Health Needs of Human Trafficking VictimsAmbassador Mark P. Lagon, Director of the Office to Monitor and Combat Trafficking in Persons
Keynote Address at the National Symposium on the Health Needs of Human Trafficking Victims at the Department of Health and Human Services
September 22, 2008
Tina Frundt, thank you so much for your introduction. Tina is one of the extraordinary people who have worked on the front lines of the anti-slavery movement, forging the best ways to do street outreach, for example, in downtown DC. I am so happy to know that you are working on a shelter project, Courtney’s House, because providing models for excellent protection services is essential. I have great confidence that your new work will advance the movement’s knowledge and capability—while helping individuals recover their lives.
As Ambassador-at-Large to Combat Human Trafficking, I travel a lot. And while the primary purpose of most official travel is to meet with foreign government officials, I always meet with survivors, together with the brave NGOs who are implementing anti-trafficking programs.
I have realized, as many of you know, that a defining aspect of the human trafficking experience is PAIN— physical, emotional, and psychological pain. In every account, in every personal tale of suffering I hear, the story includes adverse health impacts ranging from extremely painful experiences to grotesque examples of brutality.
Now, this should be self-evident, considering that force, fraud, and coercion, part ofthe defining legal criteria of human trafficking, typically include confinement and physical or psychological abuse which harm the health of the victim. But the implications of this fact have not been fully absorbed, I’m afraid.
The more I travel, and think about the people I’ve met, and worry about how we are working on this issue—the more we learn through the very fact of compiling the annual Trafficking in Persons Report—the more I’ve realized that two simplistic assumptions, shared by many, undermine general acknowledgement that human trafficking must be prioritized as a health pandemic as well as a human rights travesty. One assumption pertains to forced labor, the other to sex trafficking.
Last week, I was talking to a Congressional staffer just back from a field investigation. In describing the situation of a group of labor trafficking victims, in one breath, he mentioned that the group suffered from malaria, renal failure, gastritis, and malnutrition. Victims of forced labor are routinely beaten and assaulted. Their injuries are rarely treated, so infection is a common risk. They suffer depression and post-traumatic stress disorder, which elevate the risk of suicide.
Last year, my office dedicated the 2007 Trafficking in Persons Report to a group of Burmese fishermen who were trafficked on fishing boats. The men were forced to remain at sea for years, denied pay, and fed only fish and rice. They suffered vitamin deficiencies, and then, starvation. One by one, they began to die. So the traffickers tossed them off the boat, into the sea. Death is the ultimate adverse health impact of trafficking. And note, in this case, because there were no bodies remaining, the fishing fleet’s owner claimed not to owe families death benefits.
A study in 2001 by Janice Raymond, Donna Hughes, and Carol Gomez revealed that 86% of women trafficked within their countries and 85% of women trafficked across international borders suffer from severe depression.
Studies of the health impacts of sex trafficking and of prostitution describe similar pathologies. Dr. Melissa Farley led a team investigating the physical and psychological damage of prostitution. First published in the Journal of Trauma Practice in 2003, the study found that 73% of women used in prostitution were physically assaulted, 89% wanted to escape but had no other means of survival, 63% were raped, and 68% met the criteria for post-traumatic stress disorder. I am very happy that Dr. Farley will be able to discuss her research at this symposium.
Additional psychological consequences common among prostituted women include dissociative and personality disorders, anxiety, and depression. Yet, the adverse health impacts of commercial sexual exploitation are almost universally disregarded, except the risk of HIV/AIDs.
The categorical pain, violence, and health risk of prostitution is obscured by a covering myth that individual volition is involved. Prostituted women are ensnared not just by brothel owners and pimps. They are ensnared by the camouflaging assumption that prostitution is work. It’s always degrading and dehumanizing.
Importance of Research
It has been estimated that half of all female sex trafficking victims in South Asia are under age eighteen at the time of exploitation. Yet, research on HIV and sexually-transmitted infections has rarely sought to identify minors or adult trafficking victims.
Dr. Silverman and his team partnered with major NGOs across India, Nepal and Bangladesh involved in rescue and care of sex trafficking victims to examine the process of sex trafficking, HIV prevalence, and trafficking-related risk factors. Among Nepalese women and girls who were repatriated victims of sex trafficking, the Silverman study found that 38% were HIV positive. The majority were trafficked prior to age 18. One in seven was trafficked before age 15, and among these very young girls, 51% were infected with HIV. Why? Very young girls were more frequently trafficked to multiple brothels and for longer periods of time.
Silverman concludes that the girls at greatest risk for being infected with HIV (and for transmitting HIV) are the least likely to be reached by traditional HIV prevention models.
U.S. Government Policy
Prioritize Attention to Health in Programming
Last winter, in an urban shelter for sex trafficking survivors, I met two young Romanian women, Anca and Silvia, who had been trafficked separately to Western Europe, wound up together in a shelter, and were repatriated back home. Both women had the look of traumatized people. They clung to each other. Just a few days after we met in Romania, the NGO caring for them discovered that Anca had advanced TB and Silvia had severe syphilis. Why weren’t these women given proper medical attention before they were repatriated? The time lost made their conditions worse.
Despite increased attention by law enforcement to sex trafficking, we do not see significant improvement in victim protection or services provided, and this includes medical attention. But unless this trend is reversed we will never be able to help significant numbers of victims become survivors.
Thank you all for being here. I hope this symposium will stand as one of the most significant accomplishments of 2008 for the anti-slavery movement. Finally, I must thank Melissa Pardue, a valued colleague and friend who is an extraordinary policymaker and organizer of research. We have her to thank for making this event happen.
Released on September 26, 2008