Ligia Kiss of the London School of Hygiene & Tropical Medicine led a team that investigated the psychological effects on children of trafficking in the region. “We were shocked by the numbers,” she told IRIN. While such effects have been well-documented over the years, few, if any, previous studies have delivered such quantitative detail with regard to children and adolescents.
More than half of the 387 people interviewed showed symptoms of depression; 12 percent reported that they had tried to harm or kill themselves in the month before the interview; and nearly 16 percent reported suicidal thoughts, according to the team’s report.
The interviewees had recently arrived in various institutions set up to help people freed or who escaped from trafficking in Cambodia, Vietnam and Thailand. Some had been brought in by border guards after being intercepted on the way to their destination, others were referred by police or other officials. The oldest was 17 and the youngest just 10 years old.
Southeast Asia has a network of government and NGO-run shelters and transit centres that work with the International Organization for Migration to look after the young victims and reunite them with their families.
Still, according to Kiss, before the research “there was so little data on people who had been trafficked. We didn't have a good sense of what kind of experiences they underwent or the consequences that they were facing, especially in terms of their mental health.”
A third of those interviewed had suffered violence during trafficking and 23 percent of those reported serious injuries. Twenty-one percent of the boys had been injured while working, reporting such things as bad burns, head and back injuries and broken bones. Excessively long hours were common, sometimes without any rest days, and some of the children were kept locked up, had no proper place to sleep or were denied food or water.
In an investigation into the reintegration of male trafficking victims released last month by Cambodian protection agency Hagar, survivors spoke about the difficulties they had overcoming the abuse.
“I want my mental health to be like before I went to Thailand. I have forgotten many things, I am sometimes dizzy, sometimes have headaches, and I’m always worried,” said one. “I also have dreams and nightmares, dreaming of the time on the boat. Every time I dream I am not well at all.”
The report makes the point that these were enterprising young people who had mostly gone with the traffickers in the expectation of a better life. Although a small number reported having been abducted, most had set out voluntarily on the journey; 64 percent said they had left home for economic reasons and others (24 percent) were looking for new experience. A smaller number (eight percent) had left because of violence or drunkenness at home.
Looking at the victims' past experience produced one very interesting correlation. Although only eight percent cited it as their main reason for leaving, 22 percent of those interviewed had already suffered physical or sexual violence before they were trafficked, and it was these young people who were most likely to self-harm. Violence during the trafficking process had no such influence on the likelihood of self-harm later.
Even though the interviewees were now in a safe place, with the prospect of returning to their families, they expressed great anxiety. Just over half said they were worried about how they would be treated when they returned home, a similar number said they felt shame or guilt, and a third were still fearful of their traffickers.
Chhan Sokunthea, head of the Women and Children's Rights section at the Cambodian Human Rights and Development Association, ADHOC, works closely with repatriated trafficking victims and has witnessed first-hand the impact of such experiences as well as the fallout for families.
She pointed out that many suffer doubly when they are brought home having failed to secure financial stability for their families and instead return with serious health problems. “They feel disappointed because when they want to work abroad, they want to do so to improve their livelihood,” Chhan Sokunthea said. Instead, “they go to Malaysia or Thailand, they don’t get a full salary or any salary. They are abused by their boss. Some of the victims have mental health problems… the families spend all their money to cure them, making them poorer and poorer.”
What is clear is that the organisations that work with these teenagers need to do far more than simply provide shelter while arranging for them to return to where they came from. The researchers in Kiss’s team found dedicated staff who were working hard to respond to the needs of the trafficking victims, but who didn't feel equipped to deal with these kinds of mental health problems. Thailand, where most trafficked children end up, and where they first come into the care of post-trafficking organisations, has slightly more options for referral, but there is a still a shortage of specialised mental health provision.
The lack is greater still in the poorer neighbouring countries to where some of the children are returned. Mental health is severely underfunded in Cambodia, allocated just one percent of the healthcare budget. With a reported 41 registered psychiatrists out of a population of 15 million, access to mental healthcare for the repatriated poses further complications for organisations like Chhan Sokunthea's.
“Most of them just get help from the organisation only for travelling costs or transportation,” she said. “But for the treatment, no NGO or government can support them. They support themselves. For the NGO, we don’t have the budget for health problems. All of these issues, the government should be helping them… but the government does not.”
The research also casts doubt on the assumption that return to their families is automatically the right solution for these young people. “They are getting sent back to the same situation they left in the first place,” said Kiss. “Other research and the experience of the service providers show that a lot will migrate again. They may perhaps have more information now to help them avoid some of the traps, but they will still face the same risks as in the past.”
(Additional reporting by Abby Seiff in PHNOM PENH)