Shedding Light on Human Trafficking: Insights from the 13th Annual Global Health Conference

Human trafficking is the second most lucrative criminal enterprise worldwide, after drug trafficking, and represents a major public and global health issue as well as a human rights issue. At some point while they are being trafficked, the vast majority of victims have contact with a healthcare provider, often in an emergency department. Healthcare providers have the opportunity to intervene and need the knowledge and skills so that they can identify victims and intervene appropriately.

This need helped inform the topic for the recent 13th annual global health conference. Titled “Addressing Human Trafficking in Healthcare at Local & Global Levels,” the hybrid conference was hosted by Case Western Reserve University School of Medicine and the Cleveland Clinic Lerner College of Medicine and held on April 20 at the Health Education Campus and also live-streamed.

Two forensic healthcare experts spoke at the conference: Michele Reali-Sorrell, DNP, RN, SANE-A, SANE-P, Enterprise Forensic Nurse Program Manager at Cleveland Clinic, and Kathleen Hackett, MSN, RN, SANE-P, Pediatric Forensic Program Coordinator at University Hospitals Rainbow Babies & Children’s. Their participation added valuable perspectives to the discourse on combating human trafficking within the healthcare context.

In addition to the keynote speakers, the conference included a mix of student presentations, a powerful video featuring a survivor’s message and an interactive session in which participants viewed video scenarios of trafficking victims seeking medical care. The participants then shared what they noticed including any red flags that led them to suspect criminal activity.

One of the planning committee members, Chineme Onwubueke (‘25), says that the most impactful aspect of the conference was the sharing of survivor stories. While acknowledging the emotional difficulty involved in sharing their stories, Chineme says this particular element played a vital role in educating attendees and increasing awareness about this pressing issue.

In addition to Chineme, the planning committee included Katherine Lowe (‘24), Eran Maina (‘27), Obichi Onwukwe (‘23), Evonne Pei (University Program ‘24) and Egan Sanchez (‘27). Lora Sowunmi, MD, Assistant Professor of Medicine and Pediatrics, Cleveland Clinic, and Suet Kam Lam, MD, MPH, MS, Assistant Professor of Pediatrics, Cleveland Clinic, served as the faculty advisors.

Facts

• Human trafficking is the second most lucrative criminal enterprise worldwide. Drug trafficking is number one.
• Worldwide, sexual exploitation is the most commonly detected form of trafficking, followed by labor trafficking.
• 34% of all trafficking cases involve children.
• In the United States, you have to prove force, fraud or coercion for adult victims to be considered trafficked. You do NOT have to prove force, fraud or coercion for minors.
• Top three trafficking recruiter types: family member/caregiver, intimate partners, employers.
• 87.8% of human trafficking survivors reported having contact with a healthcare provider while being trafficked. 63.3% of those who had contact were treated in an emergency department (Lederer & Wetzel 2014).

Red flags

• Discrepancies in clinical presentation and oral history
• Patient appears fearful, anxious, depressed, submissive or hyper-vigilant
• Evidence that care has been lacking for prior or existing conditions
• High number of visits or treatment for STIs
• Frequent ED or urgent care visits
• Patient accompanied by someone who speaks for them
• Tattoos: People who willingly get tattoos tend to be proud of them; trafficking victims who have had tattoos forced on them tend to be more reluctant to talk about them

How to approach suspected victims

• Create a means of separating the patient and suspected trafficker.
• Gather information from patient.
• During the physical exam, obtain consent prior to making any physical contact, as patients tend to be hypersensitive to touch.
• Involve hospital resources such as social work.
• Identify drug use and manage appropriately (drugs are often used as a means of control).
• Avoid using “why” as it often implies blame.
• Be wary of companions who insist on being the interpreter for a patient who purportedly cannot speak English.
• Always use interpreter services when available.

Action tips

• If the person is 18 or older, discuss police involvement and safety concerns.
• If the person is under 18, you are mandated to report to Child Protective Services/law enforcement.
• Text “help” to the number matching “be free” (233-733; easy to remember).
• National Human Trafficking Hotline (available 24/7): 888.373.7888.