"Because if we talk about health issues first, it is easier to talk about human trafficking"; findings from a mixed methods study on health needs and service provision among migrant and trafficked fishermen in the Mekong

Prevalence of physical violence against people in insecure migration status: A systematic review and meta-analysis

OBJECTIVES

This study summarised evidence on the prevalence of interpersonal, community and state physical violence against people in insecure migration status.

METHODS

We conducted a systematic review and meta-analysis of primary studies that estimated prevalence of physical violence against a population in insecure migration status. We searched Embase, Social Policy and Practice, Political Science Complete, SocINDEX and Web of Science Social Sciences Citation Index for reports published from January 2000 until 31 May 2023. Study quality was assessed using an adapted version of the Joanna Briggs assessment tool for cross-sectional studies. Two reviewers carried out screening, data extraction, quality assessment and analysis. Meta-analysis was conducted in Stata 17, using a random effects model and several exploratory subgroup analyses.

RESULTS

We retrieved 999 reports and included 31 retrospective cross-sectional studies with 25,997 migrants in insecure status. The prevalence estimate of physical violence was 31.16% (95% CI 25.62-36.70, p < .00). There was no statistically significant difference in the estimates for prevalence of violence for men (35.30%, 95% CI 18.45-52.15, p < .00) and for women (27.78%, 95% CI 21.42-34.15, p < .00). The highest point estimate of prevalence of violence was where insecure status was related to employment (44.40%, 95% CI 18.24-70.57, p < .00), although there were no statistically significant difference in the subgroup analysis. The prevalence of violence for people in undocumented status was not significantly different (29.13%, 95% CI 19.86-38.41, p < .00) than that for refugees and asylum seekers (33.29%, 95% CI 20.99-45.59, p < .00). The prevalence of violence in Asia was 56.01% (95% CI 22.47-89.55, p < .00). Europe had the lowest point prevalence estimate (17.98%, 95% CI 7.36-28.61, p < .00), although the difference was not statistically significant. The prevalence estimate during the migration journey was 32.93% (95% CI 24.98-40.88, p < .00). Intimate partner violence attached to insecure status was estimated at 29.10%, (95% CI 8.37-49.84, p = .01), and state violence at 9.19% (95% CI 6.71-11.68, p < .00).

CONCLUSIONS

The prevalence of physical violence is a concern among people in a range of insecure migration statuses. Prevalence of violence is not meaningfully higher for people in undocumented status than for people in other types of insecure status.

REVIEW REGISTRATION

PROSPERO (CRD42021268772).

What is the Impact of Human Trafficking on the Biopsychosocial Health of Victims: A Systematic Review

The health consequences of human trafficking have been poorly researched compared to other aspects of this crime. A systematic review was carried out to study health from a broader perspective, beyond psychophysical symptoms, to understand the global impact of human trafficking on sexual, social, physical, and psychological health. The search identified many studies focused on the violence of sex trafficking in female samples. This work leads us to conclude that social health is an important dimension of the well-being of trafficking victims. More studies are needed on aspects of social health, especially regarding research gaps related to spirituality and nutrition, thus continuing preventing and combating human trafficking. Many gender biases were also discovered: unlike studies of trafficking in women, the few studies on men did not look at parenting, sexual health, marital status, or sex trafficking.

A Systematic Scoping Review on Migrant Health Coverage in Thailand

(1) Background: Thailand is a major migrant receiving country and pioneer of migrant health policy in the ASEAN region. However, on the ground, coverage of migrants is faced with multiple barriers. (2) Objectives: We aim to scope and analyse the types of available evidence on migrant health coverage in Thailand and identify knowledge gaps. Specifically, we characterise the literature along year of publication, migrant subpopulation, health domain, scope of coverage, methods, study design, objectives and results. (3) Methods: We searched PubMed, Web of Science, Google Scholar, Cochrane Database, Worldwide Science and the Asian Citation Index for peer-reviewed and grey literature in October 2021 for studies analysing original data on health coverage of migrants in Thailand. To conceptualise health coverage, we used the three dimensions availability, accessibility and acceptability. (4) Results: 101 articles were included in the final analysis. Sixty-three were published after 2016, 39 focused on migrant workers and 18 on migrants in general. Forty-two concentrated on health in broader terms, followed by reproductive and maternal health (n = 31). Thirty-eight assessed coverage of specific services and 36 health coverage in general. Migrants themselves and key informants were the main data sources in 80 and 43 of the articles, respectively. Forty publications were qualitative, while 38 applied quantitative methods (22% descriptive; 7% analytical). Among the health coverage components, 79 articles included aspects of accessibility, followed by acceptability (n = 59) and availability (n = 30). (5) Conclusions: While there is a high number and broad range of studies on migrant health coverage in Thailand, we found that research on migrant subgroups, such as victims of trafficking and migrant children, as well as on the health domains, non-communicable diseases and occupational and mental health is neglected.

Epidemiology of occupational hazards and injuries among fishermen at Tanji fishing site in The Gambia: an analytical cross-sectional study design

Fishing is a well-known industry, and there are certain risks of work-related diseases and accidents, occupational hazards and safety issues. This study aimed at examining the determinants of occupational hazards and injuries among fishermen at Tanji fishing site, a major fish-landing site in the Gambia, West Africa. An analytical cross-sectional design was conducted in August to October 2019. Structured questionnaires were administered to fishermen at Tanji fishing site. A simple random sampling method was used to select fishermen in this study. Data entry and processing for preliminary data analysis was done using Stata version 15. Descriptive and bivariate analysis using chi-square/fisher exact test as well as binary logistics regression analysis were used. The adjusted risk ratios (aRRs) and confidence intervals of 95% were calculated. A P-value < .05 was considered for statistical significance. The proportion of occupational hazards were 95%, while reported injuries were 85%. Ergonomics, physical, and environmental/climatic hazards formed the majority at 25%, 23%, and, 21%, while muscle strains and falling formed the majority for types of injuries at 19% and 17%, respectively. Fishermen who used PPE (aRR: 0.12and 95% CI: 0.01-0.99) were less likely to have occupational hazards relative to those who did not use PPE. In terms of injuries, fishermen who were smokers (aRR: 3.18, 95% CI: 1.32-7.66), had chemical hazards (aRR: 3.14, 95% CI: 1.26-7.86) and had no fishing safety rules (aRR: 2.81, 95% CI: 1.15-6.85) were more likely to sustained injuries relative to other categories after controlling for confounders. This research found a high prevalence of OSH hazards and injuries among fishermen, highlighting the critical nature of strengthening safety regulatory services for this workforce.

"It takes a community to save a child": Child trafficking knowledge of the Portuguese community

This study aims to explore the knowledge of the Portuguese community on child trafficking. Through an online inventory, with a sample of 492 community members, with a mean age of 40.53 and mostly female (70.7%), participants were more knowledgeable about forms of exploitation, risk and vulnerability factors, the profile of the victims, and the situation in Portugal about child trafficking. On the contrary, they were less knowledgeable about the dynamics of child trafficking. Having a college education, and contacting with the subject through informal or/and formal sources were predictors of a higher level of knowledge of child trafficking. This study reinforces the importance of the community as a whole in fighting child trafficking. To protect children against child trafficking, public policies should prioritize the role of the community. An empowered community can actively contribute to the prevention, signaling, and (re)integration of victims of child trafficking.

Practitioner Experiences Responding to Suicide Risk for Survivors of Human Trafficking in the Philippines

Human trafficking survivors experience elevated suicide risk in comparison to the general population. Anti-trafficking service providers in the Philippines have identified capacity building in suicide prevention as a critical priority given the insufficient number of trained mental health professionals and lack of culturally adapted evidence-based interventions in the Philippines. We conducted a focused ethnography exploring the experiences of non-mental health professionals working in the anti-human trafficking sector in the Philippines in responding to suicidality among survivors of human trafficking (n = 20). Themes included: emotional burden on service providers, manifestations of stigma regarding suicide, lack of clarity regarding risk assessment, lack of mental health services and support systems, transferring responsibility to other providers, and the need for training, supervision, and organizational systems. We discuss implications for training service providers in the anti-human trafficking sector, as well as cultural adaptation of suicide prevention interventions with human trafficking survivors in the Philippines.

Victims or suspects? Identifying and assisting potentially trafficked fishermen: A qualitative study with stakeholders and first responders in Thailand

Prompted by reports of 'sea slavery' in the fishing industry and threats of sanctions, Thailand has faced pressure to eradicate human trafficking the fishing sector. Although the Thai government has responded with anti-trafficking policies, there remains little understanding about their implementation. Specifically, little is known about how government agencies, NGOs or industry perceive "trafficking", and no research examines how trafficked fishermen are identified and assisted. This study aimed to: 1) explore how stakeholders described trafficking in the fishing sector and their perceptions of trafficking indicators; and 2) identify challenges encountered by frontline responders to identify and assist trafficked fishermen. We conducted interviews with 33 key informants, which were analysed thematically. Findings indicate that authorities and industry representatives believed migrant brokers caused employers to "inadvertently" traffic men. Trafficking was perceived to take place primarily outside of Thai waters, beyond the government's jurisdiction. Most stakeholders considered violence and being confined as key indicators of trafficking. Officials expressed confusion about whether debt bondage and document confiscation "counted" as indicators. Ambiguity and confusion about trafficking indicators in screening forms, combined with perceived "deservingness" of official victim status, underpinned frontline responders' decisions about who was a victim of trafficking (VoT). Practical and structural constraints included interpreter shortages, and expanded civil servant remits without commensurate staff increases, which hindered officials' responses to trafficking. This study addresses a critical knowledge gap on the implementation of anti-trafficking policies and offers findings to assist policymakers to address the challenges faced by frontline responders to improve victim identification and assistance.

Mental health of adolescents in Myanmar: A systematic review of prevalence, determinants and interventions

Adolescence is a developmental phase where mental disorders typically manifest and where platforms for response (including schools and health services) change rapidly. However, data to inform public mental health responses are limited, including in countries like Myanmar which has a large adolescent population and where mental health has been identified as a priority of policy. In this paper we sought to systematically review the peer-reviewed and grey literature to determine (i) the prevalence of mental disorder among adolescents in Myanmar, (ii) determinants of mental disorder and (iii) interventions that have been implemented and evaluated. Nine publications met inclusion criteria (7 peer-reviewed and 2 grey literature) that included 7 publications reporting prevalence, 6 reporting correlates and one an intervention. The available data from the 2016 Global School-based Health Survey highlight that depression (27.2%) and suicidal ideation (9.4%) are prevalent in Myanmar, and these rates are substantially higher than regional averages. The limited available data on correlates identified violence and bullying, alcohol and substance use, and home, family and community security and cohesion as being closely related to mental health for adolescents. Only one study focussed on interventions and this found mindfulness meditation training to be an effective approach for young people whose parents were affected by HIV. These findings underscore the need to address adolescent mental health in Myanmar, but also to invest in better data collection efforts.

Human Trafficking of Children

Human trafficking has been increasingly recognized worldwide as a major public health problem. It is a crime based on exploitation of the most vulnerable and marginalized people of any community and is a violation of human rights. Children, especially immigrant and refugee children, are at risk of victimization and may experience considerable physical and mental health consequences. Adding these problems to pre-existing vulnerabilities and adversities makes human trafficking a complex health issue that needs to be addressed by a multidisciplinary team that includes health care providers. This article aims to provide an overview of human trafficking and the red flags that may alert the pediatrician to the possibility of exploitation, with a special focus on immigrant and refugee children. It describes a trauma-informed, rights-based approach and discusses ways in which pediatricians can contribute to a multidisciplinary response to human trafficking. [Pediatr Ann. 2020;49(5):e209-e214.].

Systematic review of facilitators of, barriers to, and recommendations for healthcare services for child survivors of human trafficking globally

BACKGROUND

Child trafficking is associated with multiple physical and mental health problems, yet relatively little is known about the factors that facilitate or hamper delivery of high-quality health care services to trafficked children.

OBJECTIVE

To summarize information about identified facilitators of, barriers to, and recommendations for medical and mental health service provision to trafficked children.

PARTICIPANTS AND SETTING

A systematic review was conducted of the English-language, peer-reviewed literature on medical and mental healthcare of trafficked children published since 2010.

METHODS

Inclusion criteria were: (1) the study population or focus included, wholly or in part, individuals under the age of 18 years; (2) the study focus was clearly defined as human trafficking or commercial sexual exploitation; (3) a main focus included health services or barriers to care, and (4) the article contained original data.

RESULTS

Of the 29 articles meeting inclusion criteria, 19 included facilitators of health service provision to trafficked populations, 22 included barriers to that provision, and 25 included explicit recommendations for service improvement. 45 distinct facilitators were identified a total of 140 times, 118 distinct barriers were identified a total of 174 times, and 52 distinct recommendations were identified a total of 100 times. The majority of facilitators, barriers, and recommendations fell under the locus of the healthcare provider and healthcare organization.

CONCLUSIONS

Existing research reveals abundant areas of opportunity for healthcare professionals and healthcare administrators to improve access to, and quality of, medical and mental health care for trafficked children.