Modern slavery is a serious and often hidden crime that encompasses slavery, servitude, forced and compulsory labour and human trafficking. Worldwide, it is estimated that 40.3 million people are victims of modern slavery (Unseen, 2019) and every fourth victim is a child (Home Office, 2014).
Within the UK, there were 8 536 potential victims of modern slavery in 2017, of which 37% were children (HM Government, 2019). In addition, referrals for minor exploitation categories increased 48% to 3 137 in 2018, compared to 2 118 in 2017 (National Crime Agency, 2018). Unfortunately, these figures only represent potential numbers, and the actual numbers are likely to be much higher. Slavery is a shocking crime and it is the responsibility of everyone to help identify and protect potential victims. Being aware of the signs to spot and reporting your suspicions may help ensure these victims receive the support they need.
Potential victims
Modern slavery victims can be any age, gender, ethnicity or nationality, although it tends to be more prevalent among the most vulnerable, and within minority or socially excluded groups. In 2018, the most common country of origin for adults was Albania and for child victims it was the UK (HM Government, 2019), with most of these victims being within the 16–17 age range. However, many who travel from abroad do so without any documentation or with false identity documents making it difficult to assess their actual age (Home Office, 2014). If the age of a victim is uncertain, they must be treated as a child until proven otherwise.
The different types of exploitation
There are different ways in which perpetrators may seek to exploit victims, including labour exploitation, sexual exploitation, criminal exploitation, domestic servitude and child slavery.
Labour exploitation
Labour exploitation is the most common exploitation type among both adults and children. It involves unacceptable low pay or no pay, excessive wage reductions or poor working conditions. Often victims are housed together in one dwelling. Common industries include construction, agriculture, manufacturing, car washes and beauty (nail bars).
Sexual exploitation
Sexual exploitation is the second most common type and usually affects female victims, although males may also be involved. They may be coerced into sex work or sexually abusive situations, forced prostitution or the production of images/videos (Home Office, 2014).
Criminal exploitation
Criminal exploitation involves the manipulation of a person to commit a crime for someone else's gain (e.g. shoplifting, entering a sham marriage, benefit fraud, begging, drug cultivation such as cannabis farming) (Home Office, 2017).
Domestic servitude
Domestic servitude often goes unnoticed as it typically involves victims working within a private family home performing domestic chores and childcare duties. They are subjected to unbearable working conditions, often sleeping where they work, while being made to work long hours for little or no pay, sometimes by their own family members or partners.
‘By recognising the signs of modern slavery and referring to specialist colleagues, school nurses can be at the forefront of this important campaign.’
Child slavery
Child slavery includes children forced to marry or serve in armed conflict, child labour and those exploited to make a profit (e.g. through violence, sexual exploitation, forced begging or county lines). It is widely reported that there are growing networks of exploitation across the country, both in rural areas and large urban conurbations.
Human trafficking
Human trafficking is the act of recruiting or transferring a person by means of coercion, abduction or deception for the purpose of exploitation. However, as a child cannot consent to being trafficked, they need only have been recruited, transported or received to be considered a victim of trafficking, without the act of coercion or deception. This exploitation may include any of the categories mentioned above, as well as forced marriage and forced organ removal.
In many of these situations, it is very difficult for the individual to leave due to the controlling behaviour of the perpetrator, including repeated threats, withholding their passport or identification documents, or using a position of power over the victim.
Signs of modern slavery
Many of the signs of modern slavery are like those of other types of abuse, and any of the presenting signs should encourage professionals to be vigilant:
- Signs of physical abuse (e.g. broken bones, burns, chronic pelvic pain, multiple STIs)
- Expression of fear or anxiety
- Neglect or psychological trauma
- Old or untreated injuries
- Substance misuse
- Unwanted/underage pregnancy
- Limited access to hygiene facilities.
Victims may have no passport or identification document, be unaware of their own home or work address, have moved frequently and are not registered with a GP.
Child victims can be poor school attendees, they may frequently go missing, and be ambiguous about their age or relationship with accompanying adults (Royal College of Nursing, 2017). They may also have access to money and goods inconsistent with their age.
Victims of modern slavery may present with a wide variety of physical symptoms such as injuries from assault or controlling measures, fatigue, skin problems, musculoskeletal and abdominal pains and neurological symptoms (e.g. headaches, dizziness, memory loss) (Gibson, 2018). Victims are also at a higher rate of mental health issues including deliberate self-harm, anxiety, depression and post-traumatic stress disorder (Ottisova et al, 2016). It is therefore important that when an individual presents to a health professional or an emergency department on a frequent basis, their presentation is looked at within the context of all attendances not just the presenting one, especially if they appear fearful or are accompanied by someone who seems to have some form of control over them, for example, speaking for them or refusing to leave. School nurses can discuss frequent attenders with other professionals and ensure that all staff are looking out for signs that a child may be being exploited.
Adverse childhood experiences (ACEs) is a term used to describe all types of abuse or potentially traumatic experiences that occur in young people (Centers for Disease Control and Prevention, n.d.). Modern Slavery and the exploitation involved is undoubtedly an ACE and can affect the growth and development of a child. Consequently, the abuse inflicted on these victims can result in increased chronic health conditions and risky health behaviours in later life. By helping to identify these individuals, school nurses can have a lasting impact on the health and wellbeing of these vulnerable young people.
What is currently being done in the UK
The ‘Modern Slavery Campaign’ is a UK national campaign aimed at helping end Modern Slavery (Home Office, 2014). As part of this campaign, the Modern Slavery Helpline was established to encourage the public, frontline workers, businesses and potential victims to report their suspicions and obtain appropriate advice and support. The Home Office has produced a variety of educational tools to provide more information including videos, posters and leaflets (Home Office, 2017).
Further support is available to victims via the National Referral Mechanism. This was developed in 2009 and is the UK's framework for identifying victims of modern slavery. Via this mechanism, the Salvation Army provides at least 45 days of supported recovery, including accommodation and access to medical and legal services for victims.
Moreover, in 2015 the UK government passed the Modern Slavery Act. Under this UK legislation, all modern slavery offences are punishable by a maximum sentence of life imprisonment. By introducing this law, the Government enhanced the protection and support for victims of Modern Slavery and increased the sanctions available to law enforcement agencies working to prevent this crime.
School nurses' role
School nurses should be vigilant and aware of the signs of modern slavery. If you are concerned that a child is at risk of, or is suffering from significant harm, then local safeguarding procedures must be followed. Child trafficking and exploitation is child abuse and should be dealt with immediately as a child protection matter, with the involvement of police and local authority children's services (Home Office, 2014). It is vital that modern slavery and human trafficking forms part of your mandatory safeguarding training.
As a school nurse, consider for a moment what it must be like to be trafficked or controlled, to have no choice, to feel hungry, dirty and to be violated sexually. A moment's reflection may help to put into context the child or young person that you are seeing. These children need to develop a trustworthy relationship in which they can feel safe enough to disclose. This is against a background of being told by perpetrators to trust no-one and that any attempt to leave could bring harm to themselves or their families. It therefore makes sense that in a fleeting contact they will deny everything. As a result, it may require time for the child to develop a relationship where they feel confident to confide in you. If you do have concerns about a child, you should discuss this during safeguarding supervision and jointly agree what actions should be taken. Furthermore, it may not be the child themselves that is being exploited, but rather another member of their family and thus making assumptions is not helpful.
The majority of children exploited will not attend any form of education and so your role may simply include raising awareness to ensure others know the signs to look out for. School nurses have an important role in educating other colleagues and communities about modern slavery. Everyone has a responsibility to protect children from significant harm and you can help raise awareness. School nurses could share information with parents at parents evening and have display boards in school detailing national and local information on whom to contact if suspicions are raised. School children should be encouraged to be vigilant in their communities and to raise concerns if they are worried about those working in nail bars, car washes, fruit picking or generally in agricultural settings, as this may all help to identify victims. Identifying and supporting just one victim may in turn help to discover a wider network of slavery in local areas.
Conclusions
Modern slavery has received considerable attention in recent years and is undoubtedly an important public health issue. Every year since the introduction of the Modern Slavery Act, more and more potential victims are emerging and obtaining the support they need. Within the health sector, new guidance and training are emerging for healthcare professionals on how to identify and support victims (Royal College of Nursing, 2017, e-Learning for Healthcare, 2019). School nurses play a vital role by looking after and protecting vulnerable young people. By recognising the signs of modern slavery and referring to specialist colleagues, school nurses can be at the forefront of this important campaign.
FURTHER INFORMATION
Home Office
Modern slavery – Statutory guidance: https://bit.ly/2LivOhK
Promotional material: https://bit.ly/3fxxUbo
Unseen
https://www.unseenuk.org