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Sex Trafficking of Women and Girls in Eight Metropolitan Areas Around the World Case Studies Viewed Through a Public Health Lens

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Sex Trafficking of Women and Girls in Eight Metropolitan Areas Around the World Case Studies Viewed Through a Public Health Lens Sex Trafficking of Women and Girls in Eight Metropolitan Areas around the World Case Studies Viewed through a Public Health Lens This report was written by, in alphabetical order: Roy Ahn, Elaine Alpert, Thomas Burke, Elizabeth Cafferty, Judith Palmer Castor, Wendy Macias-Konstantopoulos, Anita McGahan, Nadya Wolferstan and Timothy Williams for the Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital. January 2010 Copyright ©Massachusetts General Hospital Division of Global Health and Human Rights Department of Emergency Medicine Massachusetts General Hospital 125 Nashua St. Suite 910 Boston, Ma 02114 Tel: 617 643 4294 Website: http://www.massgeneral.org emergencymedicineglobalhealth/ Acknowledgements This report is produced by the Human Trafficking Initiative (formerly Initiative to End Slav- ery at the time of study), which is based in the Division of Global Health & Human Rights, of the Massachusetts General Hospital. All views expressed in this report are those of the authors alone. This research was made possible with the support of Humanity United. Graphics and cover illustration designed by Hao Dinh. Suggested Report Citation: Ahn R, Alpert E, Burke T, Cafferty E, Palmer Castor J, Macias-Konstantopoulos W, et al. Sex Trafficking of Women and Girls in Eight Metropolitan Areas around the World: Case Studies Viewed through a Public Health Lens. Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital. Boston, MA: Massachusetts General Hospital, 2010. Sex Trafficking of Women and Girls in Eight Metropolitan Areas around the World Case Studies Viewed through a Public Health Lens Division of Global Health and Human Rights Department of Emergency Medicine January 2010 TABLE OF CONTENTS Prologue ........................................................................................................................................ 2 Chapter 1 –Introduction ............................................................................................................. 4 Chapter 2 – Study Design ......................................................................................................... 11 Chapter 3 – Sex Trafficking of Women and Girls in New York City .............................. 23 Chapter 4 – Sex Trafficking of Women and Girls in Los Angeles ................................... 40 Chapter 5 – Sex Trafficking of Women and Girls in London ........................................... 58 Chapter 6 – Sex Trafficking of Women and Girls in Manila............................................. 79 Chapter 7 – Sex Trafficking of Women and Girls in Mumbai .......................................... 98 Chapter 8 – Sex Trafficking of Women and Girls in Kolkata ......................................... 119 Chapter 9 – Sex Trafficking of Women and Girls in Rio de Janeiro ...............................142 Chapter 10 – Sex Trafficking of Women and Girls in Salvador ..................................... 166 Chapter 11 – Conclusions ....................................................................................................... 188 Appendix A – Case Study Interview Protocol .................................................................... 201 Bibliography ............................................................................................................................. 203 1 PROLOGUE This report was written by, in alphabetical order: Roy Ahn, Elaine Alpert, Thomas Burke, Elizabeth Cafferty, Judith Palmer Castor, Wendy Macias-Konstantopoulos, Anita McGahan, Nadya Wolferstan and Timothy Williams for the Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital. The report's graphics and cover illustration were designed by Division staff member, Hao Dinh. The mission of the Division is to care for the world’s most vulnerable by developing and facilitating health-care delivery, research, education and capacity- building initiatives. The principal investigator of this project was Thomas Burke, Chief of the Division of Global Health and Human Rights, Department of Emergency Medicine. Acknowledgements This report is produced by the Human Trafficking Initiative (formerly Initiative to End Slavery at time of study), which is based in the Division of Global Health & Human Rights, of the Massachusetts General Hospital. All views expressed in this report are those of the authors alone. This research was supported by Humanity United. First and foremost, we would like to thank Horacio Trujillo and Lori Bishop of Humanity United for their guidance, patience, and collaboration throughout the project. We are also indebted to our academic department at Massachusetts General Hospital, the Department of Emergency Medicine, and its Chief, Dr. Alasdair Conn, Associate Chief, Dr. David Brown, Senior Vice President Ann Prestipino, and Emergency Services Executive Director Julia Sinclair, for supporting this work. We also wish to thank the legion of people who helped with research and editorial assistance throughout the study: Elena Pellicer, Chelsea Harris, Sreemoti Mukerjee-Roy, Elizabeth Nowak, Christina Martin, Julie Barenholtz, Grace Chiou, Genevieve Purcell, Chinedu Ukaegbu, Omowunmi Omoniwa, Sylvia Lichauco, Roshni Daver and Emily Altman. We also thank Lydia Mann-Bondat, Hannah Chapel, Diana Swett and Amelia Levitan for early work in conceptualizing the research proposal. In Brazil, we thank Peter Lenny, Kenna Silva, Jorge Cardoso and Derrick Phillips for their assistance with translation and logistics. We would like to thank Dr. Michele Decker of Johns Hopkins University and Dr. Jay Silverman of Harvard University, for their assistance in helping us to frame and design the study, and for helping us better understand the landscape of public health and sex trafficking. Also, thank you to Dr. David C. Henderson, of Massachusetts General Hospital and the Harvard Program in Refugee Trauma, for guidance on mental health issues associated with human trafficking. Furthermore, we acknowledge Dr. Mary Simmerling of Weill Cornell Medical College for insights on the study. Finally, we thank 2 the Carr Center for Human Rights Policy, especially trafficking program administrator Christina Bain, for convening a work group on trafficking where scholars and practitioners can meet and openly discuss issues in the field. The study respondents in each city were vital to our research project, and we thank them for sharing their stories with us and for caring for victims/survivors of sex trafficking. 3 CHAPTER 1: INTRODUCTION Study Goals This report presents the principal findings from eight case studies of sex trafficking of women and girls in metropolitan areas of five countries. New York City and Los Angeles, United States London, England Manila, Philippines Mumbai and Kolkata, India Rio de Janeiro and Salvador, Brazil Our research team conducted these case studies between October 2008 and October 2009. Collectively, these case studies were designed to: (a) examine the issue of sex trafficking through an integrative, public-health lens; (b) identify current, local health-system responses to sex trafficking; and (c) determine the potential role of local health systems* in addressing sex trafficking, alone and alongside other anti-trafficking stakeholders, in affected communities. Rationale The sex trafficking of women and girls† is a significant global health concern, because of the scope of the practice worldwide as well as the severe health consequences associated with sex trafficking. The 2009 U.S. Trafficking in Persons (TIPS) report cites UNICEF data that “as many as two million children are subjected to prostitution in the global commercial sex trade.”1 The 2005 TIPS report estimated that eight out of ten trafficked persons were women and girls, with the “majority” in the sex trade.2 A report of the UN Global Initiative to Fight Human Trafficking (UN GIFT) cites International Labor Organization estimates of nearly 2.5 million trafficking victims worldwide, with nearly half of these victims in “commercial sexual exploitation.”3 The accurate tabulation of the scope of global sex trafficking is difficult; the lack of consensus on the prevalence of these practices is a major concern for the field. Hence, estimates of these practices have varied significantly.4, 5 However, as indicated by the TIPS report and the UN GIFT * In this project, we defined “local health system” as the collection of health-focused institutions in a given community, including, but not limited to: hospitals, clinics or health centers, public health departments/ministries of health, health professional schools, and medical societies. † We recognize that the trafficking of men and boys is also a significant societal problem—the TIPS report1 cites ILO and UNICEF statistics that state that men and boys comprise “two percent” of the sex trade. However, the focus of this project was women and girls. 4 Report, sex trafficking, by any estimate, is a major, global social problem – one that affects many women and children worldwide. Definition of Sex Trafficking Studying sex trafficking is challenging for a compendium of reasons, but the lack of consensus on a definition of sex trafficking is a significant challenge for researchers. At the core, people generally agree that the trafficking of human beings to sexually exploit them is a harmful activity—some even note that it violates one’s basic human rights. Beyond that,
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