Doctors and other frontline health workers are in a unique position to spot, help and advocate for victims of hidden slavery in New Zealand, experts say.

Writing in the latest New Zealand Medical Journal, they say modern forms of slavery – which include forced, underage and servile forms of marriage, and worker exploitation – are still largely hidden.

The authors are experts in public health, emergency medicine, women, child and youth health services and worker exploitation.

“Slavery has serious health consequences, but is a mostly neglected issue within the health system,” says lead author Dr Paula King, a public health physician and clinical research fellow at the University of Otago in Wellington.

“Victims are at increased risk of acute and chronic physical and mental health problems, injuries from dangerous living or working conditions, or physical or sexual abuse, so they are likely to come into contact with health workers.

“We know that health workers may have had contact with people in situations of slavery, but may not have had the knowledge, resources or skills to identify victims and offer effective help.”

Examples of scenarios that should ring alarm bells for health workers include migrant workers with “workplace injuries” accompanied by a “superior” who insists on rushing treatment to get back to work; and an infectious outbreak where it is found that workers are living together in crowded conditions.

Victims may go to the doctor for routine care, but show tell-tale signs of exploitation such as unexplained injuries, contradictions in their stories and behaviour, not knowing their home address or lack of personal identification.

Dr Christina Stringer, an associate professor in the University of Auckland Business School and one of the authors, published an influential report late last year revealing the exploitation of migrant and New Zealand-born workers across many industries, including horticulture, hospitality and construction.

“One migrant we interviewed was beaten up in an orchard by his contractor, while another was physically assaulted and denied sufficient food; he ran away and was found sleeping on the streets in a distressed state,” says Dr Stringer. “There is also evidence of exploitation in the health and aged-care sectors themselves.”

More than 70 businesses were banned from hiring migrant workers for breaching labour laws in the last six months.

“Slavery is a violation of many human rights, including the right to health,” says Dr King. “Doctors and other health workers hold a privileged position in the health sector and can, and should be, leading advocates for change at government, health system and organisational levels to address slavery and its health consequences.

“A robust health response to slavery includes the ability to identify current victims or those at risk, and to treat them in a culturally competent and trauma-informed manner in collaboration with other services.”

Health workers in Australia and New Zealand can:

• Improve their own cultural competency, knowledge and expertise in addressing slavery
• Build alliances with local organisations working with migrants and refugees, and women’s refuges
• Take the lead on developing protocols and guidelines, including referral processes, within their organisation
• Take the lead in developing policies and resources within their professional or regulatory bodies, such as the Medical Council of New Zealand and medical colleges and associations

The editorial’s other authors are Dr Alison Blaiklock, a public health physician and honorary senior lecturer at the University of Otago, Dr Jay Amaranathan, an emergency medicine physician at Capital & Coast DHB, and Dr Margot McLean, Clinical Director of Women, Child and Youth Services at Hauora Tairawhiti, Gisborne.