Human Trafficking of Children and Adolescents: A Global Phenomenon With Horrific Health Consequences.

Human trafficking has severe adverse effects on the health, development, well-being, and human rights of vulnerable young people globally and in the United States. Awareness of human trafficking—once hidden in the shadows—is growing. Although precise estimates arenotavailableofhowmany children and adolescents are affected, there is little doubt that youngpeople everywherehaveexperiencedphysical and sexual violence from being trafficked and millions worldwide are at risk. Despite the increased awareness, significant gaps remain in evidence-based knowledge about the causes, consequences, and responses; the gaps are particularly noteworthywith respect to thehealth implications of human trafficking and the appropriate role of health care professionals. The study by Kiss et al1 of 387 children and adolescents aged 10 to 17 years (82% female) in posttrafficking services in Cambodia, Thailand, and Vietnam begins to fill the gaps by documenting the horrific health consequences for the young survivors of sex and labor trafficking: depression, posttraumatic stressdisorder, anxiety, suicidal ideation, self-harm,and suicide attempts. TheKiss et al1 study of children and adolescents is part of a larger study of 1102 traffickedmen, women, and children.2,3 The larger study included 359 young adults aged 18 to 24 years (66% female). The adult men and women in the larger study experienced similarly severe health consequences from their trafficking experiences as their younger counterparts, although at even higher rates than the children and adolescents. Thesehealthconsequencesmayseemunsurprisinggiventhe extentofphysical andsexual violenceexperiencedby the individualsbothprior to traffickingandwhile trafficked, sovividly documentedbyKisset al.1Nonetheless, this study represents a majorcontributiontoourunderstandingoftheexperienceofchildrenandadolescentswhohavebeen traffickedwith its careful, ethical approach to interviewing vulnerable individuals about sensitive and potentially traumatizing topics. Kiss and colleagues1 have highlighted several important aspects of the human trafficking experiences and characteristics of the young survivors they interviewed. First, human trafficking isnot limitedbysex: it affectsboysandgirls,women andmen. Second, severe health consequences are associated with both sex trafficking and labor trafficking; althoughmost of those interviewedwere forced into sex work, many others were trafficked into fishingandfactorywork.Third,healthcare professionals have important roles to play in the identification of those who have been trafficked and in responding to theirneedswith targeted, trauma-informedposttraffickingservices. Thedata in this studyare fromtheGreaterMekongSubregionof SoutheastAsia but havemajor implications for child and adolescent survivors of human traffickingworldwide, althoughtheavailabilityof reliabledataabout thosewhoare trafficked, the survivors, and their experiences in different trafficking situations varies by region and country. Thosewhoare trafficked and survivors of human trafficking come fromdiverse backgrounds in termsof geography, income, race,ethnicity, religion,sex,andsexualorientation;however, some children and adolescents are likely to be at heightened risk. For example, in the United States, children and adolescents who have experienced sex trafficking includeyoungpeoplewhohavebeensexuallyabused;youthwho lackstablehousingor live indysfunctional families; sexual and genderminority youth; youthwhohaveusedor abuseddrugs oralcohol;andyouthwhohaveexperiencedhomelessness, foster careplacement, or juvenile justice involvement.4 InSoutheast Asia, youngpeople living in poverty or escaping violence at home may also be at increased risk for both sex and labor trafficking.1-3 Once the riskhas transformed into reality, health careprofessionals canplay a significant role: identifying trafficked individualsandsurvivorsandaddressing theirhealthcareneeds. They can do this through direct clinical care, research, and policy.1-7 Although recognition of the extent and importance of theseproblems is relatively recent—amonghealth care professionals and the general public—examples of strategies to meet theneeds of trafficked individuals and survivors are beginning to emerge from thededicated and innovativework of governmental agencies, nongovernmental organizations, and professionals in diverse settings worldwide.1,4,8 Responsestohumantraffickingintheserviceandpolicyarenas have been grounded in broad andwidely accepted human rights principles. Building on the foundation of theUnitedNations (UN) Universal Declaration of Human Rights in 1948 and theConventionon theRightsof theChild in 1984, international protocolshavebeenadoptedbymostnations, clearly articulating an array of prohibitions against human trafficking andprotections for trafficked individuals.9,10Manyof the foundational human rights clearly pertain to both human trafficking and health. For example, the UN Universal Declaration of Human Rights includes the rights to life, liberty, andsecurityofperson; freedomfromslaveryorservitude; freedomfromtorture, cruel, inhumane,ordegradingtreatment;healthandwell-being;medical care; and freedomofmovement.TheUNConventionon the Rightsof theChild includes the right to life; the right to freedom Related article at jamapediatrics.com Opinion