Child Modern Slavery and Human Trafficking is on the rise: what do paediatricians need to know about this global and local threat to child health?
Dr Laura C N Wood & Dr Sarah Boutros
“One of the worst things a person can ever do to a child is to deny them their humanity, to treat them as a mere thing, a disposable commodity, a tool to be manipulated, used and disposed of at will for personal gain.” — Laura Wood
With myriad potentially devastating impacts on children’s physical, mental, developmental, social and emotional health, modern slavery and human trafficking (MSHT) is a serious exploitative crime and child rights abuse that paediatricians must play a part in addressing. RCPCH members Dr Sarah Boutros and Dr Laura Wood work together in VITA, a clinician-led organisation dedicated to advancing the health and public health approach to MSHT. Working alongside multi-disciplinary, multi-sector professionals such as the Office of the Independent Anti-Slavery Commissioner (IASC), public health experts, police, NGO’s and the Home Office, Sarah and Laura bring child health sciences and a social paediatric lens to challenge and assist development of local, national and international anti-trafficking responses.
By definition, child trafficking is the recruitment, transportation, transfer, harbouring or receipt of a child (any person under 18 years old) for the purpose of exploitation. Child trafficking sits under the UK umbrella term of ‘modern slavery’, which also includes other types of servitude and debt-bondage. By law, no child can ever consent to their own exploitation, and this must be taken into account when considering actions children may have taken in their lives as part of this experience, and times where children do not even realise they are being exploited or have been groomed for abuse. The forms of exploitation are diverse, from labour exploitation to criminal exploitation such as County Lines drugs gangs, forced begging and theft. It includes sexual exploitation which can be linked with perpetrators making children believe they are in a romantic relationship, and domestic servitude, financial exploitation such as using children for benefit fraud, illegal adoption, forced marriage and organ trafficking. Children of any gender may experience many forms of abuse and exploitation at one time or in succession.
MSHT are not niche, siloed, unlucky experiences for a few children in far-off places. An estimated 40.3 million people are victims of MSHT globally, a quarter of those being children. In the UK in 2021, over 12,700 potential victims were identified, about half of whom were children. Many more people are experiencing MSHT but are invisible to the system and data collection. Thousands of British and international children are victims across the UK, and many more children are at risk of harm due to the exploitation of their parents, carers, or siblings. Some of these children will not be invisible and unreachable to us however, as we know that victims access healthcare including emergency services, paediatrics and looked after children’s care.
Exploited children, often (but not always) have life experiences or health-related issues that increase their vulnerability to MSHT. Challenges such as poverty, Adverse Childhood Experiences (ACEs), neglect, rejection of an aspect of their identity (such as their gender, sexuality or faith), experiences of conflict and forced migration, or the presence of physical, mental or developmental needs can all contribute to increased vulnerability to exploitation. The physical, psychological, developmental and emotional harms related to trafficking experiences pile on top of these pre-existing issues making a complex health picture. The health impacts of trafficking depend very much what they are manipulated or forced to do physically, their living environment, and the level of fear, threat, uncertainty and psychological violence experienced.
In the majority of cases, it is not ropes, chains and handcuffs that keep children enslaved, but it is fear and genuine threat of harm from traffickers against themselves, other children, their families and threats about what the police or government will do to children if they ever tell the truth to authorities. Perpetrators also make children feel powerless, voiceless, and full of shame, often making them believe their situation is their own fault, and that they are useless, stupid, dirty and unlovable. Opportunities for exploitation increase further when systems of victim recognition, support and justice are compromised or ineffective in some way. The impact of COVID-19 and mitigating policies has increased many people’s vulnerability, placing them at greater risk of manipulation and exploitation at a time when education, health, policing, asylum and justice systems are all under strain. When we understand this, we see that modern slavery is not merely ‘unfortunate’ or the random acts of a few corrupt perpetrators, but it is deeply related to our systems and structures, our national and international histories, the ongoing impacts of discrimination, climate change and food insecurity, war, migration and the human rights landscapes of people’s lives.
Paediatricians understand what children, families and what healthy societies need. We have really important opportunities to make a difference in the lives of children before, during and after exploitation. We can use our skills, scientific knowledge, advocacy authority and multi-disciplinary team-based working to recognise and safeguard vulnerable children before they are exploited online or offline. We can apply our Trauma Informed Care approaches in all healthcare scenarios, paying attention to indicators of child trauma and stress and ensuring we speak safely with children and young people independently of any accompanying adult, especially if they appear controlling in any way. We can question dangerous and unhelpful narratives about children and young people, not accepting comments like ‘he’s a bad kid — no hope for that one, chosen to be a criminal’. This is vital, as what people believe to be the ‘truth’ about a child drives their response towards empathy and support, or to distancing from the child or criminalising them, adding to the child’s trauma and rejection overload.
For children who have been harmed, we can provide expert healthcare and refer them on to colleagues for therapy and specialist input, working with the school and other team members to provide trauma-informed, well communicated, child-centred support to help them thrive. We can ensure they are referred to Children’s Social Care so they can enter the National Referral Mechanism (NRM), the government’s process for victim identification and support.
At local, national and international level, child health needs a seat at the table for all policies that impact children directly (such as the NRM and the Nationality and Borders Bill) and indirectly (such as policies that impact family incomes). As the Public Health Approach to MSHT develops in the UK, this is an exciting time for child health professionals to help shape a better future.
NEW RCPCH Guidance on Child Trafficking and Modern Slavery is available and is full of resources to help your practice in this area.
For more details on how you can be involved in the health and public health response to modern slavery contact VITA Network (www.vita-network.com ) and see VITA Training (https://www.vita-training.com/) to learn more about advanced trauma informed consultation skills education.
