Transcript Slide 1

STOLEN SMILES
Physical and mental health consequences of
women and adolescents
trafficked in Europe
Funding from the European Commission’s Daphne Programme, Sigrid Rausing Trust, International Organization for Migration
How big is the trafficking problem?
Pre-departure
Integration and
reintegration
Travel
and transit
Health
risks and
opportunities
Detention,
deportation,
criminal
evidence
Destination
Migrant women
Exploited
labourers
Trafficked
women
Sex workers
Violence
against
women &
Torture
victims
Recruitment Equation
PUSH & PULL
FACTORS
DECIDING
FACTORS
Vulnerabilities
+
Hopes
Strengths
CREDIBILITY OF
THE OFFER
Timing of the
offer
Quality of the
offer
= ACCEPTS
OFFER
Study of trafficked women accessing
services in seven European countries
Study participants:
• Women & adolescents accessing services in Moldova, Ukraine, United
Kingdom, Italy, Bulgaria, Czech Republic & Belgium.
• Trafficked into forced sex work (92%) domestic labour (4%), and both
(3%).
• Ages 15 to 45 from 14 countries, the majority from Moldova and
Ukraine.
• 38% had children, of whom 82% were single parents.
• 81% exploited for at least one month, 20% over one year.
Three interviews conducted: 207 women interviewed 0-14 days after entry
into care, 170 between 28-56 days, and 63 at 90+ days.
Violence women experienced prior to being
trafficked
80%
60%
50%
60%
32%
40%
22%
15%
20%
0%
Physically
and/or sexually
abused
Physically
abused
Sexually abused Both physically Sexually abused
and sexually
before age 15
abused
Violence women experienced during
trafficking
FORM OF VIOLENCE
Physical violence
Sexual violence
Either physical and sexual violence
Both physical and sexual violence
YES (%)
(n=207)
76%
90%
95%
71%
158
186
196
148
89%
36%
34%
185
75
70
THREATS DURING TRAFFICKING
Woman was threatened
Woman's family was threatened
Woman AND her family were threatened
Identifying a trafficking situation
“How often were you free?”
Always 3%
Occasionally
4%
Often, 2%
No Response,
4%
Seldom, 10%
Never, 77%
Multiple physical health symptoms that
improve with support services
0-14 Days
28-56 Days
6%
7%
57%
43%
90+ Days
93%
0 to 11 symptoms
12 to 23 symptoms
94%
The most common physical health symptoms
reported by women at 0-14 days
81% headaches
63% memory problems
71% dizzy spells
60-70% various sexual
health problems
69% back pain
82% fatigue
How the memory gets disrupted
Fight or flight
response to danger
Peritraumatic
dissociation
Loss of details
Levels of psychological distress are high,
with multiple presenting symptoms
28-56 days
0-14 days
90+ days
52%
71%
19%
29%
48%
0 to 9 symptoms
10 to 17 symptoms
81%
What is a post-traumatic response?
• Severe or prolonged traumatic experiences can result in an
individual being unable to turn-off” their basic biological and
safety alarm mechanisms or cause them to have an “all-ornothing” physical and emotional response to negative stimuli
• Repetitive helplessness of this kind may result in
disorganising the cognitive processes, or disable an
individual’s instinctive ability to respond appropriately.
Post-traumatic stress disorder
Percentage of women reporting symptom levels
suggestive of PTSD
44%
56%
Lower symptoms levels
PTSD symptom levels
Post-traumatic stress disorder symptoms
Changes in post-traumatic stress symptom levels
Percentage of women with scores suggestive
of PTSD
56%
60%
percentage
50%
40%
30%
12%
20%
6%
10%
0%
Interview 1
Interview 2
Women ≥ 2.5
Interview 3
Mental health improvements
2.5
score level
2
Depression
Depression
1.5
Anxiety
Anxiety
Hostility
Hostility
1
0.5
0
0-14
days
Period
1
28-56
Period days
2
90+
days
Period
3
Trafficked women’s mental health compared
to a general female population
100
90
80
70
Depression
Anxiety
Hostility
Norms
60
50
40
30
20
10
0
Period
1
0-14
days
Perioddays
2
28-56
Period
3
90+ days
Reactions are individual
I feel like they’ve taken
my smile and I can
never have it back.
Lithuanian woman trafficked to London
Maybe some people could call
me a “dirty whore”, but for
others I might be the girl who
can give them good advice.
Moldovan woman trafficked to Turkey
WORKING WITH WOMEN
WHO HAVE BEEN TRAFFICKED
Give Control and Establish Trust
1. EXPLAIN AND INFORM
• The purpose for the questions and the process, step by step.
• General subjects that will be discussed and acknowledge difficulty of
some questions.
• Who will and who will NOT have access to the information.
• She may return to difficult questions later.
• If she does not understand something, she should ask for it to be
repeated slowly or explained differently.
Give Control and Establish Trust
2. INQUIRE ABOUT HER
• How are you feeling? Are you currently in any pain or
discomfort?
• Are you hungry or thirsty? Do you want to use the toilet?
• Is there anything that is making you feel unsafe right now, or that
you might be harmed?
• Do you have any questions that you want to ask me?
• Do you have any urgent concerns or fears that you want to tell me
about before I ask you some questions? Are you ready to start?
Give Control and Establish Trust
3. BE ON HER SIDE
Ask questions in a way that shows she is believed and that
you have concern for her:
• What was done to her vs. “what she did”
• Did you feel free to go where you wanted? vs. Did you ever
try to escape?”
• Did anyone hurt you while you were in this country? before
“How did you enter this country?”
• Are you worried for anyone in your family? before “What is
your home address?”
Of benefit to the victim = benefit to the case
Physical
comfort
Comforted,
comfortable
individual
+
Psychological
comfort
+
Time
More thoughtful, more
reliable, accurate
information
About Sexual Violence
A history
of sexual
violence
RISK-TAKING:
sexual
substance
misuse
A Complex Victim Group
Disclosure barriers
• Fear of retaliation by traffickers
• Guilt of her perceived complicity in what occurred
• Guilt over any criminal activities in which she participated
• Shame about what she has done, particularly sexual activities
• Little trust in officials, e.g., police, immigration, health workers
Interpreters
1. Security- DO NOT USE ‘VOLUNTEER’ INTERPRETERS
2. No discrimination - against sex work, migrants, women
3. No neighbours – no one from the same village or town,
or local destination community
4. Gender – may prefer a female or male
5. Warn against any disclosure, with criminal sanctions,
e.g., official secrets, data protection act
CHECK ACCEPTABILITY OF INTERPRETER WITH
THE WOMAN HERSELF
A senior police officer referring to a victim
who refused to cooperate
I feel that she was really too scared, but it was
her decision. Our offer was made in fairly hostile
conditions, during a police interview. This is a
case where a three month “reflection” period
would have been useful.
London Metropolitan police officer
Trafficking legislation and “the recovery and
reflection period”
Council of Europe Convention on Action Against
Trafficking
Article 13 – Recovery and reflection period
1. Each Party shall provide in its internal law a recovery
and reflection period of at least 30 days…Such a period
shall be sufficient for the person concerned to recover
and escape the influence of traffickers and/or to take an
informed decision on cooperating with the competent
authorities.
Recommendations (1)
1. Recognise the serious health consequences of trafficking
2. Pass legislation requiring a full range of health services be
provided to trafficked women, regardless of their legal
status.
3. Establish procedures to require authorities to ensure that
upon contact with a woman suspected of having been
trafficked, her health needs are assessed and urgent
needs are immediately addressed.
Recommendations (2)
4. Legislate a minimum 90 day period of reflection and recovery
during which time women will:
– receive appropriate and adequate support services
– not be required to make decisions about cooperating with
authorities or about returning home
5. Prohibit the detention, removal or deportation of trafficked
women until their health needs have been met and their safety
for return assessed
6. Provide services based on models of good practice used for
survivors of other forms of violence and for minority or refugee
communities.
Recommendations (3)
7. Increase involvement of health sector in trafficking
dialogue and activities.
8. Train relevant health professionals to provide appropriate
physical, sexual, reproductive and mental health care for
trafficked women’s needs
9. Codes of service provision should draw on models of good
practice used for survivors of other forms of violence,
and/or minority communities & refugees.
Guiding principles for conducting ethical and safe
interviews with women who have been trafficked
• Do no harm
• Ensure safety, security and comfort
• Ensure privacy
• Ensure confidentiality
• Provide information
• Request informed consent
• Ask questions in a sensitive and sensible manner by paying attention to the purpose,
sequence and tone of the question
• Listen actively and responsively by not talking, asking questions and providing
clarification, giving the person time to answer, being perceptive and acknowledging what
the person says
• Observe signs indicating the woman needs a break during the procedure
• Consider any preconception and prejudices you may hold
• Believe, do not judge
• Maintain professionalism while treating persons with respect and compassion
• Ensure trafficked persons feel in control of their body and communications
• Reassure trafficked persons they are not to blame
• Inform trafficked persons of their right to a forensic medical exam and report
• Inform the individual of their rights to copies of all health & medical records
• Remind the trafficked person of their strengths
Suggested citation
Zimmerman, C. 2006. Presentation on the health
consequences among women who have been trafficked
and their implications for services and policy. London:
London School of Hygiene & Tropical Medicine.
The full report, Stolen Smiles, is available at:
www.lshtm.ac.uk/genderviolence