Care and Support for Adult Victims of Trafficking in Human Beings: A Review

A Review examining the care and support needs of victims of human trafficking and what works to meet those needs, including a consideration of Scottish provision.

Section 1: Review Of The Evidence In Regards To The Support And Care Needs Of Victims Of Human Trafficking

Measuring the extent of trafficking

The effective provision of services aimed at providing care and support to adult victims of trafficking is dependent on the identification of different forms of trafficking, and some acknowledgement of the extent to which different forms of trafficking occur. However, as the Home Affairs Committee (2009: Para 40) has indicated:

Trafficking is a hidden crime: its victims cannot or dare not make themselves known to the authorities (for fear of retaliation or because they are or think themselves to be illegal immigrants) and some (…) do not even realise that they are victims. They are concealed by physical isolation or language or cultural barriers, and may be operating under false identities.

Internationally, there is an ongoing recognition of the limitations of research on trafficking and the challenges in estimating prevalence (Kangaspunta, 2003; Segrave et al, 2009). An exact global estimation is doubtless impossible, to achieve. Methodologies for data collection are inconsistent between agencies and across regions. Additionally, internal trafficking is often excluded from the statistical data while human smuggling is at times included (UNODC 2006: 120). The result is that anti-trafficking NGOs, as well as the numerous documents from national and international bodies which report estimates of the size and scale of the trafficking problem, are inconsistent. Yet, all agencies working in this area agree that the problem of human trafficking is increasing (see also Home Affairs Committee, 2009).

Identification is necessary for a variety of reasons but crucially as a mechanism for directing victims to services - notably healthcare, support and accommodation and access to legal advice. While not identifying an individual could compromise their safety and access to support, it can also mean that unidentified victims of human trafficking with irregular immigration status may be detained, criminalised and deported without consideration of risks they face, particularly that of re-trafficking (Home Affairs Select Committee, 2009).

Practitioners find that trafficking victims do not always and immediately identify themselves as such; they are often unfamiliar with the terminology and may define their experiences in ways that are not immediately recognizable to untrained officials (Haynes, 2006). Evidence suggests that unless victims fit into stereotypical roles of victimhood as defined by law enforcement officials, they may not be identified as trafficking victims and may be labeled as criminals and further victimized (Haynes 2007; Srikantiah, 2007: Hoyle et al, 2011). The psychological as well as physical coercion involved in the trafficking experience can problematise ‘active agency’ thus obscuring representations of the ‘ideal victim’ (Srikantiah, 2007).

Additionally there are a number of other barriers to achieving an accurate victims story, including; “the private-sphere or nature of the crime, linguistic and social isolation, fear or threat of exposure and shame, threat of reprisals against loved ones, and the special set of circumstances that ensure that immigrant victims in particular ‘remain in the shadows of our communities’” (Haynes 2007: 366). Having established two key concepts within the international definition of human trafficking, movement and exploitation, there are indicators which can help determine if the person was maintained by force, coercion or intimidation, whether the person was tricked into the work or travel, and if they live in fear and under the constant threat of violence and abuse[5].

Although there has been some contention over reported data on the incidence of trafficking in the UK, referrals to the National Referral Mechanism (NRM) between 1 April 2009 and 31 March 2011 indicate that 1481 adults were referred to the NRM of whom 72% were female, highlighting the gendered nature of trafficking in human beings (Equality and Human Rights Commission, 2011: 45). However, it is widely acknowledged that the official figures are significant underestimates, with many trafficking victims never coming to the attention of services or the authorities, and a significant number who are suspected victims of trafficking refusing to be referred to the NRM for reasons such as fear of authorities, and of being detained or deported. The impossibility of obtaining accurate figures is well recognised nevertheless it is generally believed that internationally, women and children are the predominant victims of trafficking in humans (estimated to account for around 80% of reported trafficking victims worldwide). However, while this illustrates the gendered nature of trafficking, it may also be the result of gender bias in identification procedures and practices.

Wider attention has, in the past, been given to trafficking for the purpose of commercial sexual exploitation leading to claims that other forms of trafficking (for forced labour and domestic servitude) are often overlooked (Kelly, 2005; Goodey, 2008; Equality and Human Rights Commission, 2011). Indeed the Home Office (2007: 5) stated: “At the moment we do not have sufficient evidence regarding trafficking for forced labour to enable us to make a full assessment of whether it poses a significant problem for the UK”. Recent attention to trafficking for domestic servitude and forced labour has highlighted the complexities of definitions in this area with the continuum which spans ‘forced labour’ and ‘labour exploitation’ making it difficult to distinguish these practices. It is often NGOs working with victims who have highlighted the issues facing trafficking victims in all categories; existing evidence therefore is drawn from those who have been identified as a victim. Nevertheless, there is increasing evidence of the prevalence of these other forms of trafficking into and within the UK. As Stepnitz (2009:7) notes “Persons trafficked for labour exploitation are deceived, coerced or forced into their situation, in the same way as those trafficked for sexual exploitation”. Law enforcement agencies tend to have substantial expertise in identifying ‘vice’ crimes such as sexual exploitation[6] and indeed police officers are perhaps less likely to recognise other forms of exploitation, notably labour exploitation and domestic servitude. The Secretary of State (2009) noted the need to do more to raise awareness of domestic servitude amongst all front-line police officers.

Research conducted for the Scottish Government (Lebov, 2009) estimated that between April 2007 and March 2008, 79 victims of human trafficking were in contact with agencies in Scotland. In terms of types of exploitation identified, Scottish Government statistics indicate that of adult victims identified as trafficked in 2010: 44 were victims of labour exploitation; 6 were victims of domestic servitude; 27 were victims of sexual exploitation. In 2011 (1 Jan - 30 June), 43 victims of labour exploitation were identified; 2 victims of domestic servitude; and 13 victims of sexual exploitation. This reflects a growing awareness of different forms of exploitation and indicates a predominance in reported incidents of trafficking for the purpose of labour exploitation in Scotland.

International evidence of needs of victims

Victims experiences of being trafficked result in a wide range of significant needs; many of which are characteristic to all trafficking victims, regardless of the type of exploitation for which they were trafficked. Movement is an important factor in trafficking in humans; the removal of a person from a situation where they can ask for help effectively isolates them. This isolation then allows for a more total control to be exerted over the victim. If the person is taken across an international border they are more likely to be further isolated, by language and culture; however border crossing is not a necessary factor in the case of internal human trafficking. Focusing on illegal border crossing can direct attention toward migrants and clouds the existence of internal trafficking which occurs within the boundaries of the nation state[7].

Victims of trafficking of all forms of exploitation may suffer severe physical and psychological consequences likely to result in ongoing traumatisation. This may affect their ability to present as, and be identified as, victims of human trafficking[8]. Existing evidence suggests that it is difficult to make generalisations about the experiences and needs of victims of human trafficking as circumstances can vary significantly (Schloenhardt and Loong, 2011:167).

Clawson and Dutch (2007) in their review for the US Department of Health and Human Services identified the needs of victims of human trafficking as being extensive. Safety needs were viewed as the first priority, with screening for safety needs of victims and service providers as key to every assessment conducted. At the point of crisis intervention, victims (regardless of the form of exploitation experienced) required basic necessities such as emergency accommodation; food and clothing; interpreter services and the facilitation of communication. Short and long term needs consisted of:

  • housing (transitional and permanent)
  • legal assistance
  • health screening (tuberculosis, sexually transmitted diseases, pregnancy) and immunisations
  • treatment for physical injuries
  • dental care
  • child care
  • education
  • life skills training (including operation of basic household appliances, use of public transport) and financial management
  • family reunification or repatriation

Service providers in Clawson and Dutch’s review (2007) reported that all victims of trafficking (regardless of type of exploitation) had mental health needs requiring trauma counselling. Beyond common immediate needs, victims displayed a wide range of needs, that often changed during the course of support provision (Zimmerman and Borland, 2009; Clawson et al 2009).

Williamson, Dutch and Clawson (2008) draw upon a number of international studies to highlight the significant extent of mental health needs among victims of trafficking and the significant levels of post-traumatic stress disorder (PTSD) among this group. Victims are also likely to suffer from “anxiety and mood disorders including panic attacks, obsessive compulsive disorder, generalized anxiety disorder, and major depressive disorder” (2008: 2) and extremely high levels of anxiety and depression symptoms including nervousness or shakiness, recurring attacks of terror and panic, fearfulness, feeling depressed or very sad, and hopelessness about the future. Victims may also be at risk for the development of dissociative disorders (especially those with histories of physical and/or sexual abuse), substance-related disorders (often used to help them deal with their situations, or in some cases after being forced or coerced to use drugs or alcohol by traffickers). Zimmerman et al (2006) highlight the wide-ranging and profound physical and psychological health consequences of trafficking experienced by women and adolescents. Without doubt, victims are at risk of complex and enduring mental health problems in the short and longer term.

Evidence available internationally suggests that victims of all forms of exploitation have very similar needs; however, the extent to which particular needs vary depends on the victims circumstances. International victims may require some form of identification or legal documentation and may need to send money back to their country of origin to support their family. They may also fear for the safety of those family members who may be under threat from traffickers operating in source countries. This may make victims less willing to co-operate with the authorities.

Issues of substance use may be a more prevalent feature for victims of domestic trafficking, however Clawson and Dutch (2007) suggest that international victims may be less likely to disclose substance abuse problems given potential shame or stigma, and fear that this information may be used against them in any legal cases that are ongoing (for example civil, criminal or immigration).

Macy and Johns (2011) reviewed services for adult survivors of trafficking for sexual exploitation and identified similar needs. This included:

  • secure, safe shelter, and housing
  • physical health care
  • mental health care
  • legal and immigration advocacy
  • job and life skills training
  • substance abuse services (Macy and Johns 2011)

Macy and Johns (2011) also identified the importance of a continuum of aftercare services to address changing needs as survivors progress from initial exiting of trafficking situations to longer term recovery and independence. A particularly important finding of Macy and Johns was that specific intervention details are rarely documented, so that it is often unclear exactly what type of intervention is being undertaken.

Evidence of the needs of victims in Scotland

Easton and Matthews (2011) highlight the particular needs of victims trafficked into commercial sexual exploitation in Scotland. They indicated that the women in their study were often vulnerable prior to being trafficked and were subsequently “often subjected to violent sexual acts or encounters motivated by racist and highly sexualised cultural stereotypes” (p10). These experiences led to a range of physical and mental health symptoms following trafficking experiences with high levels of trauma, fear, anxiety and physical and mental health problems which had an impact on their ability to function on a daily basis. This reflects the significance of recognising gendered experiences of trafficking. While similar needs are identified for men and women in general, it would appear that attention is given to the gendered nature of exploitation and the particular needs which may arise (Zimmerman, 2003; Zimmerman et al, 2006; Zimmerman and Borland, 2009).

Evidence of the needs of victims of different forms of exploitation in Scotland (for sexual exploitation, labour exploitation and domestic servitude) was obtained from case studies provided by TARA and Migrant Help. This highlighted the shared needs of all victims for the following key resources:

  • Safe accommodation
  • Medical care (short -longer term)
  • Financial assistance
  • Practical support (including interpreters)
  • Legal advice
  • Support to access a range of services (i.e. support worker/co-ordinator)
  • Trauma counselling/support
  • Longer-term psychological support (particularly in the case of victims of sexual exploitation)

In addition, longer-term needs arise for victims who have debts to pay off in their home country or whose family are in danger from traffickers or their associates.


There is clear consensus within the literature available to indicate the key needs of victims, particularly in the immediate and short-term. While these overarching needs may be similar regardless of the type of victim - adult or child, international or domestic - there is a clear consensus that the extent of the needs varies for each victim depending on their circumstances and at each stage of the rehabilitation process (Clawson and Dutch 2008). Despite this recognition of what is required there is little evaluative research on the long-term needs of trafficking victims (Busch-Armendaiz et al 2011; Macy and Johns 2011).

The needs of victims of trafficking in Scotland are similar to those identified by international studies and are reflected under the EU Convention and Directive, and the current Bill progressing through the House of Lords Human Trafficking (Further Provisions and Support for Victims) Bill [HL] which specifies the requirement to provide ‘assistance and support’ which is set out as including, but not restricted to:

“(a) appropriate and safe accommodation;
(b) material assistance, including assistance for a person with special needs caused by pregnancy, physical or mental health, disability, or being the victim of serious psychological, physical or sexual violence;
(c) medical treatment, including psychological assistance;
(d) counselling;
(e) information, including information on a reflection and recovery period, the possibility of granting international protection and refugee status;
(f) translation and interpretation services;
(g) access to education for child victims and children of victims[9];
(h) legal counselling, either through legal aid or other means;
(i) legal representation, either through legal aid or other means;
(j) assistance in applying for compensation”.

The shared needs of victims, regardless of forms of exploitation experienced, highlights the importance of individualized approaches to identifying and recognizing these needs, as well as the significance of a comprehensive, coordinated response.


Email: Debbie Headrick

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