beating, twisting limbs, bruising and superficial burns) may cause considerable pain without leaving any visible scars. 3.1.3 The Changing of Victims’ Physical Appearance Women and girls who have been trafficked for sexual exploitation may be dressed or presented by traffickers specifically for the purpose of passing easily through airport customs or for the most lucrative “sale” of their bodies. Therefore some trafficked women may appear to be well groomed, which can lead to the misperception by others that they are in control of their situation. For example, they may have had their hair braided or curled, their nails manicured and makeup applied which makes them appear older or more like a woman who is pictured in their passport photograph. HBF clinicians work with women who have had regular, supervised visits to tanning, nail and hairdressing salons, the payment for which may be added to the “debt payments” that they owe the trafficker. This ensures that their “debt” continues for longer and the control that the trafficker has over them is prolonged. but in cases in where it occurs, victims suffer physical and psychological effects which reflect the extreme subjugation and infringement of personal identity that such enforced procedures entail. Clinical notes on Asian women trafficked for sexual exploitation Jia was not told that the operation she would be having was a breast enlargement procedure. She suffers from recurring aches and pains in the chest area. She does not know what substance was used during this procedure and is concerned that it is unsafe and leaking. “They gave me injections to put me to sleep. They put something in my breasts to make them bigger. They used (tattooing) needles to make my lips redder. They also tattooed my eyebrows.” 3.1.4 Disfigurement: However, there is no typical appearance of women who have been trafficked for sexual exploitation. While some are forced to wear revealing and sexually suggestive clothes while they are “working”, others may appear to be conservatively dressed. Some women have been injured and disfigured or are older than the expected age demographic, but nonetheless continue to be held in sexual exploitation. Traffickers are also known to use disfigurement as a punishment, for example by branding, cutting or burning. Some victims of trafficking are controlled through the threat of disfigurement, for example of having their face cut with a knife or being burned with acid. In some cases clinicians have observed a distinctive pattern marked on a victim’s body with burns or cuts used as a form of branding.31 In HBF’s experience, changes of appearance controlled by traffickers may include: 3.1.5 Trafficking Cases in which there is no Evidence of Physical Injury – Deprivation of food, controlled food intake and supervised exercise in order to sustain a weight and muscle tone that customers of prostitutes perceive to be attractive. – Being dressed as sex objects and having pornographic photographs posted on the Internet. – Piercing of women’s ears and being forced to wear heavy earrings which enlarges the piercing. – Prolonged use of skin lightening agents which may be toxic or harmful. In some cases women have been left with extensive and disfiguring striae (stretch marks) as a result of the high steroid content of skin lightening treatment. Some traffickers go beyond control of victims’ clothing, hair and makeup and into the area of enforced cosmetic procedures such as breast enlargement and eyebrow and lip tattooing. This is not common among HBF’s client group, 60 HBF clinicians often observe and document trafficking cases in which a person has a long history of beatings to the body but does not have any scars which can be directly attributed to those beatings. Blows which do not penetrate the skin commonly leave only temporary bruising which heals without leaving a scar. The Istanbul Protocol states that “the absence of physical evidence should not be construed to suggest that torture did not occur, since such acts of violence against persons frequently leave no marks or permanent scars”. 32 Sometimes bruises do leave marks, but these may be difficult to notice and interpret, for example there may be a subtle pattern of hyper-pigmentation (darkening) of the skin which derives from the pattern of force caused during 31