How to Recognize Human Trafficking as a Nurse

Think human trafficking isn’t an issue where you live? This is not the case. In 2021, the National Human Trafficking Hotline received a total of 51,073 substantive phone calls, texts, emails, Webchats, or online tip reports of suspected human trafficking incidents nationwide. Human trafficking was reported in every state in the United States and its territories… EVERY one of them. 

Not only is human trafficking occurring all around us, it is a growing problem. It is estimated that anywhere from 14,500 to 17,500 victims are trafficked in the United States every year. The Department of State labels the United States as a source, transit and destination country for human trafficking, and the number of signals received by the National Human Trafficking Hotline has more than doubled over the last decade. As nurses and healthcare professionals, you can make a difference in identifying and rescuing these victims if you know what to look for. 

Types of human trafficking

Human trafficking is defined as the use of force or coercion which compels someone to work against their will. It includes involuntary servitude, sex trafficking of minors, and forced labor. 

Human traffickers underpin their victims and control them through economic abuse, threats, intimidation, emotional abuse, isolation, physical and sexual abuse, corruption, and other means. 

It’s important to know that while sex trafficking is a prominent form of human trafficking, it is not the only form. Within United States borders, sex trafficking is the most prevalent form of human trafficking while labor trafficking is the most prevalent in many other parts of the world.  

Signs that should raise suspicion of a potential trafficking victim

There are some general signs that should begin to raise your suspicions that an individual may be a victim of human trafficking. While these things do not definitively mean that the individual is a victim, they should cause you to think twice and begin asking additional questions. 

The individual you are treating: 

• Appears to have no (or suspicious looking) legal documentation
• May not be using their real name or changes personal details as you are speaking
• Has limited understanding of time and space
• Is vague about or has no next of kin details 
• Claims to be “visiting” an area but cannot offer times and dates of arrival or addresses and phone numbers of other people
• Appears to move locations frequently
• Has poor eye contact and closed-off body language
• Appears withdrawn, submissive and afraid to speak to you as a professional
• Has a neglected appearance which can result from abuse or loss of self-esteem
• May have old or untreated injuries with poor history concerning those injuries
• Displays paranoia, anxiety, fear, depression, submission, tension, or general nervousness when speaking
• Has numerous inconsistencies in his/her story
• Is vague about their address or where they live
• Is accompanied by a person who speaks for them and controls the information offered

As you continue working to understand how to recognize human trafficking as a nurse, note that it is not always a female victim with a male trafficker. There are many female traffickers and even other kids who are recruited to help as traffickers.

What to look for when treating an individual

There are various signs that will become apparent when treating a victim of human trafficking. These signs can include general health indications and sexual exploitation indications. Any of these signs could raise a red flag that abuse may be occurring at some level and encourage you to begin to take action steps. 

General Health Indications

• Malnourishment or overall poor health
• Multiple unexplained bruises, burns, cuts and/or broken bones
• Broken teeth or dental pain
• Multiple scars or evidence of prolonged infection that could have been easily treated
• Sexually Transmitted Diseases (especially in minors) 
• Late booking maternity, signs of recent birth, or post natal signs 
• Possible self-harming
• Addiction to drugs and/or alcohol
• No knowledge of last medical check up
• Lack of health insurance or registration in government services

Sex Exploitation Indications 

• Underage sexual exploitation or prostitution (under age 18 - internationally defined as trafficking) 
• Suspicion the individual is younger than they claim
• Physical evidence of sexual trauma
• Untreated STIs
• Multiple or frequent pregnancies 
• Inappropriate interest in or relationship with older men
• Large amount of sexual partners inappropriate for age
• Evidence of controlling relationship with partner or another person
• Inappropriate attire for the time of day or season
• Unexplained tattoos on neck or lower back (or other types of branding) 
• Outlook on situation and health issues inappropriately downplayed
• Lack of engagement with services due to fear of negative outcomes

What should you do if you suspect human trafficking? 

First and foremost, never place yourself or the individual you are treating in danger. Be as sensitive and understanding of the individual's experiences (both claimed and real) as possible. Try to record as many details and as much information as you can without endangering yourself or the patient. Contact your supervising nurse and follow all hospital or health institution policies. 

Legal requirements for reporting differ from state to state. Not all situations require mandatory reporting, and it’s important to be aware of how HIPAA regulations impact reporting and confidentiality. 

Take a victim-centered approach. Nurses must take a victim-centered approach to reporting suspected human trafficking incidents. Not all victims are comfortable speaking about their situation or ready to seek help. You must be careful not to put the victim, those close to them, or yourself in danger. 

Studies have shown that up to 88% of known human trafficking victims came into contact with the healthcare system at some point while being trafficked so it is imperative that you learn how to recognize human trafficking as a nurse. 

If you or someone you know may have information about a trafficking situation, please seek help. You can call the National Human Trafficking Hotline at 1-888-373-7888 or text 233733, 24 hours a day, 7 days a week. And if you or someone you know is in immediate danger, call 911.

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