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exploitation. In some cases, victims from different countries or cultures don’t realize that their exploitation is unusual or criminal. Also, some human trafficking victims have bonded with their exploiter, a condition called trauma bonding that is similar to Stockholm syndrome. Victims may keep silent about their exploitation from shame or fear of being humiliated. Since medical care is occasionally necessary for trafficking victims, health care professionals are in a unique position to help these unfortunate victims.1 What is human trafficking and who is victimized? Human trafficking is modern-day slavery.3 The United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, Article 3, defines human trafficking as: The recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs. 4 The U.S. Victims of Trafficking and Violence Prevention Act of 2000 (TVPA) defines and classifies human trafficking into two categories: sex trafficking and labor trafficking.5 According to the Office on Trafficking in Persons, human trafficking is a public health issue that impacts individuals, families and communities. Traffickers disproportionately target at-risk individuals, including those who have experienced or been exposed to other forms of violence, and individuals disconnected from stable support networks.6 See the sidebar for vulnerable populations. Recognizing signs of human trafficking The NHTRC and other sources provide the following signs of human trafficking that can be used to recognize potential victims:2 Poor mental health or abnormal behavior: • Appears fearful, anxious, depressed, submissive, tense, nervous or paranoid Quick Safety Issue 42, June 2018 Page | 2 Legal disclaimer: This material is meant as an information piece only; it is not a standard or a Sentinel Event Alert. The intent of Quick Safety is to raise awareness and to be helpful to Joint Commission-accredited organizations. The information in this publication is derived from actual events that occur in health care. ©2018 The Joint Commission, Division of Healthcare Improvement Health problems that may alert health care providers to human trafficking • Burns • Fractures • Bruises/contusions • Respiratory and other infections • Tuberculosis • Sexually transmitted diseases • HIV infection • Pregnancy • Abortion-related complications • Abnormal vaginal discharge • Chronic vaginal and cervical infection • Pelvic inflammatory disease Source: Journal of Applied Research on Children: Informing Policy for Children at Risk, Human Trafficking, 2011; Vol. 2: Issue 1, Article 8. Sample screening questions for human trafficking victims • Where do you sleep and eat? • Do you live there with other people? • Is your family there, or nearby? • Are the doors and windows locked so you cannot get out? • Has your ID or documentation been taken from you? • Have you been denied food, water, sleep or medical care? • Have you been threatened if you try to leave? • Has anyone threatened your family? • Have you been physically harmed in any way? • Are you being forced to do anything you do not want to do? • Avoids eye contact • Refuses to change into a gown and/or to cooperate with physical exam • Behavior or demeanor does not align with injury or complaint (i.e., acts like it is “no big deal,” even with concerning injuries) • Refuses treatment that does not take place during that visit (i.e., refuses to go to specialist) Poor physical health: • Appears malnourished • Signs of repeated exposure to harmful chemicals • Signs of physical and/or sexual abuse, physical restraint, confinement or torture Other: • Is not in control of identification (ID or passport) • Is not allowed or able to speak for themselves (a third party may