The level of victims’ knowledge and education also relates to their vulnerability. Some victims in the care of HBF are educated to secondary level, university or higher. However, many are illiterate or educated to primary level only. This fits a general pattern of relatively higher risk of trafficking among those who are poor and whose families may not be able to afford to keep them, who may not be able to make a living, who may not have fathers or familial protection. Some victims we work with have been raised from childhood in domestic servitude or sexual exploitation and have never had access to education outside of a household, farm or brothel 51. HBF clinicians also work with victims of trafficking who have not suffered adversity during their childhood and adolescent development and have enjoyed a relatively high degree of family stability and a good education. However, in these cases there are also identifiable pre-trafficking vulnerability factors which have resulted in their being targeted for trafficking. In some cases the victim is psychologically vulnerable, for example they may suffer psychiatric or psychological conditions or have learning difficulties. They may be naive about the motivations of others which relate to lack of knowledge, to immaturity or to having had a strict or sheltered upbringing. Pre-trafficking vulnerability can also arise from a significant change in the victims’ personal circumstances, for example the loss of essential familial protection, financial security, or political changes in their country of origin: Childhood background of a West African woman trafficked for sexual exploitation. A Central African woman trafficked for sexual exploitation following political persecution not doing things right, not cooking properly or returning home late”. From early childhood Feyin worked on the family farm and did housework. Her family were poor, she only had one meal a day and it never seemed enough. Because she was a girl she was not permitted to go to school and she was subjected to Female Genital Mutilation. She was captured by rebels at the age of 15 and kept as their slave for a number of months during which time she was raped: “If they want to sleep with you and you don’t want to, they beat you. They force you or kill you”. She was also forced to carry heavy loads from village to village for the rebels. Many victims in the care of HBF have lacked sufficient familial protection at a crucial stage, or throughout their lives. This is especially significant in countries where the patriarchal protection of adult men is vital for safety, security and well-being. People with backgrounds of socio-economic vulnerability/ poverty are ideal targets for trafficking because of the driving need for survival and betterment. They are less likely to understand or question the motivations of people who offer economic/educational assistance and they are less likely to be protected, or searched for, by people who have any influence within the country of origin or internationally. Childhood adversity, including poverty, may also increase vulnerability to mental health problems in adult life.52 A friend of her father arranged for her to leave the country on a student visa. Once in the UK this man handed her over to another who raped her repeatedly over days, tied her to a bed and locked her in a room. Two days later he informed her that she must work as a prostitute. An East African woman trafficked for sexual exploitation Susan was educated at university in an East African country. She and her girlfriend were attacked by a mob because they were lesbians. Her girlfriend was killed in the attack and Susan was seriously injured. Her parents threatened to kill her when they found out about her sexuality. Facing the threat of being killed either by mob violence or her own family, her friends arranged for her to be smuggled out of the country. The smuggler turned out to be a trafficker who forced her into prostitution in a brothel in the North of England. British Journal of Psychiatry Report 70