Monitoring and Evaluation Report of the 1 st pilot training in Krems of the Project on

Transcription

1 Monitoring and Evaluation Report of the 1 st pilot training in Krems of the Project on Joint efforts of Police and Health Authorities in the EU Member States and Third Countries to Combat and Prevent Trafficking in Human Beings and Protect and Assist Victims of Trafficking. EC/ISEC/PAYOKE DUK Project HOME/2010/ISEC/AG/ CE / February 2013 Prepared by: Gudrun Biffl, Birgit Zetinigg, Aga Trnka Kwiecinski, Friedrich Altenburg Danube University Krems, February 2013

2 Content 1 Executive summary and recommendations Objectives of the expert meeting and the pilot training The objectives of the expert meeting Objectives of the pilot training Points of discussion and outcomes of the Expert meeting Who are the main cooperative partners/institutions and who should/could be added in? What are the main challenges in the identification of victims? What are the main gaps in the current procedures? What are the main challenges in the topic of prosecution of traffickers? What does the prosecutor need from the medical profession? Points of discussion and outcomes of the Pilot training Aim of the training course Introduction into the project and pilot training Case Study (1) Case Study (2) Group 1: Police, Law enforcement Group 2: Medical Profession Group 3: NGOs Evaluation of the Pilot Training Outcomes of the evaluation...25 i

3 Appendix 1: Presentations...30 Presentation 1: Patsy Sörensen...30 Presentation 2: Gudrun Biffl & Birgit Zetinigg...34 Presentation 3: Gerald Tatzgern...40 Appendix 2: Administration...45 Agenda 11th of February 2013, Steering Committee Meeting and Expert Meeting, Krems...46 Agenda: 12th of February 2013 Pilot Training Krems...47 List of Participants Expert Meeting List of Participants Pilot Training Pre and Post Course Questionnaire/evaluation to be filled out before and after the Pilot Training, to check the learning outcomes of the training...52 Appendix 3: Pilot training , picture protocol...55 ii

4 1 Executive summary and recommendations The main purpose of the pilot training, involving experts and professionals in the various fields of combating Trafficking in Human Beings at the Danube University in Krems, Austria, was to establish the current standard procedures and to provide recommendations to move ahead towards developing better regulations and instruments to combat and prevent THB, to ensure the rights and wellbeing of the potential victim and to protect public health. Accordingly, the recommendations cover a wide field, flowing from expert advice as well as professional multidisciplinary dialogue in training workshops. Recommendations as to governance: For a governance system to be effective in combatting THB all relevant institutional actors have to be involved, i.e. a comprehensive approach has to be taken. The means of coordination and cooperation may differ by country, i.e., there are many ways of getting it right. In Austria, the major Ministries involved are the Ministry of the Interior, of Justice, of Labour and Social Affairs, of Economic Affairs, Family and Youth, of Health and of Women Affairs. In addition, the federal states have to be integrated, either by law or by involving the Chancellery, which has the authority to give directives to the Länder. In addition, more key institutions have to be part of the comprehensive network, such as health and care services, social services, professional associations (in particular medical association), as well as trade unions. A national support team providing specialist advice should be implemented, which has the function of a national helpdesk for various actors, who may potentially be involved with identification of THB. Further, the formation of informal networks of NGOs should be promoted within and between regions in order to promote understanding, trust, learning and cooperation between all the professions involved (NGOs, health care, social workers, special police force). Learning from other country s experiences both in terms of institutional arrangements as well as specific challenges in health care and service provision should be organized via exchange programs, possibly modeled after Médecins sans Frontières. International Cooperation between authorities should go beyond police and law enforcement on the one hand and beyond bilateral agreements on the other. It is suggested 1

5 that the EC issue a directive obliging all MS to cooperate in the identification, prosecution and re integration of cases of THB, in particular also for citizens of another country. Procedures for the medical profession (THB Protocol) have to be put in place in all EU MS which have to be adhered to in case of suspected cases of THB, possibly following established procedures against domestic violence or against torture (Istanbul protocol). It is recommended that the treatment of potential victims of THB is free of charge in hospitals, outpatient clinics as well as at family doctors, but adequate compensation of the cost has to be provided by the state. In case of successful prosecution of the trafficker the costs incurred should be borne by the perpetrator (compensation). It is recommended that in case of suspected case of THB a covenant between the medical association and/or Ministry of Health and law enforcement should be put in place which would lift the obligation to confidentiality and oblige the medical profession to cooperate with law enforcement. Recommendations for NGOs, health professionals and institutions: The issue of trust is at the centre of coordinated action in identifying potential victims. The earlier and faster one acts the greater the chances of successful identification and of the chances for success in prosecuting the trafficker based on medical evidence. It is therefore recommended that multidisciplinary specialist teams across institutions are involved as early as possible in order to decide on coordinated action. Recommendation: involve all persons around the potential victim in the process of identification. It is recommended to institutionalise efforts towards transparency of methods and intentions between the various institutions and professions involved such that standard operating procedures can be developed and implemented as default actions, also case management procedures. Institutionalised operating procedures constitute a road map, identifying sequencing of actions, their timing and spacing and entailing learning from each other. The list of professions and institutions included in cooperative actions on THB should be expanded, e.g. by ambulance drivers and embassies Trust building does not only entail to learn to speak and understand the professional language of the cooperating partners, e.g. by involving multidisciplinary teams, but also to 2

6 know that there is a special police unit focusing on THB (training and information as well as more casual regulars tables could be a way to go). It is recommended that the medical profession is obliged by law to inform the special police unit in case of suspected THB, because they may contribute thereby to the prevention of THB (added value). It is suggested to provide special protection for a patient in the mental hospital in case of suspected trafficking. It is recommended that a list of possible injuries and combinations of symptoms be provided to the medical profession for better orientation. For law enforcement and the judiciary also light physical injuries should suffice for further questioning in case of a combination with other factors, thereby promoting action in favour of the potential victim, including prosecution of the perpetrator. It is recommended to develop a memorandum of understanding between doctors and law enforcement agencies in case of suspected THB, where both sides understand their role in protecting the victim and acting against the trafficker (default action). It is recommended to establish focal points in hospitals in order to promote a coordinated action between the medical profession and the special police unit. Recommendations for health professionals and health services: In order to allow direct communication between the medical profession and the potential victim, procedures have to be put in place in hospitals to get interpreters/persons of trust with special THB training (Skype, special hotline). It is recommended to develop a differentiated communication policy for medical professions, whereby pocket cards for GPs and hospitals may be important first steps. The information most needed is on legal regulations, rights and duties of the medical personnel. In case of a referral of a potential victim to the health system by the police, it is recommended that the suspicion of a case of THB should be clearly documented and added to the case history as environmental (circumstantial) information. As medical staff tends to be under constant time pressure it is recommended to provide guidance for the medical profession in terms of: o Documentation needs (medical report) o Securing forensic evidence o With whom of law enforcement to have contact (specialist team) and on what issues communication is warranted 3

7 o Joint planning of precautionary measures to ensure the safety of the victim and protect public health. It is recommended that Case Management is applied, possibly from a neutral institution such as NGOs, who may act on behalf of the potential victim and in the interest of the potential victim. As forensic evidence is often key to prosecute a perpetrator it is necessary to provide adequate education and training of medical personnel either in medical university education or as a supplementary training in case of work in special multidisciplinary teams in THB units. It is recommended to provide training to the medical profession on indicators, operating procedures, and legal ramifications in case of suspected THB. By offering credit points for successful participation in training measures on issues of THB the motivation to engage in further training may be raised. A list of specialists and GPs could flow from that, identifying those providers of medical care who are knowledgeable in the field of THB (added value). Such lists of medical service providers who are sensitized to victims of THB may facilitate networking between the medical professions as well as NGOs and law enforcement. Recommendations for law enforcement and politics: Go beyond focusing only on the human rights aspect of the crime of THB and focus also on the economic crime aspect. This would allow a shift of action from the victim to other witnesses who may provide evidence, thereby taking the load off the victim to serve as the only witness in the phase of prosecution. The focus should be put on pro active police action. Actions should be taken to harmonise data collection and protection. A media campaign on THB focusing on various target groups is recommended to raise awareness of the issue of THB and to provide some key contact points for victims, e.g. hotline on THB. The social media should be included in such an information campaign. Recommendations for law enforcement and health professions: The first responder to a potential victim has to have knowledge on how a victim of trafficking may look like (indicators) and what action to take (default regulation). Thus a training need of general police officers is given. 4

8 As a tribute to gender based different needs of victims: For example in case of sexual abuse a female victim should have the right to talk to a female police officer. And furthermore, due to cultural or religious needs also a male victim should have the right to talk to male key persons. The communication between the judiciary and the medical profession is key to effectively prosecuting a case of THB; it is recommended that training is provided to the medical profession on what to look for (indicators) and how to write a medical report, which can be used in the court. It is recommended that victims receive an explanation why and on what issues they should provide evidence such that the perpetrator may be prosecuted. 5

9 2 Objectives of the expert meeting and the pilot training The overall objective of the first pilot training in Krems (project activity 10), was to deliver the training curriculum and to promote cooperation among counter trafficking specialists from law enforcement, judiciary and NGO s and extending such cooperation to health authorities and health care providers and border guards from participating EU and non EU countries as primary target of this action. The total number of participants was 41, as envisaged in the project proposal. Participants with no specific knowledge about the topic of THB (Trafficking of Human Beings) where evaluated on their awareness, their knowledge and their attitudes towards THB. Experts from various institutions working in the field of THB have been evaluated by monitoring their contributions and roles as representatives of institutions in the chain of action in the fight against THB, their awareness of the gaps in the current procedures and their recommendations for improvement and possibilities of better cooperation between the current network and by identifying possible new partners/institutions. The experiences of Austrian experts were juxtaposed with those of external experts, thereby helping to develop guidelines for more efficient governance schemes and identifying training needs. 2.1 The objectives of the expert meeting To assemble around the table a very select group of experts and persons in decision making power in one or the other area of action of the National Action Plan on THB (Trafficking in Human Beings), To identify the institutional chain of action and the gaps in the chain To identify the main challenges in identifying victims of THB and to draw up action plans for improvement/amendments (identification phase) To draw up the necessary plan for action to render actions against the perpetrators more efficient and to ensure the health and safety of the victims (prosecution phase) To identify the main challenges for the medical profession/health system, for Law enforcement/judges, for social workers/ngos To identify the action chain in the area of re integration after the successful prosecution phase, the major challenges for the medical profession/health system, for labour market institutions, for social workers/ngos To promote the mutual understanding for actions to be taken, for cooperation and concerted action in the area of identification, prosecution and re integration of victims 6

10 To set priorities in the coordinated action plan by focusing on the gaps and major challenges 2.2 Objectives of the pilot training To raise awareness of and develop understanding for the crime of human trafficking To raise awareness of the need to focus in addition on the social implications of THB, in particular the public health implications to learn about the motives and actors involved in this serious crime and about the consequences for the individuals/victims to learn about the chain of institutions involved in the various phases, their role in helping the victim and prosecuting the trafficker to identify the gaps between health protection and law enforcement in the three dimensions of THB (identification, prosecution and integration/re integration) to help health services and health care service providers to identify victims and to learn about the actions to take/procedures to follow (victim protection as well as public health protection) to develop skills and best practices for the better medical identification to strengthen interagency relationships and identify contact points/persons in each organisation (specialised and well informed/trained representatives of the respective institutions) 7

11 3 Points of discussion and outcomes of the Expert meeting It can be taken from the list of experts (in the Appendix) that all the major institutional actors involved in combatting THB in Austria could be motivated to participate in the expert meeting. High level officials charged with the responsibility of combatting THB in the own organisation and cooperating with other partner institutions at the interface were actively participating in the discussion, e.g. the Ministries of European Integration and Foreign Affairs, of the Interior, of Justice, of Women Affairs, of Labour, Social Affairs and Consumer Protection, of Economic Affairs, Family and Youth. The Ministry of Health indicated its interest and was ready to participate at a later stage. It delegated two persons from the Medical University who are supporting the Ministry in the area of THB. In addition to ministerial delegates representatives from the city of Vienna, of out patient clinics and outreach health and social services, NGOs (specialising on the protection and care of specific groups of victims of trafficking, namely children and youth, women and men) were present as well as the medical profession (general practitioners and public health officers). In addition, external experts participated, namely from Frontex, Europol, Ministry of Justice in Sweden, CEIPA and the project partner Payoke. The discussion followed the guidelines below which were provided ahead of time to ensure an effective debate. 3.1 Who are the main cooperative partners/institutions and who should/could be added in? It was pointed out by the head of the Austrian task force on THB that the cooperation between all ministries worked well except with the Ministry of Health. In addition it is difficult to get the medical profession to cooperate in the efforts to combat THB. There is also close cooperation with several NGOs particularly LEFÖ (Focus on women) and ECPAT (focus on children and youth). As many aspects of combatting THB need the cooperation of Federal States (health services and youth affairs are decentralised and in the legislative and executive domain of the Federal States), their inclusion in the task force is an objective, but not all Federal States cooperate. The representative of the Ministry of Economic Affairs, Family and Youth pointed out that there are big differences between the federal states in providing help and protection to trafficked children. She identified a great need for awareness raising in that respect in Austria in general and in certain Bundesländer in particular. THB tends to be neglected as an issue; in addition there are no resources available for training persons in youth welfare services. The representative of the Ministry of Labour, 8

12 Social Affairs and Consumer protection argues in the same vein. Also they face limited will for cooperation in the area of labour exploitation of victims of trafficking by the Bundesländer. As there are no legal ways to oblige them to participate in training measures and discussions on THB, nothing much happens in some of the Bundesländer. Accordingly the Ministry sees a great need for awareness raising. Apart from an integration of the Federal States in combatting THB the social partner should also be addressed, in particular the federal Chamber of Commerce, the Association of Industries, the Unions and the Chamber of Labour. But also other associations were seen as potentially important institutional actors, in particular the Chamber of Agriculture, as this is an area where victims of trafficking may end up. It was also pointed out that there is no good cooperation between the main authorities in Austria and abroad, particularly if other than their natives are involved in trafficking. Recommendations as to governance: For a governance system to be effective in combatting THB all relevant institutional actors have to be involved, i.e. a comprehensive approach has to be taken. The means of coordination and cooperation may differ by country, i.e., there are many ways of getting it right. In Austria, the major Ministries involved are the Ministry of the Interior, of Justice, of Labour and Social Affairs, Economic Affairs, Family and Youth, of Health and of Women Affairs. In addition, the federal states have to be integrated, either by law or by involving the Chancellery, which has the authority to give directives to the Länder. In addition, more key institutions have to be part of the comprehensive network, such as health and care services, social services, professional associations (in particular medical association), as well as trade unions. Further, the formation of informal networks of NGOs should be promoted within and between regions in order to promote understanding, trust, learning and cooperation between all the professions involved (NGOs, health care, social workers, special police force). Learning from other country s experiences both in terms of institutional arrangements as well as specific challenges in health care and service provision should be organized via exchange programs, possibly modeled after Médecins sans Frontières. International Cooperation between authorities should go beyond police and law enforcement on the one hand and beyond bilateral agreements on the other. It is suggested that the EC issue a directive obliging all MS to cooperate in the identification, prosecution and re integration of cases of THB, in particular also for citizens of another country. 9

13 It is recommended that the treatment of potential victims of THB is free of charge in hospitals, outpatient clinics as well as at family doctors, but adequate compensation of the cost has to be provided by the state. In case of successful prosecution of the trafficker the costs incurred should be borne by the perpetrator (compensation). 3.2 What are the main challenges in the identification of victims? On this subject a medical doctor from an outpatient clinic in Vienna pointed out that it needs medical specialists in the various fields if one wants to identify victims of trafficking. Of particular importance are gynaecologists and dermatologists, but this does not suffice. This point was hotly debated by other medical doctors who argued that GPs should be trained to learn to identify victims. It was also mentioned that the question of payment for examination may be an issue, particularly if the person has no health (insurance) card. While Vienna has several outpatient clinics where no expenses are charged this is not the case in many regions in Austria. As victims may not have any money at hand this may deter them from addressing medical doctors. Another aspect was raised by the medical profession, namely trust. Trust building between the patient and the medical doctor is a priority of doctors as well as providing help and care. There was little incentive to cooperate with police and law enforcement to help with the prosecution of perpetrators. There is little awareness about the rights of victims, e.g. that they get legal residence status in case of identification as a victim. Instead they tend to think that they help the victim by not informing the police. There was general recognition that if properly informed about the existence of specialist police officers in case of THB that their position on involving law enforcement could change. A law enforcement officer argued in favour of a pool of specialist doctors complemented by psychological and psychiatric services to identify victims of trafficking. He also pointed out that other professions may be very important in the identification of victims. Some of the most important partners are, in his view, ambulance drivers and helpers, as they may be the first to get in contact with a potential victim. They would have to be a target for training measures on THB. He also pointed out that many victims may end up in psychiatric hospitals, as they may be identified as having a mental health problem. He argues that it is very important to sensitize the medical profession in psychiatric care institutions to THB as he knows several cases where THB was highly probable but the psychiatrists did not want to cooperate with the police. There is a gap in his view. He also identified foreign consulates are potential partners in identifying possible victims of THB because victims tend 10

14 to contact consulates to obtain passports. There is no legal basis for receiving information on personal data in case of suspected cases of THB; steps towards some type of cooperation should be taken. It was made clear several times that the willingness to cooperate with the police is very limited, both by the medical profession as well as social workers. There is little trust in the police as an institution to help the victim. Therefore it is important to build a network of institutions that can help the doctors, including trustworthy special police forces. The challenge will be to inform and train the persons who are cooperating in helping the victim, while at the same time ensuring that the perpetrators are prosecuted. Recommendations for NGOs, health professionals and institutions The issue of trust is at the centre of coordinated action in identifying potential victims. The earlier and faster one acts the greater the chances of successful identification and of the chances for success in prosecuting the trafficker based on medical evidence. It is therefore recommended that multidisciplinary specialist teams across institutions are involved as early as possible in order to decide on coordinated action. It is recommended to institutionalise efforts towards transparency of methods and intentions between the various institutions and professions involved such that standard operating procedures can be developed and implemented as default actions, also case management procedures. Institutionalised operating procedures constitute a road map, identifying sequencing of actions, their timing and spacing and entailing learning from each other. The list of professions and institutions included in cooperative actions on THB should be expanded, e.g. by ambulance drivers and embassies Trust building does not only entail to learn to speak and understand the professional language of the cooperating partners, e.g. by involving multidisciplinary teams, but also to know that there is a special police unit focusing on THB (training and information as well as more casual regulars tables could be a way to go). It is recommended that the medical profession is obliged by law to inform the special police unit in case of suspected THB, because they may contribute thereby to the prevention of THB (added value). 11

15 It is recommended that a list of possible injuries and combinations of symptoms be provided to the medical profession for better orientation. For law enforcement and the judiciary also light physical injuries should suffice for further questioning in case of a combination with other factors, thereby promoting action in favour of the potential victim, including prosecution of the perpetrator. 3.3 What are the main gaps in the current procedures? It was acknowledged by all that we need a platform of trust. The representative of Europol argued that there should be a memorandum of understanding between doctors and law enforcement agencies. Some written document i.e. a model contract, where both sides understand what is possible or not for the other partner and what are the expectations. This could be a possible mechanism to enhance a dialogue. The representative of the Ministry of Justice in Sweden argued in the same vein, addressing the lacking trust between social workers and law enforcement. He pointed at the root cause, namely that social workers do not see the whole trafficking case but just one aspect of the situation of the victim. In order to provide a better understanding for the specific case of THB, Sweden set up a national support team, which has the function of a national helpdesk. One can turn to the help desk for expert advice. As there are different windows for identification, not only NGOs but also the police and the health sector, specialist advice is needed for every one of them. The Austrian police expert retorted that a national support team may not be enough, as the Austrian example shows. Austria has a hotline, however only in German and English. The challenge is to make victims aware of this hotline, another one is the language as victims of THB tend to come from many different corners in the world. In addition one has to be aware that it is very difficult to identify a case as THB in the first interview. A specialist on victimised children and youth drew attention to the fact that a medical doctor will only come across a victim if this person has severe injuries or problems. He generally has little time to treat a patient, which is a great problem, as it needs time to identify a victim of THB. Not many doctors have time to go deeper into a case. It needs time and this reduces the supply of medical doctors; those who do often work free of charge, e.g. in the outpatient clinic in Vienna. 12

16 It was also pointed out that a first step in getting cooperation between the medical profession and law enforcement may be the establishment of focal points in hospitals. In order to do that every country will need to set up procedures for that. The representative of the Viennese department for health and social affairs voiced challenges of identifying a victim as some may be heavily bruised or injured, but some may have no visible bodily harm and one may just guess that something was wrong. Often the victim does not want to open up, is afraid to talk. How do you identify this person as a victim of trafficking? LEFÖ has done a small project on peer education of sex workers, who were informed about exploitation, violence, how they could react in case of being exploited. This project focuses on empowering women about their rights and giving information about hotlines and about empowerment strategies. It took years of building trust and after having learnt about the issue of exploitation those women started to speak out. The expert also pointed at the issue of trust relative to police by asking: how can you build trust if there are some who are seen cooperating with their tormentor? How do you know which one you may trust? The representative of the Ministry of Labour informed about a project on male victims of THB. This is a particularly difficult topic as there is a lack of institutions to help men. The research project looks into institutional ramifications in other regions in Austria and abroad. In Vienna there are specialist services, the men s health centre, which is also present among the expert group. It was also pointed out by a law enforcement expert that we may need a manual on THB which could be modelled after the Istanbul protocol manual on torture. Recommendations for health professionals and health services It is recommended to develop a memorandum of understanding between doctors and law enforcement agencies in case of suspected THB, where both sides understand their role in protecting the victim and acting against the trafficker (default action). It is recommended to establish focal points in hospitals in order to promote a coordinated action between the medical profession and the special police unit. In order to allow direct communication between the medical profession and the potential victim, procedures have to be put in place in hospitals to get interpreters/persons of trust with special THB training (Skype, special hotline). 13

17 A national support team providing specialist advice should be implemented, which has the function of a national helpdesk for various actors, who may potentially be involved with identification of THB. Procedures for the medical profession (THB Protocol) have to be put in place in all EU MS which have to be adhered to in case of suspected cases of THB, possibly following established procedures against domestic violence or against torture (Istanbul protocol). 3.4 What are the main challenges in the topic of prosecution of traffickers? It was pointed out that data protection is an important issue in this case. In addition, attention has to be given to the need of harmonisation of data protection and collection, as we have to make sure that everyone is collecting the same data. A judge drew attention to the main challenges of a judge, namely to obtain adequate evidence for prosecution. Cases are very complex and usually there is not a lot of evidence one may make a judgement on: Most of the time you have only a victim on whose statement you have to rely. Victims are often put under pressure and withdraw what they said. If the victim changes his/her mind, then the case is over. It was pointed out that the problem is that we ask the weakest link in the chain to provide evidence. We should move away from the idea that the victim is the only source to get evidence. We need more witnesses to support the victim s statement. Accordingly, we definitely need more cooperation. Investigations need to be proactive and not reactive. The problem is that we only start a trafficking case once there is the testimony of a victim. But you may have other witnesses which may step in before we turn to the victim. The head of the Austrian task force on THB states that in Austria the objective is to get first hand evidence, and this is the victim s statement. Even if we find other ways to get supporting evidence, we still are dependent on the most damaged person in the case, the victim. In addition, it was suggested that we need to focus more at the business factor in THB, e.g. by proactive investigations, cooperations to get better evidence and by defining THB also as an economic crime which allows the confiscation of assets and gains. 14

18 Recommendations for law enforcement and politics: Go beyond focusing only on the human rights aspect of the crime of THB and focus also on the economic crime aspect. This would allow a shift of action from the victim to other witnesses who may provide evidence, thereby taking the load off the victim to serve as the only witness in the phase of prosecution. The focus should be put on pro active police action. Actions should be taken to harmonise data collection and protection. 3.5 What does the prosecutor need from the medical profession? For successful prosecution good forensic evidence is often necessary. However, the quality of forensic evidence is not always good, as medical education in Austria tends to reduce the hours of education/training on the topic of forensic medicine. Apart from more and better education in forensic medicine, training should be provided on how to write a good forensic report. The questions are who pays for such training and what would be the motive of a GP to attend such training? One law enforcement officer informs that the special police unit on combatting THB works closely with the forensic institute in Graz (Ludwig Boltzmann Institute for Clinical Forensic Imaging). He states that this is a big benefit for the police. The centre takes care of the victims and collects forensic evidence (magnet resonance, CT ). It was stated again that the communication between doctors and judges may be less than perfect, e.g. if a doctor identifies an injury as light this does not mean that it could not be a case of THB, but it tends to be from a judicial point of view too little to warrant prosecution of the offender. A medical doctor draws attention to the time factor between the identification, e.g. by the doctor in the emergency room. This will be the first documentation. The judge needs the evidence months after the incident. Then one may need forensic imaging in order to see the problem, but it will always be second line evidence. A ministerial expert pointed out that forensic evidence does not always help in the legal proceedings. In Austria, the child protection centre stopped asking for a forensic opinion in legal cases. For example: in a legal process forensic information was provided, indicating an injured muscle. But since 15

19 no information was given about the cause for the injury, the evidence had to be discarded, as it was not sufficient proof for the court. In case a victim is a minor he/she tends to be sent to a specialized centre. Sometimes this service is abused by victims who claim they are minors but are in fact adults. A medical doctor argues that there should be places in forensic institutes where victims of rape can go to have the forensic documentation done. There is one department in the Vienna General Hospital, but not many women go there due to ignorance. The victims of violence should be aware of where they have to go to get forensic evidence. An expert on female affairs states that it is important from the viewpoint of a victim to render the collection of evidence more transparent. Victims have to get an explanation why certain evidence needs to be collected in their specific case. Recommendations for law enforcement and health professions As forensic evidence is often key to prosecute a perpetrator it is necessary to provide adequate education and training of medical personnel either in medical university education or as a supplementary training in case of work in special multidisciplinary teams in THB units. The communication between the judiciary and the medical profession is key to effectively prosecuting a case of THB; it is recommended that training is provided to the medical profession on what to look for (indicators) and how to write a medical report, which can be used in the court. It is recommended that victims receive an explanation why and on what issues they should provide evidence such that the perpetrator may be prosecuted. 16

20 4 Points of discussion and outcomes of the Pilot training 4.1 Aim of the training course To raise awareness of and develop understanding for the crime of human trafficking To raise awareness about the need to focus also on the social implications of THB, in particular also public health implications To learn about the motives and actors involved in this serious crime and about the consequences for the individuals/victims To help health services and health care service providers to identify victims and to learn about the actions to take/procedures to follow (victim protection as well as public health protection) To learn about the chain of institutions involved in the various phases, their role in helping the victim and prosecuting the trafficker To strengthen interagency relationships and identify contact points/persons in each organisation To identify the gaps between health protection and law enforcement in the three dimensions of THB (identification, prosecution and integration/re integration) 4.2 Introduction into the project and pilot training Ms. Gudrun Biffl, head of department (migration and globalisation) and dean of faculty (business and globalisation) of the Danube University Krems extended her warm welcome wishes to all participants of the pilot training. In a short introduction note she explained the reason for inviting them to this first two day workshop in Krems. Before starting the day, the participants were asked to fill in the pre course questionnaires which were handed out at the beginning of the workshop. The questions in the questionnaire follow the themes addressed in the awareness raising film referred to below. The questionnaire is all about finding out about attitudes, prejudices, knowledge and guesswork about THB. After the participants had filled in the questionnaire Ms. Patsy Sörensen, Director of Payoke, provided a short project description, pointing out the main objectives and aims of the project. Ms. 17

21 Sörensen then started with her lecture on the standard operational procedures explaining amongst other things the Payoke intake and assistance process. To introduce the topic of THB a film on trafficking was presented (Film Affected for Life, _Short.flv), followed by a short reflection on the major issues by Ms. Gudrun Biffl. The lecture included topics on the legal ramifications, key players in law making and on implementation, the definition of THB, the difference between smuggling and trafficking, the three phases of the trafficking process, the identification (indicators) of recruiters, traffickers and victims, the purpose of THB and potential causes of trafficking. After the introduction, which aimed at raising awareness, Mr. Gerald Tatzgern, the director of the Austrian special unit on combatting THB in the Federal Office of Criminal Investigation, gave a short lecture on the topic of victim identification, which is the focus of the Pilot training in Krems. The lecture included the following issues and questions: who are the victims (article 4 COE), what are the adverse effects human trafficking can have on victims, the physical impact of sexual exploitation, the psychological impact of sexual exploitation and the impact of trauma and emotional abuse on victims. Following the lecture, Mr. Tatzgern (trainer) presented two case studies upon which the participants were to reflect in 3 multidisciplinary working groups. The trainer prepared three questions around the themes of the case studies. The aim of the group work was to apply the formerly acquired knowledge to the cases and to come forward with recommendations for action. 4.3 Case Study (1) A young woman (19 years old) is taken to the police. She has traces of maltreatment and is claiming that she has been sexually abused. The police officers identify, however, a mental disturbance, which means that her claim is not taken seriously instead the woman is taken to a psychiatric care unit in the hospital. The three guiding questions for the participants where the following: Who interviews the young woman? What are the procedures to be applied? Who may determine a mental disturbance of the young woman? (Attention 19 years old!) 18

22 What about the traces of maltreatment? What evidence is there and who may come forward with a judgement? 4.4 Case Study (2) A woman from Romania (28 years old) was promised a job in a hotel. Her friend and a bar owner want her to work as a sex worker in a bar. A few days after arriving in the bar, the woman jumped out of the window of the 2 nd floor of the bar. A person walking by called the police because the young woman was badly hurt. The police officer called an emergency ambulance. The woman was taken to the hospital. The woman is not willing to provide testimony on the accident. The friend and the bar owner say that the woman has mental health problems and due to disorientation jumped out of the window by accident. The guiding questions for the participants were the following: Who has what kind of responsibility? Who can decide on what? Identification of the victim? After the presentation of the two cases in the plenum the participants split into three groups, each headed by an expert trainer, one in law enforcement, another from the medical profession and a third one from NGOs ( social work with victims of THB). 4.5 Group 1: Police, Law enforcement Chair: Mr. Gerald Tatzgern Participants: Mr. Steve Harvey, Ms. Renate Hoffmann Dorninger, Mr. Sjölinder Henrik, Mr. Duco Van Heel, Mr. Peter von Bethlenvalvy, Mr. Franz Gabmaier, Ms. Claudia Dannhauser, Ms. Eva Plank Sandhofer, Mr. Alionis Dzhamalis, Ms. Holzner Brigitte, Mr. Andreas Kallauch, Ms Birgit Zetinigg (rapporteur). Main issues discussed, remarks and recommendations regarding case study 1: 19

23 1. It is relevant for the case who takes the potential victim to the police as the person may act as a witness. Recommendation: involve all persons around the potential victim in the process of identification. 2. The golden minute. The first response/reaction given to a victim is crucial. The whole case can fall apart depending on the approach by the first responding officer at the police. The first minute (the golden minute) decides whether there will be a case or not. Therefore the potential victim has to be referred to the specialist (unit) in the police department at first sight/suspicion in order to ensure the cooperation of the victim. Recommendation: The first responder has to have knowledge on how a victim of trafficking may look like (indicators) and what action to take (default regulation). Thus a training need of general police officers could be identified in case Recommendation: In case of sexual abuse a female victim should have the right to talk to a female police officer. 4. The second person involved in case 1 was a public health officer. What responsibility does he/she have as the doctor? The doctor has to do a visual inspection. The doctor can give a recommendation to take the woman to a psychiatrist but he/she cannot give advice to the victim on a possible prosecution and to testify against a potential trafficker. It was argued that the responsibility of the doctor is to care for the patient such that she is no danger to the public (public health concern) or to herself. Recommendation: Public health officers should be sensitized to the issue of THB and receive pertinent training. The responsibility of the health officials should include cooperation with law enforcement in case of suspected THB. 5. Recommendation: all persons/institutions should be informed that this woman may be a potential victim of trafficking, thereby triggering the application of standard operating procedures. Ideally the victim would be taken to a female police officer to a special room to be able to tell her story (coffee& cookie). Good examples are rape suits in GB. In this special area there are no male police officers, professionals come to the victim to examine and treat the victim. This requires special interview training, knowledge of indicators, cooperation of multidisciplinary teams, possibly also special translators. 6. There needs to be special protection for the victim in the mental hospital in case of suspected trafficking. Otherwise the trafficker is able to march in and threaten the victim, thereby among other things jeopardising potential prosecution of the perpetrator. 20

24 7. What about the evidence? It is important to find a good balance between securing evidence and taking care of the victim. You need to seize the clothing for evidence (especially in rape cases). A forensic medical doctor should be included in the proceedings at an early stage otherwise the evidence may get lost. Recommendation: development of SOP and training 8. The doctor has an obligation to inform the police if there is a serious crime (Ärztegesetz). However, in case of light injuries the case may not be taken seriously, ignoring that multiple indicators (physical, psychological and drug use) may be typical for cases of THB. Recommendation: training need of medical profession on indicators and operating procedures in case of suspicion. 9. Data protection is also important in this case especially in the case of the doctors. The doctors have access to the victim s address, private information and it is necessary to protect this data from the trafficker who might visit the hospital (confidentiality issue). Recommendation: in case of suspected case of THB a covenant between the medical association and/or Ministry of Health and law enforcement should be put in place which would lift the obligation to confidentiality and oblige the medical profession to cooperate with law enforcement. 4.6 Group 2: Medical Profession Chair: Mr. Wolfgang Spiegel Participants: Ms. Alina Zachar, Ms. Elke Matuschak, Ms. Vezelj Horvath, Mr. Mamut Jual, Mr. Nikolaus Krebs, Mr. Friedrich Altenburg (rapporteur) Main issues discussed and recommendations made relating to case 1 and 2: As the participants of this group were predominantly composed of professionals in the medical field, complemented by some representatives of social service providers, the discussion was largely focusing on the medical perspective. The following résumé of issues discussed refers to both case studies presented by the trainer, Mr. Tatzgern, with a focus on the following themes: The doctors see their ethical obligation only towards the patient, to whom they feel also accountable. Their priorities are on medical treatment and care and their reference points are only 21

25 towards medical institutions. They have no obligation to help or cooperate with other non medical institutions on issues relating to the patient. The medical assessment (identification) has to follow a holistic approach, taking environmental information and special circumstances of the patient into account. A holistic approach is also warranted from a curative and rehabilitation perspective. The role of specialised medical professions was most vividly discussed in the group, with limited consensus. Relevant medical doctors for identification, prosecution and re integration were identified as: Public Health Officers General practitioners (family doctors) Emergency Doctors Forensic Specialists Psychiatrists All of the above might have to come into play within a chain of medical treatment processes. In addition, gynaecologists, dermatologists and other specialist services may be necessary. It was stated that additional information on key indicators for the medical profession may be needed in order to better identify potential victims of THB, and, most important, on the potential public health hazards and the health implications for potential victims in order to organise precautionary measures in the medical system (develop standard operating procedures (default regulations). Flowing from the issues discussed the following recommendations came forward, linking the health system with law enforcement and social service providers: To raise awareness information and training of the medical profession should be provided, offering credit points for successful training measures on issues of THB. This would raise the motivation to engage in further training. In addition, a list of specialists and GPs could flow from that, identifying those providers of medical care who are knowledgeable in the field of THB (added value). Such lists of medical service providers who are sensitized to victims of THB may facilitate networking between the medical professions as well as NGOs and law enforcement. A general media campaign on THB is recommended to raise awareness of the issue of THB and to provide some key contact points for victims, e.g. hotline on THB. The social media should be included in such an information campaign. 22