Trained counselors interviewed 192 women who had been trafficked and sexually exploited about abuse and evaluated their physical and mental health status within 14 days of entry into posttrafficking services. Most reported physical or sexual violence while trafficked (95%), pre-trafficking abuse (59%), and multiple posttrafficking physical and psychological problems.

Newly identified trafficked women require immediate attention to address posttrauma symptoms and adequate recovery time before making decisions about participating in prosecutorial or immigration proceedings or returning home.

My wounds are inside. They are not visible.

—Moldovan woman trafficked to Italy

Human trafficking has been defined as the “recruitment, transportation or harboring of persons by means of threat or use of force or other forms of coercion, of abduction, of fraud or deceptions for the purpose of exploitation.”1 In practice, women and girls who are trafficked and sexually exploited are frequently lured by individuals known to them or their families with promises of jobs as waitresses, nannies, or cleaners, and then forced into sex work or exploited while working as domestic help, street beggars, or factory or agricultural laborers.

The trafficking of women and adolescents is increasingly recognized as one of the world’s fastest growing crimes and a significant violation of human rights.2 Despite the compelling need for evidence on the physical and psychological health consequences to inform rapidly emerging policies and services for trafficked persons, there is limited evidence about the needs of women who have been trafficked. We investigated the health of women and adolescent girls trafficked for sexual exploitation in Europe who were entering posttrafficking services.

Study Design

Between January 2004 and June 2005, interviews were conducted with a consecutive sample of eligible women and adolescent girls accessing posttrafficking assistance services provided by nongovernmental and international organizations in Belgium, Bulgaria, Czech Republic, Italy, Moldova, Ukraine, and the United Kingdom. The multicountry design reflected the global nature of trafficking. Women judged to be psychologically unable to participate were excluded.

We followed the World Health Organization Ethical and Safety Recommendations for Interviewing Trafficked Women3 and conducted the study in secure service settings that offered access to health care and other assistance. Participants were interviewed by experienced counseling staff (psychologists or social-support workers) of partner organizations who were well positioned to react appropriately to difficult emotions, recognize when to terminate an interview, and organize medical care. Efforts were made to separate the study from the standard intake procedures and to stress the voluntary nature of participation to minimize any perceived pressure to participate.

Women’s physical symptoms were measured using a tool derived from the Miller Abuse Physical Symptoms and Injury Survey.4,5 Mental health symptoms were measured with (1) the depression, anxiety, and hostility subscales of the Brief Symptom Inventory (a short validated alternative to its parent instrument, the SCL-90-R [Symptom Checklist-90-Revised])6,7 and (2) the posttraumatic symptom scale from the Harvard Trauma Questionnaire,8 a set of 16 items derived from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for posttraumatic stress disorder (reexperiencing the trauma or intrusive memories, numbing or avoidance, and arousal).9

Both the Brief Symptom Inventory and the Harvard Trauma Questionnaire have been found to have very good reliability7,9 and high internal consistency reliability,1014 and test–retest reliability, ranging from 0.79 to 0.84 for the Brief Symptom Inventory subscale measurements7 and 0.89 to 0.92 for the Harvard Trauma Questionnaire.13,15 Although neither instrument has been validated among trafficked women, both have been used in cross-cultural settings and among other traumatized populations.11,1621 Budget constraints prohibited clinical exams and diagnostic testing for this study.

The semistructured questionnaire was translated from English into Bulgarian, Czech, Italian, Lithuanian, Polish, Russian, and Ukrainian. Each version was back-translated and reviewed for cultural meaning by bilingual social workers, psychologists, or cultural mediators.

Data Analysis

Data was entered using EpiData Entry version 3.1 (EpiData Association, Odense, Denmark) and analyzed using Stata version 9 (StataCorp LP, College Station, Tex). The standard scoring method was used for Brief Symptom Inventory subscales (i.e., an overall symptom score was calculated from response options 0–4, with 0 meaning “not at all” and 4 meaning “extremely”).

For the Harvard Trauma Questionnaire, the standard cut-off item score of 2.5 or higher was used to indicate a probable post-traumatic stress disorder diagnosis among women who were in the trafficking situation for 1 month or more.

Of 213 women invited to participate, 212 agreed. Twenty interviews were excluded because the respondents did not meet the eligibility criteria (e.g., being in the assistance program less than 14 days, trafficked for sex work or domestic service). The final data came from 192 women and adolescent girls interviewed within 14 days of their entry into posttrafficking care.

Participants ranged in age from 15 to 45 years, with the largest group aged 21 to 25 years (42%). Most participants were interviewed in their countries of origin, with the largest groups from Moldova (38%) and Ukraine (26%; Table 1).

Experiences of Violence

More than half the women and adolescent girls (59%; Table 1) reported pretrafficking experiences of sexual or physical violence, and 12% had a forced or coerced sexual experience before age 15 years; 26% cited more than 1 perpetrator, with many naming a father or stepfather (data not shown).

Nearly all the women and adolescent girls (95%) reported physical or sexual violence while in the trafficking situation; 76% reported physical abuse, and 90% reported sexual abuse. There are complex psychological and social reasons, such as women’s perceptions of what constitutes sexual violence, ignorance of the crime of trafficking, self-blame, and stigma, that may help explain why some women did not report being sexually abused. Physical injuries were reported by 57% of the participants (data not shown). The participants cited severe restrictions of personal freedoms: 76% said they were “never” able to do as they wished or go where they wanted.

Physical Symptoms

The women and adolescent girls were asked about 26 physical symptoms experienced in the past 2 weeks and to rate how much this symptom bothered them (Table 2). Headaches (82%), feeling easily tired (81%), dizzy spells (70%), back pain (69%), memory difficulty (62%), stomach pain (61%), pelvic pain (59%), and gynecological infections (58%) were among the most common and severely felt symptoms.

Nearly two thirds (63%) of the participants reported more than 10 concurrent physical health problems upon entering posttrafficking programs, highlighting the compounding pain and discomfort experienced by a majority of this population.

Mental Health Symptoms

The Cronbach coefficient alpha measure of internal-consistency reliability for this sample was estimated to be 0.89, 0.91, and 0.77 for the Brief Symptom Inventory depression, anxiety, and hostility subscales, respectively, and 0.94 for the posttraumatic stress disorder subscale of the Harvard Trauma Questionnaire.

The mean scores for symptoms associated with depression, anxiety, and hostility were 2.09, 1.90, and 1.21, respectively, according to the Brief Symptom Inventory subscales (Table 3). Compared with a general US population of adult women, the study participants’ symptoms were in the 95th percentile and in the 51st percentile compared with female psychiatric patients. (This comparison rate is offered in the Brief Symptom Inventory manual and is derived from a population studied in the United States.7) Symptoms associated with depression were most often reported, with 39% of the participants acknowledging having had suicidal thoughts within the past 7 days.

More than half of the women and adolescent girls (57%) scored at or above the 2.5 cut-off point in the posttrauma-symptom subset of the Harvard Trauma Questionnaire, suggesting posttraumatic stress disorder (data not shown). Only the participants who had been trafficked for more than 1 month (89%) were included in this analysis, to meet the criteria that symptoms associated with posttraumatic stress disorder were present 1 month or more following traumatic events.9

To our knowledge, this was the first study to quantitatively document the health symptoms of trafficked women and adolescent girls. A study of this nature has several significant challenges. In particular, because we excluded women and adolescent girls still in the trafficking situation (because of the high risk of harm and our inability to provide assistance) and those who never sought assistance, this sample of women and adolescent girls accessing services undoubtedly represents the smallest minority of women and girls who are trafficked. It is unclear how well these findings apply to all trafficked women.

Because no instruments were previously validated in this population, we drew on several tools validated in culturally diverse populations exposed to high levels of trauma. These instruments may have failed to fully capture the unique and extreme features of the physical and psychological trauma and the culturally different ways these were experienced or expressed by these women and adolescent girls.

Despite these limitations, we believe we provide urgently needed empirical data for policies and services. The severe symptom patterns identified suggest that diagnostic and treatment services should be made immediately available to survivors of trafficking. Dissecting the constellation of women’s symptoms and formulating treatment plans are not likely to be easy or short-term tasks. For example, gastrointestinal problems are well-described somatic manifestations of anxiety and stress,22 but for trafficked women, they may also be associated with poor nutrition or sexual and urogenital problems.

Further complicating diagnosis and care is trafficked women’s complex history of pretrafficking and trafficking-related violence. Existing studies on violence suggest that multiple exposures to trauma of this type can have multiple long-term effects on women’s health.23,24 Services for such women should be based on good practices used for victims of domestic violence, sexual assault, and torture and for migrants and refugees. These include strategies for crisis intervention, confidentiality, security, shelter, social support, forensics, counseling, and medical cultural competency.

The symptoms found in our sample of trafficked women and adolescent girls reveal that when authorities (e.g., police and immigration personnel) encounter trafficked women, the women are likely to be suffering pain and distress, especially memory problems that may affect their ability to engage in criminal investigations and asylum petitions. For example, during police interrogations, women may be unable to immediately recall details of the crime, substantiate their status as a victim, or make decisions about cooperating in a prosecution. Legal procedures should ensure that trained health staff and support resources are immediately available to help alleviate pain and provide necessary care.

Trafficking survivors are often quickly deported or obliged to cooperate in criminal investigations as a condition of assistance.25 For women who agree to participate in legal proceedings, investigative and judicial procedures should be developed that are sensitive to possible memory difficulties, psychological distress, and victim protection needs. The multiplicity and severity of symptoms indicate that trafficked women may not be capable of making rapid decisions about their safety. Granting trafficking survivors an adequate period of recovery and reflection (i.e., temporary legal residency with access to posttrafficking services) or asylum status might foster improvements in survivors’ health and enable them to make considered decisions about their security and future well-being.

In the study sites, organizations assisting trafficking survivors struggled to acquire adequate human and financial resources to provide the necessary support. Given that the abuse suffered by trafficking victims occurs on the territory of destination states and is often perpetrated by, or involves the participation of, citizens of these states, their governments have an obligation to fund and foster services that aim to help survivors to regain their health, well-being, and dignity.

Table
TABLE 1— Characteristics of Female Trafficking Survivors (n = 192): Europe, 2004–2005
TABLE 1— Characteristics of Female Trafficking Survivors (n = 192): Europe, 2004–2005
 No. (%)
Country where interviewed
    Moldova75 (39.1)
    Ukraine49 (25.5)
    Italy26 (13.5)
    United Kingdom18 (9.4)
    Bulgaria16 (8.3)
    Czech Republic5 (2.6)
    Belgium3 (1.6)
Country of origin
    Moldova72 (37.5)
    Ukraine50 (26.0)
    Other Europeana50 (26.0)
    West African, Caribbeanb12 (6.3)
    No data8 (4.2)
Age, y
    15–1723 (12.0)
    18–2041 (21.3)
    21–2580 (41.7)
    26–4547 (24.5)
    No data1 (0.5)
Marital status before trafficking
    Single135 (70.3)
    Married/living as married22 (11.5)
    Separated/divorced33 (17.2)
    Widowed1 (0.5)
    No data1 (0.5)
Maternal status
    Children73 (38.0)
    No children118 (61.5)
    No data1 (0.5)
Time spent in trafficking situation
    1 day to 3 mo64 (33.2)
    3.1–6 mo37 (19.3)
    6.1 mo to 1 y38 (19.8)
    > 1 y36 (18.8)
    No data17 (8.9)
Violence experienced before traffickingc,d
    Any physical abuse94 (48.9)
    Any sexual abuse59 (30.7)
    Physical and sexual abuse40 (20.8)
    Physical or sexual abuse113 (58.9)
    None79 (41.1)
Violence experienced during traffickingc,e
    Any physical abuse145 (75.5)
    Any sexual abuse172 (89.6)
    Physical and sexual abuse135 (70.3)
    Physical or sexual abuse182 (94.8)
    None10 (5.2)
Threats experienced during trafficking
    Woman was threatened171 (89.1)
    Woman’s family was threatened67 (34.9)
    Woman and family were threatened62 (32.3)
Personal freedoms experienced during traffickingf
    Never145 (75.5)
    Seldom20 (10.4)
    Occasionally9 (4.7)
    Often5 (2.6)
    Always7 (3.7)
    No data6 (3.1)

aIncludes member states of the Organization for Security and Co-operation in Europe: Bulgaria, Czech Republic, Kyrgyzstan, Lithuania, Romania, Russian Federation, and Slovak Republic.

bIncludes Cameroon, Nigeria, and Jamaica.

cPercentages total to greater than 100% because most women reported more than 1 form of abuse.

d To measure physical abuse experienced before being trafficked, participants were asked, “Before you left home, did any of the following people ever physically hurt you when you were a child or an adult?” To measure forced or coerced sexual intercourse, they were asked, “Before/after you were 15 years old did any of the following people ever make you or persuade you to do something sexual when you didn’t want to?”

e To measure physical abuse experienced during trafficking, participants were asked, “Did anyone ever hit, kick, or otherwise physically hurt you? To measure forced sexual abuse, they were asked, “While you were in the trafficking situation, did anyone physically force you to have sex or do something sexual when you didn’t want to?” To measure coerced sexual abuse, they were asked, “Did you ever have sex with someone or perform some sexual act because you were afraid something bad would happen?”

f To measure restrictions of personal freedoms, women were asked, “How often were you free to do what you wanted or go where you wanted?”

Table
TABLE 2— Physical Symptoms and Severity Levels Experienced by Female Trafficking Survivors (n = 192): Europe, 2004–2005
TABLE 2— Physical Symptoms and Severity Levels Experienced by Female Trafficking Survivors (n = 192): Europe, 2004–2005
  Symptom Severity Ranking, No. (%)
Symptom CategoryTotal No. (%)Not RankedNot At AllA LittleQuite A BitExtremely/Very Much
Constitutional symptoms
    Easily tired156 (81.25)2 (1.28). . .38 (24.36)49 (31.41)67 (42.95)
    Weight loss91 (47.39). . .4 (4.40)24 (26.37)23 (25.27)40 (43.96)
    Loss of appetite119 (61.98). . .3 (2.52)43 (36.13)27 (22.69)46 (38.66)
Neurological symptoms
    Headaches158 (82.29). . .2 (1.26)33 (20.89)38 (24.05)85 (53.80)
    Dizzy spells135 (70.31). . .. . .44 (32.59)48 (35.56)43 (31.85)
    Memory difficulty119 (61.98)1 (0.84)2 (1.68)35 (29.41)36 (30.25)45 (37.82)
    Fainting40 (20.83)1 (2.50). . .23 (57.50)10 (25.00)6 (15.00)
Gastrointestinal symptoms
    Stomach pain117 (60.94). . .1 (0.86)32 (27.35)54 (46.15)30 (25.64)
    Upset stomach, vomiting, diarrhea, constipation84 (43.75)1 (1.19). . .31 (36.9)37 (44.05)15 (17.86)
Urogenital symptoms
    Urination pain33 (17.19)3 (9.09). . .6 (18.18)13 (39.40)11 (33.33)
    Pelvic pain113 (58.85)7 (6.20)2 (1.77)21 (18.58)33 (29.20)50 (44.25)
    Vaginal discharge134 (69.79)2 (1.49)2 (1.49)32 (23.89)45 (33.58)53 (39.55)
    Vaginal pain48 (25.00). . .. . .20 (41.67)17 (35.42)11 (22.91)
    Vaginal bleeding (not menstruation)18 (9.38). . .. . .3 (16.67)11 (61.11)4 (22.22)
    Gynecological infection112 (58.33)3 (2.68). . .20 (17.86)38 (33.93)51 (45.53)
Cardiovascular symptoms
    Chest/heart pain96 (50.00). . .1 (1.04)40 (41.67)39 (40.63)16 (16.66)
    Breathing difficulty76 (39.58). . .2 (2.63)32 (42.11)31 (40.79)11 (14.47)
Musculoskeletal symptoms
    Back pain132 (68.75)3 (2.27). . .34 (25.76)46 (34.85)49 (37.12)
    Fractures/sprains24 (12.50). . .3 (12.50)9 (37.50)5 (20.83)7 (29.17)
    Joint or muscle pain68 (35.42)1 (1.47)2 (2.94)18 (26.47)29 (42.65)18 (26.47)
    Tooth pain111 (57.81)1 (0.90)1 (0.90)37 (33.33)21 (18.92)51 (45.95)
    Facial injuries18 (9.38)1 (5.56). . .4 (22.22)6 (33.33)7 (38.89)
Eye, ear, and upper respiratory symptoms
    Eye pain63 (32.81)1 (1.59). . .25 (39.68)25 (39.68)12 (19.05)
    Ear pain28 (14.58). . .1 (3.57)15 (53.58)9 (32.14)3 (10.71)
    Cold, flu, sinus infection58 (30.21). . .4 (6.89)26 (44.83)17 (29.31)11 (18.97)
Dermatological symptoms
    Rashes, itching, sores54 (28.13). . .1 (1.85)20 (37.04)24 (44.44)9 (16.67)

Note. The listed categories refer to general symptom groupings only. They are not intended to reflect a diagnosis or symptom origin for individual women.

Table
TABLE 3— Brief Symptom Inventory Mental Health Subscale Scores of Female Trafficking Survivors (n = 189): Europe, 2004–2005
TABLE 3— Brief Symptom Inventory Mental Health Subscale Scores of Female Trafficking Survivors (n = 189): Europe, 2004–2005
  Percentile Ranking in Comparison With Published Normsa
SubscaleMean Score (95% CI)NonpatientPsychiatric Outpatient
Depression2.09 (1.94, 2.23)98th51st
Anxiety1.90 (1.76, 2.04)97th51st
Hostility1.21 (1.10, 1.33)95th51st

Note. CI = confidence interval.

a Trafficked women’s Brief Symptom Inventory subscale scores were compared with available published norms of a US-based adult female nonpatient population and an adult female psychiatric outpatient population.

Funding for this study was provided by the European Commission’s Daphne Programme (grant JAI/DAP/02/082/WY), with additional funding by the International Organization for Migration and the Sigrid Rausing Trust.

Special gratitude is offered to the trafficking survivors who participated in this study and to their support workers. Thanks to Melanie Abas for reviewing this brief and to Sarah Stephens-Smith, Anne Vauthier, and Sandra Dickson for their contributions. Partner organizations for the study included Animus Association Foundation/La Strada, Associazione On the Road, Eaves Housing, International Organization for Migration in Ukraine and Moldova, La Strada–Czech Republic, and Pag-Asa.

Human Participant Protection Research ethical approval was received from the research ethics committee of the London School of Hygiene & Tropical Medicine and local partners.

References

1. Office of the United Nations High Commissioner for Human Rights. Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, Supplementing the United Nations Convention Against Transnational Organized Crime. GA Res. 55/25, Annex 2, UN GAOR 55th Sess, Supp No 49, at 60, UN Doc A/45/49/Vol 1 (2000). Available at: http://www.ohchr.org/english/law/protocoltraffic.htm. Accessed September 19, 2007. Google Scholar
2. Office of the United Nations High Commissioner for Human Rights. Traffic in Women and Girls. Commission on Human Rights 57th Sess. E/CN.4/RES/48 (2001). Google Scholar
3. Zimmerman C, Watts C. WHO Ethical and Safety Recommendations for Interviewing Trafficked Women. Geneva, Switzerland: World Health Organization; 2003. Google Scholar
4. Campbell J, Jones J, Dienemann J, et al. Intimate partner violence and physical health consequences. Arch Intern Med. 2002;162:1157–1163. Crossref, MedlineGoogle Scholar
5. Miller TW. Long term effects of torture in former prisoners of war. In: Basoglu M, ed. Torture and Its Consequences: Current Treatment Approaches. Cambridge, England: Cambridge University Press; 1992. Google Scholar
6. Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med. 1983; 13:595–605. Crossref, MedlineGoogle Scholar
7. Derogatis L. BSI Brief Symptom Inventory. Administration, Scoring and Procedures Manual. Minneapolis, Minn: NCS Pearson; 1993. Google Scholar
8. Harvard Program in Refugee Trauma. Harvard Trauma Questionnaire. Available at: http://www.hprt-cambridge.org/Layer3.asp?page_id=19. Accessed May 5, 2006. Google Scholar
9. Mollica R, Caspi-Yavin Y, Lavelle J, et al. Harvard Trauma Questionnaire (HTQ) Manual: Cambodian, Lao, and Vietnamese Versions. Boston, Mass: Harvard School of Public Health; 1991. Google Scholar
10. Aroian K, Patsdaughter C. Multiple-method, cross-cultural assessment of psychological distress. Image J Nurs Sch. 1989;21:90–103. Crossref, MedlineGoogle Scholar
11. Aroian K, Patsdaughter C, Levin A, Gianan M. Use of the Brief Symptom Inventory to assess psychological distress in three immigrant groups. Int J Soc Psychiatry. 1995;41:31–46. Crossref, MedlineGoogle Scholar
12. Morlan K, Tan S. Comparison of the Brief Psychiatric Rating Scale and the Brief Symptom Inventory. J Clin Psychol. 1998;54:885–894. Crossref, MedlineGoogle Scholar
13. Mollica RF, Caspi-Yavin Y, Bollini P, et al. The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma and post traumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992;180:111–116. Crossref, MedlineGoogle Scholar
14. Mollica RF, Caspi-Yavin Y. Measuring torture and torture-related symptoms. Psychol Assess. 1991;3:1–7. CrossrefGoogle Scholar
15. Ekblad S, Roth G. Diagnosing posttraumatic stress disorder in multicultural patients in a Stockholm psychiatric clinic. J Nerv Ment Dis. 1997;185: 102–107. Crossref, MedlineGoogle Scholar
16. Shapiro J, Douglas K, de la Rocha O, et al. Generational differences in psychosocial adaptation and predictors of psychological distress in a population of recent Vietnamese immigrants. J Comm Health. 1999;24: 95–113. Crossref, MedlineGoogle Scholar
17. Peltzer K. Trauma and mental health problems of Sudanese refugees in Uganda. Cent Afr J Med. 1999; 45:110–114. MedlineGoogle Scholar
18. Mollica RF, Donelan K, Tor S, et al. The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand-Cambodia border camps. JAMA. 1993;270: 581–586. Crossref, MedlineGoogle Scholar
19. Strober S. Social work interventions to alleviate Cambodian refugee psychological distress. Int Soc Work. 1994;37:23–35. CrossrefGoogle Scholar
20. Silove D, Sinnerbrink I, Field A, et al. Anxiety, depression and PTSD in asylum-seekers: associations with pre-migration trauma and post-migration stressors. Br J Psychiatry. 1997;170:351–357. Crossref, MedlineGoogle Scholar
21. Mghir R, Raskin A. The psychological effects of the war in Afghanistan on young Afghan refugees from different ethnic backgrounds. Int J Soc Psychiatry. 1999;45:29–36. Crossref, MedlineGoogle Scholar
22. Leserman J, Li Z, Drossman DA, Hu YJB. Selected symptoms associated with sexual and physical abuse history among female patients with gastrointestinal disorders: the impact on subsequent health care visits. Psychol Med. 1998;28:417–425. Crossref, MedlineGoogle Scholar
23. Basoglu M, Mineka S. The role of uncontrollable and unpredictable stress in post-traumatic stress responses in torture survivors. In: Basoglu M, ed. Torture and Its Consequences: Current Treatment Approaches. Cambridge, England: Cambridge University Press; 1992. Google Scholar
24. Basoglu M, Paker M, Paker O, et al. Psychological effects of torture: a comparison of tortured with non-tortured political activists in Turkey. Am J Psychiatry. 1994;151:76–81. Crossref, MedlineGoogle Scholar
25. Pearson E. Human Traffic, Human Rights: Redefining Victim Protection. London, England: Anti-slavery International; 2002. Google Scholar

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Cathy Zimmerman, PhD, Mazeda Hossain, MSc, Katherine Yun, MD, Vasil Gajdadziev, MD, Natalia Guzun, MSc, Maria Tchomarova, MA, Rosa Angela Ciarrocchi, MA, Anna Johansson, BA, Anna Kefurtova, BA, Stefania Scodanibbio, MSc, Maria Nenette Motus, MD, Brenda Roche, PhD, Linda Morison, MA, and Charlotte Watts, PhDCathy Zimmerman, Mazeda Hossain, Brenda Roche, Linda Morison, and Charlotte Watts are with the Gender Violence and Health Centre, London School of Hygiene & Tropical Medicine, London, England. Katherine Yun is with the Yale University School of Medicine, New Haven, Conn. Vasil Gajdadziev, Natalia Guzun, and Maria Nenette Motus are with the International Organization for Migration, Kiev, Ukraine, and Chisinau, Moldova. Maria Tchomarova is with the Animus Association Foundation and La Strada–Buglaria, Sophia. Rosa Angela Ciarrocchi and Stefania Scodanibbio are with Associazione On the Road, Martinsicuro, Italy. Anna Johansson is with Eaves Housing, London. Anna Kefurtova is with La Strada–Czech Republic, Prague. “The Health of Trafficked Women: A Survey of Women Entering Posttrafficking Services in Europe”, American Journal of Public Health 98, no. 1 (January 1, 2008): pp. 55-59.

https://doi.org/10.2105/AJPH.2006.108357

PMID: 18048781