Can You Own a Person?
Written by Kristin Hall & Tamara Jackson   

CONSIDER THIS CASE STUDY: A 27-year-old female presents as a trauma activation after being found unresponsive in the stairwell of a casino. She has extensive swelling and bruising to her face and an obvious deformity to her lower leg. Upon arrival to the trauma center, she is examined by the trauma team and her belongings, which included multiple cell phones, are bagged up to be transported with the patient upon disposition. Aside from the medical management of this patient, do you have any other concerns about her? Without any additional information, is this something that is reportable in your current jurisdiction? Would you be concerned about allowing visitors to see this patient?

This article appeared in the November-December 2020 issue of Evidence Technology Magazine.
You can view that full issue here.

Can You Own A Person?
Can you own a person as your property? What is human trafficking? Let’s answer some of these questions.

Human trafficking can be defined as 1) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or 2) the recruitment, harboring, transporting, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.

A few other definitions are important here:

  • Force may include rape, drugs, starvation, confinement—anything to help control the actions and limit the freedoms of another person.
  • Fraud generally involves false promises that may include romantic relationships, sometimes escalating to reproductive control or, in cases of labor trafficking, promising opportunities or payment that are not provided.
  • The federal government defines coercion as any scheme, plan, or pattern intended to cause a person to believe that failure to act would result in serious harm or physical restraint. Trafficked women who have children with their trafficker report greater difficulty leaving the relationship and the child may be threatened with harm or kidnapping if the woman chooses to leave.

There are three essential elements needed to institute trafficking: the process, the means, and the end. The process includes recruiting, harboring, moving, obtaining, or providing of a person. The means of trafficking includes force, fraud, or coercion. Defining the end looks at the purpose of involuntary servitude, whether it be debt bondage, slavery or sex trafficking.

Who Are Traffickers?
Traffickers can be anyone. It can be an individual or a group of individuals including but not limited to:

  • Friends
  • Family
  • Church
  • Organized crime
  • Organized gangs
  • Farms
  • Businesses
  • Restaurants

What Industries Are Commonly Known For Trafficking?

  • Sex work
  • Domestic service
  • Restaurants
  • Hair braiding
  • Garment industry
  • Magazine crews
  • Selling or producing drugs
  • Fishing
  • Manufacturing
  • Home and elder care
  • Construction
  • Hospitality
  • Housekeeping
  • Daycare
  • Peddling
  • Agriculture
  • Cleaning industries
  • Marriage

What Makes A Person Vulnerable To Trafficking?
There are multiple factors that contribute to trafficking and may make individuals more vulnerable. Factors in origin areas of trafficking include extreme poverty (particularly among women); limited social, economic, or political stability; scarcity of legal, reasonable jobs; wars or armed conflicts that lead to oppression; and limited education or gender discrimination.

Minority groups such as indigenous persons and those in the LGBTQ communities are also at greater risk for trafficking. Substance abuse and mental illness are also aspects that create additional vulnerabilities and can ease exploitations. Minors who are trafficked are often runaways or come from an unstable family environment.

Factors in destination areas of trafficking include increase in expenses for employers to hire workers who are legally hired; an increased demand for commercial sex workers; and an increase in demand for cheap laborers, particularly in agricultural or construction jobs.

What Are Some Common Misconceptions?
There are many myths regarding human trafficking, here are a few of the most common:

Myth 1: Trafficking requires the kidnapping or movement of people.

Reality: The exploitation of humans can be done without physically moving them. Human smuggling is the act of transporting persons across state lines or borders.

Myth 2: Trafficked persons are not compensated for the work they do, or if they entered their situation willingly, it does not constitute as trafficking.

Reality: Trafficking survivors are often paid, but they are forced to give the majority of the money earned to their trafficker. In instances of labor trafficking, the victim may not be paid the amount that was promised to them. Individuals who work in the commercial sex trade may or may not be victims of trafficking. If they are adults in control of their finances and their actions or movements, they are likely not being trafficked.

Myth 3: Human trafficking only happens outside the United States, or those trafficked here are immigrants.

Reality: The United States is the biggest consumer of human trafficking. Victims span all ages, ethnicities, and cultures.

Myth 4: All trafficking victims are held captive or chained to the wall to prevent them from leaving.

Reality: Most trafficking victims are able to leave their situation for short periods of time, but may not have the means to escape permanently. Whether they are financially dependent on their trafficker or do not have control of their documents, they are often held mentally or emotionally captive rather than by physical means.

Myth 5: Traffickers prey on those that they don’t know.

Reality: Most victims of trafficking are groomed and exploited by people familiar to them—including family members or romantic partners.

Myth 6: Women and girls are the only victims of sex trafficking.

Reality: It is estimated that almost half of sex trafficking survivors are male. That is likely a conservative estimate, as male victims are less likely to report or be identified.

Myth 7: The sex trade is responsible for most of trafficking victims.

Reality: Experts believe there are more cases of labor trafficking worldwide, but education and awareness campaigns are generally centered around sex trafficking.


Photo by Tamara Jackson

How Can You Identify A Survivor? What Are You Looking For? What Are Some Possible Indicators Of Human Trafficking?

Identifying survivors of trafficking can be difficult as many of them may not identify as being trafficked. Here are some signs of trafficking:

  • Physical abuse
  • Psychological abuse
  • Sexual abuse
  • Physical threats
  • Long work hours
  • Little or no pay
  • Withholding documents
  • Threats of deportation
  • Threats to family members
  • Isolation
  • Inhumane living conditions
  • Branding tattoos
  • Multiple cell phones or hotel keys
  • Repeated sexually transmitted infections
  • Malnutrition
  • Dehydration
  • Multiple pregnancies or abortions
  • Unusual occupational injures
  • Having to work when sick
  • Not able to refuse customer requests
  • Inconsistent or scripted history
  • Inability to state home address
  • Doesn’t know current city
  • A minor trading sex for something of value (food, shelter, drugs, or money)
  • Unusually high number of sexual partners
  • Late presentation
  • Carrying large amount of cash
  • Appearance younger than stated age

Why May Victims Not Give The Impression That They Want Help?
There are many answers to this question, and often many reasons why survivors may not be ready to leave their situation. Similar to those experiencing violence from an intimate partner, they may be financially dependent on their trafficker. Traffickers also spend time grooming their victims and isolating them from their families, friends or support groups. They often threaten violence towards their victims and children to prevent them from leaving. Victims are conditioned not to trust law enforcement or the health-care system, so it may take time before they will accept services. Survivors may feel ashamed if they entered their situation willingly and blame themselves for not being able to escape. They also may not see themselves as victims and may not be aware of the options and services available to them. A non-judgmental and victim-centered approach can help to build trust with the survivor and assist in facilitating a path of escape.

What Is Your Trauma-Based And Client-Centered Approach To Human Trafficking?
As with any other patient who may be affected by violence, their medical needs should be addressed first. If safely able to do so, getting them away from their situation for even a few hours can help start a dialogue. These conversations should happen when the person is alone and away from even those that the survivor may report as being close family members. If you are meeting the survivor in the hospital and the controlling person refuses to leave, taking the survivor to the bathroom, x-ray, or another location may be helpful.

If safety is an issue, consider notifying your facility’s security and following your facility’s safety plan. Finding a safe, comfortable, quiet, and accommodating environment can facilitate these conversations, as well as assure confidentiality. This can also help to build rapport with the survivor, which is essential in these cases. Those working with survivors of trafficking should also be careful not to impose their beliefs or values onto the survivor, as doing so can damage the rapport that was built.

Every survivor should be offered a comprehensive health assessment and physical exam. Trafficked persons often have limited access to health care, so capitalization on those opportunities may be vital for their survival.

Working with your community’s resources to allow the client interview to be performed by a forensic nurse, trauma-informed social worker, or another medical professional is strongly recommended. The path to disclosure and treatment should be led by the survivor, including any forensic exam or evidence collection.

Evidence collection by the forensic nurse in cases of trafficking can include photo documentation of tattoos or injuries, and swabs to collect trace evidence of DNA. Ideally, this should be done prior to any wound cleansing or repair, but will always come second to medical stabilizing interventions. Wound documentation and evidence collection are best performed by a forensically trained nurse or medical professional.

In a study on the effectiveness of sexual assault nurse examiner (SANE) programs who often work with survivors of sex trafficking, Dr. Rebecca Campbell et al. found that SANE programs “promote the psychological recovery of rape survivors” and can assist them in being introduced to community resources (2005). The implementation of SANE programs in recent decades has increased the amount of forensic evidence collected in cases of sex trafficking, which has allowed for increased prosecution.

Once their medical needs are met, some basic interview questions that may help with identification can include:

  • Have you ever exchanged sex for food, shelter, drugs, or money?
  • Has anyone forced you or asked you do something sexual against your will?
  • Have you been asked to have sex with multiple partners?
  • Do you have to meet a quota of money before you can go home?
  • Does anyone hold your identity documents for you? Why?
  • Have physical abuse or threats from your employer made you fearful of leaving your job?
  • Has anyone lied to you about the work you would be doing?
  • Were you ever threatened with deportation or jail if you tried to leave your situation?
  • Have you or a family member been threatened in any way?

What Are Some Social Service Needs Of Human Trafficking Survivors?

  • Safety
  • Housing
  • Food
  • Clothing
  • Medical care
  • Tattoo removal
  • Parenting
  • Mental-health counseling
  • Life-skills training
  • Case management
  • Alcohol-abuse treatment
  • Substance-abuse treatment
  • Education
  • Job training
  • Employment
  • Family reunification

What Are The Health-Care Outcomes Of Exploitation?
The health-care outcomes of exploitation can vary depending on the types and duration of exploitation, but we know that at best it is damaging both psychologically and physically.

Many survivors of trafficking have substance abuse issues. A Polaris Project report showed substance abuse was the most common risk factor for sex trafficking in 2019. Drugs and other illicit substances may also have been used as part of the means of trafficking, or survivors may be self-medicating with substances to cope with the trauma associated with trafficking. This can compound the difficulties during their road to recovery, both physically and emotionally.

Mental health is also a common risk factor for sex trafficking, which is only exacerbated by the relentless sexual abuse. Survivors may also be malnourished and any chronic health issues, such as diabetes or hypertension, may have been neglected. This can contribute to higher incidence of heart disease and strokes. Abuse in any form— emotional, physical or sexual—has been shown to increase the prevalence of chronic health issues later in life. According to a 2002 study on Intimate Partner Violence and Its Physical Health Consequences, abused women had a higher prevalence of headaches, back pain, sexually transmitted infections, urinary-tract infections, and abdominal/pelvic pain. Strangled women also had a higher incidence of strokes and transient ischemic attacks or “mini strokes” (2003).

Let’s Discuss: Can You Own A Person?
Unfortunately, the statistics are showing that the owning of persons is a fast-growing, global health crisis fueled by limited awareness of the prevalence of trafficking, as well as lucrative opportunities for traffickers. It is estimated there are 25 million trafficked persons worldwide: 45% are females, 55% are males, 74% are adults and 26% are children. Of all the trafficked persons in the U.S., 79% were minors at the time trafficking began.

According to the International Labor Organization, profits of the trafficking trade are greater than five of the world’s largest tech companies combined, equaling more than $150 billion (2014). The intricate network of traffickers creates an army that is difficult to fight as they are often hiding in plain sight. Many run legitimate businesses that may be a front for trafficking or may be the actual trafficking organization itself. Restaurants, construction companies, nail salons, massage parlors, hotels, and cleaning companies are all frequent businesses used in sex and labor-trafficking operations.

As many trafficking operations span multiple geographic regions, particularly with the aid of technology, prosecution of crimes has been difficult. The United Nations created the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, supplementing the United Nations Convention Against Transnational Organized Crime. It was created in 2003, has been signed by more than 150 nations around the world and has aided in the prosecution of international trafficking organizations.

Successful legislation in the U.S. includes the Trafficking Victims Protection Act, enacted in 2000 and reauthorized five times. This act encouraged Congress to allocate $250 million to benefit survivors of human trafficking.

There is no clear path to completely eradicate human trafficking, but it is widely discussed that in order to effectively combat trafficking we need to increase the availability of education and viable work opportunities. The Polaris Project reported a 20% increase in direct contact from survivors in 2019. Direct contact from survivors increases their likelihood of engaging in services and also allows for better reporting.

Community education is working for survivors, though we need to continue our outreach in our communities to address issues of human trafficking and gender inequality. To combat labor trafficking, we need to effectively reduce the wage gap between legal and illegal workers. And, of course, for effective prosecution, we need to eliminate corruption of law enforcement agencies and dismantle the trafficking networks.

This may seem impossible to accomplish, but every year more nations around the globe join the United Nations protocol. Non-governmental organizations have popped up and can provide survivors with food and temporary housing. Other services include access to advocacy and legal services, including visa application assistance for foreign-born survivors. Collaboration of nations worldwide stops the growth of this trade. By providing the medical assessments, forensic exams, and aftercare needed, the impact of trafficking can take less of a toll on our survivors.

Going back to our case study, this patient was found to have multiple facial fractures and a fracture to her ankle that required surgical intervention. After the initial survey performed by the trauma team, the primary nurse was able to initiate a dialogue with this patient. She built trust with her patient, who ultimately disclosed she was being sold for sex by her boss while working at an event-planning company. She had a fairly extensive drug history and her boss was using that to continue to exploit her. After a lengthy conversation with the emergency nurse and the forensic nurse, the patient elected to have a forensic exam performed and was interviewed by law enforcement. The patient was entered into witness protection as well as a drug-treatment program. The suspect was formally charged with five felonies, including aggravated exploitation of a prostitute.

Do You Need Immediate Help With Victim Response?

  • Call 911
  • Call the National Human Trafficking Hotline: 888-373-7888
  • Consult with a designated professional for your care setting to determine whether mandatory reporting is required
  • Visit www.polarisproject.org

About The Authors
Kristin Hall (BSN, RN, CEN) has worked in emergency medicine for the past 14 years and currently works as a charge nurse in the emergency department of a level I trauma center. Since beginning her career as a forensic nurse, she has worked to expand the practice of forensic nurses in her home state of Utah. She is the current clinical director for the Salt Lake Area Family Justice Center SANE program and serves as a board member of the Academy of Forensic Nursing.

Tamara Jackson (MSN, RN, SANE-A) is a dedicated professional who has served the health-care profession for more than 20 years. Adhering to evidenced-based practices, Jackson has developed an extensive database of health-care professionals within Amita Health. She is recognized as a leader and is well respected by peers, medical staff, and the patients that she serves. Jackson is responsible for the design and implementation of a training program to further goals and increase productivity of sexual assault nurse examiners within Amita Health.


References
Birkenthal, S. 2011. Human trafficking: A human rights abuse with global dimensions. Interdisciplinary Journal of Human Rights Law. 6(1):27-40.

Campbell, R., D. Patterson, and L. F. Lichty. 2005. The effectiveness of sexual assault nurse examiner (SANE) programs: A review of psychological, medical, legal, and community outcomes. Trauma, Violence, & Abuse. 6(4):313-329. https://doi.org/10.1177/1524838005280328

International Labor Organization. 2014. Profits and poverty: The economics of forced labor. https://www.ilo.org/global/topics/forced-labour/publications/profits-of-forced-labour-2014/lang--en/index.htm

International Labor Organization. 2020. 2020 Trafficking in persons report. https://www.state.gov/wp-content/uploads/2020/06/2020-TIP-Report-Complete-062420-FINAL.pdf

Polaris Project. 2020. Myths, facts, and statistics. https://polarisproject.org/myths-facts-and-statistics/

Taliaferro, E. (producer). May 2003. The Pandora Effect. Texas Tech Women's Health Conference Keynote Speech. Link here.

 

 
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Item of Interest

The language barrier between English-speaking investigators and Spanish-speaking witnesses is a growing problem. (Updated 28 February 2011)

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