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Modern slavery

Modern slavery

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.

Modern slavery

1 in 8 NHS staff in England think they have seen a victim of trafficking in their clinical practice

13,000 men, women and children are trafficked for exploitation in the UK

1 in 5 victims report having come into contact with health care services during the time they are trafficked  

(NHS England, 2016)

What is modern slavery?

Trafficking or modern slavery is defined by the United Nations Palermo Protocol (UN 2003) in three phases:

  • recruitment or acquisition of a man, woman or child
  • means, i.e. through the use of force, deception, or coercion
  • purpose, i.e. for the purpose of exploitation or forced labour.

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).

The most current estimate of the scale of modern slavery in the UK was produced by the Home Office in 2014 (Home Office, 2017). The report suggests that there are 13,000 men, women and children known to have been trafficked into or in the UK, for:

  • domestic work
  • rural work, farms and agricultural work, factories, construction, food processing, hospitality industries, plantations, fishermen, beauty industry, shops,
  • sex workers
  • criminal activity including cannabis cultivation, street crime, forced begging and benefit fraud
  • forced or sham marriages
  • organ removal.

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.

Health care issues related to trafficking

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 trafficking

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:

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