Mental Health

Government Policy, Inequality, Mental Health, Poverty

Uncovering the Realities of Human Trafficking

~Written by Sarah Weber (Contact:

There is a hidden business of slavery that is tucked away from the untrained eye but alive and thriving today. The word "slavery" most likely conjures up images of African slaves in the United States (US) or Great Britain, a practice that was abolished in the nineteenth century. Although every country in the world now has laws banning slavery (the last being Mauritania in 2007), slavery still exists today in almost every country. Modern day slavery, also known as human trafficking, affects tens of millions of women, men and children around the world in the form of forced labor, domestic servitude, and sex trade [1]. In fact, there are more slaves now than at any other time in human history [1]. While the exact number of people trafficked globally is unknown, research efforts to better understand the magnitude of the issue have estimated that 21 to 36 million people are trafficked worldwide [1]. Human trafficking is the second largest criminal industry in the world after drug trafficking. Yet, the public is often not aware that it is such a significant global issue, affecting people not only in far away countries, but also in the countries, and possibly even the communities in which they reside.

What is human trafficking?

The terms “human trafficking,” “trafficking in persons,” and “modern day slavery” all refer to, "The act of recruiting, harboring, transporting, providing, or obtaining a person for compelled labor or commercial sex acts through the use of force, fraud, or coercion" [2]. A common definition was adopted by the United Nations (UN)'s Protocol to Prevent, Suppress and Punish Trafficking in Persons as:

"Trafficking in persons" shall mean the recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power, or of a position of vulnerability, or of the giving or receiving of payments or benefits, to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation or the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal of organs [3].

There are many different types of modern day slavery, including: debt bondage, contract slavery, sex trafficking, forced or servile marriage, domestic servitude, child labor and child soldiers.  According to Free the Slaves, a nonprofit focused on advocating against modern day slavery and liberating slaves, approximately 78% of slavery victims are in forced labor, 22% are in sex slavery, and 26% are children under age 18[1]. Learn more about the types of slavery and global statistics in this Free the Slaves factsheet here.


A key component of human trafficking is the use of force, fraud or coercion to lure victims into positions of exploitation. Traffickers generally prey on people who appear vulnerable, including those who are experiencing psychological or emotional vulnerability, economic hardship, lack of a social safety net, natural disasters or political instability. Women and girls who have been victims of sexual, physical or emotional abuse, and runaway children are particularly at risk. Refugees and/or people living in areas of war or political instability are also at increased risk [2].

Human Trafficking and Health

In addition to human trafficking blatantly violating human rights, it results in devastating long-lasting health consequences for the victims. Since victims are often dependent on their traffickers for their livelihood, receive limited food and are often malnourished. This is especially problematic for the estimated 5.5 million children in slavery today [4]. Women in forced prostitution and child soldiers, are often given drugs by their traffickers to ensure compliance, thus drug addiction is sadly all too common. Women forced into the sex industry are at risk of sexually transmitted infections and unwanted pregnancy and often don't have the agency to negotiate safer sex practices. [7]. In addition to the physical health effects, victims of human trafficking suffer from impaired emotional and psychological health [7]. Traffickers control through fear, physical, emotional and sexual assault, and manipulation [8]. This has negative impacts on victims and often leaves them ashamed, psychologically traumatized, emotionally attached, and afraid to leave their trafficker [8].

Raising Awareness Globally

Although human trafficking still does not receive an adequate amount of global attention or recognition, efforts in the last decade have elevated awareness of the problem. In 2010 the UN General Assembly adopted the Global Plan of Action to Combat Trafficking in Persons and urged countries to take coordinated efforts to combat and eliminate human trafficking [3]. In 2013 the UN General Assembly adopted a resolution, designating July 30 as the World Day against Trafficking in Persons. The resolution was made to, “Raise awareness of the situation of victims of human trafficking and for the promotion and protection of their rights” [5]. In December 2014, the president of the US, Barack Obama, established January as National Slavery and Human Trafficking Prevention Month in the US and January 11th as Human Trafficking Awareness Day, in recognition that modern day slavery or human trafficking still exists in communities across the US and the globe [6].

It is important to remember that human trafficking happens across the globe. It isn't something that just happens across international borders and/or in low- or middle-income countries. The US has an estimated 60,000 victims of slavery and the United Kingdom (UK) has an estimated 13,000 [1]. While a majority of these victims come from overseas, an alarming number of people are trafficked domestically within both the US and the UK, with the Federal Bureau of Investigation estimating that 293,000 American youth are at risk for sex trafficking within the US each year [9]. Given the rise of social media and the Internet, traffickers now use the Internet as a primary mechanism for recruiting victims both internationally and domestically.

Stopping Demand

Efforts to educate the public are an important step in combating the issue. Human trafficking is an industry because there is demand. Traffickers are motivated by high profits, with an estimated $150 billion USD generated by traffickers each year [1]. Therefore, decreasing/stopping the demand is key to eliminating human trafficking. "Sex tourism"- travel planned for the specific purpose of sex, generally to a country where prostitution is legal - fuels the demand for human trafficking, as does large events which bring in crowds of people [10]. In fact, the US Super Bowl is one of the largest magnets for sex trafficking globally [10]. Efforts to hold accountable both the traffickers and those purchasing the services are needed to stop the demand. Global efforts such as the UN's Protocol to Prevent, Suppress and Punish Trafficking in Persons, tougher sentencing for traffickers and purchasers in many countries, and local efforts to raise awareness in communities are helping to combat the issue. However, vigilance and awareness from all people and continued united global efforts are needed to end human trafficking.


1. Free the Slaves.  

2. United States Trafficking in Humans report, July 2015. 

3. United Nations Office of Drugs and Crime.

4. Anti-Slavery International.

5. United Nations World Day Against Human Trafficking in Persons.

6. United States Department of Homeland Security.

7. Center for Disease Control and Protection.

8. Polaris Project.

9. Federal Bureau of Investigation, Law Enforcement Bulletin.

10. Federal Bureau of Investigation. 

Mental Health, Healthcare Workforce, Non-Communicable Diseases

The Cinderella of Health Issues in Pakistan

~Written by Sarah Khalid Khan (Contact:

Lahore Mental Hospital

Source: Available at  

As a Global Health student with a background in medicine I find all health issues interesting. Especially interesting are the mental health issues because of their lack of somatic manifestation like other physical ailments. It is surprising to know that depression alone affects almost 350 million people worldwide (WHO 2015). Even though I have been related to the medical field for quite a while, I underestimated the state of mental health in Pakistan. The fact that I grew up with a family member who was under treatment for bipolar disorder for many years did not do much to change my opinion. I am also related to a few undiagnosed cases of clinical depression but I still did not consider mental health an issue. During my medical college, the clinical rotations in the psychiatric ward also failed to show me the true picture of the burden of mental disease partly due to its scarce patient numbers.

I realise my ignorance even after becoming a clinician reflects poorly on the level of awareness of this issue in the medical community and the general population. I would have continued to be ignorant had it not been for one particular day in the Outdoor Patient Department at Services Hospital Lahore with one of the heads of medicine.

As the last patient left, the professor looked around at all the junior doctors sitting around the table, picked up one of the physician samples and said that if it were up to him, he would make the drinking water of Lahore enriched with it. Surprised at what could possibly plague our part of the world and cure it according to him, we looked at the sample. It was an anxiolytic. An anxiolytic is sometimes prescribed for people suffering from stress and often given to patients with depression (Pietrangelo 2013).

The fact that the number of mental disorders is increasing worldwide is not a secret. According to some sources, the number of people suffering from mental issues in Pakistan is estimated to be around 15 million (Anwar 2015). Most of these remain undiagnosed, often in the shadows of stigma and shame. Pakistan has many reasons to have escalating mental illness; political unrest, internal conflict, economic instability, rising poverty and crime rates, unemployment, natural disasters, the list goes on.

Unfortunately most of these cases are attributed (by the general public, doctors or both) to black magic and evil spirits (Gadit and Callanan 2006). Many such people end up at shrines and the doorsteps of spiritual healers. Some receive holy verses to recite while others get beaten, to scare away the evil spirit or “jinn” as it is called in this part of the world. While religion is good for many reasons, the fact that mental health involves underlying biochemical pathophysiology that could be treated with medical intervention needs to be addressed urgently.

But what about the people who specialize in managing and treating such disorders? According to WHO there are less than 350 psychiatrists in Pakistan, only 0.2 per 100,000 (Jooma et al. 2009). The numbers are worse for pediatric psychiatrists. With only five psychiatric hospitals in the country, the state of psychiatric wards and mental institutions is appalling (Anwar 2015).

Although psychiatry might be an area of increasing interest in medicine in Pakistan, the availability of opportunities that provide better compensation and benefits abroad cause many of these doctors to leave the country to work in “greener” pastures (Imran et al. 2011). With the prevailing conditions for doctors in general, Pakistan might even become an exporter of psychiatrists, which will only worsen the situation within the country.

The time to deal with the multi-headed monster of mental health in Pakistan is now. Raising awareness about mental issues is primary but the need to remove the stigma associated with it is a bigger concern. The truth about fraudulent spiritual healers also needs to be addressed vehemently. The number of psychiatric wards needs to be increased. Finally, the medical workforce needs to be given better incentives to stay within the country.


Anwar, Komal. “Mental Health Care: Mind Matters.” The Express Tribune. Web. 26 Oct. 2015.

Gadit, Amin A Muhammad, and T S Callanan. “Opinion and Debate Jinni Possession : A Clinical Enigma in Mental Health.” Journal of Pakistan Medical Association 56.10 (2006): 476–478. Print.

Imran, Nazish et al. “Brain Drain: Post Graduation Migration Intentions and the Influencing Factors among Medical Graduates from Lahore, Pakistan.” BMC Research Notes 4.1 (2011): 417. Web.

Jooma, Rashid, Fareed Aslam Minhas, and Shekhar Saxena. WHO-AIMS Report On Mental Health System In Pakistan. N.p., 2009. Print.

Pietrangelo, Ann. “Anxiolytics | Definition and Patient Education.” Healthline. N.p., n.d. (2013) Web. 26 Oct. 2015.

“WHO | Depression.” Fact sheet N°369. World Health Organization, n.d. Web. 26 Oct. 2015.