A mixed methods approach was used:

Qualitative research via semi-structured interviews and focus group discussions using topic guides developed in the program with MSF staff and Moroccan health-care providers to explore staff experiences of managing VoT (objective 1,3-4).

Quantitative methodology via review of sociodemographic, sexual/reproductive and mental health data from Sexual Violence Medical Reports, Mental Health Clinical Histories and patient exit surveys (objectives 2,4);

Study period: January 2011 to September 2012 (quantitative evaluation); June 2012 (qualitative).

Inclusion criteria: All patients fitting the definition of VoT* treated in the MSF program; Moroccan health-care providers and MSF program staff employed during the study period (the number of participants included was determined by data saturation being achieved).

Analysis: Qualitative data were analyzed through a codification of categories and thematic analysis. Quantitative data were analyzed using Excel.

This is a vulnerable population with a high experience of sexual violence and need for protection and material assistance (e.g. legal, transit) as well as medical care.

High rates of STIs, need for post-exposure prophylaxis and high rates of pregnancy as well as mental health issues underscore the need to provide appropriate screening and treatment services.

Although not proved, the high incidence of STIs in this population could be due to forced prostitution and/or unprotected sex.

Further evaluation should be performed to understand reason for delays in and barriers to access

Medical actions should be based on harm reduction strategies combined with a missed opportunities approach (i.e. don’t lose the chance of treating a patient once you are in contact) and be complementary with other non medical services.

The findings of this study have been integrated in the SEXUAL HEALTH MEDICAL PROTOCOL Migrants in Transit & VoT which could be used in current or similar interventions.

Qualitative results : *Definition of victim of trafficking (VoT)From the analysis of focus group discussion, a person may experience abuse/exploitation signifying the possibility of a trafficking experience when at least three criteria are present:•She/he has no freedom of movement.•She/he is monitored by a “pimp “, boyfriend or another woman in the community.•She/he does not seem to have the freedom to communicate with the outside.•She/he is an unaccompanied minor.•Women who have been pressured to become pregnant or to abort.•She/he bears the marks of violence.•MSF staff receive calls from men searching for females who are assisted in our health-

care services.•She/he says that she/he will be 'sold'.•She/he comes from an area known for trafficking (e.g., Edo State, Nigeria). She/he tells

us that someone has promised her/him a job in Europe and/or Morocco.

Migration and Human Trafficking: the experience of MSF in Morocco, 2013

Liliana Palacios, Olivia Hill, Carmen Martínez-Viciana Médecins Sans Frontières (MSF), Barcelona, Spain

INTRODUCTION

METHODS

Since 2004, MSF has provided sexual and reproductive (RH) and mental health (MH) services to sub-Saharan African migrants in Rabat and in migrant camps in Oujda, Morocco in collaboration with the local Ministry of Health (MoH).Many of the patients are victims of human trafficking (VoT)* who have experienced a

wide range of abuses and often lack legal documentation and freedom of movement. Little is known on the health profile of this population in transit or the most effective way to meet their health needs.

Qualitative results: the main challenges identified by staff and health-care workers were:1.Difficult access to and by the VoT to the services: due lack of autonomy, poor literacy,

cultural attitudes and social barriers2.Lack of MSF protocols that respond to the VoT population needs3.Poor social, protection and legal support to VoT.Quantitative results: 106 Sexual Violence Medical Reports, 73 Mental Health Clinical

Histories and 45 exit survey questionnaires were reviewed.

Mental Health:→Almost 100% of the VoT had a single consultation.→The main (40%) psychological complaint was symptoms of anxiety. →A minor proportion (13% = 10/73) were men. Sociodemographic profile of Sexual Violence Medical Reports :→Over 90% of VoT assisted were single women from Nigeria, median age 23.4 years →82.7% (n=87/106) arrived in Morocco in the last 3 years→95.3% (n=101/106) were without any legal documents Sexual and reproductive health →53.3% (n=57/106) were pregnant at the moment of the first visit→80% (36/45) had symptoms of sexually transmitted infections (STIs)→85 out of 106 accepted to be tested for HIV, among them 10.6% were positive→100% (106/106) had experienced sexual violence→The border towns of Manghia (Algeria) (51/106) and Oujda (31/106) were the most

commonly reported sites of sexual violence followed by the trip to Morocco →Figure 2 depicts the main aggressor and violence characteristics→Less than 2% (n=2/106) sought medical care within 72-120 hours after the sexual

violence and none within the 72-hour period when post-exposure prophylaxis against HIV infection can be administered

Figure 2 Main info related to violence and sexual aggressor

RESULTS (continued)

CONCLUSIONS

OBJECTIVES The aims of the study were to: 1.Develop a definition of victims of trafficking (VoT) to aid in identification of this population;2.Understand the sociodemographic and health profile (MH and RH) of patients treated;3.Identify staff perceptions of the main constraints to delivering care;4.Make recommendations for health-related interventions in this and similar contexts.

LIMITATION

RESULTS

Location of MSF projects

Figure 1 Location of MSF projects in red

The limitations of this study include:-

1.Small sample size (such programmes usually involve only low numbers)2.Low quality of retrospective data available3.Few data on men and children

Source: http://www.infoplease.com/atlas/country/morocco.html