Community-Based Rehabilitation: Rethinking rehabilitation for trafficked individuals

Human rights are not a privilege conferred by government. They are every human being’s entitlement by virtue of his humanity. —Mother Teresa

Human beings are the most intriguing creations among other species. To be a human implies belief in the dignity and moral worth of all other beings. As humans, one is entitled to be treated with a fair degree of equality and justice without being subjected to discrimination. However, when a human being is deprived of natural rights and liberties, it goes against the principles of natural justice. Human trafficking is one such grave violation of fundamental rights. Trade of humans or flesh trade is an abrasive act of taking away all the basic rights one is born and entitled to. In fact, it is the negation of the essence of being. 

This negation of basic civil liberties is not something new. Human trafficking is basically a form of contemporary slavery that can be defined as the act of removing, transferring or transporting an individual from one place to another by means of force, fraud, coercion, deception, abduction or payment for the purpose of exploitation. It may be for the purpose of commercial sexual exploitation, forced labour, forced marriage, domestic servitude, debt bondage, organ removal or begging. The people get trapped due to factors like drug use, poverty, history of sexual abuse, marginalized communities, women immigrants, LGBTQ individuals, domestic violence and sexual assault victims. ILO Global Estimates of Forced Labor shows that there are approximately 3.3 million sex-trafficked persons in the world, nearly all of them women. According to the Global Slavery Index 2018, there are around 7 million victims of modern slavery in India.

At the heart of this article lies the central theme of Community-Based Rehabilitation for survivors of human trafficking. However, before delving into this transformative concept, it is imperative to illuminate the grim realities faced by these victims and examine the inadequacies within our current policy framework. Human trafficking inflicts profound physical, psychological, and emotional scars on its victims, tearing apart the very fabric of their lives. These survivors often find themselves ensnared in a complex web of trauma, isolation, and distrust. Moreover, existing policies, while making strides in addressing the issue, often fall short of providing comprehensive support and long-term solutions. Recognizing these pressing issues is the first step towards comprehending the dire need for innovative, community-driven approaches to rehabilitation. In this exploration, we shall shed light on both the devastating consequences and the promising avenues of hope that Community-Based Rehabilitation offers to those who have endured the darkest of ordeals.

Devastating consequences 

It is beyond any doubt that most survivors of human trafficking have mental illness. Human trafficking and mental illness seem inevitably linked. The research aimed at examining the link between sex trafficking and mental illness finds that 78% of survivors experience clinical anxiety (range 48–98%); 52% depression (range 3–100%) and 37% posttraumatic stress disorder. The majority of survivors thus have depression, anxiety, post-traumatic stress disorder or a more severe diagnosis: Disorders of Extreme Stress. In addition to these diagnoses, many victims of human trafficking also have secondary psychological issues such as alcohol and drug abuse plus concurrent medical illnesses. There are other mental health sequelae too such as poor sleep, insomnia, nightmares, feelings such as of hopelessness, fear and distrust, being trapped, shame, humiliation, a sense of continuous stress, anger, and irritability. Apart from mental illness, rehabilitated survivors of sex trafficking are often stigmatized. Stigma is an amalgamation of various interrelated elements like labelling, stereotyping, separation, loss of status and discrimination. In some communities, the survivors of sex trafficking are seen as tainted and thus unable to marry. Survivors of sex trafficking are also prone to become victims of violence, and more likely to become involved in criminality. 

There are physical consequences associated with mental illness in survivors of trafficking. In the majority of cases, the skin and hair show evidence of cigarette burns attempts at self-harm, rashes, evidence of intravenous drug use, vitamin deficiency, bruising from physical abuse and infectious diseases such as tuberculosis or lice. The teeth show poor overall dental hygiene; methamphetamine and bulimia scar teeth too. In the case of sex trafficking, survivors often suffer from Sexually Transmitted Diseases (STDs), cervical dysplasia, non-menstrual vaginal bleeding, vaginal pain, dysuria, dyspareunia, traumatic scaring and ovulatory failure.

Recognizing these devastating consequences and the urgency of combating this grave violation of human rights, the Indian government has put in place various policies, initiatives and schemes. While these policies represent significant steps forward, it is essential to examine their effectiveness, implementation, challenges, and gaps that persist within the existing framework.

Current policy landscape

Holistic rehabilitation and societal reintegration remain a dream in the prevailing policy landscape. Rehabilitating trafficked women and children in institutional care is included under the Immoral Traffic (Prevention) Act of 1956 (ITPA) and IPC Section 370 as a response to victim assistance systems. When rescued, victims of trafficking are either sent home or placed in institutionalized care settings, such as shelter homes, especially if they are victims of sex trafficking. It is lamentable that the present approach to the rehabilitation of trafficked individuals follows a linear procedure, which is then followed by institutional care and family reunion. For a variety of reasons, long-term institutionalization is unproductive. It has a negative impact on survivors’ mental health and increases their risk of becoming victims again.

When it comes to the rehabilitation of women and children, childcare facilities under the Ujjawala plan and the Swadhar Greh shelter houses fall short. They don’t have the adequate funds or expertise to take care of the victims’ basic requirements, and they don’t contribute much to help the survivors integrate into the community or with their families. In-house therapists lack the training necessary to assist survivors, a majority of whom struggle with dysthymia. Also, no job-oriented vocational training is provided in shelter homes. Thus, it is clear that aftercare or reintegration services in communities are not prioritized by the system.

The draft of the Trafficking in Persons (Prevention, Care and Rehabilitation) Bill 2021 Bill, which is being touted as one of the most comprehensive documents on the prevention of trafficking has also some issues. Firstly, the definition of rehabilitation is open to interpretation. It defines rehabilitation to include all processes of restoring the physical, psychological, and social well-being of a victim and includes protection, access to education, skill development, healthcare, psychological and physiological support, medical services, economic 

empowerment, legal aid and assistance, and safe and secure accommodation. Despite the fact that the Bill claims that these services would be provided under rehabilitation, a careful examination of the definition leads one to suspect that the provision of such services would largely be limited to institutional-based protection and rehabilitation homes, which can make survivors vulnerable to discrimination. The Bill does not address skill-development training, support services, or mental healthcare for survivors. Second, there is uncertainty because the word “reintegration” is not defined. The fact that law enforcement officials do not hold social welfare organizations accountable for monitoring and assisting with the reintegration of survivors demonstrates neglect on their part.

It is clear that the current legal framework and institutionalization fails to ensure that the survivors once released from institutional shelters are equipped to battle the stigma and shame associated with being trafficked and, thus be able to reintegrate into society. Establishing a framework for community-based rehabilitation is a solution to persistent problems. The Protection of Women from Domestic Violence Act and the Juvenile Justice Act both detail non-institutional treatment based on the Community-Based Rehabilitation (CBR) method in India. A similar approach is required for survivors of human trafficking.

Community-based-Rehabilitation

Community-based Rehabilitation (CBR) was initially launched by WHO following the Declaration of Alma-Ata as a strategy to increase access to rehabilitation services at the community level for people with disabilities, but it has evolved into a much broader and multisectoral approach to community-based inclusive development. CBR can be understood as a system consisting of three pillars: 

1. The first pillar represents the members of local communities with an understanding of the issue and have positive attitudes towards the survivors. 
2. The second pillar represents a selected group of local volunteers and others who have specific knowledge and skills in CBR and also have positive attitudes.  
3. The third pillar represents individuals and organizations outside the local community who have knowledge and skills in CBR, resources for CBR, along positive attitudes.

As per the 2019 study on community-based rehabilitation interventions run by NGOs across 10 states, it is cost-efficient, effective, and decentralized and hence it is more impactful. It aids in the psychological recovery of survivors from depression, anxiety, and PTSD much more effectively than counselling services in shelter homes. It uses a grassroots approach to guide development priorities. It promotes inclusion of all people, particularly those of survivors, in local decision-making, governance and resource allocation. CBR aims to achieve rehabilitation, equalization of opportunities and social inclusion through the combined efforts of various stakeholders.

The rehabilitation process is an amalgamation of psychiatric treatment, economic empowerment, and the restoration of the victim’s civic identity. This results in the survivor’s effective assimilation into society. When a survivor is returned to his country of origin, the process of reintegration takes place while he rebuilds his life in the nation, community, and family. However, the process of integrating victims of trafficking and reorganizing ties within a community in their country of origin involves four distinct stages, and it goes beyond just returning them to their home country.

1. Physical- Resettlement of the victims in a territorial space within the country
2. Socio-economic- Establishment of a decent standard of living similar to the existing population of the country  
3. Socio-political- Ensure maximum participation of the survivors in the democratic process at the local and national level  
4. Cultural- Adaptation of the survivor within the population to ensure inclusion in society (Dr Chandrani Dasgupta, 2015) 

CBR is used by NGOs all over the world, but none of the State rehabilitation policies have it as a concept, making it difficult for survivors to assert their rights. The challenges to implementing CBR programs range from inadequate allocation of funds, and human resources to dissemination of information about CBR services. The success of any program heavily depends on the availability of resources. CBR programs have not been very successful in developing supportive socio-cultural environments for survivors of human trafficking, or in mobilizing community resources due to limited resources for welfare and development in general. There is a lack of an adequate number of personnel who understand and know how to deal with rehabilitation and community behaviour. Apart from these, there are attitudinal challenges. Most donors for rehabilitation prefer a charitable approach. Donors are thrilled with pictures and numbers of persons who have received rehabilitation services. However, it is not easy to evaluate a CBR project since CBR involves a change in the community’s behaviour, motivation, knowledge and skills. This change, which is critical for CBR, is difficult to see or evaluate.

Recommendations 

The need is to improve the quality of human resources in CBR by providing training in community development as well as in rehabilitation methods and skills. Since CBR implementation needs financial support, a change in the attitude of donors is a must. There should be regular communication between the donors and the implementers about CBR concepts and strategies, to convince the donors that CBR is a development program and not a charity effort. 

There is also an urgency for the TIP Bill to ensure that the survivors’ right to rehabilitation is fulfilled by defining ‘reintegration’ and bringing the scope of victim-centric services within its ambit. Holistic rehabilitation includes the fulfilment of basic needs, survivor-friendly support, financial inclusion, the right to access identity documents, social security and much more. Community gatekeeping mechanisms must be established to prevent intergenerational trafficking. The principle of participation, the principle of appropriateness, the principle of necessity, and the principle of suitability need to be adopted while designing policies. In addition to this, the government should address the existing trust deficit between victims and policymakers. In short, the need of the hour is a shift from a provider role to a participatory role as well as from survivor-informed to survivor-led to tackle this crisis of humanity.

References

1. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4117059 
2. https://www.tandfonline.com/doi/full/10.1080/2331205X.2017.1278 841 
3. https://www.google.com/amp/s/www.indiatimes.com/amp/news/indi a/trafficking-of-persons-bill-2021-human-trafficking-victims-sharetheir-plea-555521.html 
4. https://www.google.com/amp/s/www.thehindubusinessline.com/opi nion/holistic-rehabilitation-for-traffickedsurvivors/article66314012.ece/amp/ 
5. https://www.google.com/amp/s/www.telegraphindia.com/amp/opini on/community-caring-and-trafficking/cid/1847021 
6. https://www.legalservicesindia.com/article/2589/Rehabilitation-ofTrafficked-Children-in-India:-Socio-and-Legal-framework.html 
7. https://www.google.com/amp/s/indianexpress.com/article/india/hum an-trafficking-survivors-gaps-draft-bill-community-based-rehab7652974/lite/ 
8. https://apps.who.int/iris/bitstream/handle/10665/279966/WPR2017-DNH-005-factsheet-03-cbreng.pdf?sequence=4&isAllowed=y 
9. https://www.dinf.ne.jp/doc/english/asia/resource/apdrj/z13jo0100/z13jo0104.html#:~:text=that%20it%20has.-,Human%20resource%20development,trained%20personnel%20in %20this%20field.