‘She’s alive at least’
‘She’s alive at least’
This is a sentence that is used by the Encompass staff and volunteers, in all seriousness. It can often be the case that team members go home, worrying that a guest that they care for and have just spent time with might not be alive in the morning. Perhaps the guest has spoken about suicidal feelings or perhaps they seemed particularly intoxicated or perhaps they mentioned someone who is out to get them. It’s not unrealistic or far-fetched to think that she might be dead by the morning.
It is a reality that survivors of sex trafficking die earlier than those who have not been sex trafficked. In the last 12 months, 2 Encompass guests have died. One guest was 43 years old and the other was 41 years old. It is a tragedy to know that these women died at such a young age, and yet it is a relief to know that they will not endure anymore suffering.
The cause of death for a survivor of sex trafficking can be a number of different things:
Overdose
Suicide
Murder
Long term physical health condition
This list is not exhaustive but lists 4 of the most common causes of death witnessed by Encompass. More often than not it is a combination of various factors which result in death.
We have talked previously about Adverse Childhood Experiences (ACEs). All Encompass guests have ACEs and 100% of Encompass guests experiences Childhood Sexual Exploitation and or child sexual abuse. Research has shown that ACEs can reduce the life expectancy of a person. In a study carried out by Brown, D. W., et. al. (2009) on ‘Adverse childhood experiences and the risk of premature mortality’, it found that people with six or more ACEs died nearly 20 years earlier on average than those without ACEs (1).
As well as experiences of abuse and neglect in childhood, Encompass guests continue to experience abuse and neglect in their teenage years and in adulthood. Each guest has a different story of how they ended up where they are today. There are common themes that run throughout.
Child Sexual Abuse/ Child Sexual Exploitation
100% of Encompass guests are survivors of CSA and/or CSE. Some guests remained with their biological families where they were abused and exploited. Some were groomed outside of their homes. Others left home and lived on the streets where they became vulnerable to people taking advantage. Others left home and sought support at a hostel or housing provider where their evident vulnerabilities were preyed upon, and they were exposed to sexual exploitation and abuse. Encompass has heard heartbreaking stories of women as young as 3 years old who were raped, and then sexual abuse became a regular occurrence in their lives. This was by relatives, siblings, friends of family, strangers. Encompass has heard stories of grooming of women as children within the care system, schools, health care establishments. As girls, Encompass guests were identified as vulnerable, at-risk children, and abused and exploited by adults who were in trusted positions. Experiencing sexual trauma at such a young age has extreme life-long physical ramifications on a body (not to mention the psychological ramifications which can lead to further physical health problems).
Drug addictions
Almost 100% of Encompass guests suffer from class A drug addictions. When a child has been sexually exploited or abused, when they grow older, to cope with the flashbacks and memories of this abuse, they might turn to alcohol, drugs, self-harm, or other dangerous coping mechanisms. Almost all were introduced to drugs by their groomers/exploiters/perpetrators to initially create a relationship and eventually to develop a dependency. Not only did this mean that as teenagers they needed their groomer to provide drugs, but they would also be less conscious of the sexual violence they were experiencing.
Drug use not only has a neurological impact, but a range of long-term physical health impacts on the cardiovascular system and the respiratory system.
In Encompass, we request clothes donations to not be over size 12, because our guests are generally extremely underweight meaning that they wear smaller sized clothing. A large proportion of our guests will fit in teenage clothing.
One physical health problem that is commonly experienced by Encompass guests is that when they require blood to be taken by the Doctor, this is a very difficult and painful process. Due to sustained drug injection often since childhood, survivors of sex trafficking experience collapsed veins. Not only does this make it hard to take blood for testing, but it makes it hard to administer vital and needed drugs to help someone's health/save their life. ‘Edith’ (pseudonym) is making a conscious effort to attend all health appointments - “they’ve literally tried to get a vein in my hand, in my arm, in my leg, and they couldn’t get anything, so they’ve had to go into my neck”.
Drug injection can also lead to abscesses and infections. We have one guest who has lost an eye and one guest who has lost a leg due to this.
Physical health problems
As has already been mentioned, Encompass guests suffer from a huge range of physical health complications. Sometimes guests are aware that their physical health is poor or is failing, other times they are so numb that they do not, which can exacerbate the problems. Survivors of sex trafficking often have injuries and scars from attacks. These often go un-seen by medical professionals. For survivors of sex trafficking, their time is not their own, and so attending A&E or booking a doctors appointment is not as straight forward as it might seem. Until someone is incapacitated by a physical problem, survivors of sex trafficking will continue to be exploited. Sex buyers and perpetrators are unphased by physical ailments and sometimes if a woman looks weaker, this is more appealing to a sex buyer: “You stand out there and you see the men circling around in their cars, looking for the skinny girls... the ones that look like they won't be able to fight them off." Quote from ‘Edwina’, a survivor of sex trafficking (pseudonym).
Mental health problems
Oram et al (2016) found that symptoms of depression, anxiety and Post Traumatic Stress Disorder (PTSD) were reported by 78% of women and 40% of men who were surviving/had survived sex trafficking in England (2). Every Encompass guest suffers mentally due to the trauma they have experienced from such an early age. Not every Encompass guest has had their condition diagnosed due to not being able to attend appointments/engage with relevant services. The most common diagnoses include anxiety, depression, PTSD, multiple personality disorders, schizophrenia and psychotic disorders. There is also an extremely high prevalence of self-harm and suicidal ideation. Many of these mental health illnesses amongst guests will have stemmed from the onslaught of physical traumas over the course of their lives.
People with serious mental health illnesses often experience poor physical health as well as poor mental health, resulting in premature death. They frequently develop chronic physical health conditions at a younger age than people without serious mental health illnesses. These chronic conditions include obesity, asthma, diabetes, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), stroke, heart failure and liver disease (3). A high percentage of Encompass guests suffer with COPD.
Thus, the presence of mental health illnesses again reduces the life expectancy of someone who has been or is being sex trafficked.
Summary
All of these factors are contributing factors to premature death. This is without mentioning the dangers and threats posed to survivors of sex trafficking by their exploiters/pimps/abusers. Reduced life expectancy of a perfectly healthy child can almost be expected when they are exposed to sexual trauma. A study, published in BMJ Open, found that adults who reported experiencing sexual abuse by the age of 16 had a 2.6 times higher risk of dying in middle age – that is, between 45 and 58 – than those who did not report sexual abuse (4). We are seeing this in Encompass. So, there is a fear and at the same time a realistic expectation that our guests will die either before or between 45-58 years old. It is a miracle when they live past 58.
References
Brown, D. W., et. al. (2009). Adverse childhood experiences and the risk of premature mortality. The American Journal of Preventative Medicine, 37(5), 389-39. doi: 10.1016/j.amepre.2009.06.021.
Oram, S et al (2016) Human Trafficking and Health: A Survey of Male and Female Survivors in England American Journal of Public Health doi: 10.2105/AJPH.2016.303095
Rogers NT, Power C, Pinto Pereira SM Child maltreatment, early life socioeconomic disadvantage and all-cause mortality in mid-adulthood: findings from a prospective British birth cohort BMJ Open 2021;11:e050914. doi: 10.1136/bmjopen-2021-050914