Introduction

This research report produced by the Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS) was commissioned by the Norwegian Directorate of health and published January 2025. The report is based on a qualitative literature review of research concerning healthcare provision for victims of human trafficking in Norway and Europe. Additionally, the report is based on qualitative interviews with four key stakeholders/organisations in the human trafficking field in Oslo, who contributed insights and perspectives that helped shape the report’s conclusions.

In the introduction the report includes a brief review of international systematic reviews, action plans, and reports from the national network addressing human trafficking within the health and care services. It also examines recommendations issued by the Group of Experts on Action Against Trafficking in Human Beings (GRETA) and the Organization for Security and Co-operation in Europe (OSCE), to the Norwegian authorities, which highlight the need to strengthen the healthcare sector’s role in tackling human trafficking. The full report and reference list (in Norwegian) can be downloaded at the bottom of this page.

Lack of Research on Healthcare Workers and Human Trafficking

The report reveals that no Norwegian studies explore healthcare professionals’ experiences with, or knowledge of, human trafficking. This represents a significant gap, as healthcare professionals are often among the first to identify and assist victims. Although there are several relevant studies from Europe, including Scandinavia, most originate from the United Kingdom, and contextual differences make direct application of these findings to Norway difficult. Nevertheless, the potential to conduct similar studies in Norway is evident.

NKVTS Reccommends New Research in the Field

Considering the major knowledge gaps identified, NKVTS recommends research focused on healthcare professionals’ awareness of human trafficking and their experience with trafficking victims. This research should also explore what measures can help enhance healthcare professionals’ competencies, thereby enabling Norway to meet its international obligations and provide appropriate care to victims. The report underscores the importance of closing these knowledge gaps to improve the healthcare sector’s contribution in combating human trafficking.

The report is divided into four main chapter, briefly summarised here:

1. Norwegian Studies Addressing the Health of Victims of Human Trafficking

There is very little, if any, research that directly investigates healthcare personnel and their experiences with victims of human trafficking. In this report, we found no Norwegian studies based on data from healthcare workers interacting with human trafficking issues. We have included three Norwegian studies that discuss health and human trafficking, and these show that Norway faces structural and institutional challenges that hinder effective support and protection for victims of human trafficking.

Despite a universal welfare system and the intention to provide fair access to healthcare, the Norwegian welfare system is not adequately equipped to deal with the complexity of the victims’ situations. Victims of human trafficking are often caught in a legal and administrative grey area, where their access to healthcare and other services depends on their residency status or sheer chance. This creates an unpredictable and fragmented reality for both support services and the victims themselves.

One study highlights that healthcare professionals are in a key position to identify and assist victims of human trafficking (Vollebæk, 2023). At the same time, it is emphasised that victims, especially those with uncertain legal status, often fall between different systems that fail to provide a coherent and adequate response. This reveals a fundamental need for political action to ensure that victims of human trafficking have access to a safe and predictable support system, where the health service, social services, and authorities with legal decision-making power collaborate to meet the victims’ needs (Brunovskis, 2016; Brunovskis et al., 2010).

Norwegian studies included:

• Vollebæk (2023): Helsepersonell og avdekking av menneskehandel.
• Brunovskis (2016), Special rights within universal welfare: Assistance to trafficking victims in Norway.
• Brunovskis, Skilbrei og Tveit (2010), Pusterom eller ny start?

2. European Studies Addressing Human Trafficking and Health

Taken together, the European studies included in this knowledge summary show that victims of human trafficking face significant health challenges. These include both mental and physical health problems, which often overlap and persist over time. A recurring theme is that the healthcare system plays a central role as the first point of contact for victims.

The studies reveal that healthcare systems face substantial barriers in identifying and treating victims, lacking standardised protocols, training, and resources to meet their complex needs. Furthermore, the importance of improving collaboration and strategy development among paediatricians, primary care providers, and specialist health services is emphasised.

Access to necessary healthcare is hindered by legal and structural challenges, stigmatisation, and language barriers. The studies also highlight a need to strengthen cross-sector collaboration and develop integrated approaches where police and NGOs are included.

Support for victims cannot be handled by the healthcare sector alone but must be addressed through cooperation between various agencies. Measures such as identification procedures, anonymisation of records, and specialised health services are crucial for protection and assistance. The importance of reaching underrepresented groups – including men, labour migrants, and children – is also emphasised. A holistic, patient-centred approach combining health, rights, and social support is required to improve efforts, especially regarding long-term interventions in the reintegration phase. The importance of transnational cooperation and experience-sharing is also noted.

European Studies and reports included:

• WHO (2023), Addressing Human Trafficking Through Health Systems: A Scoping Review.
• Andersson og Örmon (2024), Healthcare providers’ experience of identifying and caring for women subjected to sex trafficking: a qualitative study.
• Hadjipanayis, Crawley og Stiris (2018), Child trafficking in Europe: what is the paediatrician’s role?
• Holly, Thompson, Schoonbeek og Scholte, (2011), Mental Health Prevention in Victims of Human Trafficking: Evaluation of a Mental Health Prevention Group.
• Knudtzen, Mørk, Nielsen og Astrup (2022), Accessing vulnerable undocumented migrants through a healthcare clinic including a community outreach programme: a 12-year retrospective cohort study in Denmark.
• Palmbach, Blom, Haynes, Primorac og Gaboury (2014), Utilizing DNA analysis to combat the worldwide plague of present-day slavery – trafficking in persons.
• Welch (2020), Relentless: A Berlin-based organization providing trauma-informed training to counter-trafficking organization.
• Ostrovschi, Prince, Zimmerman, Hotineanu, Gorceag, Gorceag, Flach og Abas (2011), Mental Health of Trafficked Women Returning to Moldova.
• Oram, Stockl, Busza og Zimmerman (2012), Physical Health Symptoms Among Trafficked Women
• Brace, Sanders og Oommen (2018), Access to Healthcare for Victims of Human Trafficking: A Focus Group with Third Sector Agencies.
• Domoney, Howard og Abas (2015), Mental Health Service Responses to Human Trafficking: A Qualitative Study of Professionals’ Experiences of Providing Care.
• Evans, Sadhwani, Singh, Robjant og Katona (2022), Prevalence of Complex Post-Traumatic Stress Disorder in Survivors of Human Trafficking and Modern Slavery: A Systematic Review
• Hossain, Zimmermann, Abas, Light og Watts (2010), The Relationship of Trauma to Mental Disorders Among Trafficked and Sexually Exploited Girls and Women.
• Howard, Oram, McKenzie , Abas , Broadbent og Zimmerman (2013), Human trafficking and mental health.
• Oram, Abas, Bick, Boyle, French, Jakobowitz, Khondoker, Stanley, Trevillion og Howard (2016), Human Trafficking and Health: A Survey of Male and Female Survivors in England.
• Ottisova, Hemmings, Howard, Zimmerman og Oram (2016), Prevalence and risk of violence and the mental, physical and sexual health problems associated with human trafficking: an updated systematic review.
• Oram, Stöckl , Busza, Howard og Zimmerman (2012), Prevalence and risk of violenceand the physical, mental, and sexual health problems associated with human trafficking: Systematic review.
• Oram, Zimmerman, Adams og Busza (2011), International law, national policymaking and the health of trafficked people in the UK.
• Ross, Dimitrova, Howard, Dewey, Zimmerman og Oram (2015), Human Trafficking and Health: A Cross-Sectional Survey of NHS Professionals.
• Westwood, Howard, Stanley, Zimmerman, Gerada og Oram (2016), Access to, and Experiences of, Healthcare Services by Trafficked People.
• Williamson, Borschmann, Zimmerman, Howard, Stanley og Oram (2018), Responding to the Health Needs of Trafficked People.
• Zimmerman, Hossain og Watts (2011), Trafficking and Health: A Conceptual Model to Guide Policy, Intervention, and Research.

3. Qualitative interviews

During the work on this report, we conducted qualitative interviews with the Health Centre for Undocumented Migrants, ROSA, Nadheim, and Laura’s Hus. These four actors all provide valuable support to individuals who are either potential or identified victims but offer very different kinds of assistance. Nadheim targets individuals involved in prostitution, while Laura’s Hus is primarily a service for victims after they have been identified. ROSA is the national assistance programme for victims of human trafficking, supporting both victims and service providers before, during, and after identification. The Health Centre for Undocumented Migrants does not primarily work on human trafficking but encounters the issue as it provides healthcare to migrants without legal residence, who therefore do not have access to public healthcare. The actors’ varied approaches to the issue illustrate the fragmented service landscape and highlight the lack of resources specifically dedicated to healthcare for victims of human trafficking.

We consistently found that the work of these three actors is often hampered by a cumbersome bureaucracy, a fragmented system, and a lack of resources. Many described a highly complex bureaucratic system, which is also reflected in the findings of Brunovskis (2016).

A recurring observation across all three interviews was the rapidly changing background of victims of human trafficking. After a period with many originating from Mongolia, 2024 saw a significant influx of young girls from Colombia. The discussions also revealed that the types of exploitation and coercive methods, as well as recruitment tactics, can change just as rapidly.

Another recurring theme was the varying level of attention human trafficking receives from both authorities and the general public. It was pointed out that when cases receive media coverage – for example, the exposure of trafficking in the grocery sector (the Lime case), or Nigerian women engaging in street prostitution in Oslo – this tends to generate increased effort and support from the authorities. All interviewees noted that in recent years, attention to and support for anti-trafficking work has diminished.

The last recurring theme we found from the interviews was the issue of how identification of human trafficking requires knowledge and having “the right glasses on”. With this phrase “the right glasses” the interviewees referred to how it is possible to identify victims of human trafficking if one knows what to look for and how it can appear. As such, the interviewees addressed an issue of how other professional groups such as police or health personnel did not identify victims as they did not “have the right glasses” on.

4. Recommended Research

NKVTS recommends initiating research that focuses on healthcare workers’ experiences, challenges, and knowledge of human trafficking. This proposal is based on this knowledge summary, which finds that there is very little Norwegian research on health and human trafficking. This particularly applies to healthcare workers’ knowledge and practice in encounters with trafficking victims in Norway.

The WHO (2023) points out in its latest report that healthcare workers, especially in primary care, are often among the first to encounter victims of human trafficking. This gives them a unique opportunity to identify and support victims. In the same report, the WHO notes that healthcare professionals generally lack the necessary training to recognise and manage human trafficking cases, and recommends systematic, standardised training. This is also a consistent theme in our review of European research on healthcare workers’ experiences in this field. The critical, close, and front-line role of healthcare professionals is also emphasised in Norwegian research (Bregård & Vollebæk, 2023).

The literature also underlines the need for and importance of generating new knowledge to inform measures that can better enable healthcare services to address the needs of this group. This knowledge gap was also mentioned in our discussions with field actors. These conversations revealed a perception that other relevant professional groups, such as healthcare workers and police, are not sufficiently trained to identify victims of human trafficking.

A lack of expertise among healthcare workers may also lead to victims not being prioritised according to their health needs.

Furthermore, the qualitative interviews highlighted that healthcare workers may find it difficult to distinguish between different forms of coercion and exploitation, creating uncertainty around the issue. The support system for victims were perceived as inadequate and unreliable, which may make healthcare workers reluctant to focus on identifying potential trafficking victims. This is because identification may not necessarily lead to improved health outcomes for the patient. To avoid referring patients into a difficult and complex collaboration with other agencies – or involving the police by reporting suspected trafficking – healthcare workers may instead prioritise providing care, in line with their primary expertise and responsibility.

GRETA and OSCE have expressed concern over the lack of access to healthcare for this group in Norway, and there is therefore a significant need for knowledge about how Norwegian healthcare workers engage with this issue. With greater knowledge in this area, Norwegian health services would be better equipped to handle encounters with potential trafficking victims. As representatives from Nadheim and Laura’s House put it: it’s about “wearing the right glasses.” Therefore, NKVTS recommends research that explore whether healthcare personnel in Norway the competence have to identify those who are subjected to trafficking and whether they can meet the needs of this group.