Victims of trafficking are failed by our state-led approach

The reliance on state actors to deliver support is inadvertently compounding the suffering experienced by some of the most vulnerable people in the UK.

Faith travelled to the UK aged 14 with a couple who had promised her parents that she would support her. When they arrived she was locked in the house and made to work day and night for no pay. She was raped by her exploiter and made to have sex with other men. Her trafficker told her that if she went to the police they would put her in jail.

After a number of years she escaped when a door was left open. She saw a policeman but hid until he passed. Instead she approached a woman on the street. She stayed with her for a while however after being abused she escaped again and stayed on the streets for a period. Help came when she befriended a woman at a local church. After telling her about her experiences the woman told her about a local support group who in turn encouraged her to approach the police. Four years after coming to the UK she approached the authorities and told them about her experiences. Her trafficker has never been identified.

Faith was one of the women who participated in IPPR’s in-depth case study report on human trafficking between Nigeria and the UK. In 2011 alone, over two thousand potential victims of trafficking were identified in the UK. Despite notable efforts by government, border officers and police, human trafficking is a crime that the UK is not getting to grips with. To start to do this, we need to acknowledge that state- led approaches alone cannot combat trafficking.

People who have escaped trafficking need to be supported. A lack of alternative support (whether real or perceived) was a key reason given by trafficked people for staying with their traffickers and exploiters. Even if they did manage to escape from their initial situation, without adequate protection people are vulnerable to further trafficking and abuse. Many exited one trafficking situation only to enter into another. Some were caught by their trafficker, others were ‘rescued’ and then re-trafficked into another situation. Others entered into informal support that was highly exploitative; including abusive relationships or support where they were obliged to offer sex or servitude to their hosts in return. Furthermore, with no access to safe support, our research was clear that trafficked people will feel less confident to pursue the prosecutions of traffickers. Addressing these issues is difficult. Trafficking victims need and deserve support, but too often their irregular immigration status prevents them from receiving it.

Perhaps acknowledging this, the UK has invested in systems to identify victims of trafficking. A process has been put in place to identify whether someone has experienced trafficking (the National Referral Mechanism or NRM, hosted within the UK Border Agency). Agencies including the police and border officials have received training in spotting signs of trafficking. Last week, the government announced that this training will be further rolled out to other professionals including social workers and GPs.

All this is welcome, but the government needs to broaden its approach. Part of the problem is that state-led solutions alone are unlikely to ever deliver a full and effective response to protect trafficked people. Due to the hidden nature of exploitation none of the forty people who participated in our research were referred into support as a result of a ‘raid’ by the police. Whether due to experiences in Nigeria or the threats of traffickers, people interviewed were afraid to seek support from authorities such as the police, border agents or social workers. Very few approached the police themselves and some actively avoided them. Instead they sought support from members of the public or people in community spaces such as churches. Critically, those they sought support from also lacked confidence in the authorities and many advised against approaching them. Often, interviewees only came forward when they came into contact with a trusted member of their community who was able to refer them into official support. By this point many were in detention, prison or had experienced lengthy periods of abuse.

Delivering training to frontline services in identifying trafficking is an important step. However, our research shows that we must go beyond state agents and ensure that the people in communities that victims of trafficking seek support from are equipped to help them. This means delivering training to people in community settings such as churches and community groups on the laws on trafficking in the UK, the support available and the routes into support. The voluntary sector also need to be involved. Finally, in order to ensure that people will engage with official agencies, the government need to make the NRM independent of the immigration system.

The reliance on state actors to deliver support is inadvertently compounding the suffering experienced by some of the most vulnerable people in the UK. We must recognise the importance of engaging communities in the response against trafficking in order to ensure trafficked people can access the help they need.

Jenny Pennington is a researcher at IPPR

Posters are displayed in Quezon City suburban, Manila, as part of the annual observance of International Day against Human Trafficking. Photograph: Getty Images.

Jenny Pennington is a researcher at IPPR

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The surprising truth about ingrowing toenails (and other medical myths)

Medicine is littered with myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery.

From time to time, I remove patients’ ingrowing toenails. This is done to help – the condition can be intractably painful – but it would be barbaric were it not for anaesthesia. A toe or finger can be rendered completely numb by a ring block – local anaesthetic injected either side of the base of the digit, knocking out the nerves that supply sensation.

The local anaesthetic I use for most surgical procedures is ready-mixed with adrenalin, which constricts the arteries and thereby reduces bleeding in the surgical field, but ever since medical school I’ve had it drummed into me that using adrenalin is a complete no-no when it comes to ring blocks. The adrenalin cuts off the blood supply to the end of the digit (so the story goes), resulting in tissue death and gangrene.

So, before performing any ring block, my practice nurse and I go through an elaborate double-check procedure to ensure that the injection I’m about to use is “plain” local anaesthetic with no adrenalin. This same ritual is observed in hospitals and doctors’ surgeries around the world.

So, imagine my surprise to learn recently that this is a myth. The idea dates back at least a century, to when doctors frequently found digits turning gangrenous after ring blocks. The obvious conclusion – that artery-constricting adrenalin was responsible – dictates practice to this day. In recent years, however, the dogma has been questioned. The effect of adrenalin is partial and short-lived; could it really be causing such catastrophic outcomes?

Retrospective studies of digital gangrene after ring block identified that adrenalin was actually used in less than half of the cases. Rather, other factors, including the drastic measures employed to try to prevent infection in the pre-antibiotic era, seem likely to have been the culprits. Emboldened by these findings, surgeons in America undertook cautious trials to investigate using adrenalin in ring blocks. They found that it caused no tissue damage, and made surgery technically easier.

Those trials date back 15 years yet they’ve only just filtered through, which illustrates how long it takes for new thinking to become disseminated. So far, a few doctors, mainly those in the field of plastic surgery, have changed their practice, but most of us continue to eschew adrenalin.

Medicine is littered with such myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery. Until the mid-1970s, breast cancer was routinely treated with radical mastectomy, a disfiguring operation that removed huge quantities of tissue, in the belief that this produced the greatest chance of cure. These days, we know that conservative surgery is at least as effective, and causes far less psychological trauma. Seizures can happen in young children with feverish illnesses, so for decades we placed great emphasis on keeping the patient’s temperature down. We now know that controlling fever makes no difference: the fits are caused by other chemicals released during an infection.

Myths arise when something appears to make sense according to the best understanding we have at the time. In all cases, practice has run far ahead of objective, repeatable science. It is only years after a myth has taken hold that scientific evaluation shows us to have charged off down a blind alley.

Myths are powerful and hard to uproot, even once the science is established. I operated on a toenail just the other week and still baulked at using adrenalin – partly my own superstition, and partly to save my practice nurse from a heart attack. What would it have been like as a pioneering surgeon in the 1970s, treating breast cancer with a simple lumpectomy while most of your colleagues believed you were being reckless with your patients’ future health? Decades of dire warnings create a hefty weight to overturn.

Only once a good proportion of the medical herd has changed course do most of us feel confident to follow suit. 

This article first appeared in the 20 April 2017 issue of the New Statesman, May's gamble

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