficking across states over the past 2 decades, provides evidence that countries that have recently experienced a disease outbreak are more likely to have trafficking outflows. The findings point to the importance of integrating trafficking prevention into outbreak response and call for a research agenda more fully examining the connection between trafficking and outbreaks (and potentially other types of natural disasters as well).

Human trafficking and labor exploitation: Toward identifying, implementing, and evaluating effective responses.

In an Editorial, Ligia Kiss and Cathy Zimmerman discuss the need for research on the prevention of human trafficking and mitigation of its effects.

The role of human rights in implementing socially responsible seafood.

Sustainability standards for seafood mainly address environmental performance criteria and are less concerned with the welfare of fisheries workers who produce the seafood. Yet human rights violations such as slavery and human trafficking are widespread in fisheries around the world, and underscore the need for certification bodies and other seafood supply chain actors to improve social performance, in addition to addressing environmental challenges. Calls for socially responsible seafood have referenced human rights law and policy frameworks to shape the guiding principles of socially responsible seafood and to provide the legal machinery to implement these aspirations, but practical guidance on how to achieve this is lacking. To provide clarity on this challenge, we reviewed the literature concerning human rights in the seafood supply chain, and prepared an analysis of opportunities and challenges to implement socially responsible seafood through relevant human rights, legal and policy instruments. We observe that human rights laws are generally framed in favour of addressing violations of civil and political rights, but there remains considerable scope for applying economic, social and cultural (ESC) rights in this context. Other challenges include weakly defined ESC rights infringements, a lack of straightforward mechanisms to enforce human rights entitlements, and practical difficulties such as resources to support and secure rights. On the positive side, governments can draw on international instruments to inspire national policies and legislation to eliminate illegalities from the seafood supply chain. However, for socially responsible seafood principles to translate into tangible actions, these objectives must be rooted in clear legal obligations and be supported by sufficient national capacity and political will.

Toward evidence-based anti-human trafficking policy: a rapid review of CSE rehabilitation and evaluation of Indian legislation.

This paper (a) examines the evidence base around rehabilitation of victims of trafficking for commercial sexual exploitation (CSE), (b) identifies the extent that India's proposed 2016 Trafficking of Persons (Prevention, Protection, and Rehabilitation) Bill reflects scientific and experiential evidence, and (c) discusses how gaps in the proposed bill can be informed by evidence. A rapid review of empirical studies on policies and interventions addressing rehabilitation of CSE victims was conducted. Although evidence is lacking, research suggests that cross-sectoral collaboration, training and monitoring law enforcement, psychotherapeutic interventions and care provided by short-term shelters, reintegration, and recognizing victims' rights improve the success of rehabilitative efforts. The proposed legislation does not sufficiently reflect evidence around successful rehabilitation efforts and suggests that implementing the bill as it currently stands would change little of the existing structures to support victims in receiving adequate services or successfully reintegrating into society.