Human trafficking and exploitation: guidance for health workers

Advice how to recognise and help victims of human trafficking and exploitation.

What is human trafficking and exploitation?

The Human Trafficking and Exploitation (Scotland) Act 2015 defines human trafficking as an action carried out for the purposes of exploitation, or with the knowledge of likely exploitation, of another person. A relevant action can include:

  • Recruiting another person
  • Transporting or transferring another person
  • Harbouring or receiving another person
  • Exchanging control over, or transferring control over another person
  • Arranging or facilitating (without necessarily doing) any of the actions above

Travel between two places is not a requirement for an offence to have taken place and coercion does not always have to be present. It is irrelevant if the victim has consented to any of the actions. Traffickers may target those in a position of vulnerability, exploiting a victim's personal, social, or economic circumstances, wherein they feel they have no option but to accept the traffickers' demands[3].

The Human Trafficking and Exploitation (Scotland) Act 2015 defines four types of exploitation:

  • Slavery, servitude and forced or compulsory labour
    This may include working excessively long hours in poor conditions in private homes doing housework, cooking and childcare; in commercial areas such as construction, agriculture, horticulture, marine farming, textiles, catering, nail bars, care homes, and car washes. It may also include forced involvement in illicit activities such as cannabis cultivation and pirate DVD selling
  • Prostitution or sexual exploitation
    This can include deceptive recruitment for prostitution or other forms of sexual exploitation such as pornography and lap dancing
  • Removal of organs
    This includes a person being encouraged or required to do anything related to the removal of organs or human tissue
  • Securing services and benefits
    This can include any person being coerced to provide services or benefits, or to enable someone else to acquire benefits. It may take the form of forced begging, benefit fraud, and forced marriage

These examples do not provide an exhaustive list and it should be noted that all crimes can be committed against women, men, children, UK citizens and non-UK citizens. People may be trafficked and experience multiple forms of exploitation, for example working in nail bars, in prostitution and also acquiring benefits.

Often trafficked people have taken what is falsely presented as a chance of a better life via a job or educational opportunity and subsequently find themselves in situations akin to slavery. People are trafficked both across and within the borders of a state.


There are important differences between smuggling and human trafficking. Smuggling is usually the illegal movement of people across a border for a fee. The relationship with the smuggler ends at the point of destination and the smuggled person is free. In trafficking, the relationship is an ongoing one of exploitation and commodification from which the trafficker continues to profit.

There are also cases where people who set out to be smuggled become victims of trafficking during their journey and are vulnerable to exploitation on arrival at their destination. Women are at increased risk of sexual violence during this process.

How common is it?

Precise data is unavailable given the hidden and criminal nature of human trafficking and its complexity. We are aware, however, that there are more people enslaved across the world now than at any other point in history. The International Labour Organisation (ILO) estimated that on any given day in 2016 there were 40 million people worldwide who were victims of modern slavery[4].

In relation to the UK, figures published by the Home Office in 2014 estimated there were between 10,000 and 13,000 potential victims of modern slavery[5]. The National Crime Agency believes this has increased and that potential victims number in the tens of thousands in the UK[6].

Information on potential victims of trafficking come from referrals to the National Referral Mechanism (NRM) which is the UK-wide framework for identifying victims and providing support.

In 2018, there were 6,993 people referred to the NRM in the UK with victims from 130 nationalities. Of these, 228 victims were referred from Scotland, comprising just over 3% of all referrals. The majority (61%) of victims in Scotland were male – 108 men and 31 boys. Of the females identified, there were 67 women and 22 girls. Most males were trafficked for labour exploitation and most females for sexual exploitation[7].

Vietnamese, Chinese, Sudanese and Nigerian were the most commonly reported nationalities of potential victims referred from Scotland. This contrasts with the figures in England which identified UK citizens as the single largest nationality of victims in 2018 – underscoring the importance of remaining vigilant to intra-country trafficking and exploitation – with Albania and Vietnam recorded as the second and third largest.

NB The NRM statistics only include individuals who have been identified and (for adults) consented to be referred to the NRM. They do not reflect those who decline to enter the NRM, and of course those who remain undetected.

Trafficking is not confined to the major cities in Scotland. Victims have been identified in all of Scotland's 32 local authority areas.

How do traffickers maintain control?

The system of control exercised by traffickers is maintained through intimidation, threats and violence. Although some victims are held in a state of captivity, others have some freedom of movement because of the psychological hold exerted by the traffickers. Some are subjected to horrific levels of violence and abuse, and experience multiple forms of coercion. Relationships between traffickers and victims may reflect the coercive controlling behaviours seen in domestic abuse cases resulting in trauma-coerced bonding[8]. In these cases, physical indicators of abuse may not be visible and victims may have a distorted view of their situation and the nature of their relationship with the trafficker. The most commonly deployed methods used to control trafficked persons are:

  • Threats against them of beatings, sexual violence, and death
  • Threats of violence against their families in their country of origin
  • Threats to inform families of involvement in prostitution
  • Removal of documentation – passports, ID, immigration papers
  • Debt bondage – people are indebted for huge sums of money which they can't repay. Often they have been charged fees for 'arranging' their work which is subject to huge interest rates. Deductions are often made from their wages
  • Ritual Oaths – ritual oath ceremonies are used to 'bind' victims to their traffickers and are usually cruel, painful and degrading. Victims are told that harm will come to them if the oath is broken
  • Drugs and alcohol – traffickers may create a dependency
  • Curtailment of personal freedom and movement
  • Lack of understanding of where they are – they may be moved around the country
  • Fear of authorities – they may mistrust state agencies, and be told that they will be badly treated if they approach the authorities or arrested for breaking the law
  • Keeping them isolated; exploiting their lack of language or awareness of their rights
  • Threats of deportation by reporting their irregular immigration status
  • Many individuals do not recognise that they are a victim of human trafficking

Male and female victims of trafficking can experience different types of coercion. Female victims are more likely to be subjected to sexual violence and have passports or other documents withheld, whereas men are more likely to be subjected to threats against their family, denial of food and sleep, and threats of legal action. Due to the sexual exploitation of predominantly women and girls, they are also more likely to be threatened regarding their involvement in prostitution or pornography with photographs used to advertise services also used for blackmail purposes.



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