Table of Contents Acronyms 48 1 49 Introduction Part One Clinical Links Between Human Trafficking and Torture 2 Forms of Interpersonal Violence Suffered by Victims of Human Trafficking 2.1 2.2 2.2.1 2.2.2 Physical Violence Psychological Entrapment The Concept of Debt Bondage The Psychological Manipulation of Relationships 2.2.3 Juju Trafficking 3 Clinical Assessment of Physical and Psychological Injuries in Human Trafficking Cases 3.1 3.1.1 3.1.2 3.1.3 Physical Injuries Physical Injuries from Rape and Sexual Abuse Clinical Investigation of Lesions The Changing of Victims’ Physical Appearance 3.1.4 Disfigurement: 3.1.5 Trafficking Cases in which there is no Evidence of Physical Injury 3.1.6 Infliction of “Invisible” Injuries 3.2 Head Injuries 3.3 Pain Symptoms 3.4 The Physical Consequences of Captivity 4 4.1 4.2 4.3 Understanding the Psychological Impact of Trafficking Upon Victims’ Ability to Provide an Account of their Experiences The Enduring Threats of Traffickers Ritualised Violence, Subjugation and Threats in Juju Trafficking Cases Pre-existing Vulnerability of Victims. 46 53 4.4 The Psychological Impact of Deception by Traffickers 71 5 Psychological Trauma Symptoms 74 5.1 5.2 Dissociation Intrusive Symptoms: Thoughts, Memories, Flashbacks, and Panic Attacks Hyper-vigilance and Altered Arousal/ Perception Re-traumatization Low Self-esteem, Shame and Self-blame The Psychological Effects of Rape and Sexual Abuse Obstacles to Memory, Recall and Providing a Chronological Account Self-harm Suicidal Ideation Sleeping Disorders 75 5.3 53 53 54 54 55 55 5.4 5.5 5.6 5.7 5.8 5.9 5.10 6 57 57 58 59 6.1 6.2 Understanding the Significance of “Complex Trauma” for Victims of Human Trafficking Components of Trafficking-related Trauma Post Traumatic Stress Disorder: Diagnosis and Treatment Effective treatment for Victims of Trafficking who Suffer Complex Trauma 60 60 6.3 60 61 61 62 64 Part Two Here, and Now: Sustaining Victims of Human Trafficking from Referral to Recovery 7 66 7.1 7.2 7.3 66 7.4 68 69 Applying Therapeutic Principles to Contact Work with Clients Prioritising Practical Needs Provision of Medico-legal Reports Working with Victims who are Accompanied to Healthcare Services Working with Victims of Trafficking who have Forged Relationships with “Rescuers” or Partners 76 77 77 78 79 80 81 82 83 84 84 85 87 89 89 89 91 93 94