7.3 Working with Victims who are Accompanied to Healthcare Services HBF clinicians sometimes work with clients who have previously been accompanied to other healthcare services by their traffickers. This is usually because the trafficker wants them to have minimal treatment for medical problems which may obstruct or interfere with their productivity in exploitative work. In such cases the trafficker may pose as a close relative or friend of the victim. Clinical notes on a woman trafficked for domestic servitude The trafficker gave Sonya a false name at the hospital and instructed her to say that the injury (inflicted by the trafficker) was caused by an accidental fall onto a railing. The doctor was a little suspicious of the explanation and asked her if she wanted to talk to him alone. She declined because she was afraid that the trafficker would harm her family if she agreed to this or told the doctor the truth about her situation. She received treatment without anyone at the hospital realizing her situation. At a later point Sonya was taken by the same woman to see a doctor who did not make any enquiries about either the trafficker accompanying her, or her personal situation. The doctor removed glass from her skin and treated cuts from an assault that had caused her to fall backwards onto a window. Sonya returned to her situation in domestic servitude for another year before managing to escape. Sometimes victims of trafficking are accompanied by other people for their initial assessment at HBF. Therefore the clinician always collects the client from the waiting room. If the client is accompanied, the clinician will greet the person accompanying them and politely explain that they cannot attend the initial assessment because it is conducted on a one-to-one basis. It is always inappropriate for a friend or relative (who may turn out to be a trafficker) to act as an interpreter. During the initial assessment, it is useful to ask about the client’s journey that day and where they live. This general conversation helps the client to relax but may also provide the clinician with some information about who the person accompanying them might be, for example they may be described as their “boyfriend/friend/aunty” etc. Conversational, “open” questions about the relationship can then follow naturally, without causing anxiety for the client. This enables the clinician to carefully observe their reactions and responses. If the clinician suspects that the client is a minor and that they are at risk of harm from the person accompanying them, they have a legal duty under UK law to inform social services or the police.95 If there is any indication that the adult client is being controlled by the person accompanying them, or is trapped within an exploitative situation, it may be possible to discuss any alternatives and explain any assistance that may be provided to them. This will depend upon the nature of the trafficking exploitation suffered and the referrals to specialist NGOs/organizations that may be made. It is good practice to create a non-judgemental environment in which the client can think about their options and make decisions. The client should not feel pressured, otherwise there is a risk that they may not return after their first session. It is possible to follow similar techniques to those used when working with victims of domestic violence who feel unable to leave an abusive partner: – Provide the client with information that can keep them safe from being harmed.96 – Explain the meaning of “informed consent” and confirm that you will not take any action which is detrimental to the client.97 – Invite the client back for a further appointment so that you can maintain contact and build a relationship of trust When the client is ready, the clinician can suggest a practical plan. The clinician must be ready for any positive action that the client may wish to take to ensure other agencies are ready to provide necessary support such as housing providers, legal professionals and statutory bodies. It is essential to WHO ethical and safety recommendations for interviewing trafficked women, Victims of Trafficking Guidelines for HIV Testing Direct Assistance for UK National “An individual must be competent to consent and should understand the purpose, risks and benefits of ”. 93