STOLEN SMILES

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STOLEN SMILES Physical and mental health
consequences of women and adolescents
trafficked in Europe

Funding from the European Commissions Daphne
Programme, Sigrid Rausing Trust, International
Organization for Migration
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How big is the trafficking problem?
?
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STAGES OF THE TRAFFICKING PROCESS
Pre-departure
Integration and reintegration
Travel and transit
Health risks and opportunities
Detention, deportation, criminal evidence
Destination
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Spheres of marginalisation and vulnerability
Migrant women
Violence against women Torture victims
Trafficked women
Trafficked women
Exploited labourers
Sex workers
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Recruitment Equation
PUSH PULL FACTORS
DECIDING FACTORS

Vulnerabilities Hopes Strengths
CREDIBILITY OF THE OFFER Timing of the
offer Quality of the offer
ACCEPTS OFFER


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Study of trafficked women accessing services in
seven European countries

• Study participants
• Women adolescents accessing services in
  Moldova, Ukraine, United Kingdom, Italy,
  Bulgaria, Czech Republic Belgium.
• Trafficked into forced sex work (92) domestic
  labour (4), and both (3).
• Ages 15 to 45 from 14 countries, the majority
  from Moldova and Ukraine.
• 38 had children, of whom 82 were single
  parents.
• 81 exploited for at least one month, 20 over
  one year.
• Three interviews conducted 207 women interviewed
  0-14 days after entry into care, 170 between
  28-56 days, and 63 at 90 days.

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Violence women experienced prior to being
trafficked
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Violence women experienced during trafficking
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Identifying a trafficking situation How often
were you free?
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Multiple physical health symptoms that improve
with support services
0-14 Days
28-56 Days
90 Days
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The most common physical health symptoms reported
by women at 0-14 days
63 memory problems
81 headaches 71 dizzy spells
69 back pain
60-70 various sexual health problems
82 fatigue
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How the memory gets disrupted
Fight or flight response to danger Peritraumatic
dissociation Loss of details
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Levels of psychological distress are high, with
multiple presenting symptoms
28-56 days
90 days
0-14 days
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What is a post-traumatic response?

• Severe or prolonged traumatic experiences can
  result in an individual being unable to turn-off
  their basic biological and safety alarm
  mechanisms or cause them to have an
  all-or-nothing physical and emotional response
  to negative stimuli
• Repetitive helplessness of this kind may result
  in disorganising the cognitive processes, or
  disable an individuals instinctive ability to
  respond appropriately.

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Post-traumatic stress disorder
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Changes in post-traumatic stress symptom levels
Post-traumatic stress disorder symptoms
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Mental health improvements
Depression Anxiety Hostility
0-14 days
28-56 days
90 days
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Trafficked womens mental health compared to a
general female population
0-14 days
28-56 days
90 days
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Reactions are individual
I feel like theyve taken my smile and I can
never have it back. Lithuanian woman trafficked
to London
Maybe some people could call me a dirty whore,
but for others I might be the girl who can give
them good advice. Moldovan woman trafficked to
Turkey
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WORKING WITH WOMEN WHO HAVE BEEN TRAFFICKED
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Give Control and Establish Trust

• 1. EXPLAIN AND INFORM
• The purpose for the questions and the process,
  step by step.
• General subjects that will be discussed and
  acknowledge difficulty of some questions.
• Who will and who will NOT have access to the
  information.
• She may return to difficult questions later.
• If she does not understand something, she should
  ask for it to be repeated slowly or explained
  differently.

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Give Control and Establish Trust

• 2. INQUIRE ABOUT HER
• How are you feeling? Are you currently in any
  pain or discomfort?
• Are you hungry or thirsty? Do you want to use
  the toilet?
• Is there anything that is making you feel unsafe
  right now, or that you might be harmed?
• Do you have any questions that you want to ask
  me?
• Do you have any urgent concerns or fears that you
  want to tell me about before I ask you some
  questions? Are you ready to start?

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Give Control and Establish Trust

• 3. BE ON HER SIDE
• Ask questions in a way that shows she is believed
  and that you have concern for her
• What was done to her vs. what she did
• Did you feel free to go where you wanted? vs. Did
  you ever try to escape?
• Did anyone hurt you while you were in this
  country? before How did you enter this country?
• Are you worried for anyone in your family? before
  What is your home address?

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Of benefit to the victim benefit to the case
Comforted, comfortable individual
Physical comfort

Psychological comfort

More thoughtful, more reliable, accurate
information
Time
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About Sexual Violence
A history of sexual violence
RISK-TAKING sexual substance misuse
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A Complex Victim Group

• Disclosure barriers
• Fear of retaliation by traffickers
• Guilt of her perceived complicity in what
  occurred
• Guilt over any criminal activities in which she
  participated
• Shame about what she has done, particularly
  sexual activities
• Little trust in officials, e.g., police,
  immigration, health workers

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Interpreters

• Security- DO NOT USE VOLUNTEER INTERPRETERS
• No discrimination - against sex work, migrants,
  women
• No neighbours no one from the same village or
  town, or local destination community
• Gender may prefer a female or male
• Warn against any disclosure, with criminal
  sanctions, e.g., official secrets, data
  protection act

CHECK ACCEPTABILITY OF INTERPRETER WITH THE WOMAN
HERSELF
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A senior police officer referring to a victim who
refused to cooperate
I feel that she was really too scared, but it was
her decision. Our offer was made in fairly
hostile conditions, during a police interview.
This is a case where a three month reflection
period would have been useful. London
Metropolitan police officer
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Trafficking legislation and the recovery and
reflection period
Council of Europe Convention on Action Against
Trafficking Article 13 Recovery and reflection
period 1. Each Party shall provide in its
internal law a recovery and reflection period of
at least 30 daysSuch a period shall be
sufficient for the person concerned to recover
and escape the influence of traffickers and/or to
take an informed decision on cooperating with the
competent authorities.
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Recommendations (1)

• Recognise the serious health consequences of
  trafficking
• Pass legislation requiring a full range of health
  services be provided to trafficked women,
  regardless of their legal status.
• Establish procedures to require authorities to
  ensure that upon contact with a woman suspected
  of having been trafficked, her health needs are
  assessed and urgent needs are immediately
  addressed.

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Recommendations (2)

• 4. Legislate a minimum 90 day period of
  reflection and recovery during which time women
  will
• receive appropriate and adequate support services
• not be required to make decisions about
  cooperating with authorities or about returning
  home
• 5. Prohibit the detention, removal or deportation
  of trafficked women until their health needs have
  been met and their safety for return assessed
• 6. Provide services based on models of good
  practice used for survivors of other forms of
  violence and for minority or refugee communities.

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Recommendations (3)
7. Increase involvement of health sector in
trafficking dialogue and activities. 8. Train
relevant health professionals to provide
appropriate physical, sexual, reproductive and
mental health care for trafficked womens
needs 9. Codes of service provision should draw
on models of good practice used for survivors of
other forms of violence, and/or minority
communities refugees.
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Guiding principles for conducting ethical and
safe interviews with women who have been
trafficked

• Do no harm
• Ensure safety, security and comfort
• Ensure privacy
• Ensure confidentiality
• Provide information
• Request informed consent
• Ask questions in a sensitive and sensible
  manner by paying attention to the purpose,
  sequence and tone of the question
• Listen actively and responsively by not
  talking, asking questions and providing
  clarification, giving the person time to answer,
  being perceptive and acknowledging what the
  person says
• Observe signs indicating the woman needs a
  break during the procedure
• Consider any preconception and prejudices you
  may hold
• Believe, do not judge
• Maintain professionalism while treating persons
  with respect and compassion
• Ensure trafficked persons feel in control of
  their body and communications
• Reassure trafficked persons they are not to
  blame
• Inform trafficked persons of their right to a
  forensic medical exam and report
• Inform the individual of their rights to copies
  of all health medical records
• Remind the trafficked person of their strengths

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Suggested citation

• Zimmerman, C. 2006. Presentation on the health
  consequences among women who have been trafficked
  and their implications for services and policy.
  London London School of Hygiene Tropical
  Medicine.
• The full report, Stolen Smiles, is available at
• www.lshtm.ac.uk/genderviolence