Modern slavery and human trafficking

Cases of people being trafficked into the UK and being forced into modern forms of slavery are on the increase. Many of these victims come into contact with health care services so as a nursing and / or midwifery professional it is essential that you are able to spot the signs and know how to act on them.

What is modern slavery?

Someone is in slavery if they are:

forced to work – through coercion, or mental or physical threat
owned or controlled by an ’employer’, through mental or physical abuse or the threat of abuse
dehumanised, treated as a commodity or bought and sold as ‘property’
physically constrained or have restrictions placed on their freedom of movement.

What is human trafficking?

Human trafficking involves recruitment, harbouring or transporting people into a situation of exploitation through the use of violence, deception or coercion and forced to work against their will.

(Slavery in the UK, Anti-Slavery International, 2019)

An estimated 40.3 million men, women, and children were victims of modern slavery on any given day in 2016 (International Labour Office & Walk Free Foundation, 2017). Of these, an estimated 24.9 million people were in forced labour and 15.4 million people were living in a forced marriage. The current Global Estimates do not cover all forms of modern slavery; for example, organ trafficking, child soldiers, or child marriage that could also constitute forced marriage are not able to be adequately measured at this time (Global Slavery Index, 2018).

In 2020, the Centre for Social Justice report, called It Still Happens Here suggested that the number of men, women and/or children affected by modern slavery and or trafficking may be around 100,000-110,000. This may be:

domestic servitude
labour exploitation
organ harvesting
sexual exploitation
criminal exploitation
forced labour/debt bondage

(The Centre for Social Justice, 2020)

The RCN's leaflet Modern Slavery Wheel identifies the key signs and what nursing staff should do if they suspect it is happening.

What to do if you spot the signs

If you suspect that a person is a victim of slavery, this is a safeguarding issue.

You should trust and act on your professional instinct that something is not quite right. It is usually a combination of triggers, an inconsistent story and a pattern of symptoms that may cause you to suspect trafficking.

If you have any concerns about a child, young person or adult take immediate action to ask further questions and get additional information and support. It is important to remember that:

trafficked people may not self-identify as victims of modern slavery
trafficking victims can be prevented from revealing their experience to health care staff from fear, shame, language barriers and a lack of opportunity to do so. It can take time for a person to feel safe enough to open up
err on the side of caution regarding age. If a person tells you they are under 18 or if a person says they are an adult, but you suspect they are not, then take action as though they were under 18 years old
support for victims of human trafficking is available.

Psychological First Aid

VITA Network’s Dr Laura Wood has recorded a 10-minute introductory video to Psychological First Aid.

Many people have some basic first aid training, to help someone who has been physically hurt, however what about knowing the safe steps to take in supporting someone who’s experienced emotional or psychological harm and distress? Particularly in the settings of severe adversity, after a disaster or in conflict. This short 10-minute video recorded by VITA Network’s Dr Laura Wood is an introduction to Psychological First Aid, showing how to support people to cope, adapt and recover in the aftermath of severe adversity and disaster. This is the latest SafeREFUGE resource.

Health care issues related to modern slavery

A victim of modern slavery may display some of the following health care issues:

evidence of long term multiple injuries
indications of mental, physical and sexual trauma
sexually transmitted infections
pregnant, or a late booking over 24 weeks for maternity care
disordered eating or poor nutrition
evidence of self-harm
dental pain
fatigue
non-specific symptoms of post-traumatic stress disorder
symptoms of psychiatric and psychological distress
vague symptoms of back pain, stomach pain, skin problems; headaches and dizzy spells.

Other signs of modern slavery

If the person:

is accompanied by someone who appears controlling, who insists on giving information and coming to see the health care worker
is withdrawn and submissive, seems afraid to speak to a person in authority and the accompanying person speaks for them
gives vague and inconsistent explanation of where they live, their employment or schooling
has old or serious injuries left untreated
gives vague information, is reluctant to explain how the injury occurred or give a medical history
is not registered with a GP, nursery or school
has experienced being moved locally, regionally, nationally or internationally
appears to be moving location frequently
appearance suggests general physical neglect
struggles to speak English
has no official means of identification or suspicious looking documents.

In addition, children and young people might show the following signs:

have an unclear relationship with the accompanying adult
go missing quickly (sometimes within 48 hours of going into care) and repeatedly from school, home and care
give inconsistent information about their age.

Next steps

There are a number of steps you can take if you have identified someone is a victim of trafficking:

try to find out more about the situation and speak to the person in private without anyone who accompanied them
when speaking to the person reassure them that it is safe for them to speak
do not make promises you cannot keep
only ask non-judgmental relevant questions
allow the person time to tell you their experiences
do not let concerns you may have about challenging cultural beliefs stand in the way of making informed assessments about the safety of a child, young person or adult.
speak to your manager, colleagues or local safeguarding leads for support and advice

In all cases for children, young people and adults:

do not raise your trafficking concerns with anyone accompanying the person
think about support and referral.

See the RCN resources for nurses designed to help recognise the signs and help direct people on what to do for those they suspect are victims of modern slavery:

Professional lead for modern slavery and human trafficking:

Carmel Bagness

Modern slavery helpline

You can call 08000 121 700 to get confidential help, report a suspicion or seek advice.

Forced marriage

Forced marriage is the term used to describe a legally binding relationship, where one or both partners married without their consent or against their will. It can occur to anyone of any age, sexual orientation, any ability, including those with learning disabilities, and includes relationships entered into with full consent if one or both are later forced to stay in the marriage against their will. It is a safeguarding issue, and one all healthcare professionals should be aware of.

See: forced marriage factsheet

See also: further information on further information on forced marriage.

The National Commission on Forced Marriage is an independent body founded in 2013. It raises awareness of forced marriage, so that individuals, families, and communities understand that forced marriage is against the law in the UK, through inquires and research. It also examines, advises and publicly reports on the practice of forced marriage across England, Scotland, Wales, and Northern Ireland.

The 2018 Global Slavery Index provides a country by country ranking of the number of people in modern slavery, as well as an analysis of the actions governments are taking to respond, and the factors that make people vulnerable. The UK is ranked thus:

136,000 Estimated number of people living in modern slavery

2/1000 Estimated proportion of population living in modern slavery

11.13/100 Vulnerability to modern slavery

(Global Slavery Index, 2018)

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