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ISTSS made a statement on human trafficking, which was presented March 11 at a session of the United Nations Commission on the Status of Women. It was in recognition of the fact that this contemporary form of slavery represents “a public health crisis in which millions of lives are devastated by trauma” (Aronson & Braak, 2003). In fact, the trauma of human trafficking may best be understood in the context of human rights and social policy.

Human trafficking is defined as the international transportation of persons for the purpose of exploitation (United Nations, 2000b). Such exploitation may be in the form of prostitution, pornography or other sexual exploitation; forced labor, servitude or debt bondage (in sweatshops, in homes or on farms); or the removal and sale of organs.

The United Nations (2000a) estimates that 4 million people are trafficked each year; at least 27 million people are enslaved worldwide (American Anti-Slavery Group, 2001). Trafficking destinations most often consist of the industrialized nations of Western Europe, North America, Australia, Asia and the Middle East.

According to the USAID Office of Women and Development, the largest number of trafficked women and girls comes from Southeast Asia, with more than 225,000 trafficked per year (Nezer, 2000). At least 150,000 are trafficked from South Asia; 100,000 each from Latin America and the former Soviet Union; 75,000 from Eastern Europe; and 50,000 from Africa.

The societal vulnerability factors that make people more susceptible to trafficking include poverty; war/violations of human rights (which may produce internally displaced persons and refugees); and a lack of opportunities for legal migration (e.g., due to restrictive immigration policies). Societal attitudes toward women and children, as well as ethnic minorities, also may contribute to the vulnerability of these populations.

In recent years, organized crime syndicates internationally have made more than $7 billion per year from human trafficking (USAID Office of Women in Development, in Dutton, Kilpatrick, Friedman, & Patel, in press). Trafficking networks include recruiters, sellers, buyers, transporters, front organizations (such as marriage and travel agencies), corrupt government officials and pimps or slaveholders (Global Survival Network, 1997).

Potential victims of trafficking may be lured by advertisements for promising jobs in foreign countries as housekeepers, waitresses, dancers or models. They may be offered a future as mail-order brides. They may be tricked by smugglers, who force them into debt bondage. They may be coerced by trusted or familiar individuals in their town or village. They may be sold into slavery by desperate family members. Or they may be abducted from street or home.

Traffickers typically use rape and other forms of violence to control their victims. Therefore, it is not surprising that studies of victimized women have found rates of posttraumatic stress disorder at 67 percent or higher (Farley, Baral, Kiremire, & Sezgin, 1998) and rates of depression as high as 84 percent (Ramirez Rodriguez, in Raymond et al., 2002).

The nature and severity of human trafficking pose certain unique challenges for researcher and clinician alike; issues of fear and safety are particularly relevant. The overwhelming intimidation and violence exercised by trafficking organizations may strongly limit the willingness of survivors to seek safety, to participate in treatment and to cooperate fully in the prosecution of traffickers. Survivors often fear for the safety of family members back home.

Furthermore, law enforcement and state officials tend to blame the victim. Survivors frequently are jailed as prostitutes or as illegal aliens. They may be deported to the same locations where the trafficking cartels operate. When trafficked women return to their villages, they may be HIV positive; they may be shunned for having lost their feminine “purity” and may face the threat of “honor killings” (Balk, 2003).

The complex problem of human trafficking requires intervention that is interdisciplinary, international and multilevel in its focus. In other words, it necessitates effective integration of research, assessment, treatment, outreach/collaboration, criminal justice, advocacy and education. Professionals must intervene at the levels of individual, relationship, family, community, society/country and world. In this context, the distinction between the clinical and the political seems less salient; prevention and healing become inseparable.

A growing number of organizations are offering treatment programs to help rehabilitate trafficking survivors, from Maiti Nepal in Kathmandu to the Victims of Violence Program near Boston (see Boston Coalition Against Trafficking & Slavery, 2003). Such organizations are likely to practice advocacy and education along with treatment; Maiti Nepal offers survivors legal representation.

Increasingly, national governments and international entities, such as Interpol, the United Nations and the International Organization for Migration, are working to apprehend traffickers, and also to assist trafficking survivors. They are supported in their efforts by international law; human trafficking is prohibited by the Convention on the Elimination of All Forms of Discrimination Against Women, the UN Convention on the Rights of the Child and the UN Convention on the Suppression of the Traffic in Persons. A protocol to the UN Convention on Transnational Organized Crime established mechanisms for combating trafficking syndicates (Boston Coalition Against Trafficking & Slavery, 2003).

As trauma clinicians, researchers and treatment centers respond to the problem of human trafficking, the field of trauma will increasingly focus on human rights as a fundamental public health issue.

To receive a copy of the ISTSS statement on human trafficking, contact Joyce Braak at jbraak@valstar.net.

American Anti-Slavery Group (2001). Available: http://www.iAbolish.com.

Aronson, E. R., & Braak, J. E. (2003). International Society for Traumatic Stress Studies: Statement on Trafficking in Women and Girls, United Nations Commission on the Status of Women, 47th Session.

Balk, M. (2003). Art as Witness: Shattered Lives–Unshattered Dreams. Available: http://www.iAbolish.com/act/abol/profile/balk.htm.

Boston Coalition Against Trafficking & Slavery (2003). http://bcats.virtualactivism.net.

Dutton, M.A., Kilpatrick, D.G., Friedman, M., & Patel, V. (in press). Violence Against Women. In B.L. Green, M.J. Friedman, J. de Jong, S.D. Solomon, T.M. Keane, J.A. Fairbank, B. Donelan, & E. Frey-Wouters (Eds.), Trauma in War and Peace: Prevention, Practice and Policy. New York: Kluwer Academic/Plenum.

Farley, M., Baral, I., Kiremire, M., & Sezgin, U. (1998). Prostitution in Five Countries: Violence and Post-Traumatic Stress Disorder. Feminism and Psychology, 8(4), 405–426.

Global Survival Network (1997). Crime & Servitude: An Exposé of the Traffic in Women for Prostitution from the Newly Independent States. Available: http://www.witness.org/store.htm.

Nezer, M. (2000). Trafficking in Women and Children: “A Contemporary Manifestation of Slavery.” Refugee Reports, 21, 1–10. Available:http://www.refugees.org.

Raymond, J.G., D’Cunha, J., Ruhaini Dzuhayatin, S., Hynes, H.P., Ramirez Rodriguez, Z., & Santos, A. (2002). A Comparative Study of Women Trafficked in the Migration process: Patterns, Profiles and Health Consequences of Sexual Exploitation in Five Countries (Indonesia, the Philippines, Thailand, Venezuela and the United States). http://action.web.ca/home/catw/readingroom.shtml?cat_name=Reports.

United Nations (2000a). Report of the Special Rapporteur on Violence Against Women, submitted to the 56th session of the UN Commission on Human Rights, E/CN.4/2000/68, para. 72. Available: http://www.un.org.

United Nations (2000b). United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, Supplementing the United Nations Convention Against Transnational Organized Crime. Available: http://www.un.org.

Eric R. Aronson is northeast refugee coordinator for Amnesty International USA and is chair (with Dolores Sarno-Kristofits) of the ISTSS Human Rights and Social Policy SIG. He can be reached at ericraronson@hotmail.com. The author would like to thank Melanie Nezer for her valuable contributions.