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Child trafficking

A public health issue

Azra Kacapor, January 2008

“inside my heart, I am like a dead person” Cambodian girl

Forms of Trafficking

• Sex Trafficking
– Prostitution, pornography, stripping, massage parlors, escort
• Labor Trafficking
– Farming, construction, restaurants, factories or ‘sweatshops’,
• Domestic Servitude
• Servile Marriage

• All forms of trafficking can involve significant sexual

violence for girls and women
Trafficking Data
1 million individuals per year are victims of trafficking
• 700,000 victims of trafficking are women and children

• Each year, more than 2 million children are

exploited in the global commercial sex trade (GTIP)

• 80 % of transnational victims are women and girls

and up to 50 % are minors. (GTIP)

• 12.3 million people in forced labor, bonded labor,

forced child labor, and sexual servitude at any given
time (ILO)
Causes of Trafficking

• Poverty, gender-based discrimination and a

history of sexual and physical violence.

• Some are abducted and sold…

• Some are sold by their parents and family
• Some are deceived into consenting …

… and some feel that entrusting themselves to

traffickers is the only economically viable option.
Hear the words of these children: “We want to be like other children who are with their
A story…

Often rape is the entry point into the trafficking world

“ ...Once a girl is 'broken' there is no other choice for her

but to go into a brothel... If you have a beautiful daughter
that is intact, she is worth 'a lot'. A family can get up to
$1000 for her in dowry. Uglier girls are worth less ($500). A
raped girl costs nothing. This is a survival thing for poorer

Hear the words of these children: (in the world).. There are the gods, then humans, and then,
below them, girls who have been trafficked
Health consequences
Effects on well-being

•It prevents victims from attaining physical, mental and social well-

•Children who are sexually abused are vulnerable to physical,

developmental and emotional problems.

Initial reactions and adaptation to captivity include:

Shock and disbelief Resistance

Development of survival strategies Submission/Resignation

Stockholm Syndrome

Hear the words of these children: “they told me not to tell others”
Then what? - Stockholm

• Gratefulness for survival

• Denial of violence/harm
• Identification with trafficker’s perspective
on the world
• Misperceived roles of rescuers/captors
• Difficulty separating from captor
Effects on wellbeing

prone to sexually transmitted diseases including HIV/AIDS.

subject to violence

coerced into having an abortion

prevented from seeking healthcare

Their life may be threatened

prone to use of drugs and/or alcohol.

Educational opportunities may also be denied them.

Medical Effects

• Violence: beatings, stabbings, broken bones

• Head injury and TBI
• Facial trauma including broken teeth
• TB, Malaria
• Hepatitis B, Hepatitis C
• Untreated illness
• Over treatment with antibiotics leads to drug resistant
• Death from homicide

Wendy Freed MD, 2007

• Post Traumatic Stress Disorder*
• Depression / Suicidality*
• Dissociation*
• Self harm
• Substance abuse (Alcohol, Amphetamines..)*

• Low Self esteem, Shame, Degradation, Loss of trust

• Damaged sense of self*
• Loss of cultural worth*
- Value of being good daughter
- Virginity/Loss of value
*Wendy Freed MD, 2007
Access to Health Care
• Victims are prevented from seeking
healthcare because of cost and the risk of
prosecution, fear and shame

• Health care provided by poorly trained illicit

providers even when it includes high risk
procedures such as abortion

• Trafficking victims are at high risk of

pregnancies and complications arising from
undiagnosed and untreated infections,

Hear the voices of these children: “Really pity the Cambodian children, living in bad
conditions, who were sold like chickens and ducks. Is this the life God provided us?”
Ethical Issues
• Public health practitioners providing HIV prevention services for
girls involved in commercial sex work don’t address the trafficking

• Treating the symptoms and effects of diseases and not the person

• Psychiatrist interviews a 14 yr old girl in Cambodian brothel. On

return visit the brothel owner asks her to treat the girl’s symptoms
of fever and tachycardia.*

• Brothel owner refuses to let her be brought to public clinic that

SHARES a WALL with his brothel. Insists they only treat syphilis.*

*Wendy Freed MD, 2007


• Risk of HIV is related to multiple sex

• Children age 15 years have an increased
risk for HIV, with 60% infection rate. Over
age 15, infection rates decreased to 38%.
(study India)
• Who has power to negotiate condom use?
• Adolescent girls with genital ulcers from
herpes, syphilis, or chancroid have 4x risk of
acquiring HIV infection (Freed, 2007)

Hear the voices of these children: “I wanted him to use condom, but he refused”

•Rescuing children from abusive situation is not

enough without the long term strategies for long
term recovery and integration

•Without long term psychosocial care and

support child victims can’t recover properly and
in some cases become abusive adults and

Hear the voices of these children: ““The girl who has been trafficked is like the moon in
the sky that has no light.”
Recommendations - continued
- Need to change perceptions which focus on persons as
patients rather then seeing them in the context of their
general wellbeing

- Broadening the focus of public health prevention from

disease focus towards a more social approach at the
community level addressing issues contributing to
inequality, poverty and education

- Need for more vigorous engagement of public health

community in providing services for victims of sexual
exploitation and enabling and empowering communities
to promote health and reduce inequalities

- Investment in gathering reliable data about the

effectiveness of mental health programs. More solid
evidence of psychometric equivalence across cultures
Wendy Freed MD, HIDDEN IN THE SHADOWS: Sex Trafficking and
Women’s Health, March 2007

World Learning, Trafficking project, Benin

World Vision – Laboratories of Learning resources

Bill Forbes, World Vision Cambodia, Peace and justice program data

Sold Like Chicken- Trafficked Cambodian girls speak out, COSECAM,

May 20003