Trafficking in human beings must be officially recognized as a medical diagnosis

EEarlier this week, nearly 100 people were found trapped in a stuffy semi trailer in San Antonio, Texas. Ten have died and others are in critical condition. Many were sent to local hospitals for treatment of severe dehydration and shock, common medical conditions in the emergency department. What may not be so obvious to emergency physicians is that these people may be victims of human trafficking. As doctors who have treated and researched victims of human trafficking, we believe that this form of serious exploitation is under-recognized in healthcare settings and that lives are being lost as a result. of that.

the International Classification of Diseases (ICD) the codes are intended to describe diseases and the causes of death and disease. These codes, which are used for everything from hospital billing to research, establish the legitimacy of conditions that harm and kill people every day. As the World Health Organization prepares its 11th version of these codes, we urge that the “victim of human trafficking” be recognized as an official diagnosis.

To provide a broader context, CIM codes currently exist for such esoteric and rare phenomenon like “hit by a duck”, “sucked into the engine of an airplane” and “walking corpse syndrome”. Human trafficking is anything but esoteric and rare – by an estimate, 21 million people are victims.


The importance of including trafficking in human beings as a chargeable medical condition by including it in the ICD system of codes is part of a wider movement to present trafficking as a significant public health problem that affects millions of vulnerable people around the world. The harms of trafficking to human health are manifold, spanning several disciplines of medicine, including emergency medicine, internal medicine, obstetrics / gynecology, infectious diseases, pediatrics and psychiatry.

To classify trafficked persons solely on the basis of their medical symptoms would fail to identify the real cause of their ill health.


As physicians, we believe that the health care system has a vital role to play in identifying and healing victims of human trafficking. But for this we must recognize that trafficking in itself is a primary form of harm and must be defined as such.

There is precedent for including systemic violence in CIM codes. Examples include “abuse of adults and children”, “issues related to release from prison”, “family disruption through separation or divorce”, “victims of crime and terrorism” , and others.

The ICD codes would help track victims of human trafficking for the purposes of longitudinal clinical care and for research into health interventions and outcomes in this vulnerable population. It would also help provide data that can advise policymakers working to create laws that can reduce the incidence and health damage of trafficking.

The reporting of human trafficking in the United States has increased considerably, although the actual extent of trafficking remains unknown. The emergency department is often the only place where victims can be identified and helped, but it needs to happen more frequently. An important way to help identify victims of trafficking is for doctors to start thinking about trafficking as part of their work. medical differentials.

Screening for trafficking, like screening for intimate partner violence, involves recognizing a pattern of medical presentations resulting from exposure to physical and emotional trauma as well as signs of an abusive relationship. Victims can suffer serious injuries from assault, HIV and other sexually transmitted diseases, tuberculosis, pregnancy-related complications, post-traumatic stress disorder and major depression with suicidal thoughts.

These conditions linked to trafficking affect not only the victim, but also families, communities and populations. To effectively control and prevent damage, and to conduct essential public policies, we must understand the social factors that contribute to these conditions.

Beyond researching what a victim of trafficking might look like (there is no single profile), it is more important that physicians begin to include “trafficking” in their lexicon. They must learn to ask the right questions, read between the lines, and think beyond existing vital signs and ICD codes.

A formal approval from the World Health Organization by including “victim of human trafficking” in the CIM codes would be an important step forward to better prepare and equip our health system to take care of people currently. victims of trafficking or at high risk of being so.

Abraar Karan, MD, is a resident physician at Brigham and Women’s Hospital and Harvard Medical School and co-editor of “Protecting the health of the poor: social movements in the South. ” Hanni Stoklosa, MD, is an emergency physician at Brigham and Women’s Hospital, an emergency medicine instructor at Harvard Medical School, executive director of HEAL Trafficking and co-editor of “Human trafficking is a public health problem”. The opinions expressed in this article are solely those of the authors and do not reflect the views and opinions of Brigham and Women’s Hospital.

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