Rights-Based Clinical Practice with Survivors of Human Trafficking
© Springer International Publishing Switzerland 2015S. Megan BertholdHuman Rights-Based Approaches to Clinical Social WorkSpringerBriefs in Rights-Based Approaches to Social Work10.1007/978-3-319-08560-9_3
3. Rights-Based Clinical Practice with Survivors of Human Trafficking
School of Social Work, University of Connecticut, West Hartford, Connecticut, USA
S. Megan Berthold
Chun Hei,1 a woman in her early twenties from South Korea, was trafficked to the United States. She was locked in a room with other young women in a rundown hotel. Her passport was taken away and she was not allowed to communicate with the outside world. She was not even allowed to call her parents to tell them she had arrived in the United States. She felt stripped of control over basic aspects of her life. Each afternoon, a muscular armed man escorted her to another building where she was forced to have sex with multiple men until the early morning hours. In the early days when she protested, she was beaten or injected with drugs to subdue her. Chun Hei learned that protesting was pointless. She was never given the money she made and was provided with only minimal food and provocative clothing to wear. She was denied access to healthcare and contraceptives and some of the men refused to wear condoms. When her boss discovered that she was pregnant, he forced her to have an abortion despite her protests. Although Chun Hei loathed the idea of having the child of one of her “Johns,” she believed that abortion was a sin. She was forced to resume her sexual “hospitality” services a few days after her abortion. One of Chun Hei’s Johns (“Mike,” a pseudonym) became quite attached to her, eventually helping her to escape from her traffickers and to live with him in another nearby city. Chun Hei felt very dependent on Mike and feared going out on her own as she believed that she might encounter those who had held her who she believed were looking for her. Over time, Chun Hei and Mike began to argue and she felt increasingly controlled and disrespected by Mike. Chun Hei began to injure herself by burning her arm with cigarette butts, cutting her belly with a razor blade, or slamming her head into the wall until she experienced relief. These were strategies she had engaged in off and on, starting as a teen in South Korea, at times when she felt particularly anxious and vulnerable. One night, Chun Hei ended up in the emergency room after Mike called the ambulance when he found her drunk and with a rope tied around her neck. Chun Hei had tried to hang herself after one of her fights with Mike.
Which of Chun Hei’s rights were violated? What human rights mechanisms might provide relevant guidance to a clinical social worker in this case? Does a person have to be transported across international borders like Chun Hei to be considered trafficked? How might you approach your work with Chun Hei from a rights perspective if you were a hospital social worker and met her in the emergency room? What rights-based principles would inform your clinical work with Chun Hei if she chose to engage in therapy with you after leaving the hospital? Given the information you have about Chun Hei, what key clinical issues might be important to address in your early work with her? What else would you want to know to inform your approach?
Chun Hei, a contract slave,2 is one of the millions of persons worldwide who have been exploited and severely traumatized through human trafficking. Human trafficking is a clear human rights violation, one that is illegal everywhere, yet is prosperous and flourishing. At its core, human trafficking is about the abuse of power, exploitation for financial gain, domination, and control. This criminal industry is estimated to make billions in profits each year for traffickers off of the enslavement and suffering of others (Belser, 2005). Fundamentally, human trafficking deprives people of their basic human rights. The impact on the health and well-being of the trafficked individuals, their family, and society is profound.
Clinical social workers may well encounter survivors of domestic or international human trafficking in a number of settings such as child welfare, hospitals, outpatient health or mental health clinics, homeless or domestic violence shelters, and substance abuse programs. These clinicians are often well placed to identify those subjected to trafficking, intervene and support their recovery of rights and well-being. Social workers must be equipped to identify those affected by trafficking and dispelled of common myths. Identifying those subjected to human trafficking, however, is not enough. Survivors have a right to have their voices heard and respected in their process of recovery and in any legal responses.
Adopting a human rights-based approach can enhance the therapeutic quality of clinical social work with survivors and provide an opportunity for countering some of the deleterious effects of their trafficking experiences. This chapter focuses on explicating the important roles that rights-based clinical social workers can and do play in working with survivors of domestic and international human trafficking. The problem of human trafficking is defined and contextual issues and common sequelae are described. Trafficked persons are identified as rights holders and relevant human rights mechanisms and tools are noted. Core principles for the clinical and forensic assessment and treatment of survivors of trafficking are illustrated consonant with a rights-based approach. Examples of macro efforts to address trafficking are introduced and the role of clinical social workers in effectively spanning micro and macro practice with this population is described. Suggested class activities and resources are provided at the end of the chapter.
Definitional and Contextual Issues
Definition of Human Trafficking
The United Nations has defined trafficking in persons as:
Article 5 of this protocol requires that states adopt domestic legislation to criminalize human trafficking, acting as an accomplice or organizing others to engage in trafficking, and attempts to traffic persons.
The recruitment, transportation, transfer, harboring, or receipt of persons, by means of the threat or use of force or other forms of coercion, abduction, fraud, deception, the abuse of power, or of a position of vulnerability or 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, and servitude or the removal of organs (Article 3, para. (a) of the Protocol to Prevent, Suppress and Punish Trafficking in Persons, UN General Assembly, 2000c).
In 2000, the United States passed legislation in keeping with international standards to protect victims of human trafficking. This legislation has been reauthorized several times, including in March 2013 (Trafficking Victims Protection Reauthorization Act, 2013a, P.L. 113–4). Under the Victims of Trafficking and Violence Protection Act of 2000 (P.L. 106–386) (known as the TVPA), “severe forms of trafficking in persons” is defined as:
sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age; or
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 (Sec. 103, 8).
The definition of trafficking does not require that a victim has been physically moved from one place to another. Further, the coercion involved does not have to be overt, physical, or extreme. It may be subtle and psychological in nature (Trafficking Victims Protection Reauthorization Act, 2013b, 18 U.S.C. § 1581).
At its core, in both the US and UN definitions, human trafficking is about violence against others and the use of deceptive and coercive methods in order to exploit and enslave them. Some prefer to use the term slavery over human trafficking as it provides historical context, does not connote crossing international borders, and emphasizes the human suffering involved (Androff, 2010)—names matter. The TVPA and the Palermo Protocol3 use various terms to describe trafficking in persons including slavery, involuntary servitude, forced labor, and debt bondage (USDOS, 2013a). Rights-based social workers should be attentive to and respectful of the terms survivors use to describe themselves and their experiences rather than imposing their own conceptualizations on survivors.
Understanding the Contexts in Which Human Trafficking Occurs
Misconceptions and myths about human trafficking abound. Social workers must educate themselves about the wide range of contexts in which human trafficking may occur. It is vital to understand, for example, that people may be considered trafficking victims regardless of whether they were born into a state of servitude, were transported to the exploitative situation, previously consented to work for a trafficker, or participated in a crime as a direct result of being trafficked (USDOS, 2013a, p. 31). Social workers also need to know that the problem is not confined to sex trafficking (DeStefano, 2007). It is not all international in nature. The International Labour Organization reported in 2012 that the majority of victims were trafficked within the borders of their own country and that at any point in time, 3 out of every 1000 persons worldwide are subjected to forced labor (International Labour Organization, 2012). US citizens were reported to be victims in 41% of the sex trafficking cases and 20% of the labor trafficking cases reported in the United States between 2008 and 2012 (Polaris Project, 2013a). Not all traffickers are members of large organized crime groups. Trafficking does not only affect women and girls. Men, boys, and transgender individuals are also trafficked. At the time of this writing, there is an unprecedented number of unaccompanied minors from Mexico and Central America entering the United States. Some unaccompanied minors have fled from family abuse, gang violence, or other forms of exploitation and, without family or other protection in transit or exile, have been particularly vulnerable to traffickers.
Scope and Form of the Problem Worldwide and in the United States
Human trafficking has a wide transnational reach and, after drug smuggling, is considered the second largest organized criminal industry worldwide (ATEST,2014). Reliable prevalence estimates of human trafficking are challenging or impossible to obtain. The methodologies utilized to estimate this problem have lacked sufficient rigor and the problem itself is inherently hidden given its underground criminal nature (Stransky & Finkelhor, 2008). Recent estimates show that 27 million men, women, and children are subjected to human trafficking worldwide (Bales, 2007; USDOS, 2013a), of whom approximately 21 million have been trafficked into forced labor (International Labor Organization, 2012). Nearly all of these men, women, and children have lacked access to help and have had their rights violated on a daily basis, some for many years. Only an estimated 40,000 were identified as having been trafficked in 2012 (USDOS, 2013a). The United States is known to be a destination, transit, and source country for human trafficking (USDOS, 2013a). In the 5 years from 2008 to 2012, the National Human Trafficking Resource Center (NHTRC) hotline received reports about 9298 cases of human trafficking in the United States (Polaris Project, 2013a).
Trafficking, sometimes called modern-day slavery, takes many forms of which sexual trafficking is perhaps the most publicized. Forcing someone to do labor or provide services through physical and/or psychological violence is also trafficking. The Trafficking in Persons Report 2013, for example, identified human trafficking in many industries including: boys forced to engage in illegal drug production and transportation in Mexico and the UK; debt bondage of entire families in South Asia in rice mills, stone quarries, brick kilns, and in agriculture; males in Africa and South America trafficked in mining, logging, construction, and agriculture; and Burmese and Cambodian boys and men forced to work on fishing boats (USDOS, 2013a). Children who are forced or coerced into being child soldiers and used as combatants, messengers, spies, porters, cooks, guards, and/or servants, or forced to marry or have sex with the soldiers is another example of trafficking (USDOS, 2013a). The top industries where trafficking can be found in the United States are: domestic labor, food service/restaurants, peddling, and traveling sales for labor trafficking; and pimp-controlled prostitution, brothels, and escort/delivery services for sex trafficking (Polaris Project, 2013a).
Common Sequelae of Human Trafficking
Being sold or coerced into forced labor or sexual slavery, with the ensuing loss of dignity and control over even the most basic aspects of one’s life, is traumatic in and of itself. Layer on top of that the abuse and neglect that is common during the time under the control of the traffickers, and it is easy to see that the experience endangers the health and well-being of those who are trafficked. As with other types of human-perpetrated trauma (including torture and intimate partner violence discussed in Chapters 2 and 4 of this book), human trafficking has an impact across multiple domains of the lives of survivors (Hossain, Zimmerman, Abas, Light, & Watts, 2010; Oram, Stöckl, Busza, Howard, & Zimmerman, 2012; Zimmerman et al., 2008). Most of the research has been conducted with girls and women survivors of sex trafficking, so further study is needed to better understand the impact of trafficking on males, transgender survivors, and survivors of other types of trafficking. The specific reactions and manifestations of distress vary from one individual to another and depend, in part, on the nature of the trafficking, the meaning of the experiences for the survivor, as well as the survivor’s intersectional position.
Survivors may struggle cognitively with difficulty concentrating, confusion, and memory disturbance. Common forms of physical distress include insomnia, chest or other pains, fatigue, or nausea. Persistent or recurrent episodes of feeling powerless, helpless, and trapped or without control are common. Most survivors experience, at least for a time, reliving their trafficking experiences in various forms (e.g., through intrusive traumatic memories, flashbacks, and nightmares) and avoidance of things that remind them of the trauma. Survivors may have prominent feelings of numbness, dissociative episodes, strong feelings of shame or worthlessness, or other forms of psychological distress. Many survivors grapple with hopelessness, suicidal ideation, and suicidal and self-injurious behavior. They may experience existential and/or spiritual distress such as questioning or loss of their faith or existential despair. Relational challenges are common, such as strained or conflictual interpersonal relationships, the breakdown of trust in others, and clinging or withdrawing behavior. Trafficking survivors have high rates of post-traumatic stress disorder (PTSD) and depression, substance abuse problems, dissociative symptoms, somatic complaints, and panic attacks. While less common, some experience psychotic symptoms. Social workers should understand that symptoms of distress may appear to be of a psychotic nature but may be more accurately understood as a posttraumatic response (Briere & Scott, 2012). Sometimes, notable changes in personality may occur. Child victims have had portions of their childhoods stolen and, having been trafficked at important developmental stages, may well experience disruption of healthy developmental trajectories.
Trafficked persons also commonly experience physical health problems. These may include chronic pain or broken bones, concussions, burns, or other injuries as a result of beatings or other physical abuse. They may experience malnutrition due to neglect and insufficient or non-nutritious food. They are often overworked and become chronically exhausted. Their traffickers typically deprive them of access to routine or urgent medical care. Those who are trafficked for sex are placed at risk for contracting various sexually transmitted diseases, developing reproductive health problems, and being killed.
Trafficking takes a toll on the family system as well. In some cases, the family does not know what happened to the person. The person may be separated from family members for years or a lifetime. The trafficked person may live in fear of the traffickers themselves. Many traffickers threaten to harm (or kill) the targets or their loved ones if they do not cooperate. A person who is trafficked may blame him or herself for putting family members at risk, even if those family members were abusive to him or her. They may think, for example, that had he or she not run away, this never would have happened. Some survivors fear being shunned by the community or disowned if their loved ones find out that they were forced into prostitution or another form of sex trafficking. This happens in some societies. Instances of honor killing for those who have been trafficked for sex have also been reported (AlZoubi, 2011). In other cases, an immediate or extended family member sold the person into trafficking. The contextual possibilities are many, with a complex array of effects that may develop for trafficked persons.
Trafficking As a Human Rights Problem and Relevant Human Rights Mechanisms/Tools
Trafficked Persons as Rights Holders
Joy Ngozi Ezeilo, the UN Special Rapporteur on Trafficking in Persons (2011), has made it clear that trafficked persons are rights holders who are entitled to effective remedies for the rights violations they have endured. Instead, they are often perceived and treated as instruments to assist in criminal investigations and prosecutions (Craggs and Martins 2010 as cited in UN Special Rapporteur on Trafficking in Persons (2011), para. 52). Ezeilo indicates that survivors of trafficking rarely receive compensation. “At worst, many trafficked persons are wrongly identified as irregular migrants, detained and deported before they have an opportunity to even consider seeking remedies” (UN Special Rapporteur on Trafficking in Persons, 2011, para. 61).
The remedies received by trafficked persons are often not holistic in nature but ad hoc and aimed to further the goals of the criminal investigation (e.g., temporary residence permits and recovery assistance conditional on the survivor cooperating with law enforcement). Linking the provision of services to the willingness or capability of survivors to cooperate with law enforcement goes against fundamental human rights principles related to trafficking (Office of the High Commissioner for Human Rights, 2010).
Ezeilo recommends that States should make improvements to the system of identification of trafficked persons, provide enhanced access to information and free legal and interpretation services, and provide temporary or permanent residence permits when the survivor is not able to return to his/her country of origin safely “or a return would not otherwise be in the best interests of the trafficked person for reasons related to his or her personal circumstances, such as the loss of citizenship or cultural and social identity in the country of origin” (UN Special Rapporteur on Trafficking in Persons, 2011, para. 76). The special rapporteur also advised States to consider the asylum claims of trafficked persons when there is risk of retaliation or reprisal from the traffickers. Additionally, the special rapporteur recommended unconditional medical, psychological, social, and legal services required to recover (UN Special Rapporteur on Trafficking in Persons, 2011, para. 66). These recommended services, however, appear to be limited to the first 90 days after the individual is identified as a victim of trafficking. Given the nature of the experience of trafficking and its serious impact (discussed later in this chapter), 90 days is often insufficient for recovery to take place. Rights-based social workers should advocate for more comprehensive and longer-term services. It is notable that the special rapporteur also stressed that many States disproportionately provide services to adult women from foreign countries that are trafficked for sex, rather than to survivors of internal/domestic or other forms of trafficking. Social workers should advocate for ensuring that everyone’s rights are respected and services are provided equitably.
Relevant Human Rights Documents
The United Nations and other international, regional, and sub-regional organizations have various mechanisms in place to combat human trafficking, a good summary of which can be found in the Trafficking in Persons Report 2014 (USDOS, 2014, pp. 428–429). This report, updated annually, also includes a listing of countries which are signatories and which have also ratified various anti-trafficking protocols. Key United Nations’ Protocols relevant to human trafficking include:
The Optional Protocols to the Convention on the Rights of the Child on: (1) the Sale of Children, Child Prostitution, and Child Pornography (UN General Assembly, 2000a)4; and (2) the Involvement of Children in Armed Conflicts (UN General Assembly, 2000b);
Articles 34 and 35 of the Convention on the Rights of the Child (CRC) (UN General Assembly, 1989);
Article 4 of the Universal Declaration of Human Rights (UN General Assembly, 1948);
Article 8 of the International Covenant on Civil and Political Rights (UN General Assembly, 1966a);
The 2000 United Nations Protocol to Prevent, Suppress, and Punish Trafficking in Persons, Especially Women and Children (“Palermo Protocol,” supplementing the UN Convention against Transnational Organized Crime) (UN General Assembly, 2000c);
Article 7 of the International Covenant on Economic, Social and Cultural Rights (UN General Assembly, 1966b); and
Article 6 of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) (UN General Assembly 1979).
Clinical Interventions, Application of Core Principles of a Rights-Based Approach, and Roles in Legal Cases
There are many valuable roles that social workers operating from a rights-based approach can play in clinical work with survivors of human trafficking. Currently, there are a number of psychosocial services that are offered to survivors or those at risk of being trafficked. These services typically are focused on the rehabilitation or protection of survivors or on prevention of trafficking and often are run by non-governmental organizations (NGOs) (ILO, 2009; Van Hook, Gjermeri, & Haxhiymeri, 2006). Survivors may cooperate with police and other authorities, such as when survivors in the United States provide information to federal and local authorities to assist in the apprehension of the perpetrator(s) and testimony if the case is brought to trial. Survivors may benefit from psychological preparation and support during these legal processes (USDOS, 2014) and from addressing the impact of their trafficking experiences in therapy with a clinical social worker.
Core Principles of a Rights-Based Approach Applied
How can a clinical social worker providing therapy or other clinical interventions to survivors of trafficking operate from a rights-base? Clinical social workers working with this population should be steeped in cultural humility and trauma-informed approaches, and should be person-centered (as described in Chapter 1 of this book). Rights-based practitioners seek to gain a deep understanding of the survivor’s experience and ensure that his or her freedom and agency are not further taken away. The words of one survivor make this point eloquently:
My definition of freedom is deeper than most. For so long my freedom was nonexistent. My every move was watched, my every conversation was observed. My clothing and food portions and options were at the mercy of another. Living in fear and terror, I had no ability to make or understand decisions and my physical self seemed to belong to everyone but me. —Withelma “T” Ortiz Walker Pettigrew, Human Trafficking Survivor, Advocate, and Activist, 2012 (USDOS, 2013a, p. 46)