3.4 The Physical Consequences of Captivity The majority of victims of trafficking in the care of HBF have been held in total physical captivity by traffickers at some stage, for days, weeks, months, or in some cases, years without being able to venture outside. They may have been held in vehicles, rooms of houses, flats and other accommodation, factories or warehouses. HBF clinicians have assisted a number of people who have been kept captive in windowless rooms for several years without release. Various physical and psychological methods are used by traffickers to maintain victims in captivity. These include: – Physical restriction of movement or locked doors. – Threats of reprisals against the victim or their family if they attempt to leave or escape. – Psychological entrapment through debt bondage and/or manipulation of relationships. – Threats to report victims to the immigration authorities and police who they say will arrest/detain and deport them. – Manipulation of victims by warning them that they risk arrest if they are found outside the trafficker’s premises. – Degrading the victim to a level of passivity such that the trafficker may exert even greater psychological control over them. This state may cease when the abuse becomes too severe, or some other circumstance changes, so as to re-awaken ideas of escape.41 For example, women whose children are threatened with violence or who become pregnant may become more focused on escape; women and men in all forms of exploitation may witness incidents of extreme violence that cause them to fear for their own survival and trigger plans for escape. As can be seen in the list above, physical control is not always necessary to maintain victims of trafficking in confinement. Some feel forced to remain in intolerable conditions 41 - 64 for long periods of time without being physically confined or injured. This may be due, for example, to traffickers’ psychological manipulation of emotions/relationships, control through the concept of “debt bondage” or psychological entrapment within exploitative work. Sanctions imposed or threatened by traffickers can operate on a purely psychological level, manipulating victims’ reasonable fears of being destitute, detained, criminalized, returned to their country of origin or pursued by traffickers. Juju threats are also an effective tool which are used to maintain victims in captivity. Environmental conditions Within the sex industry, maintaining an appearance of sanitary conditions is often an important aspect of attracting and retaining customers of prostitutes. Therefore bed sheets may be changed regularly and en suite bathrooms provided in locations where victims of trafficking for sexual exploitation are held in physical captivity. However HBF is also aware of some cases of sexual exploitation in which victims have been held in squalid and unhygienic environments. Men and women who are held in forced labour exploitation and live at their working site or in other accommodation provided by traffickers may experience unsanitary, damp conditions, lacking natural light and fresh air/ventilation. Some victims who are exploited in construction work or car wash labour have described being destitute and forced to live on the streets or in vehicles. People who are held in domestic servitude commonly suffer working conditions which are sub-standard and break the law on minimum requirements for live-in staff. The overcrowded nature of some accommodation and lack of access to basic medical services can lead to the risk of infectious diseases such as tuberculosis, measles and scabies. The combination of lack of access to appropriate healthcare services as well as specific problems related to being held in damp and/or unsanitary conditions, can lead to the onset and exacerbation of infections, for example chest conditions, wound infections and gastro-intestinal infections. Victims who are restricted to confined spaces may also suffer back and joint pains, lethargy, weakness, poor appetite and weight loss or gain following escape from their captivity. Any pre-existing medical problems may also be exacerbated. Lacking sunlight on the skin as a result of being kept indoors can lead to vitamin D deficiency and osteomalacia, a severe form of vitamin D deficiency which results in bone and muscle pain. The consequences of vitamin D deficiency