The emerging epidemiology of human trafficking and modern slavery






Mohsen Rezaeian

Correspondence:
Professor Mohsen Rezaeian
PhD, Epidemiologist
Epidemiology and Biostatistics Department
Occupational Environmental Research Center
Rafsanjan Medical School
Rafsanjan University of Medical Sciences
Rafsanjan-Iran
Tel: +983431315000
Fax: +983431315003
Email: moeygmr2@yahoo.co.uk

Abstract

Although within literature human trafficking is considered as a form of modern slavery, it should be more considered as a mediator for modern slavery. The ultimate intention of human trafficking is to capture humans and sell them to someone who wants to buy and abuse humans in one of the various types of modern slavery, for economic gain from such trade. As a result, human trafficking should be considered as a gross violation of human rights which leads to modern slavery and should be prohibited all through the world. The aim of the present article therefore, is to take a fresh look at the epidemiology of human trafficking and modern slavery.

Key words: Epidemiology; human trafficking, modern slavery

Introduction
Within literature human trafficking is considered as modern slavery (1) or at the very least as a subtype of it (2). However, in my point of view, it should be more considered as a mediator for modern slavery. The ultimate intention of human trafficking is to capture humans and sell them to someone who wants to buy and abuse humans in one of the various types of modern slavery, for economic gain from such trade. Modern slavery may include: prostitution, sexual exploitation, forced labor, bonded labor, forced child labor, slavery, servitude, child soldiering, brides and removal of organs for economic gain (3-5).

As a result, human trafficking should be considered as a gross violation of human rights and a horrific crime which leads to modern slavery and should be prohibited all through the world (6). In other words no one should be allowed to enlist, convey, transfer, harbour or receive a human being through the use of threat, compelling or kidnapping (3).

Evidence suggests that if efficient prevention strategies have not been put in place and within a short period of time human trafficking and modern slavery are going to exceed other types of trafficking including arms and drugs (7). It has been estimated that only sex trafficking of women and girls worth $32 billion annually. Furthermore, the victims of human trafficking will be abused over a number of years being more profitable than arms and drugs that might be abused just once (8). Therefore, given the soaring trend of human trafficking and modern slavery and its profound adverse health consequences, the aim of the present article is to take a fresh look at the epidemiology of human trafficking and modern slavery.

The epidemiology of human trafficking and modern slavery
It is highly difficult to have a real estimate of the sheer size of human trafficking and modern slavery in the world. There are a number of issues which contribute to this uncertainty. Firstly, human trafficking mostly occurs in those parts of the world where law and order is disrupted due to poverty, war, armed conflicts, natural disasters, social unrest due to existence of nondemocratic governments (9).

This is not happening unintentionally but it rather highlights a cause and effect relationship. Poverty, unemployment, ethnicity, gender discrimination as the most important social determinants are the root causes of modern slavery (10) and in this relation, human trafficking acts as the mediator. Moreover, manmade disasters together with natural disasters and due to displacement of people, breakdown of policy and enforcement, collapse of social cohesion could be considered as the facilitators (Figure 1).


Figure 1: The relation between poverty, unemployment, ethnicity, gender discrimination as the root causes and modern slavery as the main outcome taking into consideration the role of human trafficking as the mediator and manmade and natural disasters as the facilitators

In any out of law and order places it is very difficult to gather even straightforward data; therefore, gathering sensitive data such as detail of human trafficking would be rather impossible. Secondly, there are different definitions and connotations for human trafficking and modern slavery making their measurement very difficult (11). Thirdly, those who are involved in human trafficking either as the perpetrator and/or even some victims while they are in captivity chose to be silent for not being caught by officials or due to fear and shame, respectively. Therefore, we always should consider underreporting and underestimation in any human trafficking and modern slavery reports.

Given the above discussion, the newly published 2016 third edition of the Global Slavery Index, by using a rather methodological sound approach, provides the latest estimates. Based on this report, currently in our world there are 45.8 million of people who live as modern day slaves substantially more than the 2014 estimate which was 35.8 million enslaved people. Fifty eight percent of 45.8 million enslaved people are in five countries which are India, China, Pakistan, Bangladesh and Uzbekistan. Furthermore, the countries with the highest prevalence of modern slavery are: North Korea, Uzbekistan, Cambodia, India, Qatar, Pakistan, Democratic Republic of the Congo, Sudan, Iraq, Afghanistan, Yemen, Syria, South Sudan, Somalia, Libya, Central African Republic, Mauritania, Haiti, Dominican Republic, Myanmar and Bangladesh (11).

A report that was published in 2014 by the United Nations Office on Drugs and Crime reveals that across the world and from 2010 to 2012 victims with 152 diverse nationalities were identified in 124 countries. Furthermore, 49%, 21%, 18% and 12% of detected victims are adult women, girls, adult men and boys, respectively. This report also provides a very useful typology on the organizations which are involved in human trafficking. Based on this typology we can identify three types of organizations as follows: Firstly, there are Small Local Operations which are involved in short-distance trafficking of very few people with limited profits. Secondly, there are Medium Sub-regional Operations which are involved in Sub-regional trafficking of few people with higher profits. Thirdly, there are Large Trans-regional Operations which are involved in long-distance trafficking of large numbers of people with very high profits (12).

Investigating the geographical pattern of trans-regional trafficking reveals that: Middle East, Western and Central Europe, and North and Central America and the Caribbean, are the main destinations of this highly profitable investment. Whilst the origins of victims seems to be diverse and includes countries in most other regions including: East Asians, South Asians, Eastern and Central Europeans, Sub-Saharan Africans and South Americans (12) (Figure 2).



Figure 2. A map demonstrating the major target areas of trans-regional trafficking flows (in blue) and their noteworthy origins, 2010-2012.
Source: UNODC, Global Report on Trafficking in Persons 2014. (United Nations publication, Sales No. E.14.V.10).

This map also highlights another important and evoking issue. As it has been mentioned earlier the origin of trans-regional trafficking relates to the places where law and order is disrupted due to poverty, war, armed conflicts, natural disasters and social unrest due to existence of nondemocratic governments. Nevertheless, some of the main destinations of this trans-regional trafficking, or the places that modern slavery actually happen, are places where there seems to be law and order in place i.e. Central Europe and North and Central America. According to CNN in 2014 Atlanta's illegal sex industry makes more than $290 million (13). This trend not only explains why we should distinguish between human trafficking and modern slavery but it also reminds us how difficult it would be to prevent these social sicknesses.

The health consequences of human trafficking and modern slavery
Human trafficking and modern slavery have profound physical and psychological health consequences. This occurs because the victims experience a vast array of physical and mental health problems including appalling living situations, unsafe working circumstances, inadequate sanitation, poor nutrition, physical and psychological violence, and postponement in seeking medical care (5).

Given the hidden nature of human trafficking and modern slavery the research on physical and psychological health consequences of these social sicknesses are extremely limited. This is especially the case when people are in captivity. Therefore, in what follows the results of only a few most recent studies on physical and mental health symptoms of survivors of human trafficking and modern slavery are reported:

The results of a study on the physical health symptoms of 120 trafficked women who had received post-trafficking support in Moldova have revealed that 61.7%, 60.9% and 44.2% of them have reported headaches, stomach pain and memory problems, respectively (14).
A study on 387 children and adolescents aged 10 to 17 years, survivors of human trafficking in the Greater Mekong Sub-region which includes Thailand, Vietnam, Cambodia, Laos, Myanmar, and Yunnan Province of China, revealed that: 12% had tried to commit suicide in the month before the interview, 56% had symptoms of depression, 33% had symptoms of anxiety disorder, and 26% had symptoms of posttraumatic stress disorder (15).

In another study and by interviewing more than 1000 people who entered post-trafficking services in Cambodia, Thailand, and Vietnam it has been revealed that: 5·2% had tried to commit suicide in the past month, 61·2% had reported symptoms of depression, 42·8% had reported symptoms of anxiety, and 38·9% had reported symptoms of post-traumatic stress disorder. Furthermore, 48% reported physical violence, sexual violence, or both, 47% reported to be threatened and 20% reported to be locked in a room. Finally, 22% reported to have a severe injury at work. (16).

The results of a study on the psychological health of 66 sexually trafficked female survivors in Nepal have highlighted that 85·5% had reported symptoms of depression, 87% had reported symptoms of anxiety, and 29·7% had reported symptoms of post-traumatic stress disorder (17).

How to prevent human trafficking and modern slavery
In terms of epidemiological knowledge it would be possible to prevent any dilemmas such as human trafficking and modern slavery in a vast array of prevention strategies. From primordial and primary prevention which seek to prevent something before it happens to secondary and tertiary prevention which seeks to identify the problem and to stop its progress and complications as soon as possible.

It is no doubt that for such profound social sicknesses as human trafficking and modern slavery, it would be better to apply primordial and primary prevention strategies. Human beings are born free and they should have the right to live freely. No one should gain whatsoever the illegitimate power to force another human being to be a subject of modern slavery. Unfortunately however, human trafficking and modern slavery as inhuman social sicknesses are happening increasingly in our world and in front of our eyes.

We are all responsible no matter if we work in academia, governmental organizations, international organizations, charities, etc. We should all stand up and through close collaboration make a strong coalition against such evil phenomenon to eradicate them once and forever. Combating the root causes of human trafficking and modern slavery including poverty or its facilitator factors including wars, armed conflicts, natural disasters, social unrest due to existing of undemocratic governments, etc. should be a mandate for all of us. We also need enforcement of efficient policies (9 & 10). It has already been mentioned that taking this path would be very difficult but we should take it if we desire to protect humanity.

Furthermore, it is absolutely vital that immediately after any natural or manmade disasters proper attention is paid to the needs of the vulnerable groups such as women and children who are separated from their family (18). These people are more prone to violence and trafficking. Therefore, they should immediately be recognized and reunited with their family or obtain legal support from the relevant officials (19 & 20). Unfortunately, according to a recent report by the Guardian at least 10,000 unaccompanied child refugees have vanished after arriving in Europe mostly due to the activities of organized trafficking syndicates (21).

For secondary and tertiary prevention however, it seems that among all staff of public sectors and services, health care professionals have a major role to play (22). As it has been discussed earlier, human trafficking and modern slavery have profound physical and mental health consequences. Therefore, it is highly likely that due to these problems the victims are ultimately in contact with emergency departments and/or mental health services.

The results of a cross-sectional survey on National Health Service (NHS) professionals in UK has revealed that: 13% of them reported prior contact with a patient likely of having been trafficked, however, 86.8% reported insufficient awareness of what questions to ask to recognize possible victims and 78.3% reported that they had inadequate training to help victims of human trafficking (23).

This explains why health service professionals should be sufficiently trained about how to recognize a victim of human trafficking. Furthermore, they should be trained on how to efficiently manage such victims taking into consideration the available supports. Therefore, they should be educated on how to competently collaborate with law enforcement authorities and engage advocacy partners. In order to fulfill all above educational goals, the medical schools need to revise their medical curriculum based on the existing evidence and more educational resources and textbooks should be developed (24-26). Fortunately, existing evidence has highlighted how a brief training intervention for emergency providers could largely increase their confidence and abilities to identify and treat a trafficked patient (27 & 5).

Conclusion
The ultimate intention of human trafficking is to give illegitimate power to a human being in order to force another human being to be a subject of modern slavery i.e. prostitution, sexual exploitation, forced labor, slavery, servitude, child soldiering, brides and removal of organs for economic gain. As a result, human trafficking should be considered as a gross violation of human rights which leads to modern slavery. Both human trafficking and modern slavery should be eradicated by a coalition and close collaboration of national governments and relevant national and international organizations.

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