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June 6th, 2025
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That night, Mia* dragged herself to the emergency room, hoping for care. For six endless hours, she sat slumped in the waiting area, catching snippets of whispered conversations from behind the nurses' station.
She watched them glance her way with thinly veiled contempt, one nurse murmuring to another, "You know… she looks like she deserved it."
In that moment, the pain of their dismissal cut deeper than any of her injuries, and she realized she was alone in more ways than one.
Mia's story reflects a troubling reality across healthcare settings worldwide.
Healthcare professionals have likely encountered individuals experiencing human trafficking without realizing it. Although 88% of survivors report interacting with healthcare providers during their exploitation, only 6% of healthcare workers say they’ve knowingly treated a trafficked individual.
Despite how often trafficking intersects with the healthcare system just 5% of emergency room personnel have received training to recognize and respond to it. That gap often isn’t due to a lack of care, but rather a lack of awareness and tools.
Learning to spot the signs isn’t just helpful–it’s critical to providing trauma-informed care and potentially saving lives.
*Based on a true story
The medical community's understanding of trafficking survivors is evolving, but professionals have historically misunderstood this crime. Instead of recognizing someone in need of help, many providers stigmatized and judged these individuals for their situation.
“If two women walk into the ER with the same exact injuries, but one is wearing skimpy clothing, they should still get the same care. I wish they would have treated me with the same compassion as they often do with domestic violence or rape victims. I wish they would have asked me if I was safe.” — Robin, survivor leader and case manager1
Survivors have consistently reported painful interactions in healthcare settings–experiences marked by dismissal, blame or even mistreatment. One survivor shared, "After I escaped, I went with law enforcement to the ER. The treatment wasn't what I expected. It's not respecting us as human beings. The judgment. That you are a 'street girl.'"
These experiences show why it’s critical for health professionals to receive training that helps them recognize and challenge their own biases. Compassionate and nonjudgmental care can change everything.
But there’s reason to be hopeful. The first step–awareness–is gaining traction.
In 2014, there were just 340 views of the U.S. National Hotline’s training on spotting trafficking in clinical settings. By 2017, that number had soared to over 15,800. Healthcare worker calls to the National Hotline also jumped 171% between 2007 and 2017. These numbers show a clear shift: providers are not only becoming more aware, they’re starting to act.
Still, awareness alone isn’t enough. Recognizing the signs–and knowing what to do next– is complex, but essential.
No two cases are the same, and the signs can vary widely. Still, healthcare providers can watch for patterns–especially clusters of physical and psychological issues–that may point to trafficking.
Those who’ve experienced trafficking may face overlapping conditions: constant stress, sleep deprivation, hunger, hazards of travel, and physical and sexual violence. Inconsistent care and maintenance can also aggravate chronic conditions. These factors can lead to serious medical issues including multiple sexually transmitted infections, injuries from physical abuse, dental trauma, cigarette burns, or unsafe abortions.
The psychological toll is equally devastating. High rates of PTSD, depression, suicidal ideation, and substance use are common. And because many lack consistent access to healthcare, they may show up with advanced or untreated conditions.
One survivor recalls, "The only time I was ever admitted to the hospital, I had a UTI that got so bad that [...] I was actually two days away from kidney failure by the time I went in."
Recognizing the physical signs of trafficking is only part of the challenge. Complex trauma adds another layer, making patient interactions sometimes difficult to navigate.
One study found that those who’ve experienced trafficking are often more isolated, more fearful, and have deeper psychological wounds than other crime survivors. Providers reported that one patient in a trafficking situation could require the same time and attention as 20 domestic violence cases.
This level of trauma–rooted in prolonged, repeated abuse–can show up as extreme fear responses, distrust of authority, or learned helplessness. Survivors may seem evasive or uncooperative, but it’s not out of choice, but because survival depends on it.
Beyond the medical and psychological symptoms, providers may notice signs of control or coercion: a lack of personal identification or travel documents, an inability to speak without a third party present, being closely monitored or coached by someone else, or expressing uncertainty about their location or circumstances. Many are reluctant to share personal details for fear of judgment or retaliation.
Healthcare encounters are often fleeting—especially for people experiencing trafficking. In both Canada and the U.S., they might cycle through ERs, clinics, and urgent care settings without ever forming a lasting connection with a provider. In the U.S., inconsistent insurance coverage can be a barrier. In Canada, the lack of a family doctor, long ER wait times, and overburdened walk-in clinics can lead to delayed or fragmented care. Add fear of stigma, discrimination, or control by a third party, and many never return.
Even when someone does make it through the doors, trust takes time to build—and often there’s not enough opportunity. While some healthcare professionals report working with trafficked patients over the course of 12 months, these cases might not be the norm. Many providers may only get one opportunity to spot the signs and step in.
"I was in the hospital for female surgery,” one survivor shared. "[O]ne of my regulars called. I actually had to take out the IVs and leave the hospital, go visit my regular, collect that money, and my pimp was waiting for the money in the room when I got back. They had to hook me back up to everything and I ended up staying another 3-4 days. Nobody ever asked, 'Where did you go and why?' I went and had sex and I had just had female surgery."
In some cases, traffickers won’t even allow prescribed pain medication, because staying alert for buyers is more important than healing. The pressure to get back to work quickly, often under threat or coercion, forces people to make risky decisions that no one should have to make.
This highlights a critical gap in care, and in curiosity. Healthcare professionals must be alert to what isn’t said. Why is this person leaving early? Why aren’t they following medical advice? Who might be influencing their decisions?
Coercion doesn’t always announce itself. Sometimes, it slips out the hospital door without anyone asking why.
Even when the signs are visible, the presence of a trafficker can shut everything down. Disclosure becomes nearly impossible when someone else is answering questions, controlling the conversation, or waiting just outside Nearly half of trafficking survivors—47% —report being monitored in some way during healthcare visits.
Sometimes the trafficker is in the exam room, answering for the patient or hovering in the hallway. Other times, a "bottom" (someone still under a trafficker’s control but tasked with overseeing others) is sent to watch and report back.
Control doesn’t always require being physically present. One survivor recalled, “He or one of the girls sat in the parking lot and watched me go in and I better as hell be coming out. [...] There were cameras in the hospital [that he could access], is what I was told.”
Some people are told exactly what to say–and what will happen to them if they say the wrong thing. Even when providers ask the right questions, a truthful answer may not be possible.
"A doctor ask[ed] me, 'Your story doesn't make sense. What really happened to you?' when my trafficker was less than two feet away, glaring at me. I knew I would never be able to say anything, because if I did, there would be repercussions when I left."
In cases of familial trafficking, the red flags can be even harder to spot. When a parent or caregiver is involved or is the trafficker, their presence in the exam room often doesn’t raise suspicion. It looks normal, even expected. But the warning signs are still there.
"My bio father would often go with me to the doctor. He was standing right beside me when they were doing my pelvic exam as a teenager, making sure no conversation would take place. I was fully exposed. That's a definite red flag."
These dynamics create powerful barriers to disclosure. Recognizing the presence—or shadow—of a trafficker is critical.
Just as important is understanding how that control and manipulation show up in different ways, shaped by a person’s circumstances.
Motherhood can become one of the most insidious tools of control. Traffickers often exploit the powerful bond between mother and child with calculated cruelty, tightening their grip through threats, manipulation and fear.
"You always have this fear in the back of your mind that you are going to lose your children," -Robin, survivor leader and case manager.
That fear isn’t unfounded. Many mothers avoid discussing their exploitation, because they’re terrified that child protective services will take away their child. Traffickers take advantage of this fear–and the children themselves–to force compliance.
According to one study, 71% of trafficking victims had at least one pregnancy while being trafficked, with 21% reporting five or more pregnancies. Many of these pregnancies were the result of coercion or direct control by the trafficker.
The emotional manipulation is often reinforced with legal threats. Traffickers may be listed as the legal fathers, and use the possibility of custody battles or court action as ongoing intimidation and coercion. Even when survivors try to leave, the risk of losing their children or exposing them to further harm can be paralyzing.
Judges might overlook the coercive context and instead focus on outward signs of trauma like mental health challenges or substance use—symptoms of prolonged abuse that are often misunderstood in family court settings.
Barriers stack up when a mother has a criminal record, often from crimes committed under force or duress. Accessing housing becomes nearly impossible., Traffickers know this and exploit the instability. Children, already used as emotional leverage, become entangled in systems that too often punish survival.
Transgender individuals experience higher trafficking rates and a unique often overlooked set of barriers. Even without trafficking involved, many experience discrimination in healthcare. When combined with the stigma surrounding sexual exploitation, medical care becomes nearly inaccessible. Fear of being misgendered, judged, or ignored pushes many into silence or avoid care altogether.
People with disabilities are particularly at risk of trafficking, especially those with chronic health concerns or cognitive differences. Isolation, limited options, and systemic neglect create openings traffickers are quick to exploit. Some survivors are forced into exploitation while depending on their traffickers for basic needs like housing, transportation or even medication.
Recognizing these signs is just the first step in addressing human trafficking within healthcare settings. Medical professionals are an important,and sometimes one of the few, points of intervention and support. By understanding the complex trauma these individuals experience, the tactics traffickers use to control them, and the unique challenges of certain populations, healthcare providers can offer the informed, compassionate care that makes all the difference.
In our next blog post, we’ll provide a practical roadmap for healthcare providers: how to ask the right questions, navigate these complex situations, and connect patients with essential resources.
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