Intended for healthcare professionals

Education And Debate

Trafficking and health

BMJ 2004; 328 doi: (Published 03 June 2004) Cite this as: BMJ 2004;328:1369
  1. Joanna Busza, lecturer (,
  2. Sarah Castle, lecturer1,
  3. Aisse Diarra, independent consultant, Mali1
  1. 1Centre for Population Studies, London School of Hygiene and Tropical Medicine, London WC1B 3DP
  1. Correspondence to: Joanna Busza
  • Accepted 18 February 2004

Attempts to prevent trafficking are increasing the problems of those who migrate voluntarily

Trafficking in women and children is now recognised as a global public health issue as well as a violation of human rights. The UN Protocol to Prevent, Suppress, and Punish Trafficking in Persons, especially Women and Children states that trafficking involves force, threat, or fraud and intent to exploit individuals.1 Intermediaries often smuggle victims across international borders into illegal or unsafe occupations, including agriculture, construction, domestic labour, and sex work. A recent study identified trafficking to be associated with health risks such as psychological trauma, injuries from violence, sexually transmitted infections, HIV and AIDS, other adverse reproductive health outcomes, and substance misuse.2 These risks are shaped by lack of access to services in a foreign country, language barriers, isolation, and exploitative working conditions. However, as this article shows, efforts to reduce trafficking may be making conditions worse for voluntary migrants.

Response to trafficking

Multinational, governmental, and non-governmental groups working to counter trafficking sometimes misinterpret the cultural context in which migration occurs.3 They often seek to eradicate labour migration rather than target specific instances of exploitation and abuse.4 5Regulatory measures, such as introducing new requirements for documentation and strengthening of border controls, criminalise and marginalise all migrants, whether trafficked or not. This exacerbates their health risks and vulnerability by reducing access to appropriate services and social care. Such approaches do not adequately distinguish between forced and voluntary migrants, as it is extremely difficult to identify the motivations of migrants and their intermediaries before travel.6

We illustrate these concerns with evidence from research conducted among child migrants in Mali who had been returned from the Ivory Coast and Vietnamese sex workers in Cambodia. The evidence draws from studies conducted between 2000 and 2002.7 8 In …

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