Hospital Health Provider Experiences of Identifying and Treating Trafficked Persons

ABSTRACT

Over the past 20 years, human trafficking (“trafficking”) has generated much public attention throughout the world. The problem has received growing media coverage and increased anti-trafficking activism. Additionally countries have created new policies, laws, and enforcement mechanisms to tackle the problem. This micro level study examined the lived experiences of 22 health and allied health workers situated within St Vincent’s Health Australia’s Melbourne facility, and reports on their identification, assessment, treatment, and outreach to trafficked persons. The results indicated that trafficked persons were predominantly invisible within the health setting. When practitioners did suspect trafficking, they considered themselves as lacking the professional skills and knowledge, or the clear organisational policy or procedures to confidently identify and manage the complex health needs of the suspected trafficked persons. The findings contribute to St Vincent’s Health Australia’s goal of formulating contextually appropriate policy and practices that will assist in the identification of and response to the health needs of trafficked persons.

IMPLICATIONS

• The health needs of trafficked persons are multiple and interrelated and require health care providers and systems to be skilled in the identification, intervention, and treatment of trafficked persons.

• Education and training of health professionals is the cornerstone of the identification, intervention, and treatment of trafficked persons.

• Social workers’ specific focus on person-in-environment may be an important contribution to the identification and treatment of trafficked persons.

     

Labour,Legality and shifts in the Public/Private divide

This article discusses the changing role that work performed in private homes has played, and continues to play, in migration law in the Netherlands and at the EU level. It explores to what degree work performed in the home is defined as (exploitative) contractual labour or as inherent to family life, and what this means for claims to residence rights as a precursor to citizenship. It does this by reviewing case law of the European Court of Justice (CJEU) and of the European Court of Human Rights (EctHR) against the background of the Dutch case. It reveals tension between how citizenship is constructed and reproduced at the national level and how it is constructed and reproduced at the EU level. Following Adam McKeown, this article concludes that different perspectives on (reproductive) labour as a qualification for citizenship may reflect different perspectives on (reproductive) labour and the quality of citizenship.

Policy Implications

• Third Country Nationals must be allowed to reside in the EU with their EU children, to ensure the latter's effective enjoyment of fundamental rights.
• Policies to combat trafficking of domestic workers must respect family life.
• Family migration policies must allow individual family members enough scope to resist exploitation within families.
• Policies concerning labour protection, social protection and migration should no longer take the breadwinner‐citizen as point of departure, but the current reality of flexible labour relations in which the distinctions between home and work, and between employment and self‐employment, are no longer sharply defined.

     

Physician Migration in the Global South between Cuba and South Africa

Transnational physician migration has concerned states' health and migration policies for many years. Recent developments have increased attention to the outcomes of these flows in the global south, where physician emigration is undermining public health policies. Cuba's exporting of medical professionals presents an alternative dynamic, based upon both an ideology of humanitarian solidarity and a need to secure hard currency earnings. The benefits and challenges arising from a bilateral agreement between Cuba and South Africa to supply Cuban doctors to South Africa and training at the Latin American Medical School (ELAM) for South African medical students are addressed. The benefits of skills enhancement and professional development are noted, as well as the economic benefits for both the Cuban government and individual doctors, while concerns with the appropriateness of the medical training provided at ELAM for the South African health context and the sustainability of the current policy are discussed.

Policy Implications

• Strategic bi‐lateral agreements offer a productive route towards more sustainable management of skilled migration.
• When migration agreements include skills training, attention is needed to ensure the training provided is appropriate to the destination context: attention needs to be paid to the appropriateness of the medical training afforded to South African medical students in Cuba for health requirements in South Africa.
• International migration agreements can form part of a broader policy suite aimed at realizing public health and other development priorities. However, attention must be paid to the suitability and sustainability of the outcomes of these practices.

     

International migration policies: conceptual problems

Kritz reviews national concepts and policies of migration. She examines how nation-states approach migration and how they define who is a migrant. Policies for permanent, temporary, and illegal migrants are examined for selected countries. While the traditional permanent immigration countries--Australia, Canada, New Zealand, and the US--continue to admit large numbers of permanent migrants, they are also admitting growing numbers of temporary migrants. Other countries, in Europe and the developing world, have different migration histories and use other approaches to admit foreigners--migrants are generally admitted on a temporary basis for work or other purposes. Growing numbers of these temporary migrants, however, do become long-term or permanent settlers, and the distinction between permanent and temporary migration policies becomes a short-term legal one rather than a long-term sociological one. Governments have been seeking those policy instruments that would allow them to improve control over who enters and settles in their territories, and temporary migration policies are the measures to which they are turning. While increasing restriction characterizes the policy stance of most countries toward international migration, this does not necessarily mean that the number of migrants entering is declining. Kritz argues that the concepts employed by countries in their immigration policies frequently do not correspond to the reality, making it necessary to examine the actual context.     

Gender,labour and the law: the nexus of domestic work,human trafficking and the informal economy in the United Arab Emirates

Based on ethnographic fieldwork with female migrants in the United Arab Emirates, the focus of this article is on the confluence of human trafficking discourses, gendered migration, domestic work and sex work in the UAE. I explore three main findings. First, domestic work and sex work are not mutually exclusive. Second, women choose to enter sex work in preference to domestic work because of poor working conditions in the latter. Third, global policies on human trafficking that seek to restrict female migration have inspired female migrants in the Gulf in search of higher wages and increased autonomy to look for employment in the informal economy. Employing a theoretical lens that emphasizes structural violence, the article chronicles the individual and macro social factors structuring the transition of female migrants from the formal economy of domestic and care work into the informal economy of sex work.     

Trafficking and Human Smuggling: A European Perspective

The article reviews the empirical evidence for trafficking and human smuggling in Europe. It argues that a market for irregular migration services has emerged, in which the mechanisms and forms of organization are still relatively unknown. Irregular migrants using these services are exposed both to unscrupulous service providers and to the immigration and policing authorities, thereby generating a dependence on safeguards provided by the trafficking networks. Thus a symbiosis has developed between trafficker and trafficked. The enormous interest and concern for trafficking and human smuggling in governmental, inter-governmental and non-governmental organizations, in the media and popular opinion, is running ahead of theoretical understanding and factual evidence. This has implications for policy measures designed to combat trafficking and human smuggling, which may not work and also have unintended side effects. The article begins with a discussion of the main conceptual and definitional issues confronting researchers and politicians. This is followed by an assessment of the main theoretical approaches that have been developed and an evaluation of current statistical knowledge. Information on the organizational structure of trafficking organizations is then reviewed, followed by a summary of the characteristics of migrants involved, based on empirical studies that have been carried out. The article concludes by indicating some of the main research priorities.     

Empowering,invasive or a little bit of both? A reflection on the use of visual and narrative methods in research with migrant sex workers in South Africa

Although migration plays a critical role in the economic landscape of the world, government officials and researchers do not sufficiently include migration and/or migrants in research studies and development policies. In South Africa, many migrants – both internal and cross-border – engage in informal livelihood strategies, including sex work (see Richter et al. 2012). Currently, the bulk of research that is being conducted in South Africa in the areas of migration and sex work rely heavily on the use of traditional research approaches and focus mainly on concerns surrounding issues of public health, with increased attention to HIV (for example, see SANAC 2013; Scheibe, Drame and Shannon 2012; Scorgie et al. 2011). While this work is invaluable, there is a need for research that can counter the stigma that sex workers overwhelmingly face in light of HIV/AIDS. Participatory visual and narrative research approaches – as part of mixed method study designs – that examine the lived experiences of migrant sex workers can provide important insights that ‘move beyond the polarized and simplistic arguments that have circulated in South African about migrant sex workers’ (Nyangairi and Palmary, 2014, 132). This methodological approach makes important and necessary contributions to national and international discourses on migration and sex work (see Oliveira and Vearey 2015). In addition, these methods provide a unique platform where the normative discourses that portray migrants as a homogenous vulnerable and apolitical group of people can be contested (Palmary 2006). In this article, I present and discuss three participatory visual and narrative research projects that have been conducted with migrant men, women and transgender persons who sell sex in two Provinces of South Africa and examine the suitability of these approaches.     

Post‐Return Transnationalism and the Iraqi Displacement in Syria and Jordan

The article explores the relationship between return and transnationalism in the case of the post‐2003 Iraqis' protracted displacement in Syria and Jordan. Based on field observations and interviews with Iraqi returnees, the article argues that transnational mobility and livelihoods constitute a precondition for their sustainable return. In this refugee context, return is rarely a one‐way physical movement followed by permanent integration back home. It is a complex process that takes time and entails various degrees and modalities of transnational mobility, social networks and livelihoods connecting host and home societies. The international refugee regime in contrast is predicated on the assumption that refugees will not re‐migrate after return. Stopping returnees' mobility may hamper the independent transnational livelihoods and development opportunities that the Iraqi people have pursued in the absence of permanent solutions to their predicament.

Policy Implications

• International donors and regional states should harmonize their asylum and migration policy agendas and develop an integrated framework for durable solutions to the Iraqi protracted displacement.
• Relevant agencies should consider ways to incorporate legal transnational mobility opportunities into policy frameworks for the protection of refugee populations in the Middle East.
• Existing voluntary assisted return policies need to be revised to reflect the often non‐sedentary and non‐permanent nature of refugee returns to conflict‐affected societies.
• More research on returning refugees' transnational livelihoods is required to inform policy interventions facilitating the safe and sustainable return of refugees.

     

Family financial roles assumed by sex trafficking survivors upon community re-entry: Findings from a financial diaries study in the Philippines

People who have been trafficked often face substantial financial challenges upon exiting human trafficking and re-entering the community. This article presents findings from a 6-month financial diaries study with the households of 30 women in Cebu City, Philippines, who were trafficked into sex work. Data from 352 interviews with sex trafficking survivors and their family members were utilized to explore the roles that trafficking survivors played in promoting the economic well-being of their families upon community re-entry, as well as the challenges they faced in fulfilling these roles. Findings revealed that women who were trafficked balanced multiple roles in their families—including that of income earner, household financial manager, and financial providers for the extended family. Survivors’ limited access to employment was a key barrier that impeded their ability to achieve financial stability for themselves, their children, parents, and other family members. The employment status of trafficking survivors affected numerous crosscutting factors—including the extent to which they were able to control household finances, redistribute income to their parents, and leave violent relationships. Findings reinforce the importance of safe, sustainable employment opportunities for the security and well-being of trafficking survivors and their families.     

Shifts in Intergenerational Mobility of Indian Immigrant Entrepreneurs

The objective of this article is to examine the shift in the intergenerational mobility of Indian immigrant entrepreneurs in Australia. Based on a qualitative methodology, this article reports on the differences in the entrepreneurial attitudes of push and pull and the aptitudes of social and human capital between pre 2000 and post 2000 immigrant entrepreneurs. The findings suggest that the post 2000 Indian migrant entrepreneurs in Australia are mostly pull motivated, have higher qualifications than the pre 2000 arrivals, speak better English, have professional educational qualifications relevant to their business, and operate predominantly in the service sector. They take fewer years to get into business and are less dependent on immigrant social capital resources than pre 2000 arrivals. The study proposes that, compared with social capital resources, human capital resource have a greater impact on entrepreneurial propensity in the case of second generation Indian migrant entrepreneurs in Australia.

Policy Implications

• This research has implication for Australian immigration policy, labour laws and settlement services of migrants. It recommends successful implementation of policies and durable solutions for Indian immigrants in the labour market in Australia.
• The Australian Government will be assisted in examining and identifying future options for the intake of temporary and permanent migrants that improve the income, wealth and living standards of Australian citizens, improve the budgets and balance sheets of Australian governments, minimize administration and compliance costs associated with immigration, and provide pathways both for Australian citizens to be altruistic towards foreigners, and for Australia's international responsibilities and obligations to foreign residents to be met. Improvements in the labour laws would promote the effective integration of Indian immigrants into society.
• Further, Indians in the USA have contributed immensely to the entrepreneurial spirit due to the government support for migrant SMEs and the small business venture funds. The Australian government can replicate this policy, reduce restriction on employment opportunities and enhance entrepreneurship for all migrants.

     

Second‐Generation “Return” to Greece: New Dynamics of Transnationalism and Integration

Based on in‐depth narrative interviews with 64 second‐generation Greek‐Germans and Greek‐Americans who have “returned” to Greece, this article explores intersections between return, transnationalism and integration. Having grown up with a strong Greek identity in the diaspora, second‐generation “returnees” move to Greece mainly for idealistic, lifestyle and life‐stage reasons. However, most find living in Greece long‐term a challenging experience: they remark on the corruption and chaos of Greek life, and are surprised at the high level of xenophobia in Greek society, not only towards foreign immigrants but also towards themselves as “hyphenated Greeks”. The “return” to Greece provokes new “reverse” transnational links back to their birth country, where they still need to keep in touch with relatives and friends, including caring obligations towards parents who remain abroad. Some contemplate another “return”, back to the US or Germany.

Policy Implications

• Policymakers responsible for integration should not assume that the second generation has no connections with its parents' country of origin.
• In the diasporic home country (in this case Greece), more effort should be made to facilitate the reintegration of the second generation returning ‘home’ and to break down discrimination towards hyphenated Greeks.
• Greek policymakers should pay heed to homecoming second‐generation Greeks in order to benefit from their bicultural insights into how Greek society can be improved, especially as regards efficient public services, transparent employment opportunities, better environment management, gender equality, and the elimination of racism and discrimination.

     

Working for Legality: Employment and Migrant Regularization in Europe

Recent programs to regularize undocumented migrants suggest the increasing role of employment as a requirement for foreigners to legally reside in Europe. Taking as illustrations the cases of Spain, France, Austria, Belgium and Germany, this article examines how regularization policies frame work. Employment provisions follow a civic‐performance frame that breaks with the criterion of vulnerability. While secure forms of employment paying standard wages are privileged, the crisis has made such jobs even less accessible to migrants seeking to regularize or maintain their status. Residence permits granted through legalization have become increasingly temporary and conditional, often involving repeated transitions in and out of illegality. A vicious circle of “disintegration” thus threatens to set in where employment precariousness becomes both the source and the consequence of legal precariousness.

Policy Implications

• The article shows how employment provisions are tightly linked to policies of “earned legalization”.
• The article shows that employment can be part of a broader regularization policy emphasizing ties to the host country.
• The article brings attention to potential conflicts between access requirements based on migrant vulnerability, and those based on migrant integration.
• The article warns against the exclusionary workings of employment‐based regularization in times of economic downturn.

     

“He invited me and didn't ask anything in return” Migration and Mobility as Vulnerabilities for Sexual Exploitation among Female Adolescents in Mexico

Although human trafficking is recognized as a major human rights violation, there is limited evidence regarding the vulnerabilities that contribute to female adolescents’ risk of being forced or coerced into the sex trade. Vulnerabilities such as gender‐based violence, economic and social inequalities have been shown to shape the risk of sexual exploitation among adolescents. In‐depth interviews (n=18) with current sex workers who reported being deceived or forced into the sex trade as adolescents (<17 years old) were analysed to explore their experiences of migration and mobility in Mexico. Driven by socio‐economic and vulnerabilities in home communities, adolescents often engaged in internal migration and mobility to other Mexican communities and states. Migration and mobility further predisposed them to social isolation, economic hardship and abuse, which were used as tools to trick them into the sex trade. Policies that support safer migration for adolescents in origin, transit, and destination communities are needed.     

The Occupational Integration of Male Migrants in Western European Countries: Assimilation or Persistent Disadvantage?

This paper looks at the migrants' occupational integration process. Two main theoretical perspectives are tested: the first one (assimilation view) claims that in the short‐run migrants are penalized, but as they settle in the receiving country they get integrated into the host society; the second one (segmented assimilation view) claims that disadvantages persist in the long‐run. EU‐LFS and ESS data are described and modelled, in order to compare the labour market performances of migrants in four European old‐receiving countries (Germany, France, Great Britain and Sweden) and in two new‐receiving countries (Spain and Italy) both in a short‐term and in a long‐run perspective. We find that a) in the short‐run, migrants' labour market condition is worst with respect to the natives; b) this gap decreases with older migrants; c) the ethnic penalty disappears with the second generation, when they achieve a level of education comparable to that of the natives.

Policy Implications

• Labour market policies appear to face a trade‐off: policies oriented towards the flexibilization could improve migrants’ occupational integration, but such policies are also likely to increase the risk of poverty for the natives.
• In the case of the Southern new‐receiving countries, a similar tradeoff could emerge for policies aiming at stopping the underground economy.
• Concerning integration in the long run, our results definitely point to the importance of education. We would suggest policies oriented towards a full educational integration of the migrants’ offspring, since such policies could eliminate the gap separating them from the natives.

     

Empowered Wives and Frustrated Husbands: Nursing,Gender and Migrant Nepali in the UK

Since 2000, increasing numbers of Nepali nurses have crossed national borders to participate in the global healthcare market. The most common destination countries are the UK, US, Australia and New Zealand. In particular, educated middle‐class women are attracted to nursing with the full support of their families. There have been profound changes in women's position in Nepali society. As a female only profession in Nepal, nursing provides an excellent focus on how and why these changes have occurred. Based on a multi‐sited ethnography, including in‐depth interviews with nurses and their families, conducted in Nepal and the UK from 2006–2008, this article discusses the changing nursing profession within the broader context of gender dynamics. Between 2000 and 2008, around 1000 Nepali nurses migrated to the UK. International nurse migration hugely affects nurses' immediate family dynamics. This article illustrates how migrant nurses' husbands have to accept a compromised social position, from being family bread‐winners in Nepal to dependent husbands in the UK .

Policy Implications

• Since the late 1990s, a new women‐migration phenomenon has emerged in Nepal. The Nepal government's current women migration policy has created a serious controversy, which requires urgent policy attention.
• Because of British work permit regulations, Nepali nurses migrate to the UK on their own. Typically the UK government gives little consideration to how its international nurse recruitment practices and work permit policy affects migrants' family life. There is a need for a family‐friendly immigration policy.
• Female / nurse migration has a profound impact on nurses' families' lives in the UK. This area requires further enquiry.

     

Dancing Across Borders: ‘Exotic Dancers,’ Trafficking,and Canadian Immigration Policy

This article analyzes a Canadian immigration program that authorizes issuance of temporary work visas to ‘exotic dancers.’ In response to public criticism that the government was thereby implicated in the transnational trafficking of women into sexual exploitation, Citizenship and Immigration Canada retained the visa program de jure but eliminated it de facto. Using a legal and discursive analysis that focuses on the production of female labor migrants variously as workers, as criminals and as bearers of human rights, the article argues that the incoherence of Canadian policy can only be rendered intelligible when refracted through these different lenses. The article concludes by considering policy options available to the state in addressing the issue.     

Immigration and the Czech Republic (with a Special Focus on the Foreign Labor Force)1

This article presents an overview of international migration in the Czech Republic, with a special focus on labor immigration. Currently, the Czech Republic is an immigration and transit country. The most important immigratory segment — economic immigrants — create a colorfulmosaic of various ethnicities (80% of them from Europe), each group with their own different economic strategy and niche. After sketching historical patterns and data problems, the focus is on the current situation of labor migrants in the country. A number of issues are addressed: e.g., the relationship between immigrant inflows and the economic situation of the country; immigrants' regional concentration/deconcentration processes; the popularity of the capital city of Prague and western regions vis‐á‐vis eastern ones; and the different structural backgrounds of immigrants coming from the East versus the West. Special attention is placed on undocumentedlillegal immigration, mainly in relation to the misuse and evasion of immigration legislation. Finally, the immature Czech migration policies and practices are discussed, as are needed policy improvements and the need for new immigration legislation. It is clear that the major trend over time leads to more restrictive migratory policies, in line with efforts to harmonize Czech migratory policies and practices with those of the European Union (EU).     

Turkey's Response to Sex Trafficking of Migrant Women: Is It Efficient Enough?

Human trafficking for sexual exploitation is a serious problem affecting especially women and children. Turkey has been particularly affected by sex trafficking because of the large numbers of female migrants that it receives. This article aims to critically assess the effectiveness of Turkey's current policies against sex trafficking using a feminist theoretical perspective with a particular focus on migrant women. To this end, the scope of the problem in Turkey, the supply and demand sides of sex trafficking, and the existing policies are discussed. Sex trafficking is examined at the intersection of Turkey's migration and prostitution regimes. It is argued that Turkey's response to sex trafficking has been inefficient because it currently focuses only on the economic supply side of the problem, ignoring the patriarchal demand side of it. The article concludes with a discussion of policy recommendations for Turkey that could help reduce sex trafficking in this country.     

What Can Migration Policymakers Learn From Legal Frameworks on National Minorities? National Minorities and Migration in Armenia and Belarus

The dissolution of the USSR resulted in massive depopulation of the republics and unprecedented migration flows, including national minorities. Citizens of a once indivisible country were suddenly divided into “those of our kind” (natives) and “outsiders” (national minorities/ immigrants). The latter were often not guaranteed citizenship and were denied basic rights. Many national minorities became forced migrants and refugees, leaving neighbouring states because of discrimination or fearing violence. This article focuses primarily on the interconnection of minority and migration issues, two topics which are often discussed separately. It investigates the interrelation between migration and the minority regimes adopted by Armenia and Belarus, and the extent to which certain policies and rights for national minorities can be meaningfully extended to new migrant minorities. It also asks what lessons can be learnt from the treatment of national minorities as far as future migration legislation is concerned.

Policy Implications

• Migrants' participation policy is always based on implicit political models of participation that should always be made explicit and examined before implementation.
• There is always a plurality of political preferences, for different models of participation in the migrant population, that should be explored and accommodated.
• The number of associations in existence should not be used as an indicator of a strong civil society as much as it is at present.

     

“Those who come to do harm”: The Framings of Immigration Problems in Costa Rican Immigration Law

This article examines the political rationales at work behind the particularly repressive 2006 Costa Rican immigration law and subsequent immigration reform process and resulting 2010 law through an analysis of two rival framings of immigration in Costa Rica. First, I examine how the rushed nature of the 2006 law constructed a crisis in which migrants, particularly Nicaraguans, represented urgent threats to national security. Next, I examine the 2010 law that emerged from the reform process and the alternative framings of immigration as an issue of human rights and integration that migration advocates contributed to the new law. I argue that the juxtaposition of integration and security frameworks in the new law reinforces the law's most repressive measures, contributing to an overall project of securitization and marginalization of immigrants.