El proceso migratorio de mujeres subsaharianas víctimas de trataDesafíos y respuestas en la atención sanitaria, jurídica y social

Résumé

Introduction: Over the past decades, there has been a global increase in migration movements, where a large number of people relocate to other places in search of a better life. This is particularly the case in Sub-Saharan Africa, where many individuals, especially women, find themselves in vulnerable situations and are forced to migrate to Europe. During the migration process, they pass through several countries, with Spain being a strategic location for networks involved in human trafficking. The main causes of these migration processes are generally poor social and working conditions, specifically abuse, gender-based violence, sexual assault, and acts that violate the freedom and integrity of women. They also face health, legal, social, and economic challenges when adapting to a new cultural and legal environment. On the other hand, the trafficking of women is a means to exploit migrants during the migration process, involving the forced labor and sexual exploitation of women. Trafficking victims are often deceived, coerced, or kidnapped, and they become trapped in situations of exploitation. Trafficking women is a modern form of slavery and a violation of human rights. It is a global phenomenon that affects women of all ages and nationalities. Although immigration and trafficking of women are distinct concepts, there are cases where they overlap. Many women can become victims of trafficking during their migration process, deceived by traffickers who promise them job opportunities or better living conditions in the destination country. These women find themselves in extremely vulnerable situations and are exploited in various ways. It is therefore crucial to address both immigration and trafficking of women from a health, social, and human rights perspective. Countries must develop fair and humane immigration policies that provide protection for immigrants and prevent them from becoming trafficking victims. Additionally, it is crucial to strengthen international cooperation in the fight against trafficking of women, implement prevention and protection measures for victims, and pursue and prosecute human traffickers. General Objective: To know, describe, and understand the experiences of Sub-Saharan migrant women who irregularly arrive in Spain and the care process carried out by healthcare, legal, and social professionals who attend to them. Specific Objectives: 1. Describe and understand the experiences of Sub-Saharan migrant women who arrive in Spain by boat (patera) throughout all stages of their migration process: recruitment, transit, and emergency care. 2. Describe and understand violence against Sub-Saharan migrant women and the health consequences, with special attention to potential victims of human trafficking and sexual assaults. 3. Describe and understand the experiences of healthcare, social, and legal professionals regarding the care they provide to Sub-Saharan migrant women. This doctoral thesis is based on qualitative research aimed at understanding, describing, and comprehending the experiences of Sub-Saharan migrant women who irregularly arrive in Spain, as well as the care process carried out by healthcare, legal, and social professionals who attend to them. To achieve this, three different studies have been proposed. Methodology: The First Study of this thesis aims to understand the experiences of SubSaharan women who irregularly arrive in Spain, with a special focus on the stages of recruitment, transit, and emergency care. A. Participants: Sub-Saharan migrant women who have arrived in Spain by boat (patera). B. Data Collection Instrument: The technique used for this research is interviews, with the interview script serving as the instrument. The interview should be conducted in person to allow for greater information exchange. C. Procedure: Access to Sub-Saharan immigrant women will be facilitated through organizations responsible for providing initial humanitarian assistance to vulnerable groups upon their arrival in Spain. D. Data Analysis: • Familiarization of the researcher with the collected data. • Identification of the most relevant information for the study. • Management and classification of data and aspects identified in personalized • Establishing a fundamental structure encompassing all aspects crucial to the study and clarification of the phenomenon under investigation. The Second Study of this doctoral thesis aims to understand and describe the psychosocial and health effects affecting migrant women once they arrive in Spain, with a particular focus on victims of human trafficking and sexual assaults. A. Participants: Sub-Saharan migrant women who have arrived in Spain by boat (patera) and have been or are victims of human trafficking and sexual assaults. B. Data Collection Instrument: The technique used for this research is interviews, with the interview script serving as the instrument. The interview should be conducted in person to allow for greater information exchange. C. Procedure: Access to Sub-Saharan immigrant women will be facilitated through organizations responsible for providing initial humanitarian assistance to vulnerable groups upon their arrival in Spain. D. Data Analysis: • Familiarization of the researcher with the collected data. • Identification of the most relevant information for the study. • Management and classification of data and aspects identified in personalized interviews. • Establishing a fundamental structure encompassing all aspects crucial to the study and clarification of the phenomenon under investigation The Third Study aims to understand and describe the experiences of healthcare, legal, and social professionals who attend to irregularly arriving migrant women in Spanish territory, with particular attention to victims of human trafficking and/or sexual assaults. A. In this third study, the participants are: Health professionals belonging to the fields of medicine and nursing. Legal professionals, including lawyers specialized in criminal law and immigration law. Social professionals, personnel belonging to NGOs dedicated to assisting migrant women. B. Data Collection Instrument: The technique used for this research is interviews, with the interview script serving as the instrument. The interviews should be conducted in person to allow for greater information exchange. C. Procedure: The location and access to these professionals will be done through their respective institutions, which are as follows: Health professionals will be located and accessed through the Hospital Centers of the Andalusian Health Service located in the province of Almería and surrounding areas. Legal professionals will be located through the Almería Bar Association, accessing the list of professionals assigned to the duty counsel for assistance in points of massive entry. Social professionals will be located through NGOs that meet the inclusion criteria located throughout the national territory. D. Data Analysis: • Handling and familiarization of the researcher with the obtained data. • Identification of the most relevant information for the study. • Management and classification of the data and aspects identified in the personalized interviews. • Establishing a fundamental structure that encompasses all aspects that are crucial for the study and clarification of the phenomenon under investigation. Results: In the first study, three main themes were identified: "Poverty and discrimination drive migrant women to migrate," "Migrant women as a paradigm of extreme vulnerability," and "Migrant women in a small boat should raise the alarm." The eight sub-themes that emerged from the first study were grouped into: "The difficulty of living in social and economic inequality," "Escaping a culture of discrimination against women," "Recruiting migrant women in their countries of origin," "Sexual and reproductive control: the husband of the journey," "Waiting to board: between labor exploitation and sexual slavery," "The dangerous journey in a small boat," "Meeting needs and identifying victims of human trafficking," "The mother/child relationship: an indicator of human trafficking in migrant women." The second study highlighted the following main themes: "No borders for violence: female migration increases the risk of assault and sexual exploitation," "Trapped in the migratory journey: the struggle of migrant women against trafficking," "The deep and invisible impact of the migration process on women victims of trafficking and sexual assault." The second study yielded seven sub-themes: "Breaking barriers: how migrant women defy cultural and social norms," "Losing health in the migration process, jeopardizing women's well-being," "From migration to slavery: the tragic story of women victims of trafficking," "Sexual violence against migrant women on their path to hope," "Support systems in the country of origin as an escape from exploitation," "The price of escape: the physical and psychological impact of the migration process on women who have been victims of trafficking and sexual assault," "Rebuilding life after violence: the path to emotional healing" for migrant women victims of trafficking and sexual assault. The third study highlighted three main themes: "Overcoming barriers: challenges and opportunities in healthcare for migrant women victims of trafficking and sexual assault," "Rights without borders: legal assistance as an empowerment tool for migrant women," and "Social assistance as an integration tool for migrant women." Five sub-themes were identified as follows: "Comprehensive approach in healthcare," "Beyond illness: promoting the holistic health of migrant women through healthcare," "Comprehensive legal protection for migrant women: a human rights approach," "The importance of legal assistance for victims of trafficking and sexual assault," and "The role of social assistance in the lives of migrant women." Conclusions: Conclusions from the first study: Many immigrant women live in a culture of oppression, discrimination, and inequality that drives them to migrate to Europe from their countries of origin in search of a better life. During this dangerous journey, they suffer from hunger, dehydration, or injuries. Additionally, they incur significant debt that exposes them to sexual abuse and rape. After a long wait, migrants cross the Mediterranean Sea in small boats, which involves dangerous and deadly journeys that can last for days or weeks. The development of joint protocols between governments, NGOs, police, and healthcare providers, along with the observation of the relationship between migrant women and children, are crucial steps in improving emergency care. These findings can be used to enhance the care for migrants arriving in Europe by sea from North Africa. Conclusions from the second study: The feminization of migration is a reality and entails women facing patriarchy and a culture of machismo. Statistical data show an increase in the arrivals of women from Sub-Saharan countries on the Spanish coasts. Trafficking begins as an opportunity to change their precarious situation and their subordination to male relatives. It is presented as their only option to cover the expenses of the journey they intend to undertake. Migrant women are sexually assaulted and feel that they have no control over their bodies or decisions. They recognize themselves as inert beings due to the objectification imposed on them by criminal networks. Migration and trafficking can be risk factors for women's mental health, as they are exposed to extreme aggression, mistreatment, and injuries that can be both physical and psychological, while also displaying resilient capacities. In addition to facing the inherent difficulties of the migration process and those experienced in trafficking, these migrant women must also confront their integration into a new country and socialization within a new community. Conclusions from the third study: To understand the assistance phenomenon of trafficking, it is necessary to approach it from a broader perspective and understand the role played by professionals in assisting migrant women victims of trafficking. Healthcare professionals highlight the need for continuous training and adequate resources to address the assistance of migrant women. Legal professionals emphasize the need for greater capacity and flexibility in providing legal assistance and guidance to women victims of trafficking. They emphasize the importance of being able to privately interview women with the main objective of promoting early detection of victims. The group of legal professionals emphasizes the need to facilitate and flexibilize requirements in order to protect their right to effective judicial protection in assistance before Spanish courts. Social agents emphasize the importance of joint action between healthcare, legal, and law enforcement professionals to minimize the negative impact of trafficking on women. interviews