A Way Station on the Long Road Back

Unique rehabilitation centre assists victims of trafficking in Ukraine

Oleh (all names have been changed) lost his home, all his savings, and almost lost his life after being trafficked. Now he's on the mend and getting his life back together, one of almost 14,000 victims assisted by the IOM, the UN Migration Agency, Mission in Ukraine, since 2000. This article takes a look at the IOM Medical Rehabilitation Centre in the capital Kyiv.

In a separate wing of a public hospital in Kyiv, experienced medical specialists care for very special patients 24/7. The IOM Medical Rehabilitation Centre, which opened 15 years ago, remains a unique facility in Ukraine and a crucial rehabilitation service for trafficking survivors by offering free-of-charge medical assistance that addresses complex health issues in a safe and confidential manner. To date, over 3,200 people have benefited from its services.

The centre has the capacity to accommodate 14 patients, and on average, there are six to twelve people staying in the facility, all trafficking survivors who have multiple medical conditions.

“Gastroenterological and neurological disorders, as well as depression and anxiety related disorders are the most common conditions victims of forced labour suffer from,” says Olha Scherbatiuk, IOM’s physician and centre administrator. Survivors of sexual exploitation additionally suffer from sexually transmitted diseases; some also require treatment for substance abuse acquired as a result of their exploitation. The average stay in the centre is two weeks, however, some patients with more severe conditions might receive treatment for longer period of time.

Identified victims are referred to the centre by IOM’s partners: state social services and counter-trafficking NGOs working across the country. Not everyone goes to the Rehabilitation Centre though, some trafficking survivors refuse medical assistance; others receive it in their home towns.

The Ukrainian State provides healthcare, which in most cases means a free-of-charge medical consultation only. Laboratory tests, ultrasound, MRI, medicines usually have to be covered by patients themselves and are costly, especially for people in difficult conditions, such as trafficking survivors. Also, many victims, due to their psychological conditions and life circumstances, find it hard to spend their time travelling from one clinic to another, waiting in long queues. When they learn a diagnosis this leaves them feeling even more helpless and deters them from seeking additional medical help. The IOM Rehabilitation Centre helps them, arranging consultations of external specialists, and also developing treatment plans.

“If several specialists prescribe a person six to eight medicines each, this can be harmful. We manage this process by helping to prioritize treatment and provide recommendations, as well as providing a small supply of medication for the few months after a patient is discharged,” explains Olha.

When it comes to psycho-social support and treatment of psychological conditions, trafficking survivors appreciate the confidentiality they have at the IOM Rehabilitation Centre. They prefer not to see psychiatrists at the State clinics in order to avoid stigmatization in the eyes of the State healthcare system, at their workplaces, as well as among their neighbours, relatives and friends.

Special attention is paid to the nutritional needs of the patients

Some patients require surgery: this was the case with Oleh. The cost of such surgeries is usually very high. IOM partners with government entities, donors, international NGOs, charity funds and other organizations to fund operations. Oleh was granted official status as a victim of trafficking by the State, and so, received a free-of-charge heart valve replacement, which usually costs around USD 2,000.

Patients of the centre undergo all testing and treatment voluntarily. Before any medical procedure takes place, they receive professional consultations and sign a formal agreement.

Patients of the centre undergo all testing and treatment voluntarily. Before any medical procedure takes place, they receive professional consultations and sign a formal agreement.

After the heart surgery his health improved and he was able to move further with the support of IOM: he participated in personal development training and psychological sessions offered by IOM’s holistic reintegration programme. His medical care didn't stop after surgery; the IOM Rehabilitation Centre specialists see him for check-ups once every three months.

Oksana, a mother of two, went through a similar ordeal, after she and her husband were trafficked for labour exploitation. After that traumatic experience, Oksana started experiencing progressive heart failure, which was only diagnosed after she was referred to the IOM Rehabilitation Centre. Specialists arranged a consultation with a cardio surgeon, and facilitated the surgery she desperately needed.

Iryna, also a victim of labour exploitation, who had been suffering from oedema, had a urology consultation at the Centre, which discovered with kidney disease. The treatment allowed her to avoid developing full kidney failure, and her health has since improved.

The overwhelming majority of trafficking survivors assisted at the IOM Rehabilitation Centre have been exploited in the construction, manufacturing and agriculture sectors.

Men comprise up to 40 per cent of rehabilitation centre patients, and 62 per cent of the overall IOM Ukraine caseload.

IOM’s psychologist Eugenia Dubrovska explains the disparity this way: “Women generally ask for help and accept assistance more often than men. For men, applying for rehabilitation would often mean admitting that they are vulnerable. Even those who agree to undergo treatment want to do it as quickly as possible in order to get back to jobs that usually require hard, manual labour. We observe that men are more inclined to request means for economic reintegration – help getting a job – than healthcare.”

In the initial meetings with patients, Eugenia’s task is to explain that health should first be improved in order to then address other aspects, such as their personal or professional life. She shows former victims broader perspectives on life, and asks questions to help them start thinking how things can be improved.

The majority of victims assisted at the centre are between 30 to 60 years old. However, the centre treats minors and elderly victims as well. A recent case was that of a 76 year old woman who suffered from labour exploitation. Ksenia is a veteran of the Soviet war in Afghanistan, and keeps very active. Three years ago, she wanted to earn money in order to help support her children and grandchildren, so she decided to go to the Russian Federation with a group of other women from her home city. They were recruited for home care positions, but fell prey to traffickers and were exploited at a construction site, forced to work 14 hours a day. After rehabilitation in Kyiv, Ksenia is home and continues to receive further assistance through IOM’s reintegration programme.

In the mornings, patients are usually busy with medical examinations and treatment programmes. After lunch they have free time, when they can read books, watch TV, rest or socialize. Some of clients made these embroideries now decorating the centre's premises as thanks from all over Ukraine. These are from Ternopil...

In the mornings, patients are usually busy with medical examinations and treatment programmes. After lunch they have free time, when they can read books, watch TV, rest or socialize. Some of clients made these embroideries now decorating the centre's premises as thanks from all over Ukraine. These are from Ternopil...

Over 230,000 Ukrainians fell prey to human trafficker since 1991, according to IOM estimates. Since 2000, the UN Migration Agency in Ukraine has assisted almost 14,000 of them to return to a dignified life. In addition to medical care and psychological counselling, IOM provides shelter, legal consultation and representation in criminal and civil court. There is also a vocational training and small-grant programme supporting those who aspire to start their own businesses.

... from Odesa...

... from Odesa...

In the first half of 2017, IOM Ukraine identified and assisted 639 victims of trafficking who suffered from forced labour and sexual exploitation in 23 different countries, including in Ukraine. This represents an increase of 30 per cent compared to the victims identified in January-June 2016.

... and from Vinnytsia.

... and from Vinnytsia.

The work of the IOM Ukraine Rehabilitation Centre has been generously supported by the United States Agency for International Development (USAID), Global Affairs Canada, Norwegian and Danish Ministries of Foreign Affairs, the European Union, the Swiss Agency for Development and Cooperation (SDC), Swedish International Development Cooperation Agency (Sida), the U.S. Department of State’s Bureau of Population, Refugees and Migration (PRM), the Western Union Foundation and the World Childhood Foundation.