The Health Risks and Consequences of Trafficking in Women and Adolescents Findings from a European Study including: Human Rights Analysis of Health and Trafficking and Principles for Promoting the Health Rights of Trafficked Women London School of La Strada Foundation University Global Alliance London Metropolitan Hygiene & Tropical Ukraine Against of Padua, Against University, Trafficking in Department Trafficking in Child and Women Medicine Women (STV) of Sociology Women Abuse Studies Unit The health risks and consequences of trafficking in women and adolescents findings from a european study Research conducted by Cathy Zimmerman, Katherine Yun, and Charlotte Watts (London School of Hygiene & Tropical Medicine, United Kingdom), Inna Shvab (La Strada, Ukraine), Luca Trappolin, Mariangela Treppete, and Franca Bimbi (University of Padua, Department of Sociology, Italy), Sae-tang Jiraporn (Global Alliance Against Trafficking in Women, Thailand), Ledia Beci (International Catholic Migration Committee, Albania), Marcia Albrecht (Foundation Against Trafficking in Women (STV), the Netherlands), and Julie Bindel and Linda Regan (London Metropolitan University, United Kingdom). Research supervised by Charlotte Watts. Report written by Cathy Zimmerman. The chapter “Human rights analysis of health and trafficking” was written by Brad Adams. Report edited by Charlotte Watts, Brad Adams, and Erin Nelson. Report citation: Zimmerman, C., Yun, K., Shvab, I., Watts, C., Trappolin, L., Treppete, M., Bimbi, F., Adams, B., Jiraporn, S., Beci, L., Albrecht, M., Bindel, J., and Regan, L. (2003). The health risks and consequences of trafficking in women and adolescents. Findings from a European study. London: London School of Hygiene & Tropical Medicine (LSHTM). Report design and layout: Becky Shand. This study was funded with support from the European Commission’s Daphne Programme. Acknowledgements First and foremost, the researchers for this study would like extend our enormous gratitude to the courageous women who spoke with us about their experiences. We recognise the energy it took to discuss such private tragedies and personal emotions. We hope the effort they put into sharing this information will result in better assistance for them, and for other women in need of support and assistance. In addition, we would like to thank the tireless individuals and organisations assisting trafficked persons who took their highly-demanded time to meet with us and provide invaluable information about their services, and the women in their care. We encourage them to continue the much-needed, strenuous, and extremely generous work. We would also like the thank all of the other very busy individuals who agreed to speak with us, and offer their insights based on their years of experience and expertise in the areas of physical and mental health, social support, law, and policy-making. For the information these individuals provided, we are most grateful, and hope that this report adequately conveys their words and reflections. We would also like to offer special thanks to the following individuals who gave generously of their time, and provided their thoughtful insight: Elaine Pearson, Marina Tzvetkova, Bruno Moens, Irene Elliot, Jo Nurse, and Claudia Garcia Moreno. © London School of Hygiene & Tropical Medicine 2003 The London School of Hygiene & Tropical Medicine, the Daphne Programme of the European Commission, La Strada, Ukraine, Foundation Against Trafficking in Women (STV), University of Padua, Department of Sociology, Global Alliance Against Trafficking in Women, International Catholic Migration Committee, Albania, the London Metropolitan University, Child and Women Abuse Studies Unit and any other organisations involved in this study; do not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. London School of Hygiene & Tropical Medicine Keppel Street London WC1E 7HT United Kingdom Tel: +44 (0)207 927 2431 Website: www.lshtm.ac.uk The health risks and consequences of trafficking in women and adolescents. findings from a european study. Table of contents Trafficked women defining trafficking 1 Summary of findings and general recommendations 3 Terms and definitions 11 Aims and methodology 13 Conceptual frameworks 21 1. Pre-departure stage 29 1.1 Personal history 29 1.2 Home country health services and health promotion 32 1.3 Epidemiological and socio-economic conditions of a woman’s home country 34 2. Travel and transit stage 37 2.1 Anxiety and the “initial trauma” 37 2.2 Transport conditions 38 2.3 Buying and selling women 40 2.4 Violence and sexual abuse 41 3. Destination stage 45 3.1 Physical health 45 3.2 Sexual and reproductive health 47 3.3 Mental health 51 3.4 Substance abuse and misuse 55 3.5 Social well-being 56 3.6 Economic related well-being 59 3.7 Legal security 61 3.8 Occupational and environmental health 62 3.9 Health service uptake and delivery 63 4. Detention, deportation, and criminal evidence stage 71 4.1. How authorities come into contact with women 71 4.2. Officials’ awareness of risks and abuse 72 4.3 Officials’ reported procedures related to health 72 4.4 Detention conditions 74 4.5 Deportation procedures 75 4.6 Assisted voluntary return 76 4.7 Cooperating in a prosecution 76 4.8 Trial and testimony 79 4.9 Asylum and leave to temporary residency 80 5. Integration and reintergration stage 83 5.1 Refuge and return 83 5.2 General health 83 5.3 Access to services 84 5.4 Overview of the process: meeting women’s needs 87 5.5 Support for support workers 99 Table of contents 6. Human rights analysis of health and trafficking 103 6.1 The UN Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children 103 6.2 The International Covenant on Economic, Social and Cultural Rights and the right to health 105 6.3 The European Social Charter 107 6.4 The rights of migrants 107 7. Principles for promoting the health rights of trafficked women 109 8. Conclusion: politics and the health of trafficked women 111 9. Recommendations 113 10. References 121 Appendix 1 Research partners contact information 131 The health risks and consequences of trafficking in women and adolescents. findings from a european study. Trafficked Women Defining Trafficking What comes to your mind when you hear the term “trafficking in women?” Oh-oh-oh! Terrible, serious problem. I think about pain, loneliness. It is very painful, for “ me, to think about this. I know what it means, it had just happened to me. I was being sold as though I was cattle. I was being captured and stripped of all my dignity and self- control. Disgust and hate for all those people. It is a nightmare, I'd never have thought that so many girls get in such situations. Something horrible, the most terrible experience a woman could face. It upsets me. It is a nightmare. I'd never have thought that so many girls get in such situation. It reminds me of my life and that of my colleagues. It's like slavery. It hurts because I live through it myself. I've been trafficked. I feel bad. It's disgusting. I feel bad for the girls, and the pimps are disgusting the way they treat them. Very bad. Terrible, serious problem. Because there is unemployment. I think about the girls working as prostitutes as I did. I want to help them, but I don't know what to do. Anyway, I am a woman. I feel sorry for the girls and sorry that I cannot help them. I remember my story. Police are combating it, but not very successfully. I don't like this term. I want to put in jail all the people who are guilty in trafficking. I'd like to kill them. Too many people deal in trafficking of people. 1 ” The health risks and consequences of trafficking in women and adolescents. findings from a european study. Summary of findings and Pre-departure stage general recommendations Women’s health status and knowledge about health prior to leaving home affects their health throughout a trafficking experience. Overview of study ! There are a number of common factors that make This report represents the findings of a two-year multi- women vulnerable to trafficking and exploitation. country study on women’s health and trafficking to the Factors influencing trafficked women’s decision to European Union. It is an initial inquiry into an area migrate included poverty, single parenthood, a about which little research has previously been history of interpersonal violence, and coming from conducted. Interviews were conducted by researchers in a disrupted household. Albania, Italy, the Netherlands, Thailand, and the United Kingdom with women who had been trafficked, health ! Women who were trafficked often had limited care and other service providers, NGOs working against information and many misconceptions about key trafficking, law enforcement officials, and policy- aspects of their own health – for example, only one makers. of 23 trafficked women interviewed during the study felt well-informed about sexually transmitted Summary findings infections or HIV before leaving home. This lack of knowledge has implications for women’s later health Conceptualising health and trafficking and health seeking behaviour. ! The health risks, consequences, and barriers to Travel and transit stage services for trafficked women are similar to those experienced by other marginalised groups, During the travel and transit stage of the trafficking including: process women were faced with the risk of arrest, illness, injury, and death from dangerous modes of 1. migrant women; transport, high-risk border crossings, and violence. 2. women experiencing sexual abuse, domestic violence, or torture; ! Before starting work in a destination setting, nearly 3. women sex workers; and half of the 23 trafficked women interviewed had 4. exploited women labourers. been confined, raped, or beaten during the journey.