Case A: London

Twenty-year-old Ms. Z. presented to the emergency department (ED) of a hospital in London, anxious and hyperventilating after 4 days sheltering on night buses. She was brought in by an elderly couple whom she had approached when she overheard them speaking her Nigerian language. Once in an exam room, Ms. Z. reported that she’d fled to the United Kingdom from Nigeria after witnessing the murders of her husband and her father. Distant relatives, warning her that her life was in danger, brought her to London with an offer of employment. When Ms. Z. arrived, however, they confiscated her passport and locked her in a house, where she was raped repeatedly over the ensuing 6 months and threatened that “If you leave, you will be arrested and sent back home to die.” When her captor left the door unlocked, Ms. Z. escaped.

In the ED, Nurse M. took down Ms. Z.’s details, noting that her immigration status was ambiguous. The ED doctor explained to Ms. Z. that her symptoms resulted from panic and trauma. He provided instructions on registering for a full assessment and ongoing National Health Service (NHS) care at the local family medicine clinic, emphasizing that the care is free regardless of patients’ immigration or financial status. But as Ms. Z. left the ED, she was arrested. She spent a month in detention until a lawyer specializing in human trafficking arranged for her release.