Trafficking, exploitation and forced marriage — viva

Opening question

A 15-year-old girl presents to your emergency department with vaginal discharge, accompanied by an older man who answers every question for her, refuses to leave, and holds her identity documents. She is withdrawn and cannot name her school. Walk me through how you define child trafficking, recognise this presentation, and respond at the bedside. [5] [2]

Branch 1 — Definition and classification

Examiner: Define child trafficking under the Palermo Protocol, and tell me the single most important principle when the victim is a child. [10]

Candidate should state: Trafficking is the recruitment, transportation, transfer, harbouring or receipt of a person by means of threat, force, fraud, coercion, or abuse of a position of vulnerability, for the purpose of exploitation — including sexual exploitation, forced labour, servitude, and the removal of organs. For a victim under eighteen, the means element is not required: any child moved for the purpose of exploitation is a victim of trafficking, and any child or adolescent in commercial sex is a victim of trafficking regardless of apparent force, fraud, coercion or stated consent. Forms include labour exploitation, commercial sexual exploitation, domestic servitude, forced criminality, and forced marriage. [10] [1]

Branch 2 — Recognition and the trauma-informed response

Examiner: What are the red flags here, and how would you secure the history? [5] [2]

Candidate should state: The relational red flags are the controlling accompanying adult who speaks for her, refuses to leave, and holds her documents; the clinical red flags are withdrawal, avoidance of eye contact, inability to name her school, and a sexually transmitted presentation. Address her directly, explain confidentiality and its limits, and secure time alone by separating the adult with a neutral reason such as examination policy. Use a trained professional interpreter — never the accompanying adult — and document who was present. Take a trauma-informed history with open questions about safety, school, money and documents; believe, do not press for timeline, and do not promise secrecy. Brief validated screening tools can prompt a safeguarding pathway but are not a diagnostic endpoint. [5] [12]

Branch 3 — Investigations and acute safety

Examiner: What investigations would you arrange, and how do you keep her safe while you do? [2]

Candidate should state: Address acute medical and psychiatric risk first — injury, self-harm, suicidality, ectopic pregnancy, sepsis. For possible sexual exploitation, arrange STI testing including chlamydia, gonorrhoea, syphilis, HIV and hepatitis B and C, and pregnancy testing, and refer to the specialist sexual-assault or child-sexual-abuse service for forensic examination and prophylaxis; timing, consent and chain of evidence are the specialist's domain. Do not allow her to leave with a suspected exploiter — use hospital policy, security and the child-protection team, and a calm, neutral hold while the plan is made. Never confront or accuse the controlling adult in front of the child. [2] [13]

Branch 4 — Reporting, referral, and forced marriage

Examiner: Describe your reporting and referral steps. Now imagine instead a 14-year-old who discloses a forced marriage next week with an overseas trip — how does the management change? [15]

Candidate should state: Make the mandatory child-protection report on a reasonable-belief threshold — the duty overrides ordinary confidentiality — and refer in parallel into the National Referral Mechanism or local equivalent, the statutory route to support and formal victim identification; both are documented. For forced marriage, the definition turns on the absence of full, free, informed consent, and child marriage is a form of child abuse. Family mediation is contraindicated because it can place the young person at immediate risk; refer to the specialist forced-marriage unit, consider an emergency protection order or harbour placement, do not return her to the family home while risk is live, and treat the planned overseas trip as a same-day emergency requiring statutory intervention to prevent travel. [15] [2]

Closing synthesis

Examiner: Summarise the clinician's role in one sentence. [10]

Candidate should state: The clinician's job is to recognise the pattern, make the child safe, treat the acute harms, document verbatim and contemporaneously, report on a reasonable-belief threshold, refer into the statutory support system, and arrange continuity — because the first encounter is the start of a relationship, not a rescue, and re-traumatisation and loss to follow-up are the commonest failures. [1] [10]