Human Trafficking: Nurses at the Front Line

It has been over 150 years since the thirteenth amendment abolished slavery; unfortunately, the concept is still alive today. The United Nations defines human trafficking as the recruitment, transportation, transfer, harboring, or receipt of persons by improper means (such as force, abduction, fraud, or coercion) for an improper purpose (including forced labor or sexual exploitation) (UNODC, 2020). Human trafficking is a major health crisis and human rights violation affecting individuals across all demographics, and millions of people worldwide (Scannell, MacDonald, Berger, & Boyer, 2018). 

The term ‘human trafficking’ often brings the image of sexual exploitation and abuse to mind for most people, as this is the sector upon which the media tends to focus.  Basically, individuals are enslaved for another person to achieve personal financial gains (UNODC, 2020). Examples of human trafficking include forced labor, domestic/involuntary servitude, sexual exploitation, organ harvesting, drug sales, armed combat, begging on the street, forced marriage, and illegal child adoption (Scannell, et al., 2018). As this epidemic continues to grow, it is important that healthcare providers and the public are educated regarding this topic. 

Even though the victims of human trafficking can be anyone, of any race, age, or sexual orientation, there are those who are more at risk than others. Scannell, et al. (2018, p. 118), report that the highest risk populations include runaways, homeless youth, indigenous people, those with disabilities, and members of the LGBTQ communities. In addition, those who have a history of sexual abuse, financial instability, domestic violence exposure, and a dysfunctional family environment are at a higher risk of being a victim of sex trafficking (Scannell, et al., 2018, p. 118). 

Physical, financial and psychological abuse are common tactics used by traffickers to control their victims. Physical abuse can lead to “severe and permanent injury” (Scannell, et al., 2018, p. 118). Victims can also end up with unwanted pregnancies and sexually transmitted infections. Psychological trauma can be caused by the traffickers isolating their victims, preventing proper sleep habits, and threatening and humiliating them on a daily basis (Scannell, et all, 2018). The main objective is to use power to maintain submissive behavior from their workers. 

Health care workers, especially nurses, may be one of the first persons to come in contact with a trafficking victim after their capture. It is reported that approximately 87.7% of victims encounter a health care provider while being trafficked (Stevens & Berishaj, 2012). There are key signs and symptoms that should alert all health care providers when obtaining a detailed medical and social history from all patients. Stevens & Berishaj, (2016, p. 52) detail the red flags of human trafficking to include: 

  • The victim not being free to leave or come and go as they please
  • Being paid very little, unpaid, or paid only through tips 
  • Works excessively long or unusual hours
  • Recruited through false promises 
  • Claims of just visiting or unable to give a specific address 
  • Unaware of their location
  • Lack of medical care or is denied medical care from an employer 
  • Malnourished 
  • Physical signs of sexual abuse, physical restraint, confinement or torture 
  • Present to the visit with an older man or woman that will not leave the room, or dominates the appointment for the victim 
  • Avoiding eye contact, fearful, anxious, submissive, nervous, paranoid 
  • Inconsistencies in their story, reason for visit, gaps in medical history 
  • Not in control of his/her money, no records of bank accounts or financial records 
  • Not allowed to speak for themselves 

Gaining information about the social aspects of patients’ lives and being alert to their physical and psychological condition is key to being able to save these victims. It can be hard in a busy emergency room, medical office, or clinic to be able to take the time to ask all of these questions or to interpret their personal relationships, but simply taking a few extra minutes to allow a victim to feel someone cares about them, can make all the difference in saving a life. 


Scannell, M., MacDonald, A. E., Berger, A., and Boyer, N. (2018). Human trafficking: how nurses can make a difference. The Journal of Forensic Nursing. 14(2). 

Stevens, M., and Berishaj, K. (2016). The anatomy of human trafficking: learning about the blues: a healthcare provider’s guide. The Journal of Forensic Nursing. 12(2). 

United Nations Office on Drugs and Crime. (2020). Human Trafficking. Retrieved from