The Complexity of Head Injuries Kara fled her African country due to persecution of her family and threats to herself. A friend of her mother’s organized for her to work for a family in a Middle Eastern country as a domestic worker through an agent who provided her with a passport. However she was subjected to prolonged physical, psychological and sexual abuse. The physical abuse included being beaten, grabbed by the hair and having her head hit against a wall. She reported several episodes of loss of consciousness during this period. She escaped this family when they took her with them to the United Kingdom where this abuse continued. She managed to escape and sought asylum. When she sought medical help it was apparent she had several neurological issues that were difficult to diagnose. She was in a severely distressed psychological state and would sit with her head in her hands rocking backwards and forwards. She complained of headaches constantly, which did not respond to simple analgesia. It was difficult to explore her exact symptoms as she was usually so distressed and tearful. It took months to diagnose the different kinds of headaches that she was experiencing, each of which would require specific treatments. She was having episodes of migrainous headaches with specific neurological symptoms including giddiness, blurred vision and photophobia. Added to these episodes, she had a constant background tension headache which always worsened at times of stress. She was finally treated with specific anti-migraine medication and general strong analgesia. The migraines were helped by treatment but the constant, background headaches did not improve significantly until her stressful circumstances reduced years later. because they do not properly remember it, do not feel it is significant, or they may only recall the state of temporary unconsciousness as a pause or relief from their suffering. 3.3 Pain Symptoms Victims can suffer enduring pain from violence inflicted by traffickers, and from work in exploitation. It is common for people who have been trafficked to complain of pain from specific injuries, but also of pain that is more generalized. Aches and pains all over the body may not have one identifiable cause because injuries are frequently multiple in both cause and effect. At the same time, pain may also be “psychosomatic” i.e. a physical expression of psychological pain. A study of women 207 women from 14 countries who had been recently released from a trafficking situation37 found that the physical sites of women’s injuries spanned their entire bodies and included: head, face, mouth, nose, eyes, back, neck, spine, legs, hands, feet, kidneys, pelvis, abdo- In addition to her headaches, she was also complaining of episodes of giddiness, where she would “fall over and not know what was happening to her”. Eventually, it was recognized that she was having periods of loss of consciousness. On one occasion she had fallen downstairs and fractured her elbow. She was referred to a neurologist due to the possibility of post-traumatic epilepsy and was started on anticonvulsant therapy. This was also a difficult diagnosis to establish as some of the symptoms she experienced during these episodes were similar to those she experienced during a migrainous attack. However, the anti-convulsant therapy lessened the frequency of the episodes of loss of consciousness. Source: men, and the genital area. A 2010 USAID report 38 documents male victims of trafficking in many countries suffering workplace injuries and medical problems. Results of the USAID study in Ukraine of 73 male victims of trafficking showed that 71% had gastrointestinal disorders, 56% had “nervous breakdowns,” 26% had problems with their spines, 21% kidney diseases, 16% respiratory disorders, and 14% dental problems. 6% acquired permanent disabilities as a result of their exploitation abroad. All of them attributed their medical problems directly to the working and living conditions they experienced while trafficked. Victims of trafficking often suffer chronic or prolonged sleep loss which weakens the body’s immune system and their ability to endure pain. Cumulative pain Clinicians frequently find that people who have been trafficked have suffered various forms of violence and injury from childhood. Their consequent pain can therefore be Trafficking of men in the Europe and Eurasia region 62