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Health Care Professionals Often Don’t Recognize Victims of Human Trafficking; American Journal of Nursing Report Highlights Indicators to Help Identify Victims

U.S. human trafficking cases estimated at 14,500 to 17,500 annually

​​A report, published in the February issue of the  American Journal of Nursing (AJN), underscores nurse and physicians’ lack of knowledge about the indicators of human trafficking when they encounter a patient who is a victim of trafficking. The report details how clinicians can recognize the signs of a victim of human trafficking and provides guidance on how to intervene to help victims.  AJN, the leading voice of nursing since 1900, is published by  Lippincott Williams & Wilkins, part of  Wolters Kluwer Health.

Human trafficking has been broadly defined as activities involved when one person obtains or holds another person in compelled service. Categories include sex trafficking, labor trafficking (including debt bondage, forced labor, and indentured servitude) and trafficking in child soldiers.

“Although there has been an increase in the number of non-governmental organizations that address trafficking issues and a growing public awareness over the last decade, many people, including health care professionals, remain uninformed about the problem,” said the report’s author Donna Sabella, Assistant Clinical Professor in the College of Nursing and Health Professions at Drexel University, Philadelphia, PA; and director of education for the National Research Consortium on Commercial Sexual Exploitation.

 “As the largest group of health professionals, and therefore the ones most likely to encounter trafficking victims, nurses are in a position to help intervene at several points -- from the initial encounter when we can identify the situation to the victim’s rescue and restoration to health,” said Sabella.

Yet often these opportunities are missed.  According to a study by the Family Violence Prevention Fund, of 21 survivors of human trafficking in the San Francisco, Los Angeles, and Atlanta areas, researchers found that although 28% had come into contact with healthcare providers during their captivity, the providers didn’t realize their patients were being trafficked.

It is estimated that between 600,000 and 800,000 adults and children worldwide are trafficked across international borders and 14,500 to 17,500 people are trafficked into the United States annually. And not all of those trafficked within U.S. borders in this country are foreign nationals; an unknown number of victims are U.S. citizens. Although trafficking victims include people of all ages and both sexes, the majority are women and girls.

How to Recognize a Victim of Trafficking
Nurses and other clinicians who encounter a person who’s being trafficked are not likely to realize this about the patient.  Although no one sign can definitively demonstrate that someone is being trafficked, healthcare professionals should be aware of one or more of the following indicators that should prompt investigation:

  • The person does not speak fluent English and someone else is speaking for him or her.
  • The person appears disoriented.
  • The person doesn’t have any identification or travel documents or someone else is holding the documents.
  • The person has no spending money.
  • The person appears to be under the control and supervision of someone else who never leaves the person alone.
  • There are signs of malnutrition, dehydration, drug use or addiction, poor general health or poor personal hygiene.
  • There are signs of physical abuse or neglect, such as scars, bruises, burns, unusual bald patches, tattoos that raise suspicion (for example, “Property of —” or gang like symbols), or untreated medical problems.
  • The person appears depressed, frightened, anxious, or otherwise distressed.
  • The person’s story about what he or she is doing in this country or on the job does not make sense. 
  • The person lives with an employer or at the place of business and cannot give you an address.
  • Those who brought the person in for treatment are resistant to letting you speak with the person alone.

“Nurses have traditionally received little training in recognizing victims and understanding how to effectively intervene,” said Maureen Shawn Kennedy, MA, RN, editor-in-chief of AJN.  “It’s critical that nurses and other health care providers become knowledgeable in this area, because the time when a trafficking victim presents with a health problem may be one of the only chances that victim will have to get help.”

Human trafficking - also called modern slavery - happens worldwide and is believed to be the fastest growing industry in the world and, after drug dealing, is tied with illegal arms dealing as the second largest criminal industry. Since 2000 when the Trafficking and Violence Protection Act was established into law, public awareness has increased, yet there have been few studies regarding the health issues of trafficking victims.

Read the full report at and listen to a  podcast interview of the author as part of AJN’s Behind the Article series offering insight and additional information related to the report.

If you suspect that someone is a trafficking victim and are unsure how to proceed, call the National Human Trafficking Resource Center hotline: 1-888-3737-888.

About the American Journal of Nursing
The American Journal of Nursing (AJN) is the leading voice of nursing and the most established nursing journal in the world, since 1900 ( It has received numerous awards for editorial excellence and dissemination of information. It is published by Lippincott Williams & Wilkins ( 

  About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.

LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health and pharmacy. Major brands include traditional publishers of medical and drug reference tools, journals, and textbooks, such as Lippincott Williams & Wilkins; and electronic information providers, such as Ovid®, UpToDate®, Medi-Span®, Facts & Comparisons® and ProVation® Medical.