Trafficking toolkit – identifying and supporting victims of human trafficking

Human trafficking, modern slavery and exploitation of both adults and children is not an issue confined to the past. It exists here and now. In this country. In your country. Possibly even in your street.

Slavery is much closer than you think and I have previously drawn attention to a short video (30 seconds only) highlighting some of the issues.

For those people reading this who work in the health sector there is helpful guidance that you can use to assist you in identifying victims of trafficking. This guidance is relevant to all kinds of healthcare settings including Emergency Departments, Sexual Health Services (Genitourinary Medicine (GUM) clinics) and Primary Care (General Practice). The guidance includes:

  • providing information that will help staff identify potential victims of trafficking
  • setting out the physical and behavioural signs that someone may have been trafficked
  • advising on how to respond in a way that will not put the potential victim in further danger
  • providing information on how to respond in the person you suspect has been trafficked is under 18

Further guidance on how to respond if you think someone has been trafficked is available through the e-learning for health module.

Although this guidance is aimed at UK healthcare staff, professionals working in other sectors and countries may also find it to be useful.

ALL professionals working with children or adults in all settings could potentially spot a victim of human trafficking.

What is Human Trafficking?

Human trafficking is the recruitment, movement, harbouring or receiving of children, women or men through the use of force, coercion, abuse of vulnerability, deception or other means for the purposes of exploitation.

It is crucial to remember that children, women and men can be trafficked into, around and out of the United Kingdom. This is not just something that occurs to people outside of the UK.

Why are people trafficked?

Children are trafficked for many reasons including:

  • Sexual exploitation
  • Domestic servitude
  • Forced labour
  • Benefit fraud
  • Involvement in criminal activity (for example, pick-pocketing, theft and working in cannabis farms)
  • Involvement in the sex industry
  • Organ harvesting


Why is trafficking possible?

People may be trafficked from other countries for a variety of reasons and there are a number of factors in the country of origin which might make children vulnerable to being trafficked, including:

  • Poverty
  • Lack of education
  • Discrimination
  • Cultural attitudes
  • Grooming
  • Dysfunctional families
  • Political conflict
  • Economic transition
  • Inadequate local laws and regulations

How are trafficked individuals recruited and controlled?

Traffickers use a variety of methods to recruit  their victims. For example, looking specifically at children’s issues, some are coerced and some are trapped in subversive ways for example:

  • Promising education
  • Promising employment in restaurants or as domestic servants
  • Persuading parents that their children will have a better life elsewhere

Many children travel on false documents and even those whose documents are genuine may not have access to them. One way that traffickers exert control over children is by keeping their passports and threatening children that they will be deported if they escape. Even before they travel, children may be subjected to abuse and exploitation to ensure that the trafficker’s control over them continues after the child is transferred to someone else. Controlling methods include:

  • Confiscating identity documents
  • Threatening to report the child to the ‘authorities’
  • Violence or threats of violence
  • Social isolation
  • Imprisonment
  • Telling the child they owe large sums of money and that they must work to pay this off
  • Depriving the child of money
  • Frightening the child with threats based on cultural or belief systems, for example witchcraft or spirit possession

Identifying children who might have been trafficked

Possible indicators that a child may have been trafficked are as follows:

The child:

  • Has false (or no) documentation
  • Possesses money and goods not accounted for
  • Is malnourished
  • Is accompanied by an adult who insists on remaining with the child at all times
  • Is withdrawn and refuses to talk, or appears very afraid to talk, to anyone in authority (even in their own language)
  • Exhibits self-assurance, maturity and self-confidence not expected to be seen in a child of such an age
  • Does not appear to have money but does have a mobile telephone
  • Is unable, or reluctant, to give details of accommodation or other personal details
  • Receives unexplained or unidentified phone calls whilst in hospital
  • Shows signs or physical or sexual abuse (remembering Sexually transmitted infections and unwanted pregnancies)
  • Has limited freedom of movement
  • Is being cared for by adult(s) who are not the child’s parents and the quality or the relationship between the child and their adult carers is not good
  • Is of school age but has not been enrolled in school
  • Has not been registered with a GP
  • Might claim to be a child but is clearly an adult (or vice versa)

It is important to remember that trafficked children might not show obvious signs of distress or abuse and this does make their identification difficult. Many children are unaware that they have been trafficked and some may actively participate in concealing it for the above reasons.

What about adults?

Some of the features of potential trafficking that apply to children also apply to adults as well. A person who has been trafficked may be accompanied by someone who appears controlling, who insists on giving information and coming to see you as a professional.

Some specific features of people who have been trafficked might include:

  • Being withdrawn and submissive, seeming afraid to speak to a person in authority
  • Giving a very vague or inconsistent explanation about where they live, their employment or their schooling
  • Having old injuries or injuries that appear to have been left untreated. Be concerned about delayed presentations, without adequate explanation, and if people are reluctant to explain how injuries have occurred or to give you a medical history
  • Not being registered with a GP (or in the case of children a GP, nursery or school)
  • Having experienced being moved internationally, nationally, regionally or locally. Remember that trafficking does not just involve people being moved into or out of the UK (or your own country)
  • Showing signs of physical neglect
  • Struggling to speak English
  • Going missing regularly
  • Having an unclear relationship with any accompanying people
  • Giving inconsistent information about their age
  • Having no official means of identification or suspicious-looking documentation

How might you suspect that a person is a victim of trafficking?

Although the above guidance might help you, one of the important things is to trust your professional instinct. If you think that something is not right, even if one or more of the above features does not exist, then you need to do something about it. It may be a combination of triggers, an inconsistent story and a pattern of symptoms that concerns you. Or it might simply be your gut professional instinct that something is wrong.

Remember that:

  • Trafficked people may not self-identify as victims of trafficking
  • Trafficked people can be prevented from revealing their experiences from fear, shame, language barriers and lack of opportunity
  • Support is available for victims of trafficking

Have a look at the PROTECT website for details of research into trafficking.

What are the possible health consequences of human trafficking?

Health issues may include:

• Evidence of long term multiple injuries
• Indications of mental, physical and sexual trauma
• Sexually Transmitted Infections
• Pregnant, or a late booking over 24 weeks for maternity care
• Disordered eating or poor nutrition
• Evidence of self-harm
• Dental pain
• Fatigue
• Non-specific symptoms of Post Traumatic Stress Disorder
• Symptoms of psychiatric and psychological distress
• Back pain, stomach pain, skin problems; headaches and “dizzy spells”

Further guidance

Seeking refuge? Trafficking, sexual exploitation and the law

Safeguarding children who may have been trafficked

Reducing and preventing crime

Guidance for child first responders

Human trafficking victims: referral and assessment forms

This freely available e-learning module and guidance sheet are both really helpful.

What should you do?

If you are a professional and suspect that someone might have been trafficked you must follow your own local protocols to deal with this suspicion.

If you suspect that someone has been trafficked you must report it. Your own safety, and the safety of the victim, is paramount and you must let the authorities take the necessary action. If you feel that you are a victim you can use the same methods to report your own situation. If it is an emergency, call the police (24 hours a day, 7 days per week).

There is advice and assistance about slavery here and some of this advice will be helpful to you if you think someone has been trafficked.

Further information: ECPAT UK

ECPAT UK, who campaign against child trafficking and transnational child exploitation, have published a helpful booklet to empower practitioners and the general public to ensure the needs of trafficked children are considered at every level of UK society. Launched to coincide with Anti-Slavery Day 2014, FAQs on Child Trafficking provides insight into the frontline issues and questions identified by ECPAT UK in daily interactions with practitioners and children who have been trafficked.

And finally…

You can identify potential victims of trafficking and you can make a difference to them and others facing similar situations.

What are you waiting for? Watch the above video, have a look at the free e-learning, read the guidance sheet and think about what you would do next time you are concerned.

Together, with a coordinated approach, we can and will make a difference to the victims of this terrible crime.


Churchill Fellow 2014 summary and looking forward to exciting projects in 2015!

2014 was a fascinating, exciting, educational year that filled me with great optimism for the coming year ahead.

The link below will take you to a summary of my activities as a Churchill Fellow 2014, working up to the publication of Living on a Railway Line.

Here is an excerpt but please do click through to the full summary to see exactly what I’ve been up to:

A San Francisco cable car holds 60 people. If this blog were a cable car, it would take about 50 trips to carry as many people as have viewed my posts over the last year – in over 40 different countries.


Click here to see the complete report.


I’ll be updating this site throughout 2015 as projects take place stemming from Living on a Railway Line.


Happy New Year to you all!