Date Published: November 22, 2017
Publisher: Public Library of Science
Author(s): Elena Ronda-Pérez, Bente E. Moen
Abstract: In this essay for the collection on Human Trafficking, Exploitation, and Health, Elena Ronda-Perez and colleague discuss ways occupational health services can detect and address labour trafficking.
Partial Text: Labour trafficking is a form of modern-day slavery in which individuals are recruited or transported to perform labour or services through the use of force, fraud, or coercion and under the threat of some kind of penalty. In addition, the person has not offered himself/herself voluntarily for the activity in question. The International Labour Organization (ILO) uses the expression ‘forced labour’ instead of the word ‘trafficking’ and estimates that 25 million people are victims of forced labour . This represents about 5.4 out of every 1,000 people globally. Approximately 90% are exploited by private individuals and enterprises. While in the past the ILO focused narrowly on sex trafficking, recently more attention has been paid to a broader range of sectors and circumstances in which forced labour may take place . Global assessments suggest that a substantial proportion of labour migrants end up in situations of extreme exploitation, some of which are formally identified as human trafficking [2,3]. These problems can occur in any country, though the relative magnitude of the problem in different countries is not clear. The workers involved represent both genders  and come from different geographic regions including Asia, Africa, Latin America, and Eastern Europe, in addition to other parts of the European Union .
The main task of the field of occupational health is to avoid and reduce the effect of workplace factors that can have an adverse impact on the health of workers. These factors can be physical, organizational, or psychosocial in nature. There are several definitions of occupational health, but the most commonly used definition is that developed by the Joint ILO/WHO Committee on Occupational Health (1950). Occupational health is defined as the ‘promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations’ .
Labour trafficking is seen in work sectors such as agriculture, factory work, fishing, mining, construction, hospitality industries, and domestic services [2,4,6,7] (Table 1). These work sectors are characterised by frequent labour shortages and use of subcontractors, often in the informal economy. Also, trafficking occurs mainly among migrant workers .
Health professionals should be able to contribute to the important work of identifying and properly treating trafficked workers, in addition to reporting cases (Table 2). The ILO suggests a set of 11 indicators to identify and assess a forced-labour situation. The indicators include abuse of a worker’s situation of vulnerability, deception, restriction of movement, isolation, physical and sexual violence, intimidation and threats, retention of identity documents, withholding of wages, debt bondage, abusive working and living conditions, and excessive overtime. Sometimes the presence of a single indicator implies forced labour; other times it is necessary to consider several indictors together . This might be observed, for instance, when a worker comes to a hospital with a serious head trauma after falling from a scaffold at a building site. The worker might not have any identification papers, a home address, or provide the name of any employer. This situation is difficult, and health professionals need to be educated in knowing the proper steps to take. Currently, a major problem is that health professionals are often not aware of what trafficking is and have not considered how to handle such a problem. There is a risk of worsening the problem and putting the workers in even greater danger if the situation of trafficking is revealed, so discretion is important when trafficking is suspected. Due to different legislation and official responses, the solutions to these problems vary in different countries, and local strategies and procedures must be developed to properly handle these situations. It is important for the health personnel in all countries to be involved in developing the specific response to these challenges. When response procedures are in place, health personnel should be formally trained on how to handle problems related to trafficking . Training should include provision of information on in-country referral and support options for trafficked people as well as national reporting requirements. Situations involving trafficking victims that have been identified show that the victims involved are unaware of their labour rights and their employers’ obligations on their behalf, such as social security contributions.
The ILO developed the legally binding Protocol for Forced Labour in 2014 , which requires governments to work on the levels of protection, prevention, and compensation in order to address forced labour. Countries must first ratify the Protocol before being subject to it. Governments must implement robust laws and measures that seek to address labour trafficking at its multiple sources. So far, just a few countries have ratified the protocol, but as it gains more widespread recognition and implementation, it will have the potential to promote a coherent institutional response to labour trafficking that includes provisions for protection of victims and prevention of labour trafficking practices.