Occupational hazards, safety, violence and abuses at sea
Half (49.5%) of trafficked long-haul fishermen incurred at least one serious injury compared to 40.0% of short-haul fishermen (Table
3). Common accidents and injuries described by NGO participants assisting men included severed limbs, injuries from rope pulleys, winches and sharp fish bones. Other hazards included inhaling poisonous fumes from the fish storage room and men falling off the boat accidentally:
Table 3
Occupational hazards, abuses and healthcare during trafficking among fishermen using post-trafficking services in Cambodia and Thailand (n = 275)
| Number | Percent | Number | Percent | Number | Percent |
Occupational hazards (selected) |
Unstable or heavy work platforms | 169 | 85.4% | 57 | 74.0% | 226 | 82.2% |
Work along rocky coasts or in remote offshore | 111 | 56.1% | 68 | 88.3% | 179 | 65.1% |
Small, unstable or badly maintained fishing vessel | 56 | 28.3% | 38 | 49.4% | 94 | 34.2% |
Badly maintained or no fishing equipment | 48 | 24.2% | 29 | 37.7% | 77 | 28.0% |
No safety/bad or no survival equipment | 105 | 53.0% | 65 | 84.4% | 170 | 61.8% |
Long hours in the sun, cold or wet without a break | 189 | 95.5% | 77 | 100.0% | 266 | 96.7% |
Protective gear |
Sun hat | 76 | 38.4% | 63 | 81.8% | 139 | 50.6% |
Gloves | 151 | 76.3% | 24 | 31.2% | 175 | 63.6% |
Life vest | 59 | 29.8% | 15 | 19.5% | 74 | 26.9% |
No protective gear given | 28 | 14.1% | 9 | 11.7% | 37 | 13.5% |
Hours worked per day |
<=8 | 13 | 6.6% | 2 | 2.6% | 15 | 5.5% |
8 to 10 | 0 | 0.0% | 5 | 6.5% | 5 | 1.8% |
11 to 15 | 12 | 6.1% | 13 | 16.9% | 25 | 9.1% |
16 to 19 | 9 | 4.5% | 12 | 15.6% | 21 | 7.6% |
> = 20 | 103 | 52.0% | 12 | 15.6% | 115 | 41.8% |
No fixed hours | 61 | 30.8% | 33 | 42.9% | 94 | 34.2% |
Median hours worked/day (median average deviation)a | 137 | 22 (2) | 44 | 18 (3) | 181 | 21 (3) |
Occupational health risk score (median)b | 198 | 50 | 77 | 60 | 275 | 50 |
Worked every dayf | 192 | 97.5% | 75 | 97.4% | 267 | 97.5% |
No or very few rest breaks | 176 | 88.9% | 69 | 89.6% | 245 | 89.1% |
No time off for sickness or holiday | 172 | 86.9% | 67 | 87.0% | 239 | 86.9% |
Experienced at least 1 serious injuryg | 98 | 49.5% | 30 | 40.0% | 128 | 46.9% |
Injuries still cause pain/difficulty | 57/98 | 58.2% | 9/30 | 30.0% | 66/128 | 51.6% |
Ever needed healthcare or was injured | 129 | 65.2% | 49 | 63.6% | 178 | 64.7% |
Who provided medical cared |
Doctor | 10 | 7.8% | 2 | 4.1% | 12 | 6.7% |
Nurse | 2 | 1.6% | – | – | 2 | 1.1% |
Owner/manager | 44 | 34.1% | 13 | 26.5% | 57 | 32.0% |
Co-worker | 8 | 6.2% | 5 | 10.2% | 13 | 7.3% |
Received regular health checks from trafficker/employer | 6 | 4.7% | 2 | 4.1% | 8 | 4.5% |
Other | 2 | 1.6% | 2 | 4.1% | 4 | 2.3% |
Did not receive healthcare | 61 | 47.3% | 32 | 65.3% | 93 | 52.3% |
Cheated of wages | 140 | 70.7% | 55 | 71.4% | 195 | 70.9% |
Median payment in USD/day (median average deviation) | 58 | $1.33 ($1.00) | 21 | $2.52 ($1.73) | 79 | $1.44 ($1.14) |
Restricted freedome | 162 | 81.8% | 70 | 90.9% | 232 | 84.4% |
No documents | 151 | 76.3% | 57 | 75.0% | 208 | 75.9% |
Violence severity |
No violence | 61 | 30.8% | 18 | 23.4% | 79 | 28.7% |
Experienced less severe violence | 36 | 18.2% | 12 | 15.6% | 48 | 17.5% |
Experienced more severe violence | 101 | 51.0% | 47 | 61.0% | 148 | 53.8% |
Living conditions |
Living and sleeping in overcrowded rooms | 176 | 88.9% | 67 | 87.0% | 243 | 88.4% |
Sleeping in dangerous conditions (close to generator or engine) | 80 | 40.4% | 28 | 36.4% | 108 | 39.3% |
Nowhere to sleep/sleeping on the floor | 141 | 71.2% | 71 | 92.2% | 212 | 77.1% |
Poor basic hygiene | 127 | 64.1% | 52 | 67.5% | 179 | 65.1% |
Inadequate water for drinking | 101 | 51.0% | 44 | 57.1% | 145 | 52.7% |
Insufficient food | 94 | 47.5% | 27 | 35.1% | 121 | 44.0% |
No clean clothing items | 155 | 78.3% | 64 | 83.1% | 219 | 79.6% |
Overexposure to sunlight or rain | 191 | 96.5% | 76 | 98.7% | 267 | 97.1% |
Other hazards | 30 | 15.2% | 21 | 27.3% | 51 | 18.6% |
Living situation score (mean, SD)c | 198 | 5.5 (1.8) | 77 | 5.8 (1.9) | 275 | 5.6 (1.8) |
Alcohol |
Never drank alcohol | 86 | 43.4% | 44 | 57.1% | 130 | 47.3% |
Drank afew times per year | 82 | 41.1% | 13 | 16.9% | 95 | 34.6% |
Drank afew times per month | 23 | 11.6% | 19 | 24.7% | 42 | 15.3% |
Drank afew times per week | 4 | 2.0% | 1 | 1.3% | 5 | 1.8% |
Drank everyday | 3 | 1.5% | – | – | 3 | 1.1% |
Forced to take drugs by employer or trafficker | 15 | 7.6% | 1 | 1.3% | 16 | 5.8% |
“They work during the night and there are no toilets on the boat. They must walk along the keel and do their business hanging from the boat. If it is a new worker without proper skill there could be a chance that he would fall into the sea and simply disappear.” (NGO, 6).
NGOs and industry participants cited crew inexperience leading to accidents and injuries. Swimming under boats to retrieve tangled fishing nets and cutting them from the propeller was another occupational hazard, bringing risk of death among fishermen who did not know how to swim. Children were deemed particularly suited for this task by some employers because captains perceive that they were smaller and more agile to swim under the boat:
“I ask why you (captain) need children in the vessel? They say “sometimes we throw the rope, or for swimming under the fishing vessel, the children are really nice”… (they) swim, pull the rope [free].” (NGO, 13).
Most trafficked short-haul fishermen (84.4%) reported having no safety or survival equipment compared to 53.0% of long-haul fishermen (Table
3). Just 26.9% of trafficked fishermen had a life vest. Most short-haul fishermen (81.8%) had sun hats compared to 38.4% of long-haul fishermen, a higher proportion of whom received gloves (76.3%) compared to short-haul fishermen (31.2%). An industry participant spoke about the difficulties and questioned the suitability of applying global safety standards and personal protective equipment (PPE) recommendations in the Thai context:
“The ILO had meetings with us about [boat] safety. They told us that, in foreign countries, when we pull the rope, we must put on gloves and shoes. But the foreign fishery and Thai fishery are different. Sometimes wearing gloves can be dangerous as the ropes we use are fluffy and the gloves get stuck. If we don’t pull out our hands in time, it can be really dangerous… Sometimes we can’t apply some requirements with the way we work.” (FA, 21).
He went on to describe other examples of how applying Western safety standards was not suitable:
“Sometimes the ship is slippery and in Europe, the workers put on mechanic jumpsuits. But we can’t do this as the weather is really hot and it can be uncomfortable… We only put on working shoes when we go to the cold storage [room] or when we catch live fish and need to protect ourselves from them. Besides that, we don’t wear them as they are slippery and uncomfortable.” (FA, 21).
This participant alluded to PPE not only being uncomfortable in the climate, but as causing more danger. International organization (IO) participants suggested that OSH was not prioritized by employers; they did not see it as enough of a problem, and were reluctant to invest in safety measures following already large upfront costs of the boat, particularly among employers using trafficked labour:
“Safety of the workers is not their priority.” (IO, 3).
To improve outcomes, one participant said that boats would have to be redesigned completely, e.g. winches covered, requiring more investment. Other hazards included extreme working hours (median 21 h/day) among trafficked fishermen; 89.1% had no or few rest breaks. Half (52.7%) of trafficked fishermen had inadequate drinking water; 44.0% had insufficient food (Table
3). Among key informants, descriptions of food provision varied between inadequate/not fresh to unlimited fresh fish supplied. One government Health Service Provider (HSP) described the case of a fisherman returning from Indonesia with vitamin deficiencies because of a lack of vegetables, as has been observed in several cases of beriberi at Thai ports recently [
58,
59]. Half (53.8%) of trafficked fishermen experienced severe violence (Table
3). Being killed and thrown overboard was sometimes threatened by superiors. Among trafficked men who were sold from boat to boat, one participant noted the toll the work would take on men and how quickly they’d fall sick:
“When they sold [a fisherman], first it’s 15,000 baht (473 USD), and work 1 year without wages… after that they sold to the second vessel, 8000 baht (252 USD). [They] work maybe 6 to 8 months, until they’re sick. No need to treatment. And they throw to the sea.” (NGO, 13).
Men were ultimately perceived as disposable once their labour and health had been exhausted. Being forced to take drugs was another abuse, experienced by 7.6% of long-haul and 1.3% of short-haul trafficked fishermen (Table
3).
Health as an inroad to assisting trafficked men
Health and welfare NGOs’ mandates involved addressing health (primarily HIV) among migrants, not trafficking. However, their health mandate did grant NGOs access to potentially trafficked fishermen, as health was a less contentious topic for employers. When NGOs provided free medicines and health education, it allowed NGOs to become useful to employers and ultimately gain their trust:
“When we work on AIDs or health issues they are already a soft topic. We sometimes approach [employers] individually and introduce them to our drop in [centre]… The workers can come in and get treated without going to the doctor so [employers] see the benefit of the place… They want their workers to work with them for a long time without sickness or health issue or at least get treated when they do.” (NGO, 6).
This participant went on to explain how the NGO’s position of putting health before legal concerns about undocumented workers had won employers over:
“Our selling point is that they do not feel that we are harmful to them. Their concern is that they have employed illegal workers, but we assure them we understand that there are many requirements to get the workers registered... At first we were not trusted, but after a time they saw our work and started trusting us.” (NGO, 6).
Similarly, other NGO participants discussed using the “healthy employee” frame to encourage employers to invest in migrant fishermen’s health. Health provided a less controversial entry point before discussions or awareness raising with employers about trafficking could take place:
“Because if we talk about health first it is easier to talk about human trafficking. That is a serious issue. But when we mix everything in all together I think there is a better chance, I think this is a good strategy.” (NGO, 6).
Trafficking is a sensitive subject with employers. Another NGO participant observed that some employers were not receptive to them expanding their remits beyond health to include trafficking, labour conditions or human rights. NGOs might demand that employers improve working or living conditions, or raise awareness among migrant workers about their rights:
“The employer sometimes thinks the NGO is the problem… they don’t need us to be close with the fishermen. Because we will teach them everything. They will understand what is their right. That’s why, when we need something from [employers], if I need information, it’s difficult to go you see. But when I say ‘employer, today we have announcement from MOH, maybe you get vaccine’…If we go and give, the employer allows.” (NGO, 13).
“We just step in about health issues first… [employers] really like that. Not the human rights issue…” (NGO, 7).
NGOs had a better chance of safeguarding access to fishermen via free health services or education, which gave employers benefits in the form of a healthier workforce. To preserve access, NGOs could not be seen to be assisting trafficking cases directly. Instead they referred potential cases to a government unit or another NGO (not from the local area) to conduct the rescue:
“If I go to that area and help a trafficking case, maybe the trafficker will say ‘next time don’t allow this van go to this area’. And now I [provide] HIV training, health education, medicines, then we can get closer with the fishermen. Then we can talk with them “what happened?” If its trafficking or something they can report to us.” (NGO, 13).
This strategy safeguarded NGOs’ access to the area for health promotion and continued monitoring of potential trafficking cases.
Most (86.9%) trafficked fishermen could not take time off for sickness or holidays, but two thirds (64.7%) reported ever needing healthcare or being injured (Table
3). Among them, 52.3% said they did not receive care. Most long-haul fishermen (58.2%) were still in pain from their injuries at the time of interview. Among those who received care, one-third (32.0%) said they received some form of care from their manager, 7.3% said they were treated by co-workers and just 6.7% saw a doctor. Following accidents and injuries, lack of first aid knowledge at sea was cited as a problem among health and welfare providers, leading to makeshift self-treatment by fishermen:
“We only saw workers who have been in accidents and are getting complications. For example if a worker got his hand into the boat winch and bled, he would put tobacco paste on it, [causing] swelling or inflammation. Or… if a worker broke his arm he would just put oil on it instead of using a slab to hold it in place. The bone would join themselves back together in 15 days [resulting] in a crooked arm. They do not know how to do it properly… a lot of people get stung by jelly fish and when they don’t do first aid complications will follow. That takes us longer to treat them. That is an important issue.” (HSP, 27).
Self-treatment without proper knowledge could result in long-term harm e.g. wrongly fused bones.
Availability
Drop in centres, port outreach and mobile health units ensured availability of primary health services for migrant fishermen. Drop in centres were inviting, including free snacks, books, television; men could access health information, STI testing and Voluntary Counselling and Testing (VCT) for HIV/AIDs. Staff availability was a key theme:
“(This centre) opens at 8 and closes at 5. But we usually we accept people the whole day because the staffs are always here. If you want to drop by then just knock on the door anytime.” (NGO, 15).
One health provider described a pilot Floating Hospital initiative, whereby short-haul fishermen were trained in basic first aid and given medicines to dispense at sea. Participating boats with at least one trained fisherman were given a flag so that other boats could recognise and approach it when men were injured or sick. When boats docked, serious cases were referred to the hospital via mobile health units near ports:
“We have a mobile health unit to do check-ups for crew members. [We diagnose] chronic diseases that are not contagious, diabetes, and high blood pressure. There is also waist measurement to gauge the possibility of being overweight.” (HSP, 27).
Beyond treating injuries, this health provider was concerned about chronic diseases and related risk factors among fishermen. One industry participant described the MOPH doing health checks for infectious diseases among crew on boats returning from international waters:
“… Sometimes they come with diseases… [MOPH] has a space, like the airport… Sometimes the (crew) just walk through, nobody there. [But] if there’s some news about [infectious diseases], now Ebola, if the plane comes from West Africa, then [MOPH] has to come.” (FA, 8).
During a global infectious disease outbreak, where state concerns about disease transmission from mobile groups like fishermen was heightened, checks were more likely to be carried out according to this participant.
Health worker attitudes
Staff attitudes and fear of arrest partly governed the decision around which health provider to bring migrant workers. Private clinics where fees could be paid upfront asked fewer questions and were sometimes considered a safer and easier option. This NGO participant suggested that staff at government hospitals were prejudiced against migrant workers who requested fee waivers:
“Sometimes we don’t go to the hospital… We, they [migrant] are scared. We bring them to the sub district hospital… a small treatment centre… If we pay cash they don’t ask too much. If we need assistance from government... Sometimes the hospital (staff) think that the migrant is spending our Thai budget... They don’t like it. Their acting is not human, [like migrants] are not same as their level. They study nurse, the study doctor, but they don’t have heart.” (NGO, 13).
This participant expressed disappointment in health workers who seemed to lack professional ethics in treating migrant workers well, due to inability to pay or perhaps racism. Transporting undocumented migrants in Thailand is illegal, thus getting fishermen to larger, public HSPs entailed personal risk for this participant:
“Sometimes we go to a nearby clinic, pay money and finish… Sometimes we don’t need to bring them far from their home… maybe I will be arrested... Because they are illegal.” (NGO, 13).
Other NGO participants discussed similar fears of arrest and how the law prompted them to be very careful with their work. One participant’s colleague faced criminal charges for transporting an undocumented migrant in their car. Other participants suggested that health workers were welcoming of migrants in healthcare settings, linked to higher volumes of migrants entering Thailand and the ASEAN Economic Community’s (AEC) policy encouraging freer labour movement:
“But I feel like the new doctors that recently graduated are friendly to Burmese because they see more of them and AEC is opening soon. They tell me what they expect from these workers and ask if there is anything they could do to help develop them.” (NGO, 15).
“[Our] hospital is like their ally. [Migrants] can come with or without the money. They are not afraid of this hospital.” (HSP, 27).
In high migration areas where these participants were based, younger doctors and HSPs may be more familiar with and kinder towards migrants seeking care.
Paying for treatment
Among trafficked fishermen, 70.9% were cheated of wages and among the few men who received wages these were extremely low (median US$1.44/day) (Table
3), implying that it would be near impossible to pay out-of-pocket for healthcare. Existing long term relationships with HSPs were important when it came to negotiating free treatment, or flexibly paying costs over time, for uninsured migrant workers. When employers refused to pay for treatment, NGOs often had to step in and negotiate with hospitals on fishermen’s behalf:
“We have to check the cost, for example 5000 baht (158 USD). [Fisherman] do not have [that money]. So, that hospital say we only need to pay for the treatment or the medicine... they reduce the cost. So we agree, OK we’ll pay 2000 baht (63 USD). So the hospital say OK… But sometimes it’s very difficult also.” (NGO, 17).
HSPs had discretion to waive fees entirely, or request payment for specific items only. When fees could not be waived entirely, one NGO participant described migrant savings clubs making up the shortfall where fishermen were members. For men in post-trafficking care, hospital invoices would be sent to the Anti-Human Trafficking Fund for payment. Both NGO and government health and welfare providers were concerned about budget constraints when paying treatment costs for uninsured migrants. One HSP noted high awareness among migrants and NGOs about the HSP’s duty to provide free care when needed:
“[Migrants] knew that the government hospitals must give free treatments. We are still doing it now, giving free treatments to illegal foreign workers. In the past 5 years that has cost us 65 million baht (2 million USD). We did not get even a single baht back. 65 million baht, we are in trouble… When we are working with NGO we always request them to help find funding for the government hospital but they always refuse us saying it would be illegal to do so. It is very difficult because it is the government hospital’s responsibility to provide treatment to everyone in need.” (HSP, 27).
This participant highlighted the difficulty of balancing budgets while fulfilling both a legal and moral duty to provide care. Enrolling in the Health Insurance Card Scheme (HICS) was one suggested solution, but fishermen “outside the border” were less likely to enrol than migrants working in other sectors. HICS could only be used for healthcare in Thailand, so long-haul fishermen on boats departing for Indonesia or elsewhere would not be able to use HICS for treatment costs incurred overseas. Other barriers to uptake of HICS included fishermen only being concerned with their health when they had an accident, by which time they would have to pay out-of-pocket. The HSP participant noted that discontinuity of care was common among fishermen because of limited time onshore to have check-ups and get medicines. Some inpatients discharged themselves early to avoid paying for treatment. One NGO participant explained how fishermen were also unlikely to avail of health benefits under the Social Security Scheme (SSS) as they did not enter Thailand via the MOU. Fishermen were entirely dependent on employers’ goodwill to pay out-of-pocket when they were not registered:
“On one boat, there are approximately 40 men, maybe only 2 have documents – pink card [work permit] or passport. Employers don’t normally register them…When they get sick, it depends on how much the employers will take care of them.” (NGO, 25).
NGOs were often contacted by fishermen to help negotiate settlements with employers. One participant discussed numerous challenges in obtaining accident compensation for migrant workers:
“Mostly it’s the social security officers, they try to say that the employers have paid for the treatment, they paid like hundreds of thousand baht… Sometimes they think we are the one who told the employee to be tough. But our duty is to explain to the employees what their losses are, how much they should be compensated. Employees are threatened by employers too. Sometimes we have to help the employees; when they had an accident at work, they cannot work, we have to take care of their rent and food until the case is closed. There are many challenges. Everyone is threatened.” (NGO, 25).
Social security and other government officers also sided with employers during disputes according to other participants, indicating that migrant testimony is not taken seriously by authorities compared to employers’ claims. Employers may threaten migrant employees and NGOs not to pursue compensation claims to avoid pay-outs.
Language barriers, interpreters and treatment
Among trafficked fishermen, just 41.1% could speak the language of the destination country (Table
2). Key informants described language barriers as deterring migrant workers from seeking care, or from understanding the benefits of migrant health insurance; one suggested that some health workers’ poor attitudes towards migrants were amplified by frustrations around language:
“Sometimes, the nurse, or official in the hospital sometimes they don’t welcome [migrants]… in my place we don’t have an interpreter in Myanmar or Cambodia language, and then when the nurse shouting them, they don’t want to go. They have problems.” (NGO, 13).
Lack of interpreters in health facilities and the possibility of being reprimanded for language inability discouraged migrants from seeking care. Migrant health volunteer (MHV) interpreters were key in facilitating access to care. An NGO participant who had played a major role initiating a provincial MHV program with the MOPH described high demand for interpreter services. MHVs were not paid, but took pride in their work; they were trained by the NGO and the local public hospital; doctors had translated medical terms to Burmese for the MHV handbook. Being a MHV was a privilege that extended to affording protection from the police, who might otherwise arrest migrant workers:
“Each volunteer will get a Migrant Worker Volunteer shirt… They would let the governor sign their shirts so that the police know they are working with the Health Department and will not arrest them.” (NGO, 15).
The MHV program had extensive support from the provincial health office and governor, indicating that local authorities valued the health of migrants. This support enabled MHVs to operate without having to worry about being arrested. Another participant whose NGO organized their own migrant health interpreters described how employers appreciated this service:
“We have officers and volunteers that can speak Cambodian. We can understand them. When workers are sick, employers send them to the drop in [centre] to let them go to the hospital with volunteers so that they can translate for them. Now the employers saw what we do so they have given us a car to deliver patients. In some cases the workers are sick and they want to go home, we send them all the way to the border with expenses covered by employers.” (NGO, 6).
Employers saw value in interpreter services, engendering further cooperation and a positive relationship with the NGO. Over half of trafficked fishermen (61.7%) were symptomatic of any mental health disorder (Table
4). Key informants also discussed challenges finding interpreters or counsellors speaking native languages in post-trafficking care. One shelter described calling interpreters to translate by phone, or sometimes requesting a resident trafficked person with language skills to interpret. The same shelter usually observed mental health problems among Thai and not migrant residents, for reasons that are unclear but may be related to lack of interpreters to facilitate diagnosis or treatment. One IO provided an additional psychologist and interpreter to support the shelter psychologist with group and individual counselling. Another participant noted that culturally, migrant men dealt with trauma by “getting on with things”, which may be related to treatment in other languages being unavailable:
Table 4
Physical and mental health symptoms and concerns post-trafficking among fishermen using post-trafficking services in Cambodia and Thailand (n = 275)
| Number | Percent | Number | Percent | Number | Percent |
Symptoma |
Dizzy spells | 69 | 34.9% | 14 | 18.2% | 83 | 30.2% |
Headaches | 67 | 33.8% | 11 | 14.3% | 78 | 28.4% |
Dental problems | 32 | 16.2% | 10 | 13.0% | 42 | 15.3% |
Nausea/indigestion | 46 | 23.2% | 10 | 13.0% | 56 | 20.4% |
Diarrhea/gastrointestinal | 24 | 12.1% | 8 | 10.4% | 32 | 11.6% |
Back pain | 40 | 20.2% | 17 | 22.1% | 57 | 20.7% |
Skin problems | 37 | 18.7% | 14 | 18.2% | 51 | 18.6% |
Feeling completely exhausted | 63 | 31.8% | 18 | 23.7% | 81 | 29.5% |
Fainting | 6 | 3.0% | 2 | 2.6% | 8 | 2.9% |
Significant weight loss | 56 | 28.3% | 7 | 9.1% | 63 | 22.9% |
Memory problems | 58 | 29.3% | 8 | 10.4% | 66 | 24.0% |
Persistent coughing | 33 | 16.7% | 5 | 6.5% | 38 | 13.8% |
Reporting > = 3 areas of pain | 62 | 31.3% | 18 | 23.4% | 80 | 29.1% |
Self-assessed health (past month) |
Poor | 63 | 31.8% | 11 | 14.3% | 74 | 26.9% |
Fair | 100 | 50.5% | 27 | 35.1% | 127 | 46.2% |
Good | 34 | 17.2% | 32 | 41.6% | 66 | 24.0% |
Very good | 1 | 0.5% | 7 | 9.1% | 8 | 2.9% |
Want to see doctor or nurse for these symptoms# | 135/177 | 76.3% | 35/66 | 53.0% | 170/243 | 70.0% |
Post-trafficking mental healthb |
Symptomatic of depression | 122 | 61.9% | 27 | 35.1% | 149 | 54.4% |
Symptomatic of PTSD | 94 | 47.7% | 14 | 18.2% | 108 | 39.4% |
Symptomatic of anxiety | 106 | 53.8% | 17 | 22.1% | 123 | 44.9% |
Symptomatic of any Mental Health Disorder (MHD) | 197 | 69.5% | 77 | 41.6% | 169 | 61.7% |
Self-harm | 11 | 5.6% | 3 | 3.9% | 14 | 5.1% |
Suicide attempts | 11 | 5.6% | 1 | 1.3% | 12 | 4.4% |
Thoughts of ending your life | 18 | 9.1% | 2 | 2.6% | 20 | 7.3% |
Post-trafficking concernsb |
Own physical health | 73 | 37.1% | 19 | 24.7% | 92 | 33.6% |
Own mental health | 36 | 18.3% | 6 | 7.8% | 42 | 15.3% |
Earning money/having job/paying debt | 110 | 55.8% | 24 | 31.2% | 134 | 48.9% |
Nowhere to stay short term | 17 | 8.6% | 4 | 5.2% | 21 | 7.7% |
Nowhere to stay long term | 45 | 22.8% | 12 | 15.6% | 57 | 20.8% |
Money-related problems in family | 130 | 66.0% | 40 | 52.0% | 170 | 62.0% |
Health-related problems in family | 90 | 45.7% | 38 | 49.4% | 128 | 46.7% |
Afraid of trafficker or associates | 11 | 5.6% | 10 | 13.0% | 21 | 7.7% |
Guilt or shame | 73 | 37.1% | 19 | 24.7% | 92 | 33.6% |
Documents | 15 | 7.6% | 21 | 27.3% | 36 | 13.1% |
Spiritual/religious concerns/ghosts | 7 | 3.6% | 7 | 9.1% | 14 | 5.1% |
Other | 24 | 12.2% | 23 | 29.9% | 47 | 17.2% |
No concerns | 5 | 2.5% | 8 | 3.5% | 13 | 4.7% |
Money concerns (aggregate personal or family) | 161 | 81.7% | 47 | 61.0% | 208 | 75.9% |
Post-trafficking concern score (mean)c | 198 | 3.2 | 77 | 2.9 | 275 | 3.1 |
“They’re kept in the shelters simply for rehabilitation purposes, which generally fishermen, there’s really not much involved in rehabilitation. For migrants… of course they suffer the trauma, but it’s a very different way of dealing with trauma in this culture, you just get on with things… and the centres are not equipped to provide counselling to people in different languages…They have very basic translators… this is not the kind of advanced stuff, if you’re going to give psychological counselling, you at least need to have decent translators, otherwise how could you do it?” (IO, 2).
For this participant, having professional interpreters, perhaps with medical or specialist knowledge, as opposed to informal interpreters, was considered important to provide appropriate treatment.
Physical and mental health, post-trafficking concerns
Key informants described seasickness, headaches, muscle pain, fevers and colds as health problems among men at sea, although one HSP noted that it was difficult to know about health problems faced by long-haul fishermen because they did not self-identify as such when seeking care. Among trafficked fishermen, the most commonly reported physical health symptoms were: dizzy spells (30.2%); feeling completely exhausted (29.5%); headaches (28.4%); memory problems (24.0%) (Table
4). If fishermen had escaped trafficking, those who had experienced abuse may experience memory problems:
“Sometimes these people they tend to forget their actual age already because of the continued abuse and exploitation.” (NGO, 7).
Memory problems can complicate repatriation when men forget key information, e.g. names and home addresses. A quarter (26.9%) of trafficked fishermen reported poor self-assessed health and 29.1% reported pain in three or more areas (Table
4). The majority (70.0%) wanted to see a doctor or nurse for their symptoms. Trafficked fishermen had high symptom levels for depression (54.4%), PTSD (39.4%) and anxiety (44.9%); long-haul fishermen had worse mental health than short-haul fishermen; 69.5% of long-haul fishermen were symptomatic of any mental health disorder and 9.1% had suicidal thoughts, compared to 41.6% and 2.6% of short-haul fishermen respectively (Table
4). Money-related concerns (75.9%) and health-related problems in the family (46.7%) were the main post-trafficking concerns among trafficked fishermen (Table
4). Higher proportions of long-haul fishermen were concerned for their physical health (37.1%) and mental health (18.3%), compared to 24.7% and 7.8% respectively among short-haul fishermen. A third (33.6%) were concerned about guilt or shame.