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While migration within and across national borders has been an economic and social mobility strategy that has benefited millions of people around the world, there is growing recognition that labor exploitation of migrant workers has become a problem of global proportions. Human trafficking and other forms of extreme exploitation, including forced labor and forced marriage, now collectively under the terminological umbrella "modern slavery," are reported to affect an estimated 40.3 million people globally, with 29.4 million considered to be in situations of forced labor. PLOS is launching a collection of essays and research articles on "Human Trafficking, Exploitation and Health" to increase awareness of the problem and to urge health and nonhealth professionals alike to engage in international and local responses to protect the health of individuals and populations affected by trafficking.Human trafficking is a multidimensional human rights violation that centers on the act of exploitation. The United Nations defines trafficking in persons as "the recruitment, transportation, transfer, harbouring 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". The elements of coercion, exploitation, and harm link human trafficking with other forms of modern slavery, forced labor and forced marriage.

BACKGROUND: Emerging evidence indicates the extreme forms of violence and acute and longer-term mental health consequences associated with trafficking and exploitation. However, there has been little research on post-trafficking mental health and psychosocial support services for survivors. This study explored the availability and accessibility of mental health and psychosocial support services in Cambodia for women, men and children trafficked and exploited for sex or labour purposes. METHODS: Semi-structured interviews were conducted with a purposively selected sample of representatives from seven service organizations providing mental health and psychosocial support services for people who have been trafficked. This qualitative method was selected to gain insights into the service approaches and challenges faced by the small number of post-trafficking service providers in Cambodia. A conceptual framework outlining access dimensions associated with service provision guided the structure of the study. RESULTS: Findings indicate that among the available post-trafficking services, there are few trained mental health specialists, an over-representation of shelter services in urban versus rural areas and limited services for males, people with disabilities, individuals exploited for labour (versus sexual exploitation) and those with more serious mental illnesses. Providers believe that discrimination and stigma related to both mental health and human trafficking hinder trafficked people's willingness to access services, but suggest that awareness-raising may reduce these prejudices. Care in this sector is precarious due to over-reliance on financial support by donors versus government. Recent increases in newly qualified professionals and providers suggest potential improvements in the quality and availability of psychological support for trafficking survivors. CONCLUSIONS: Psychological support for the growing number of identified trafficking survivors in Cambodia will depend on improved geographical distribution of services, more mental health support professionals and growing acceptability of mental health service use among trafficked people and the Cambodian public.

BACKGROUND: International labour migration has become a crucial livelihood strategy, especially in countries where decently paid employment opportunities are limited. Such opportunities come with many potential benefits but also many stressors that challenge migrants' coping skills, especially when they are in a foreign environment away from their normal support network. This paper explores how labour migrants coped with migration-related stressors using a sample of male Nepali migrants. METHODS: Qualitative life histories were conducted in Kathmandu among returnee male migrants. Coping responses were categorised based Skinner and Zimmer-Gembeck's coping typologies. The interview scripts were transcribed in Nepali and translated into English for analysis. Each interview script was open coded and then categorised according to the 12 core coping families. Data were analysed thematically to explore relationships across and within coping and stressors. RESULTS: Forty-two men were interviewed who mainly worked in low- and semi-skilled jobs in Malaysia, and the Gulf States. The coping strategies most commonly used belonged to the families of problem-solving, support-seeking, negotiation and helplessness. Men used these either individually or collectively with other migrants. Those who sought assistance from authorities or civil society organisations did not always receive the help needed and there were mixed messages as to when and what types of assistance were available. Some stressors involved multiple coping strategies simultaneously, others described changing strategies following unsuccessful earlier attempts. The coping families of helplessness and social isolation reflected migrants' limited power in challenging certain stressors. The choice of coping strategies was also moderated by factors such as outstanding loans, language difficulties, or not wanting to cause their family distress. Some coping strategies used led to new stressors. CONCLUSIONS: Migrants need greater clarifications on their rights with respect to contract discrepancies, the types of support available, how and from whom to access them once in destination. Improvements to the support mechanisms migrants can access as well as strengthening migrant-led initiatives in destination countries to support labour migrants' in managing stressors are needed. These may contribute to reducing the experiences and impact of such stressors, which may ultimately lead to more successful migration outcomes. As labour migration from Nepal is likely to continue, government and CSOs need to ensure migrants have the support they need to cope with the challenges they may encountered along the way.

With the increase in female migration, especially in the domestic sector, and accompanying reports of worker exploitation and abuse, labour-sending countries are grappling with the question of how to protect these workers. Drawing on a critical feminist policy analysis framework, this article analyses the policy and regulatory frameworks of Nepal related to female labour migration and examines their implications. Our analysis indicates that Nepal's policy regime consist of a set of measures which are simultaneously liberal, protective and restrictive, and as such, they have not altered the structural conditions and economic reasons for women's migration. Instead, women appear to be largely uninformed about government regulations, and most importantly, working conditions abroad are not affected by sending country policies, including the various migration bans put in place to protect women.

BACKGROUND: International migration has become a global political priority, with growing concern about the scale of human trafficking, hazardous work conditions, and resulting psychological and physical morbidity among migrants. Ethiopia remains a significant "source" country for female domestic workers to the Middle East and Gulf States, despite widespread reports of exploitation and abuse. Prior to introduction of a "safe migration" intervention, we conducted formative research to elicit lessons learned by women who had worked as domestic workers abroad. The aim of the study was to identify realistic measures future migrants could take to protect themselves, based on the collective insights and experience of returnees. METHODS: We conducted a qualitative assessment among returnee domestic labour migrants in Amhara Region, Ethiopia, an area considered a "hotspot" for outmigration. We conducted in-depth interviews and focus group discussions with a total of 35 female returnees, exploring risk and protective factors experienced by Ethiopian women during domestic work abroad. We used thematic content analysis to identify practical messages that could improve prospective migrants' preparedness. RESULTS: Returnees described the knowledge and skills they acquired prior to departure and during migration, and shared advice they would give to prospective migrants in their community. Facilitators of positive migration included conforming to cultural and behavioural expectations, learning basic Arabic, using household appliances, and ensuring safety in employers' homes. Respondents also associated confidence and assertiveness with better treatment and respect, and emphasized the importance of access to external communication (e.g. a mobile phone, local sim card, and contact details) for help in an emergency. Following their own challenging or even traumatic experiences, returnees were keen to support resilience among the next wave of migrants. CONCLUSIONS: There is little evidence on practices that foster safer migration, yet attention to human trafficking has led to an increase in pre-migration interventions. These require robust evidence about local risk and protective factors. Our findings identify knowledge, skills, attributes and resources found useful by returnee domestic workers in Amhara region, and have been used to inform a community-based programme aiming to foster better decision-making and preparation, with potential to offer insights for safer migration elsewhere.

Background: Human trafficking has been recognized both by the international community and many individual states around the world as a serious violation of human rights. Trafficking is associated with extreme violence and a range of physical, mental, and sexual health consequences. Despite the extreme nature of the harm caused by human trafficking, harm is not a concept that is integrated in the definition of trafficking or in policies to address the health of trafficked people. This paper examines the United Kingdom's response to human trafficking as a case study to explore national policy responses to the health needs of trafficked people and assess the willingness of UK authorities to implement international and regional law in securing trafficked people's health rights. Methods: Between 2007 and 2010, data on the development of the UK response to trafficking were obtained through 46 interviews with key trafficking policy stakeholders and health care providers, participant observation at 41 policy-relevant events, and document collection. Framework analysis was used to analyze the data. Results: International and regional instruments specifically protect the health rights of trafficked people. Yet, UK engagement with trafficked people's health rights has been limited to granting, under certain circumstances, free access to health care services. Changes to trafficked people's entitlements to free health care occurred following the ratification of the Council of Europe Convention on Action against Trafficking in Human Beings, but had limited impact on trafficked people's access to medical care. Conclusions: International and regional instruments that provide specific or mandated instruction about states' health care obligations can be effective in furthering the health rights of vulnerable migrant groups. The UK government has demonstrated limited appetite for exceeding its minimum obligations to provide for the health of trafficked people, however, and key principles for promoting the health rights of trafficked people are yet to be fulfilled. Adapted from the source document.

Background: Human trafficking has been recognized both by the international community and many individual states around the world as a serious violation of human rights. Trafficking is associated with extreme violence and a range of physical, mental, and sexual health consequences. Despite the extreme nature of the harm caused by human trafficking, harm is not a concept that is integrated in the definition of trafficking or in policies to address the health of trafficked people. This paper examines the United Kingdom's response to human trafficking as a case study to explore national policy responses to the health needs of trafficked people and assess the willingness of UK authorities to implement international and regional law in securing trafficked people's health rights. Methods: Between 2007 and 2010, data on the development of the UK response to trafficking were obtained through 46 interviews with key trafficking policy stakeholders and health care providers, participant observation at 41 policy-relevant events, and document collection. Framework analysis was used to analyze the data. Results: International and regional instruments specifically protect the health rights of trafficked people. Yet, UK engagement with trafficked people's health rights has been limited to granting, under certain circumstances, free access to health care services. Changes to trafficked people's entitlements to free health care occurred following the ratification of the Council of Europe Convention on Action against Trafficking in Human Beings, but had limited impact on trafficked people's access to medical care. Conclusions: International and regional instruments that provide specific or mandated instruction about states' health care obligations can be effective in furthering the health rights of vulnerable migrant groups. The UK government has demonstrated limited appetite for exceeding its minimum obligations to provide for the health of trafficked people, however, and key principles for promoting the health rights of trafficked people are yet to be fulfilled. Adapted from the source document.

BACKGROUND: Human trafficking has been recognized both by the international community and many individual states around the world as a serious violation of human rights. Trafficking is associated with extreme violence and a range of physical, mental, and sexual health consequences. Despite the extreme nature of the harm caused by human trafficking, harm is not a concept that is integrated in the definition of trafficking or in policies to address the health of trafficked people. This paper examines the United Kingdom's response to human trafficking as a case study to explore national policy responses to the health needs of trafficked people and assess the willingness of UK authorities to implement international and regional law in securing trafficked people's health rights. METHODS: Between 2007 and 2010, data on the development of the UK response to trafficking were obtained through 46 interviews with key trafficking policy stakeholders and health care providers, participant observation at 41 policy-relevant events, and document collection. Framework analysis was used to analyze the data. RESULTS: International and regional instruments specifically protect the health rights of trafficked people. Yet, UK engagement with trafficked people's health rights has been limited to granting, under certain circumstances, free access to health care services. Changes to trafficked people's entitlements to free health care occurred following the ratification of the Council of Europe Convention on Action Against Trafficking in Human Beings, but had limited impact on trafficked people's access to medical care. CONCLUSIONS: International and regional instruments that provide specific or mandated instruction about states' health care obligations can be effective in furthering the health rights of vulnerable migrant groups. The UK government has demonstrated limited appetite for exceeding its minimum obligations to provide for the health of trafficked people, however, and key principles for promoting the health rights of trafficked people are yet to be fulfilled.

Social scientists are working with epidemiologists to produce evidence that questions traditional epidemiological HIV 'core group' models. Adapted from the source document.

Preventing modern slavery is of global interest, but evidence on interventions remains weak. This paper presents findings from a 5-year theory-based evaluation of an empowerment and knowledge-building intervention to prevent the exploitation of South Asian female migrant workers. The evaluation used realist evaluation techniques to examine the intervention mechanisms, outcomes, and context. Findings from qualitative and quantitative data from Nepal, India, and Bangladesh indicate that the intervention mechanisms (trainings) were not well-targeted, not delivered by appropriate trainers, and did not address participants' expectations or concerns. The outcomes of empowerment and migration knowledge were not achieved due to poor integration of context-related factors, flawed assumptions about the power inequalities, including barriers preventing women from asserting their rights. Ultimately, interventions to prevent exploitation of migrant workers should be developed based on strong evidence about the social, political, and economic realities of their migration context, especially in destination settings.

Preventing modern slavery is of global interest, but evidence on interventions remains weak. This paper presents findings from a 5-year theory-based evaluation of an empowerment and knowledge-building intervention to prevent the exploitation of South Asian female migrant workers. The evaluation used realist evaluation techniques to examine the intervention mechanisms, outcomes, and context. Findings from qualitative and quantitative data from Nepal, India, and Bangladesh indicate that the intervention mechanisms (trainings) were not well-targeted, not delivered by appropriate trainers, and did not address participants' expectations or concerns. The outcomes of empowerment and migration knowledge were not achieved due to poor integration of context-related factors, flawed assumptions about the power inequalities, including barriers preventing women from asserting their rights. Ultimately, interventions to prevent exploitation of migrant workers should be developed based on strong evidence about the social, political, and economic realities of their migration context, especially in destination settings.

Abstract Background The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. Methods Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. Results Paediatric care can be complex, usually involving both the patient and the patient's family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. Conclusions International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care for PMs at both policy and service levels is an investment in the future that will benefit native and migrant families.

BACKGROUND: The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. METHODS: Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. RESULTS: Paediatric care can be complex, usually involving both the patient and the patient's family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. CONCLUSIONS: International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care for PMs at both policy and service levels is an investment in the future that will benefit native and migrant families.