Position Statement

Human Trafficking

The intent of this position statement is to heighten awareness, encourage education among Registered Professional Nurses and all healthcare providers regarding human trafficking; and to enhance nursing’s ability to advocate for public safety.

Definitions

Human Trafficking: “The recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal of organs” (United Nations, Protocol to prevent, suppress and punish trafficking in persons, 2000).

Severe forms of trafficking in persons include a) 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 (b) the recruitment, harboring, transportation, 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.(United States Department of State, Victims of trafficking and violence protection act of 2000, public law, Section 103, Definitions (8), 2000)

Victim shall mean (a) a person who suffers personal physical injury as a direct result of a crime; (b) a person who is the victim of either the crime of (1) unlawful imprisonment in the first degree as defined in New York State (NYS) penal law, (2) kidnapping in the second degree…, (3) kidnapping in the first degree…, (4) labor trafficking, (5) sex trafficking; or a person who has had a frivolous lawsuit filed against them. (New York State Human trafficking law, 2007, article 10-D, Services for victims of human trafficking, Section 12, 2007).

Position

It is the position of the New York State Nurses Association that:

• Nurses are at the forefront of increasing public awareness of the issue of human trafficking to increase identification of victims and exposing traffickers.
• Nurses are proactive in advancing education and providing standards for the potential signs and symptoms of human trafficking.
• Nurses are proactive in addressing the concerns of any individual who claims to be a victim of human trafficking.
• Nurses are proactive in assessing and advocating for those individuals who exhibit signs and symptoms of human trafficking.
• Patients/families and significant others are entitled to education regarding human trafficking including but not limited to the availability of information pamphlets, and contact numbers to report suspected cases.
• Patients/families and significant others are entitled to the formation of policy and procedure, by multidisciplinary practice groups, which address the facilities role in advocating for victims of human trafficking.
• Nursing supports legislation that will fund programs that enhance protections and support services for healthcare professionals who may be victims of exploitation.
• Nursing supports legislation that will fund ongoing education of government officials in anti-trafficking techniques and methods.
• Nursing supports ongoing research that will better monitor trends and patterns of trafficking so that there can be a clearer understanding of the nature and magnitude of the problem, so that the appropriate policy responses can be developed and implemented.
  

Background

Recognition of Crime

Global impact

Human trafficking, also known as ‘modern day slavery”, continues to be prevalent throughout the world despite global initiatives. This crime impacts over 800,000 innocent victims annually, is grossly underreported, and leads to a magnitude of social and public health problems. As a violation of human rights to life, liberty and freedom, human trafficking victims, who are predominantly women and children, are subject to various forms of abuse and maltreatment. Compounded by language barriers and cultural differences, victims of trafficking are fearful to expose their perpetrators and are often vulnerable to life-long health and social problems.

Since 1994, the United States Department of State has monitored the impact of human trafficking nationally and internationally. It was realized that trafficking was growing as an international concern and action to combat trafficking of persons was indicated.

In 2000, “Congress passed the Victims of Trafficking and Violence Protection Act of 2000 (the "Act"), P.L. 106-386. The Act requires that by June 1 the Secretary of State submit a report to Congress with respect to the status of severe forms of trafficking in persons…. The Act enhances pre-existing criminal penalties, affords new protections to trafficking victims, and makes available certain benefits and services to victims of severe forms of trafficking; establishes a Cabinet-level federal interagency task force to investigate and prosecute trafficking, and establishes a federal pilot program to provide services to trafficking victims. The U.S. government recognizes the need to sustain and further enhance our efforts in order to achieve the goals and objectives of the Act.” (United States Department of State, Trafficking in Persons Report (TIP), Introduction, 2001)

The staggering dimension of trafficking realized by governmental and non-governmental organizations, lead to cooperation and coordination efforts from local to international groups to enhance the global ability of combating trafficking. “The UN Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, which supplements the UN Convention against Transnational Organized Crime adopted by the UN General Assembly in November 2000, is an important new tool to facilitate international cooperation. Governments that sign and ratify this protocol make a commitment to criminalize trafficking and to protect its many victims. The United States and 80 other countries signed the Protocol in December 2000.

Two other international instruments that address sale and trafficking in children have also recently been adopted; International Labor Organization (ILO) Convention 182 concerning the Prohibition and Immediate Action for the Elimination of the Worst Forms of Child Labour (which the United States ratified in December 1999), and the Protocol to the Convention on the Rights of the Child on Sale of Children, Child Prostitution and Child Pornography (which the United States signed in July 2000).” (United States Department of State, Trafficking in Persons Report, Steps Towards Solutions, 2001)

For a yearly updated TIP report go to http://www.state.gov/g/tip/rls/tiprpt/index.htm.

Domestic Impact

Human trafficking, often associated with transnational prostitution and/or undocumented immigration, is occurring in what otherwise may appear as legitimate employment. The conceptualization of a victim of trafficking remains largely perceived by the public in the United States, as seeing the individual as a criminal or as being foreign-born. This misconception demonstrates the continued need for increased awareness and extensive reeducation efforts at many levels. In addition, individuals may have been lawfully recruited for service within the United States by an employment agency, however exploitation occurs when an unscrupulous employer changes the conditions of employment after arrival, confiscates or holds legal travel documents, or provides unsuitable living arrangements for the victims. Nurses, who are at the forefront of public health, may be aware of situations in which trafficking is occurring; caring for patients who are victims of exploitation, or may have colleagues who are trapped in compelled service after voluntarily taking a job.

Federal Law

In October of 2000, the United States responded to this plight through the enactment of the Trafficking Victims Protection Act (TVPA). (United States Department of State, Victims of trafficking and violence protection act of 2000, Public Law 106-386, October 28, 2000, pp. 1-3). This law recognized all dimensions of human trafficking as Federal crimes. The original and subsequent reauthorizations of this Act in 2003 and 2005 have defined human trafficking, established annual reports and task forces to research, investigate, and prosecute the crime, along with addressing violence against women and children. The TVPA sought to strengthen law enforcement initiatives, education and training to combat violence against women, increase access to health care services and provide for initiatives to limit the effects of trafficking.

As a result of an increase in terrorism activities around the world since 2000, the United States sought to enhance efforts to enforce operations and laws, as well as other responses to combat and reduce facilitation of human trafficking. These efforts lead to Section 7202 of the Intelligence Reform and Terrorism Prevention Act of 2004. For more detail on this act go to: http://www.state.gov/m/ds/hstcenter/41449.htm.

The act established the Human Smuggling and Trafficking Center which serves as a focal point for agency activity, a clearinghouse for information relevant to terrorist travel and facilitation of trafficking activities, and to ensure cooperation among all relevant agencies to combat facilitation of trafficking. (United States Department of State, Bureau of Diplomatic Security, Human Smuggling and Trafficking, Section 7202)

In December 2008, the Human Smuggling and Trafficking Center released a report reinforcing the domestic incidence of human trafficking. (United States Department of State, Human Smuggling and Trafficking Center, Domestic Human Trafficking- An Internal Issue, 2008, pp. 1-2).

The report reviews the misconceptions than trafficking only involves foreign individual, and provides suggestions for increase awareness and education for law enforcement and the public sector. The authors of the report delineate the language of the law in that:

The TVPA provides a sentence of fifteen (15) years to life if force, fraud, or coercion is used to cause a victim to engage in a commercial sex act or the victim is under the age of 14. If the victim is aged 14 to 17 and no force, fraud, or coercion is used, the sentence is no less than 10 years to life. In addition to criminal sanctions which prohibit sex trafficking, the TVPA also includes a civil remedy allowing trafficking victims to sue their traffickers in federal district court. (p. 4)

State Law

Over thirty states have now passed laws that criminalize trafficking. In 2007, New York State (NYS) passed an amendment to modify several areas of law that further defines trafficking; toughens penalties; established access to services for victims; and directs the establishment of an interagency task force. In August 2008, the NYS Interagency Task Force on Human Trafficking released its first year report which discussed the progress in NYS and its recommendations for improving responses to trafficking. (NYS Division of Criminal Justice Services, 2009)The report revealed:

• Thirty six victims, of whom 27 were women, ranging in age from 16 to 52;
• Thirty came from disparate locations; however 6 were United State citizens;
• Nineteen of these victims were trafficked for prostitution;
• Seventeen of the victims were trafficked for labor;
• The locations for the trafficking included hotels, restaurants, massage parlors, and on a farm;
• 5 cases representing twenty eight of the victims were in upstate NY, while the remaining six cases (representing eight victims) were from downstate.

The advance of prosecution in trafficking cases in NYS was also demonstrated.

The report documents its involvement with key organizations such as ( although not inclusive) the Department of Labor; Division of State Police; Department of Health; Crime Victims Board; and the Office of Alcoholism and Substance Abuse Services. A program that attends to the needs of victims of trafficking on a regional level, the Response to Human Trafficking Program (RHTP), was established when it was discovered that many services at the federal, state and local level were not available to individuals with no immigrant status, as well as facilitating assistance referrals to local departments of social services for U. S citizens, eligible alien, and child trafficking victims.

With the implementation of the law in NYS services and assistance to victims of trafficking were also established. To review the current report regarding the process and services available in NYS go to: http://criminaljustice.state.ny.us/pio/humantrafficking/human_trafficking_rpt_aug08.pdf.

Costs

As the movement towards global expansion and investment reached its peak, the need for cheap labor became recognized as an additional source of revenue. There is no particular face that can be given to a trafficker or victim of trafficking because of the magnitude of dehumanizing factors that contribute to the supply and demand that fuels the crime. Human and healthcare costs associated with trafficking are immeasurable. According to the 2008 Trafficking in Persons report (TIP):

• Human trafficking has a devastating impact on individual victims, who often suffer physical and emotional abuse, rape, threats against self and family, and even death. But the impact of human trafficking goes beyond individual victims; it undermines the health, safety and security of all nations’ it touches (United States Department of State, TIP Report, 2008)

Although traffickers are difficult to distinguish as perpetrators of the crime, individuals who are vulnerable are mostly women and children. Statistics in the trafficking report reveals that 80 percent of the victims were women and girls, with 50 percent being minors. The statistics are only assumptions of the actual numbers as the crime is difficult to expose. Researchers have found that reluctance of the victim to reveal the crime is due to multiple factors including language barriers, violence against families or themselves, as well as acceptance of trafficking as a norm. Moynihan (2006) reviews other effects of trafficking that include:

The breakdown of the family and loss of support networks (friends, school, etc.) increases vulnerability, contributes to isolation, and lessens the opportunity for rescue or escape…public health implications include the victims subject to pelvic inflammatory disease, tuberculosis, and HIV/AIDS (p. 100).

She states that “assessing and identifying human trafficking cases is essential to rescuing victims from a life of desperation and brutality…As healthcare providers we have a responsibility to provide comprehensive, holistic, and culturally-sensitive care in a safe setting”(Moynihan, 2006, p. 101)

Awareness

Whether at a global or local level the importance of developing awareness of the signs and symptoms, as well as the dangers of trafficking is paramount for prevention, and further elimination of the crime. The ability to understand the levels of assistance and protection that is available for victims, the means to prevent further occurrences of the crime and the ability to provide the correct information to illicit the investigation and prosecution of traffickers must being with those individuals most apt to encounter the crime, such as healthcare providers. Denise L. Spear (2004) examines the need for healthcare providers who are involved with areas of women’s health. Her article offers examples of trafficking, resources and assessment guidelines for recognition and intervention strategies. She suggests that “awareness must include the understanding of the possibility or probability of identifying cases within [our] own communities. A plan of care should be developed in each clinic or institution to assist providers in providing care for these victims” (p. 314).

Nursing Responsibility

Nursing is at the forefront of public health which aligns the profession with the ethical and moral responsibility for promoting awareness and further prevention of trafficking. The Code of Ethics has mandated nursing to practice with compassion, and respect for all patients regardless of their social, economic or personal attributes; to commit and advocate for all patients, regardless of the setting; acceptance of accountability and maintaining competency; continuation of personal and professional growth; improvement of the healthcare environment; advancement of the profession and personal growth; collaboration with other healthcare professionals to promote the efforts to meet the health needs of all; and maintenance of the integrity of the profession. (American Nurses Association, Code of Ethics, 2002)

Achieving this level of involvement requires recognition of both nursing’s accomplishments and recommendations for ongoing achievements. Educational efforts at multiple levels of the profession beginning with entry level programs must be directed at increasing awareness among colleagues; advocating for the continuation of research in trafficking impact from the local to global levels; disseminating the information regarding recognition cues and flags that can help identify a victim, and advocating for the application of these standards throughout the healthcare environment. The Federal and State laws advocate for the reporting of a reasonably potential victim of trafficking.

Access to reporting at the National level includes the National Human Trafficking Resource Center (NHTRC).The NHTRC is a national, toll free hotline that operates 24 hours a day seven days a week, 365 days a year. The NHTRC can be reached by calling 1-888-3737-888 or emailing NHTRC@PolarisProject.org

The NHTRC works to improve:

The national response to protect victims of human trafficking in the United States by providing callers with a range of comprehensive services, including crisis intervention, urgent and non-urgent referrals, tip reporting, and comprehensive anti-trafficking resources and technical assistance (U.S. Department of Health and Human Services, 2009, Campaign to Rescue and Restore Victims of Human Trafficking, About Human trafficking, Assistance for victims of human trafficking, Section 3).

For more information on the Campaign to Rescue and Restore Victims of Human Trafficking, go to: http://www.acf.hhs.gov/trafficking/

Reporting in NYS

To report a suspected victim or potential situation of human trafficking follow the policy and procedure for your facility; or call your local police or district attorney office if you are not at your place of employment.

Recommendations

In order for RNs to enhance their provision of safe, quality care to the public where the anonymity of victims of human trafficking may inhibit adequate recognition and ultimate recovery and removal of these individuals from their involuntary situation, the New York State Nurses Association recommends:

• RNs advocating for policy and procedure in areas of probable contact within their practice setting, that establish standards of recognition for potential victims of human trafficking;
• RNs promoting and collaborating on educational and awareness opportunities for the public, and their colleagues on human trafficking;
• RNs advocating for collaboration with internal and external agencies to help identify victims and expose traffickers.

The Nurses Association reinforces the RNs responsibility to uphold the ethical standards that are inherent in our practice. The Code of Ethics for Nurses (2002) call for the RN to collaborate with other’s to promote public health and influence the environment in which we practice. Ensuring through standards of care that the well being and safety of the public as well as our colleagues is fostered allows nurses to fulfill their ethical obligations.

The RN has the responsibility to:

• Advocate for patients, families and significant others who may be inadvertently involved with traffickers;
• Advocate for the rights of the patient to receive adequate healthcare free of coercion from the trafficker;
• Advocate for the recovery and release of the trafficking victim through the available resources;
• Active participation in state and national initiatives that research, disseminate and demonstrate standards and codes that impact governments who do little or nothing to prevent and prohibit trafficking;
• Know the available resources or where to find such resources in the event of reasonable suspicion of a victim of trafficking;
• Document the subjective and objective assessment of the potential victim according to policy to ensure adequate information in collection of evidence;
• Seek continued education and competency in areas of forensic nursing and certification in areas of violence towards women, such as Sexual Assault Nurses Examination.

In addition to the nurse’s responsibilities, the employer is obliged to promote and establish conditions of employment that provides nurses with the ability to practice within acceptable standards and guidelines assuring quality care to the public.

The employer has the responsibility to:

• Utilize existing multidisciplinary policy groups to examine, establish or review current language in policy and procedures related to identification guidelines, methods for referral, access to resources, and management of information of a potential victim of trafficking to ensure the safety of the healthcare worker, and of the patient;
• Encourage collaborative efforts with local agencies and resources to ensure proper methods for reporting suspicion of a victim, which ensure complete transfer of information and safety measures for the healthcare worker and the victim;
• Provide adequate access to information regarding trafficking to healthcare workers, and the public;
• Support and promote ongoing research opportunities that focus on the development of standards for nursing’s impact on trafficking;

Note: the term “patient” anywhere in this document is intended to be generic and refers to the receipt of nursing care.

Approved by the Board of Directors on January 13, 2010.

References

American Nurses Association (2002) Code of ethics for nurses with interpretive statements.
Washington, D. C.: American Nurses Publishing.

Moynihan, B. A. (2006). The high cost of human trafficking. Journal of Forensic Nursing, 2(2),
100-101.

New York State Division of Criminal Justice Services (2008). Human trafficking: Report of the
interagency task force on human trafficking. Retrieved February 15, 2009 from
http://criminaljustice.state.ny.us/pio/humantrafficking/humantrafficking.htm

New York State Public Health Law (2007). Penal Law Chapter 74: Human trafficking.
Retrieved February 15, 2009 from http://public.leginfo.state.ny.us

Spear, D. L. (2004) Human trafficking: A health care perspective. Association of Women’s
Health, Obstetrics and Neonatal Nurse Lifelines, Health Care Advocate, 8(4), 314-321.

United Nations (2000). Protocol to prevent, suppress and punish trafficking in persons. Retrieved
February 15, 2009 from http://www.unodc.org/unodc/en/human-trafficking/index.html

United States Department of State, Office of the Undersecretary for Global Affairs (2001)
Trafficking in persons report (2001). Retrieved February 15, 2009 from
http://www.state.gov/g/tip/rls/tiprpt/2001/index.htm

United States Department of State, Office of the Undersecretary for Global Affairs (2008)
Trafficking in persons report (2008). Retrieved February 15, 2009 from
http://www.state.gov/g/tip/rls/tiprpt/2008/index.htm

United States Department of State, Office of the Undersecretary for Global Affairs (2009).
Trafficking victim’s protection reauthorization act of 2005. Retrieved February 15, 2009 from
http://www.state.gov/g/tip/laws/index.htm

United States Department of State, Office of the Undersecretary for Management Bureau of
Diplomatic Security (2009). Human Smuggling and Trafficking Center. Retrieved February
15, 2009 from http://www.state.gov/m/ds/hstcenter/index.htm

United States Department of Health and Human Services, Administration for Children &
Families (2009). The campaign to rescue & restore victims of human trafficking: About
human trafficking. Retrieved June 29, 2009 from http://www.acf.hhs.gov/trafficking/about/index.html

Appendix A

Resources

http://www.humantrafficking.org/updates/649 - A web resource implemented by the Academy for Educational Development (AED). The site was developed as part of an initiative from the Asian Regional Initiative Against Trafficking (2000) to promote cooperation and partnership among governments, and develop network opportunities to combat human trafficking. This site was supported by the United States Department of State between 2001 and 2008.

http://www.stophumantraffickingny.org/about/- A web site devoted to Coalition information in regards to building and maintaining strong New York State law to “hold traffickers accountable and help the victims rebuild their lives”.

http://www.acf.hhs.gov/trafficking/campaign_kits/index.html - This resource guide contains the following tools developed to provide background information and guidance for health care practitioners in identifying and communicating with victims of human trafficking. Other tools from this website include:

• Tips for Identifying and Helping Trafficking Victims
  Health care providers in community clinics and emergency rooms may encounter victims of human trafficking without realizing it, therefore losing the chance to help these victims escape from their bondage. This tool provides tips and guidelines for identifying and assisting trafficking victims.
  
  
• Screening Questions to Assess Whether a Person Is a Trafficking Victim
  This tool contains the types of screening questions health care providers should consider when trying to determine if someone is a trafficking victim.
  
  
• Understanding the Mindset of a Human Trafficking Victim
  By understanding a trafficking victim’s mindset – molded by coercion, violence and fear at the hands of the trafficker – health care practitioners can help gain a victim’s trust so they can provide optimal care and initiate important support services to help the victim rebuild her/his life.
  
  
• Communicating with Victims of Human Trafficking
  This tool offers health care providers suggested messages for communicating with victims of human trafficking. Because most victims are afraid and initially hesitant to cooperate, often fearing for their lives, these messages provide strategic word choice and usage geared to establish trust between the provider and the victim.
  
  
• Health Problems Seen in Trafficking Victims
  Trafficking victims may suffer from a host of medical problems – both physical and psychological – that are often neglected until they reach critical stages. This tool outlines problems to lookout for.
  
  
• PowerPoint Presentation for Health Care Providers
  This PowerPoint presentation can be used as an information tool or training resource for health care providers to gain a better understanding of their role in helping to identify and assist victims of human trafficking.

http://www.state.gov/m/ds/hstcenter/index.htm -Section 7202 of the Intelligence Reform and Terrorism Prevention Act of 2004 established the Human Smuggling and Trafficking Center. The Center will achieve greater integration and overall effectiveness in the U.S. Government's enforcement and other response efforts, and work with other governments to address the separate but related issues of alien smuggling, trafficking in persons, and criminal support of clandestine terrorist travel. Migrant smuggling, clandestine terrorist travel and trafficking in persons are transnational issues that threaten national security. The Center provides a mechanism to bring together federal agency representatives from the policy, law enforcement, intelligence, and diplomatic areas to work together on a full time basis to achieve increased effectiveness, and to convert intelligence into effective law enforcement and other action.

For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.

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