arly this week, nearly 100 people were found trapped in a sweltering tractor-trailer in San Antonio, Texas. Ten have died and others are in critical condition. Many were sent to local hospitals for treatment of severe dehydration and shock, medical conditions that are common in the emergency department. What may not be as obvious to emergency physicians is that these people are possibly victims of human trafficking. As physicians who have treated victims of human trafficking and research this scourge, we believe that this form of severe exploitation is under-recognized in health care settings and live are being lost because of that.
The International Classification of Disease (ICD) codes aim to describe diseases and causes of death and disease. These codes, which are used for everything from hospital billing to research, establish legitimacy for the conditions that harm and kill people every day. As the World Health Organization works toward its 11th iteration of these codes, we urge that “victim of human trafficking” be recognized as an official diagnosis.
To provide broader context, ICD codes currently exist for such esoteric and rare phenomenon as “struck by a duck,” “sucked into a plane’s engine,” and “walking corpse syndrome.” Human trafficking is anything but esoteric and rare — by one estimate, 21 million individuals are victims of it.
The importance of including human trafficking as a billable medical condition by including it in the ICD code system is part of a larger movement to frame trafficking as a significant public health issue that affects millions of vulnerable people around the world. The harms of trafficking to human health are multifold, spanning multiple disciplines of medicine, including emergency medicine, internal medicine, obstetrics/gynecology, infectious disease, pediatrics, and psychiatry.
To classify victims of trafficking solely on their presenting medical symptoms would be a failure to identify the true cause of their poor health.
As physicians, we believe that the health care system has an essential role to play in identifying and healing victims of human trafficking. But in order to so, we must recognize that trafficking is itself a primary form of harm and should be defined as such.
There is precedence for including systemic violence in the ICD codes. Examples include “adult and child abuse,” “problems related to release from prison,” “disruption of family by separation or divorce”, “victims of crime and terrorism,” and others.
ICD codes would help keep track of victims of human trafficking for the purposes of longitudinal clinical care and for research regarding health interventions and outcomes in this vulnerable population. It would also help provide data that could advise policymakers who are working to create laws that can reduce the incidence and health harms of trafficking.
The reporting of human trafficking in the United States has increased substantially, although the true extent of trafficking remains unknown. The emergency department is often the only place for victims to be identified and helped, but this needs to happen more frequently. An important way to help identify trafficking victims is for physicians to begin thinking about trafficking as part of their medical differentials.
Screening for trafficking, much like screening for intimate partner violence, involves recognizing a pattern of medical presentations from exposure to physical and emotional traumas as well as signs of being in an abusive relationship. Victims may experience severe injuries from assault, HIV and other sexually transmitted diseases, tuberculosis, pregnancy-related complications, post-traumatic stress disorder, and major depression with thoughts of suicide.
These trafficking-related conditions affect not only the victim, but also families, communities, and populations. To effectively control and prevent harm, and to drive essential public policy, we need to understand the social factors that contribute to these conditions.
Beyond searching for what a trafficking victim might look like — there is no single profile — it is more important that physicians begin including “trafficking” in their lexicon. They must learn to ask the right questions, to read between the lines, and to think beyond vital signs and existing ICD codes.
A formal endorsement from the World Health Organization by including “victim of human trafficking” into the ICD codes would be an important step forward to better prepare and equip our health system to care for those who are currently trafficked or at high risk of being so.
Abraar Karan, M.D., is a resident physician at Brigham and Women’s Hospital and Harvard Medical School and co-editor of “Protecting the Health of the Poor: Social Movements in the South.” Hanni Stoklosa, M.D., is an emergency department physician at Brigham and Women’s Hospital, an instructor in emergency medicine at Harvard Medical School, executive director of HEAL Trafficking, and co-editor of “Human Trafficking Is a Public Health Issue.” The opinions expressed in this article are solely those of the authors and do not reflect the views and opinions of Brigham and Women’s Hospital.