Trafficking injuries observed at HBF include (but are not limited to): – Dental injuries from assault by traffickers and/or customers of prostitutes, for example, broken or missing teeth caused by punches to the face or blows to the side of the mouth. Injuries from punches to the jaw area can result in pain from contusions, fractures or dislocations to the mandible and/or the temporo-mandibular joint (the hinge joint between the temporal bone and the lower jaw) which can cause difficulties with opening the mouth and eating/drinking. – Beating (including kicking, pushing, slapping, punching or hitting) using hands and implements including a belt, stick, iron bar, cane, boots, whips, iron wire etc. This may result in abrasions, bruises, scars, fractures, tendon and ligament injuries, damage to internal organs and persistent, specific and generalized pain. – Stabbing and cutting with knives, broken crockery, or other implements; scratching with fingernails, which may leave scars. – Burning with cigarettes, scalding with hot liquids and branding with domestic irons and other implements, and chemical burns. These may leave scars, although superficial burns may heal without scarring. – Being tied with ropes, chains and/or handcuffs to force co-operation or to prevent escape. This may also be done to please a customer of prostitutes wishing to have sex with a person who is tied down/constrained. These restraints may result in scarring to the skin (e.g. around the wrists of forearms) and may cause persistent pain in the relevant joints. – Chili powder or other toxic substances rubbed into the eyes. HBF clinicians have recorded this as having been inflicted upon West African children who are held in domestic servitude. – Twisting ears or pulling hair/being pulled by the hair. – Being constricted or forced into positions that can result in musculo-skeletal damage and persistent pain. – Cosmetic ill-treatment such as enforced use of skin lightening cream which, if used excessively can cause disfiguring striae (stretch marks). Some 58 examples of enforced breast enlargement and tattooing of various parts of the body have been documented at HBF although these are not common among our client group. 3.1.1 Physical Injuries from Rape and Sexual Abuse Women and men who have been trafficked for sexual exploitation often suffer multiple rape and sexual abuse. Violence inflicted against male and female prostitutes by customers of prostitutes is common. Research shows that rape is the most common form of violence amongst prostitutes working indoors, whereas for women working on the streets, punches and other forms of physical attack are often the first forms of violence experienced.24 However, sexual exploitation is only one of the forms of trafficking in which men and women suffer rape. Women who are trafficked for domestic servitude and other forms of forced labour are known to suffer a high incidence of rape and sexual abuse.25 Clinicians also suspect that some men with whom they work have suffered rape on their trafficking journey or within forced labour situations, but feel unable to disclose it.26 Frequently it is found that trafficked women and men have also suffered rape or sexual abuse prior to being targeted for trafficking or during the journey to the destination country. An East African man who was trafficked for sexual exploitation From his time of arrival in the UK, John was kept by the trafficker in his house and remained under his control. The front door was always kept locked and after the first time he was sexually abused, he was locked into his room and only allowed out once a day to use the bathroom. He cannot remember the details of the first incident of abuse because he was drugged, but believes he was raped because of the pain he felt in his anus the next morning. British Medical Journal, Unprotected Work, Invisible Exploitation: Trafficking for the Purpose of Domestic Servitude, Of Human Bondage: Trafficking in women and contemporary slavery in the UK Working with Men and Boy Survivors of Sexual and Gender-based Violence in Forced Displacement Protocol - Medico-Legal Journal,