A few reflections on health care for victims of trauma on the 6th EU Anti-trafficking Day…

The EU has recently published its new anti-trafficking strategy (2012-2016) built on and around the directive 2011/36/EU. While it impresses with its comprehensive approach, rather little is said about the steps to improve health care access and provision for (potential) victims and nothing is said about the care for the carers. In this article we offer some reflections concerning this taken for granted area as a food for thought on the 6th EU Anti-trafficking Day.

Following the establishment of National Referral Mechanisms (NRMs) in nearly all EU countries, current and newly identified victims, and those in need of long term care (whether staying in their current destination or going home), receive social and security support. Yet, they also need quality health care access, referral and specialised treatment, especially mental health care, all of which are lacking an evidence base. The 2009 CoE Convention on Action Against THB, the 2000 Palermo Protocol and the NRMs also stress the health authorities’ role in the support system as an NRM is a cooperative framework through which state actors, together with civil society, protect and promote the victims’ human rights, ensuring in particular that they are referred to comprehensive services.

However, NRM is multi-purpose – simultaneously a framework, a welfare structure and a process – giving rise to complexity that brings difficulties to development and enforcement. Furthermore, efforts to address trafficking are hindered by poor understanding of the problem, especially around victims’ health needs, even though health care professionals can play a critical role in both captivity and recovery. All this requires urgently an evidence-based intervention among EU health authorities to strengthen NRMs and trans-national cooperation.

Such an intervention should aim at enhancing the response of health authorities in the EU based on the following principles:

• Survivors’ access to comprehensive, sustained, gender, age and culturally appropriate healthcare aiming overall physical, mental and social well-being (BDPHTHB, 2003).
• The cultural context at all stages of migration is taken into account to ‘provide appropriate services at destination (and origin) points, taking into consideration specific occupational hazards, language barriers, and ability to access health and social care facilities’ (Busza, Castle and Diarra, 2004).
• Medical assistance that is tailored to the individual victim’s needs (UNODC, 2008). The health complications range from severe psychological trauma to effects of working under hazardous conditions, injuries from violence, sexually-transmitted infections, HIV and AIDS, various adverse reproductive health outcomes, and substance misuse (Beyrer and Stachowiak, 2003; Zimmerman et al., 2003; Zimmerman et al., 2006; IOM, 2006; Zimmerman and Borland, 2009).
• The expanded immigration options to improve victims’ protection and to provide better evidence for prosecution (see Heynes, 2004) require paying special attention to their long-term needs, particularly to the mental trauma.

There are a range of questions that need answers: What actually are the health needs stemming from the survivors’ experiences? What are the needed health care, organisational and systemic arrangements at EU policy level and within individual EU countries to address these needs whilst building the practitioners’ resilience to dysfunctional defences and vicarious traumatisation? How can the learning from the answers to these questions be applied in everyday practice to support survivors of trafficking in the EU by a whole range of services responding to their needs and, in particular, by health practitioners?

EU anti-trafficking policies are mainly enforced through formal and informal national and transnational referral mechanisms. They require that health authorities participate yet the majority are unprepared. They need to go a long way to incorporate recent legal and policy tools as well as international conventions. This takes place in the context of austerity re-structuring across the EU. The child protection systems, also of relevance, are not well linked with health authorities and their practices are still in development even in advanced states. Not least, THB data is flawed and difficult to improve as the phenomenon’s dimensions are mainly hidden. All this is further exacerbated by psychological and organisational dysfunctional defenses mobilised in response to painful and challenging work.

The issue is kept high in the political domain in the UK and the NHS agenda but in our experience the systemic transformation needed should be based on a coordinated effort at EU level as the phenomenon itself is trans-national. Contemporaneously, there is a body of existing tools waiting to be updated, upgraded and put in practice. In the meanwhile, there are very few projects funded in this key area and accessing funding is more and more challenging. The 2012-2016 EU strategy clearly shows the advances made in supporting survivors and outlines new avenues for harmonisation. However, the area of health requires special attention as the existing arrangements do not necessarily offer the most adequate approach to physical and mental trafficking trauma.

Related publications:

The EU Strategy towards the Eradication of Trafficking in Human Beings 2012–2016

Civil society commentary on the EU strategy towards the Eradication of Trafficking in Human Beings

For more information please contact Dr Milena Stateva.