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State of Hate 2025

Edited by  Nick Lowles

The far right poses its biggest political threat in Britain since World War Two. At the ballot box, on the streets and online, the far right – in all its guises – is increasingly confident, assertive and growing. With Donald Trump returning to the Presidency of the United States and Elon Musk, the world’s richest man, financially and ideologically supporting the British far right, we can only assume that the threat will grow in 2025. REFORM UK Britain faces a genuine far-right political threat for the first time in our history, in the form of Reform UK: Reform UK received 4.2m votes in the 2024 general election, a 14.3% vote share Support for Reform UK has continued to grow since the election and now regularly tops opinion polls The party currently has 218,000 members and, with an influx of money and experienced political campaigners, is becoming an increasingly professional outfit RIOTS 2024 saw the worst race riots in 100 years, following the murder of three young girls in Southport by 18-year-old Axel Rudakubana: Violence broke out in 18 towns and cities across England While activists from known far-right organisations were involved in the trouble, most incidents emerged from localised, post-organisational far-right networks The riots were fuelled by disinformation and the widely reported claim across the entire far right that the authorities were covering up the Islamist motives of the attacker. Despite Axel Rudakubana not being a Muslim, much of the far right still refer to him as such HOPE not hate identified the man behind the Southport Wake Up Telegram group, which played a central role in stirring up the violence. He was recently imprisoned for seven years TOMMY ROBINSON Former EDL leader Stephen Lennon, better known as Tommy Robinson, continues to be the most influential far-right activist outside Reform: Lennon held a demonstration of 30,000 to 40,000 people in London in July, the largest far-right protest ever Lennon has acquired more than one million followers on X, and his tweets on the day of the big demonstration were seen by 58m people He was imprisoned for 18 months in late October for contempt of court He received support from Elon Musk, including funding RADICAL RIGHT ECOSYSTEM Fuelling the British far right is a growing, increasingly confident and well-resourced radical-right ecosystem, which spans traditional media, new media and a burgeoning number of individual actors: GB News is increasingly the mouthpiece for Reform UK A growing number of radical-right activists are leaving platforms like GB News to establish their own media outlets, backed by donations and subscriptions from supporters Academic-turned-activist Matt Goodwin is playing an increasingly important role in supporting Reform, backed by a Substack with more than 70,000 followers TERRORISM Far-right terrorism continues to pose a major threat in the UK: Twenty-three people who were far-right sympathisers were convicted under terrorist legislation A new violent cult called 764, closely linked to the nazi Satanist group Order of Nine Angles, is active in Britain A growing number of extremely violent young men are becoming increasing ideologically fluid, drawing inspiration from a diverse array of extremes in order to justify their thoughts and acts of violence. The Southport killer Axel Rudakubana is a case in point DEMOCRACY The public continue to be downbeat about the state of democracy and politics in the UK: 40% of Britons in a poll of 23,000 support a “strong and decisive leader who has the authority to override or ignore parliament” over a representative parliamentary democracy 68% do not believe that politicians listen to people like them, with just 9% believing they do The more pessimistic people are about their own lives, the more likely they are to support Reform UK, to believe multiculturalism is failing, and to oppose immigration    

London: Hope Not Hate, 2025. 140p.

A Decade of Harm: Survivors of Gender-Based Violence Locked Up in Immigration Detention

By  Anne Marie Munene, Christine Harris, Deborah Rest, Etracy Rukwava, Goldie Joseph, Hadnet Tesfom Habtemariam and Kaffy Kazep.

  Over the past decade, Women for Refugee Women’s (WRW) groundbreaking research on women in immigration detention has shown that the majority of asylum-seeking women detained are survivors of rape and other forms of gender-based violence, including domestic violence, forced marriage and sexual exploitation. Locking up women who have already survived serious violence and abuse retraumatises them, causing profound and long lasting damage to their mental health. Since WRW started campaigning on this issue there have been important changes to women’s detention, including a huge reduction in the numbers detained: from over 300 women at any one time in 2014, to around 100 women now. Yet despite this progress, for women who continue to be locked up, the harms of detention remain. New research we have carried out has found that despite the Home Office banning practices through which male detention centre staff see women in intimate situations, these practices nonetheless continue. In mid-2016 the Home Executive Summary Office banned male staff from carrying out ‘constant supervision’ of women deemed at risk of suicide – yet in our survey of 40 women, 71% of respondents subject to ‘constant supervision’ since the ban came in told us they us had been watched by male staff. This means they will have been watched by men in situations including while in bed, on the toilet, in the shower or getting dressed. Survey respondents who told us they had been subject to constant supervision by male staff included women detained as recently as 2024. Since coming to power in July 2024 the Labour Government has made welcome commitments to prioritise survivors of gender-based violence and make sure they receive the support they need. We urge the Government to ensure that asylum seeking survivors are included in these commitments by taking the practical and achievable step of ending women’s immigration detention, and setting up a new   

London: Women for Refugee Women, 2025. 23p.

Asylum Processing at the U.S.-Mexico Border

By Stephanie Leutert and Caitlyn Yates

In recent years, hundreds of thousands of migrants have sought asylum annually along the U.S.-Mexico border—either by arriving at ports of entry or by turning themselves in to Border Patrol agents. In response, U.S. authorities have enacted a range of policies, which have oscillated between channeling asylum seekers into specific legal pathways and either partially or fully blocking their access to the U.S. immigration system. During each shift, migrants have reacted in varying ways, such as by creating asylum waitlists or encampments along the border. In November 2018, the Robert Strauss Center for International Security and Law at the University of Texas at Austin began publishing quarterly reports on asylum processing at ports of entry. As of January 20, 2025, there is no longer any asylum processing at the border. On this day, President Donald Trump assumed office for a second term and immediately halted all asylum processing—including both at and between ports of entry. This shift left hundreds of thousands of asylum seekers in limbo across Mexico, without any path to make an asylum claim in the United States. Simultaneously, the Mexican federal government has also increased its immigration enforcement at its borders and across the country’s interior. Specifically, it has expanded the number of migration-focused checkpoints on highways heading north, deployed more soldiers to the U.S.-Mexico border, and bussed apprehended migrants to cities in southern Mexico. The Trump Administration’s elimination of foreign assistance has also hurt Mexican civil society organizations, with some migrant shelters struggling to provide food and other basic resources. This February 2025 asylum processing update focuses on current U.S. asylum policies at ports of entry and migrants’ experiences in Mexican border cities. It draws on phone and WhatsApp interviews with Mexican government officials and members of civil society organizations on both sides of the border from February 17, 2025 through February 24, 2025. It also relies on local news articles to fill in any gaps.

Austin, TX: The Robert Strauss Center for International Security and Law, 2025. 14p.

Modern Slavery Act – Ten Years On: How to Use the Employment Rights Bill to End the Conditions for Labour Exploitation

By  Focus on Labour Exploitation (FLEX)

Labour exploitation must be recognised as part of a continuum of experiences which range from decent work through to minor and major labour law violations, all the way to severe exploitation, including human trafficking. When workers are unable to access rights or to challenge poor employment conditions at those ‘earlier stages’ or ‘lower levels’ of exploitation, it paves the way for more severe exploitation including trafficking. 

The Modern Slavery Act 2015 focused on identifying trafficking which had already taken place. For those people who have been trafficked, this is too late. Ten years later, and with an Employment Rights Bill going through parliament, policy-makers should turn their attention to prevention, by addressing the conditions which have allowed trafficking for labour exploitation to thrive.

The Employment Rights Bill provides significant opportunity here. The Bill must be amended to ensure that all workers can access rights early, knowing that the authorities will focus on addressing their exploitation and delivering justice. 

London: FLEX, 2025. 5p.

The End of Asylum? Evolving the Protection System to Meet 21st Century Challenges

By Susan Fratzke, Meghan Benton, Andrew Selee, Emma Dorst, Samuel Davidoff-Gore 

  The territorial asylum system at the heart of the global protection regime has proven itself to be a blunt tool with which to address the protection challenges of the 21st century. New crises, protracted displacement situations, and expanding norms about who merits protection have created a significant and growing population of individuals in need of international protection. In addition, growing mobility pressures due to demographic change, economic inequality, and climate change have found an outlet in asylum systems, providing an avenue of entry even for those who do not technically qualify for protection. Meanwhile, national governments have struggled to reconcile their international protection responsibilities with their domestic responsibilities to maintain security and order and to foster public trust. Asylum adjudication systems have become unwieldy and unable to keep pace with the demands placed on them, particularly when confronted with rapid changes or complex needs. These failures have had serious consequences. For individuals, the absence of large-scale alternatives to territorial asylum means that access to protection often depends on taking extreme risks or enduring hardships in order to reach the territory of a country where they can seek protection, journeys that may not be possible for the most vulnerable. For states, territorial asylum places governments in a largely reactive position, only responding to protection needs once their hand is forced by the arrival of people seeking protection on their territory. And at the global level, the lack of tools to facilitate the legal mobility of individuals in search of protection and of opportunities for displaced persons to move to a country other than their country of first asylum has concentrated protection responsibilities in a small number of countries, most of them low- or middle income. According to estimates by the United Nations High Commissioner for Refugees (UNHCR) nearly 40 percent of the world’s refugees and individuals in refugee-like situations were hosted by just five countries as of mid-2023. To answer these challenges, there is an urgent need to shift the focus of protection responses away from an exclusive reliance on territorial asylum and toward a diversified set of policy tools. Territorial asylum will, and should, remain accessible as a safety valve, but states should seek to proactively facilitate access to protection as soon after and close to a displacement crisis as possible—and well before dangerous journeys become necessary. At the same time, policy approaches should recognize the agency of refugees and displaced persons—and the mobility pressures this can create—and provide legal avenues for individuals to move within and outside of their country of first asylum to join family and other connections through family reunification or sponsorship channels and to pursue education, work, or other opportunities. Aside from the benefits for displaced persons, such approaches would help transit and destination countries to reduce disorder at their borders and, by capitalizing on the resiliency and resourcefulness of displaced individuals in locating and securing solutions for themselves, to better allocate scarce resources to assist those who are most vulnerable. Policy approaches should also be responsive to the specificities of each crisis or situation. This may mean adopting expedited procedures or flexible forms of status in order to enable faster access to  status, prevent processing backlogs, or respond to legitimate needs that are not recognized in existing legal frameworks.    

Washington, DC: Migration Policy Institute, 2024.  33p.

Lives in Limbo: Devastating impacts of Trump’s migration and asylum policies

By Amnesty International

This briefing presents Amnesty International’s findings and observations from a week-long research trip to Tijuana, Mexico, in February 2025, whose purpose was to document the human rights impacts of changes to US migration and asylum policies since President Trump took office on 20 January 2025.1 In particular, it focuses on the end of applying for asylum at the US-Mexico border and the situation of asylum seekers in Mexico. This briefing does not provide detailed information about mass immigration arrests and detentions in the United States, nor an analysis of the discriminatory impacts of these measures. The cumulative effects and harms of the Trump administration’s punitive and discriminatory immigration and asylum measures are the subject of Amnesty International’s ongoing monitoring and analysis of the situation in the United States. During the trip to Tijuana, Amnesty International interviewed people seeking safety, met with legal, humanitarian and social service providers, local and international organizations, and visited shelters and spaces where migrants and asylum seekers are staying. The organization spoke with two Mexican men who had recently been deported from the United States to Mexico, as well as with 35 people seeking safety (almost half of whom were women) from Belarus, Colombia, Cuba, Ecuador, Haiti, Honduras, Mexico, Russia and Venezuela. Amnesty International interviewed local and international organizations operating in Tijuana including Al Otro Lado (AOL), Asylum Access México and Haitian Bridge Alliance. The organization also visited and spoke with those running migrant shelters, including Borderline Crisis Center, Casa de los Migrantes, Casa de los Pobres, El Rubi, Jardin de las Mariposas and Villa Haitiana. The interviews with Spanish-language speakers were conducted in Spanish, while interviews with non-Spanish speakers were conducted in English with interpretation assistance from staff of local organizations and other people seeking safety. Amnesty International requested meetings with the San Diego offices of Customs and Border Protection (CBP) and Immigration and Customs Enforcement (ICE). ICE declined the meeting request and CBP did not respond. The organization’s request to visit the Otay Mesa Detention Center in San Diego was denied. Various individuals and organizations spoke to Amnesty International on the condition of anonymity. Their names have not been included in this report.  

London: Amnesty International, 2025. 24p.

Promise vs. Reality: Access to Justice for Refugees in Greece

By Vivi Paschalidou

The project titled “InteGRation: Tackling chronic challenges in the field of integration of refugees in Greece” was funded by the Oxford Policy Engagement Network (OPEN) at the University of Oxford and supported the partnership of the Border Criminologies research network with the Greek Council for Refugees. The present report is one of the outputs of the above project. In response to requests from refugee participants for information about state funded free legal aid in Greece, we created a new leaflet that provides practical information on the topic. It includes essential guidance on how to navigate the free legal aid system and a list of contact points for requesting aid at the courthouses in Athens and Thessaloniki. This leaflet has been distributed in the two major Greek cities’ Courts of Law in four languages: English, French, Arabic and Farsi. This builds on an ongoing collaboration between the two organisations. Together they have contributed to a number of key developments in the field of academic and policy inquiry into border control and immigration detention in Greece, including increasing public access to knowledge about immigration and creating a leaflet on access to rights in immigration detention. Greek Council for Refugees is a specialized Non-Governmental Organization that has been leading efforts to protect asylum and human rights in Greece since 1989. It provides free legal and social services to refugees and individuals from third countries who are entitled to international protection, with special emphasis on the most vulnerable cases, such as unaccompanied minors and victims of human trafficking. Border Criminologies is an international research network and website based at the Centre for Criminology at the University of Oxford, which showcases original research from a range of perspectives, supports advocacy work and creates practical resources to help those working in the migration field. This report examines a specific aspect of the integration of applicants and recipients of international protection in Greece: The effectiveness of their access to the Greek justice system. We undertook thirty interviews with respondents from fourteen countries. Our questions focused on the refugees’ experience with the Greek justice system, the difficulties they faced and their recommendations for its amelioration. We also interviewed members of two key stakeholders, namely the judiciary and legal professionals handling asylum and migration law.

Athens: Greek Council for Refugees, 2024. 40p.

Not Just an Afterthought: The Experience of Women in Immigration Detention

By Australian Human Rights Commission

In April and May 2024, the Commission visited the Broadmeadows Residential Precinct (BRP) and parts of the Melbourne Immigration Detention Centre (MIDC), the Villawood Immigration Detention Centre (VIDC), and the Perth Immigration Detention Centre (PIDC), all facilities where women are held. This Report documents the key observations arising from the Commission’s inspection of these facilities. Some of the issues that the Commission identifies are specific to individual facilities and others are systemic in nature. The Report finds that in an overwhelmingly male system, women in immigration detention are often an afterthought when it comes to detention infrastructure, the provision of programs and activities, equitable access to services and the delivery of staff training. Women’s experiences of detention differ substantially from men’s, not only because they are minorities, but because they have particular needs and vulnerabilities that are often unrecognised and unmet. For many of the women, the negative impacts of detention are compounded by histories of abuse and trauma and heightened risk of exposure to violence and sexual harassment. The Report finds that these impacts are exacerbated by the continued use of operational quarantine (separation from the main population without medical symptoms) and the probable separation from family supports owing to the limited accommodation available for women close to their families and the inadequacy of visiting facilities for those with children. The Report finds that women have fewer opportunities for meaningful self-development, and the programs and activities offered are often unresponsive to their needs or not age appropriate. Staff working in these facilities often have no specific training on the vulnerabilities and needs of women in their care, which can result in routine activities being undertaken insensitively or exposing women to further trauma. The Report emphasises concern about women being routinely exposed to the possibility of harassment and violence because many of the services that are available to them are located in male compounds or adjacent to them. In particular, the Report highlights concern about the co-location of men and women in the Broadmeadows Residential Precinct and, the safety of women at Villawood Immigration Detention Centre, who are housed next to a compound with registered sexual offenders. The recommendations made in this Report are designed to assist the Department to improve the situation for women in immigration detention, ensuring they are managed safely, while also protecting their human rights.

Sydney: Australian Human Rights Commission, 2024. 93p.

Migrant Returnees as (Anti-)Migration Messengers? A Case of Street-Level Representative Bureaucracy in Senegal

By Katerina Glyniadaki, Nora Ratzmann, Julia Stier

International organizations and foreign-funded NGOs run campaigns in Senegal to raise awareness of the perils of irregular migration. To increase their effectiveness, these organizations often enlist local migrant returnees to share their personal migration experiences and transmit an anti-irregular migration message to their compatriots. This article examines whether policymakers' assumptions regarding the representativeness of migrant returnees operating as (anti-)migration messengers in terms of shared identities corresponds to reality at the street level. It draws from theories of street-level bureaucracy and representative bureaucracy and is based on 31 qualitative interviews with migrant returnees and experts. The study shows that migrant returnees engaged in migration information campaigns are not as representative of the local population as envisaged by policymakers, potentially impacting policy outcomes. They stand out from their compatriots in terms of skillsets and social status – partly because of the selection mechanism employed by organizations and partly because of the training and capacity-building efforts directed at migrant returnees.

International Migration. 2025;63:e13382.

Border Security, Asylum and Immigration Bill: Still a Tool for Exploitation

By Focus on Labour Exploitation (FLEX)

2025 marks the 10 year anniversary of the Modern Slavery Act. Since that time the gaps in the UK’s systems to prevent, identify and address exploitation, including trafficking and modern slavery, have been well evidenced.

The Border Security, Asylum and Immigration Bill misses a crucial opportunity to drive meaningful change to ensure that all victims of exploitation are protected, whatever their immigration status.

By failing to repeal key elements of the Nationality and Borders Act 2022 and the Illegal Migration Act 2023, this Bill does not address key drivers of exploitation. Instead, this Immigration Enforcement centred approach fails to provide meaningful opportunities for survivors to recover through security and decent work. This only plays into the hands of exploiters.

London: T (FLEX) , 2025. 6p

Scenarios of Fundamental Rights Violations at the Borders: Guidance for Border Guards on Dos and Don'ts

By European Border and Coast Guard Agency (Frontex)

The following scenarios are based mainly on Serious Incidents Reports received by the Frontex' Fundamental Rights Office, concerning violations that allegedly took place at border areas where the Agency is operating. All cases refer to situations where third country nationals are under the jurisdiction of the authorities of the host state participating in a joint activity. In 2022-23, the Fundamental Rights Office launched approximately 100 Serious Incident Reports related to fundamental rights, matching the scenarios outlined below. This indicates that they represent potential violations of a widespread nature. Outlined scenarios, regardless of the direct or indirect involvement of Frontex staff and/or assets, may negatively impact the Agency and have potential legal implications, including for the broader European Border and Coast Guard community and respective national authorities. Active involvement by participants in joint activities in practices presented below, such as collective expulsions, amounts to a violation of EU and international law as well as a breach of the Frontex Code of Conduct. To ensure Frontex' full compliance with fundamental rights, it is necessary that the Agency makes clear to all operational participants that practices and policies as the ones described below are in violation of EU and international law and may result in Frontex' disengagement, triggering of Article 46 of the European Border and Coast Guard Regulation, or other forms of administrative, financial and operational consequences. Frontex' Fundamental Rights Office recognises that similar cases often form part of broader systemic issues, identified through its monitoring. The Office is mandated to provide recommendations to the Agency, relevant also for national authorities. The following scenarios are complementary to these efforts and aim to provide basic guidance for officers deployed at the borders as well as other staff tasked with related duties. Seven different scenarios of fundamental rights violations are briefly presented. While presented scenarios have been developed on the basis of most frequently alleged violations, it is important to note that this is a non-exhaustive list. While this document includes basic references to violated rights, it is not intended to be a legal analysis. Outside of the official border crossing point. based on real-life Serious Incident Reports (SIR) Category 1, and includes a list of potentially violated rights. The last section of the document outlines "dos" and "don'ts" for border guards in case of witnessing or learning about similar cases in the performance of their duties.

Warsaw • Poland : European Border and Coast Guard Agency (Frontex), 2024 . 16p

Global Report on Trafficking in Persons 2024

By The United Nations Office on Drugs and Crime

The 2024 UNODC Global Report on Trafficking in Persons is the eighth of its kind mandated by the General Assembly through the 2010 United Nations Global Plan of Action to Combat Trafficking in Persons. This edition of the Global Report provides a snapshot of the trafficking patterns and flows at global, regional and national levels. It covers 156 countries and provides an overview of the response to the trafficking in persons by analysing trafficking cases detected between 2019 and 2023. A major focus of this edition of the Report is on trends of detections and convictions that show the changes compared to historical trends since UNODC started to collect data in 2003, and following the Covid-19 Pandemic.

The findings are further informed and enriched through the analysis of summaries of more than 1000 court cases adjudicated between 2012 and 2023, providing closer insights into the crime, its victims and perpetrators, and how trafficking in persons comes to the attention of authorities.

As with previous years, this edition of the Global Report on Trafficking in Persons presents a global picture of the trends, patterns and flows of trafficking (Chapter 1), alongside detailed regional analyses (Chapter 3). This edition of the Global Report presents a special chapter on Africa (Chapter 2) produced with the purpose of unveiling trafficking patterns and flows within the African continent. The chapter is based on unprecedented number of African countries covered for the Global Report.

This edition of the Report presents a new contribution from an early career and young academic researchers, as part of UNODC’s Generation 30 initiative, aimed at building new connections between the UN and academia, while expanding research opportunities for young people. The contributions featured in the report was submitted in response to a call for proposals issued on the UNODC website in 2023.

Vienna: UNODC, 2024. 176p.

Torrance County Detention Facility: Troubling Role in Detaining Haitian Migrants During the 2021 Del Rio Incident

By The American Immigration Council

The Torrance County Detention Facility (Torrance) is one of approximately 200 facilities across the United States where Immigration and Customs Enforcement (ICE) detains immigrants with pending removal proceedings. Located in the rural New Mexico desert, this detention facility holds a notorious reputation for its inhumane living conditions and for the speed at which individuals detained there go through their removal proceedings, often without adequate legal counsel. Despite these noted abuses, in September 2021, ICE placed over 100 Haitian migrants into Torrance while they awaited removal proceedings. For months thereafter, the media continued to report on a variety of obstacles Haitians endured in detention including inadequate access to legal counsel.

Due to the increase in complaints from individuals being held at Torrance, the American Immigration Council (The Council) sought to ascertain whether particular barriers to due process exist for Haitian nationals, as well as to investigate the overall treatment of Haitian nationals at Torrance. The request sought data related to individuals detained at Torrance from January 1, 2021, including arrest/apprehension information, immigration status, biographic information, detention history, and release information. ICE responded by providing data between January 1, 2021 and November 17, 2022, and this is what we found when we analyzed it:

ICE's Use of Racial Classifications Are Unreliable, Labeling Most Detained Individuals “White:” Individuals in detention at Torrance represented 54 different countries spanning five different continents. However, 86 percent of individuals detained at Torrance were categorized as racially “white.” The data suggests that ICE failed to systematically document the race of detained individuals.

Africans Had the Highest Lengths of Detention at Torrance: Because ICE’s race categorizations proved unreliable, researchers grouped detained individuals by continent to measure the impact geographic location has on detention lengths. The data showed that African migrants had the highest lengths of detention.

ICE Officers Continued to Populate Torrance Despite Multiple Warnings: During the reviewed time period, ICE had substantial warning signs that Torrance was not equipped to house detained migrants through failed inspections, COVID surges, staffing shortages, and even

government oversight agency reports recommending shutting the facility down. Despite these warning signs, the data showed that ICE continued to detain migrants at Torrance, putting them at risk.

Oversight Efforts Seemingly Reduced the Detained Population at Torrance—But Only Temporarily: The data shows that between August and November 2022, a period that included the suicide of Kesley Vial at Torrance and a government report calling for the closing of Torrance, the population of Torrance consistently decreased. However, in December 2022, ICE began repopulating the facility.

Washington, DC: The American Immigration Council, 2024. Published: October 24, 2024

Forced Labor in Global Supply Chains: Trade Enforcement Impacts and Opportunities

By Victoria A. Greenfield, Tobias Sytsma, Amanda Kerrigan, Maya Buen

Forced labor—work performed involuntarily and under menace of penalty—occurs globally, with reports of abuses in all countries. About 28 million people—one in every 300 people worldwide—work against their will, bound through physical violence, threats, debt bondage, and other exploitative means. The United States has long imposed prohibitions on imports of goods made with forced labor—notably, under the Tariff Act of 1930 and the Uyghur Forced Labor Prevention Act of 2021 (UFLPA). The UFLPA targets China's extensive use of forced labor as a state-sponsored, coercive policy tool in the Xinjiang Uyghur Autonomous Region (XUAR), by barring U.S. imports of goods made in the XUAR or sourced from entities connected to it. Still, such goods flow through global supply chains. In 2021, the United States accounted for over one-fifth of the world's imports of goods that were at risk of being made with forced labor.The U.S. Department of Homeland Security (DHS), which leads trade enforcement under these laws, requested an analysis of trade enforcement and its impact. Researchers set out to (1) assist DHS in developing analytical capabilities for assessing the impact of its efforts to combat forced labor through trade enforcement and (2) evaluate the impact that DHS's actions and investments have had on meeting the goals of eliminating U.S. imports of goods made with forced labor and eliminating the use of forced labor globally. This report outlines the

researchers' methods for evaluating DHS's impact and presents findings on efforts and recommendations for strengthening enforcement.

Key Findings

DHS's impact in trade enforcement depends on stakeholders.

Trade enforcement is making measurable progress, but stakeholders are encountering impediments that DHS cannot address entirely on its own. U.S. businesses—and consumers—remain exposed to goods made with forced labor through indirect supply chain linkages with limited visibility.

Trade enforcement still holds value even if it, alone, cannot change China's policy on forced labor in the XUAR. Economic sanctions face inherent obstacles, but trade enforcement can help limit U.S. imports of goods made with forced labor, prevent U.S. complicity in other countries' labor abuses, and send a strong policy signal.

Trade enforcement comes with costs that can undermine its aims. U.S. businesses can incur costs from tracing supply chains, switching suppliers, and mitigating commercial disruptions; the environment could experience related harms; and China could retaliate and obfuscate.

DHS can track trade enforcement progress and unintended consequences, but it might be unable to know whether it is meeting its ultimate aims. Capturing broad effects on U.S. businesses, workers, and consumers; the environment; and global working conditions might be harder than capturing those on immediate goals for enforcement efforts.

DHS needs enough of the right resources and information to do its job, but stakeholders have suggested that it does not have them. Concerns about staffing included hiring, skills, burnout, and retention.

DHS and its stakeholders would benefit from more and higher-quality information. Better visibility into global working conditions, supply chain composition, the content of goods, and enforcement processes could strengthen trade enforcement.

Recommendations

Look for opportunities to encourage robust stakeholder participation by improving the flow and quality of information through greater transparency and improvements in tools, technology, and methods of data analysis.

Consider a more comprehensive approach to combating forced labor in global supply chains by working with other U.S. agencies and other countries to better leverage potential complementarities of economic sanctions and other types of measures.

Consider options for mitigating unintended consequences in concert with other U.S. agencies and with input from nongovernmental stakeholders, either by reducing them or responding to them, depending on their severity and likely prevalence.

Work with other U.S. agencies to monitor indicators of progress and unintended consequences over time to better understand how conditions are evolving.

Develop evidence with stakeholders to inform public debates on trade enforcement, including those on concerns about de minimis entries and environmental initiatives.

Continue to make the case for funding and staffing, which are critical resources for trade enforcement and are likely to need to increase.

Santa Monica, CA: RAND, 2025. 196p.

Necessity Rather Than Trust: Smuggling Dynamics on the Eastern Route Through Yemen

By Ahmed Hussain, Ayla Bonfiglio

This report focuses on the nature and dynamics of human smuggling along this Eastern Route from the Horn of Africa across the Red Sea between locations of origin in Ethiopia and points of arrival along the coast of Lahj Governorate in Yemen. It examines the role of smugglers, the services they offer, the financial aspects of the journey, and how migrants perceive their

smugglers. The study is based on 346 surveys with migrants in Lahj, Yemen and 16 with smugglers in Ethiopia.

The Eastern Route is widely regarded as among the most dangerous mixed migration routes originating from the African continent, in terms of migrants' exposure to violence, abuse, and exploitation. This report, based on 346 surveys with migrants in Lahj, Yemen and 16 with smugglers in Ethiopia, focuses on the nature and dynamics of human smuggling along this route between locations of origin in Ethiopia and points of arrival along the coast of Lahj Governorate in Yemen. It examines the role of smugglers, the services they offer, the financial aspects of the journey, and how migrants perceive their smugglers. Additionally, the report delves into the abuses associated with smugglers, migrants’ protection strategies, and the forms of assistance that migrants receive from smugglers. This study was carried out against the backdrop of reduction in recorded migrant arrivals in Yemen, not merely because of the joint military campaign in the Red Sea and anti-smuggling campaigns by Yemeni and Djiboutian coastguards since August 2023, but also owing to decreased access to data collection in key transit locations along this route. The data provide some insight into these dynamics, which is critical to informing the work of humanitarian actors and policymakers, and fundamental for developing interventions that address the vulnerabilities of migrants along this precarious route. The key findings include: • Smugglers played a limited role in influencing respondents’ migration decisions (9%) and route selection (11%) between Ethiopia and coastal departure points in Djibouti or Somalia. Indeed, more than half of the respondents (57%) stated that they were not influenced by anyone in their decision to migrate, indicating that their choice was largely self-motivated rather than driven by persuasion. • Far from being coerced into using smugglers, migrants reported hiring smugglers to make the journey easier (75%) and cheaper (45%), and they were often proactive in initiating contact (85%) themselves. • The vast majority of respondents (95%) employed the services of one smuggler on their journey to Lahj, Yemen. Of these, most (62%) employed them for one part of the journey—likely for the Red Sea crossing. • In contrast to 4Mi data from the Central Mediterranean Route or the Southern Route (towards South Africa), showing smugglers provide a range of services to migrants, the primary service provided by smugglers along this section of the Eastern Route was arranging transit across borders (99%). • On average, 97% of the respondents paid around 300 USD to the smuggler for their services, largely for the sea crossing. With an average of 100,000 migrants crossing annually, this would amount to a smuggling business worth 30 million USD annually, a significant source of income for smugglers operating out of Djibouti. • Over half of surveyed migrants (60%) paid their smuggler in full before starting the journey, which, according to past MMC research, can be a driver of vulnerability, as migrants deplete their resources at the start of the journey and fall victim to smugglers extracting further compensation. • Despite actively seeking to employ smugglers and reporting that smugglers helped them to achieve their migration goal (99%), strikingly, all migrants felt that smugglers intentionally misled them. This finding stands out for its stark contrast with other migration routes, which portray a more mixed picture of misinformation, underscoring the unique and exploitive dynamics of the Eastern Route. • Smugglers were rarely trusted (2%) by migrants as reliable sources of information; with this in mind, few respondents used smugglers as information sources before (12%) and during the journey (28%). • 72% perceived smugglers as perpetrators of abuse in dangerous locations along the route, identifying physical violence (82%), death (68%), and robbery (58%) as the top

dangers. • While smugglers were rarely regarded as trustworthy and were seen as perpetrators of abuse, only 22% of surveyed migrants viewed them as criminals. Indeed, most perceived their smugglers as service providers (64%), highlighting an inherent complexity in migrant-smuggler relationships. The same complexity can be seen in migrants’ strategies for keeping safe along the route: 18% cited hiring smugglers while 1% cited avoiding them to reduce the risk of abuse and crime.

London/Denmark: Mixed Migration Centre, 2024. 24p.

"Canada Has Destroyed Me": Labour Exploitation of Migrant Workers in Canada

By Amnesty International
Tens of thousands of migrant workers travel every year to Canada in the hope of providing a better life for their families. They are promised labour opportunities and working conditions that very often they cannot enjoy in their countries of origin. Yet, many find a different reality upon arrival. This report investigates the human rights impact of Canada’s Temporary Foreign Worker Program (TFWP), a temporary migration scheme that allows employers to hire migrant workers, primarily in low-pay occupations.

London: Amnesty International, 2025. 71p.

An Evaluation of the Safe Harbor Initiative in Minnesota – Phase 4 Supplemental Materials

By Wilder Research

In the decade since Safe Harbor became Minnesota law, the state has built an extensive network in response to the sexual exploitation of youth, and more recently human trafficking, both sex and labor. The network spans from state and local government to Tribal Nations and community-based nonprofit programs. Founded on a public health approach within the Minnesota Department of Health (MDH) in recognition of the significant health and social impacts created by exploitation and trafficking on populations, Safe Harbor also partners extensively with entities in public safety, human services, and human rights, including the Minnesota Department of Human Services (DHS), the Minnesota Department of Public Safety (DPS) and the Minnesota Coalition Against Sexual Assault (MNCASA) to offer a comprehensive multidisciplinary response. State law requires the Safe Harbor Director, based in MDH, to submit a biennial evaluation of the program to the Commissioner of Health under Minnesota Statute Section 145.4718. The purpose of the evaluation is to ensure Safe Harbor is reaching its intended participants, increasing identification of sexually exploited youth, coordinating across disciplines including law enforcement and child welfare, providing access to services, including housing, ensuring the quality of services, and utilizing penalty funds to support services. The Safe Harbor law passed in 2011 and after a three-year planning period called No Wrong Door, the Safe Harbor system was fully enacted in 2014. In the years since, Safe Harbor has submitted three evaluation reports to the legislature, beginning in 2015. Each evaluation was conducted by Wilder Research at the Amherst H. Wilder Foundation (Wilder) under a competitive contract with MDH. The evaluation process is an opportunity to hear and learn from trafficked and exploited youth as well as participants from a variety of disciplines who respond to the needs of these youth on a daily basis. For the current Phase 4 report, MDH contracted with Wilder again while MDH’s Safe Harbor Program produced accompanying evaluation materials. As a result, this Phase 4 Safe Harbor evaluation draws from complementary background reports that are combined to represent a variety of perspectives from both outside and within the Safe Harbor network. These resources not only evaluate Safe Harbor’s activities, but also address these activities in the context of significant current events including the global COVID-19 pandemic and the civil rights movement in Minnesota, as well as around the nation and world, in the wake of George Floyd’s murder. The supplemental evaluation materials, containing expanded findings, data, and appendix are contained in this document. All findings focus on the Safe Harbor network and activities between April 1, 2019, and June 30, 2021. The Wilder data collection and analysis took place between January 1, 2021, and June 30, 2021. The MDH data collection and analysis took place between September 1, 2020, and August 1, 2021. Between January 2021 and June 2021, Wilder interviewed grantees, multidisciplinary partners, and youth clients, and also surveyed youth clients to evaluate Safe Harbor. Wilder submitted its report including several findings and recommendations to MDH. Wilder found evidence for outcomes related to multidisciplinary partnership and access to services, including culturally specific services; the factors contributing to Safe Harbor’s impact; gaps and challenges; opportunities for improvement; and the pandemic’s impact on service provision. MDH analyzed the provision of the statewide Safe Harbor Regional Navigator component and the reach of the Safe Harbor Network to identify and serve youth, as well as availability, accessibility, and equity of Safe Harbor supportive services and shelter and housing, in addition to training for providers. MDH then submitted a Phase 4 evaluation report to the legislature including combined findings, recommendations, and conclusions. Summary recommendations are listed here, but included with further detail in the legislative report and within the supplemental evaluation materials included in this document: Recommended actions: ▪ Increase stakeholder ability to identify youth. ▪ Expand protections and services regardless of age and remain flexible in identifying service needs. ▪ Increase and improve access to services, especially for youth from marginalized cultures and greater Minnesota. ▪ Support more diverse and consistent staffing. ▪ Increase amount and cultural appropriateness of technical assistance, education, and training provided. ▪ Increase prevention efforts (by decreasing demand and identifying risk factors). ▪ Support improvement of more continuous, comprehensive, and robust outcome and process evaluation as well as inferential research. ▪ De-silo the response to sex and labor trafficking. ▪ Increase youth voice and opportunities within Safe Harbor. ▪ Heal organizational trauma to better help organizations, staff, and clients. ▪ Improve equity by conducting a cultural needs assessment with several cultural groups as well as strategically directing allocations of funds and resources to culturally specific groups. ▪ Strengthen relationships within the public health approach. ▪ Further promote government agency collaboration.

St. Paul, MN : Minnesota Department of Health, Safe Harbor, Violence Prevention Unit, Health Promotion and Chronic Disease Division 2021. 130p.

Assessment Report Task 5.1.6: Assess Efforts of Governments, Industry, and Workers’ Organizations to Address Child Labor and Forced Labor in the Cocoa Sector in Brazil, Ecuador, and Indonesia

By Rafael Muñoz Sevilla , Bladimir Chicaiza. et al.

The U.S. Department of Labor’s Bureau of International Labor Affairs (USDOL-ILAB) has contracted with the American Institutes for Research® (AIR®) to assess the current landscape of efforts to address child and forced labor in the cocoa supply chains in Ecuador, Brazil, and Indonesia. The main research questions focused on (a) the identification of efforts of governments, industry, and civil society organizations, including international organizations, nongovernmental organizations, and workers’ organizations, to address child and forced labor in the cocoa sectors; (b) identification of the challenges encountered in these efforts; (c) review of situations that could potentially increase child and forced labor in the cocoa supply chain; and (d) identification of indications that these child labor and forced labor situations exist in the cocoa sector in these countries. The research methodology employed a comprehensive approach involving desk research, stakeholder interviews, and mixed-methods data analysis. The research team conducted a thorough review of more than 70 documents and websites, encompassing a wide range of sources. The team conducted interviews with 46 stakeholders, representing a total of 35 institutions and companies across the three countries. The research team adopted a mixedmethods data analysis approach, combining both primary qualitative data from stakeholder interviews and secondary data from document review. The research team adopted two conceptual frameworks to guide each country case’s analysis and triangulation between secondary data from document review and information gathered from key informants. The use of conceptual frameworks allows for comparability across the case studies, while recognizing and capturing the unique contexts and challenges of child and/or forced labor in cocoa in each country landscape. This study uses the structure of the (1) Cocoa Production Stages Framework, 1 to review phases of cocoa production in the supply chain in each country for relevant child labor and forced labor risks, as well as the (2) Systems Framework of Key Dimensions to Reduce Child and/or Forced Labor, 2 to assess the current efforts by actors in that country to make progress on child labor and forced labor reduction in cocoa. Qualitative data from interviews and the desk research were systematically analyzed to respond to the research questions and identify patterns, themes, and variations within these frameworks.

Arlington, VA: American Institutes for Research | 2024. 162p.

Assessment Report Task 5.1.5: Assess Efforts of Governments, Industry, and Workers’ Organizations to Address Child Labor and Forced Labor in the Cocoa Sectors in Ghana and Côte d’Ivoire

By Mei Zegers

The United States Department of Labor’s Bureau of International Labor Affairs (USDOL-ILAB) has contracted with the American Institutes for Research® (AIR®) to research, identify, and develop indicators of progress and to assess efforts to address child labor and forced labor in the cocoa sectors of Côte d’Ivoire and Ghana. Based on a participative process, this report covers the analysis of stakeholders’ implementation of efforts, with emphasis on the period since 2019. The main research questions focused on (a) the identification of the initiatives and good practices of governments, industry, and workers’ and farmer-based organizations (FBOs) to address child labor and forced labor in the cocoa sectors in Côte d’Ivoire and Ghana; (b) identification of the challenges of and the extent to which and workers’ organizations and FBOs are actively and meaningfully involved in efforts to address child labor and forced labor in the cocoa sectors; and (c) a review of the efforts under and outside the Child Labor Cocoa Coordinating Group (CLCCG) to address child labor and forced labor in the cocoa sector. The main stakeholders asked to contribute to the research were the governments of Ghana and Côte d’Ivoire; private-sector cocoa representatives; international development agencies; and international and national civil societies, including workers’ organizations and FBOs. The specific individuals contacted were selected on the basis of their membership in the CLCCG or as identified in mapping exercises of key cocoa production stakeholders. This research was based on a systems approach to data gathering, analysis, and interpretation. The approach identifies interrelationships, dependencies, and feedback loops to analyze dynamics, identify patterns, and make informed planning decisions for maximum results. A thorough literature review of 613 documents and websites was conducted for the analysis covered in the report. Interviews were conducted with 79 individuals. One-day workshops were conducted in May 2023 in Côte d’Ivoire and Ghana to discuss the development of a repository of progress indicators. These workshops also provided some information that was useful for the report. Further useful information resulted from email correspondence with representatives of 14 types of stakeholders that particularly focused on issues regarding needed support to strengthen the capacities of workers’ organizations and FBOs to address child labor and forced labor. Data analysis was primarily conducted using the qualitative data analysis software Atlas.ti and with Mind Mapping software.

Most research limitations fell into three categories. First, although child labor and forced labor are both considered throughout our research, much more information is available on child labor. There has been increasing attention, as well as strategy development, to address forced labor in cocoa among key stakeholders. However, there have been very few in-depth initiatives aimed at addressing this issue in cocoa, aside from examples such as the Forced Labor Indicators Project (FLIP),1 and a collaboration between the Rainforest Alliance, International Cocoa Initiative and Solidaridad. 2 Given the lack of existing data on forced labor initiatives, it is difficult to cover forced labor in the same depth as child labor. Second, some studies have identified good practices to reduce child labor in cocoa production, but these do not cover the breadth of approaches and initiatives used. Ideally, good practices should be identified through independent studies instead of through self-assessment of implementers. Independent studies may include evaluations of projects, but these are limited in number on this specific subject matter. Third, throughout the report we refer to a broad range of types of strategies and initiatives; although there are some commonalities, there are also major differences that need to be taken into account because they limit comparability. Main Findings The research confirmed that there is no one way to approach child labor and forced labor reduction; rather, it is the combination of implemented strategies and practices that will lead to greater success in reducing child labor and forced labor. Since 2019, there have been positive changes in terms of strengthened collaboration, coverage, and (new) directions in the efforts to reduce child and forced labor in cocoa in Côte d’Ivoire and Ghana. However, there are still many aspects that need attention to reach higher levels of impact on the reduction of child labor and forced labor. Currently, the focus on eliminating child labor at a household level has rightly expanded to consider many contextual issues and child well-being overall. This means focus on encompassing the availability of social services—including education and social protection coverage— functioning of workers’ organizations and FBOs and their voices, and deforestation and other environmental issues. In addition, the need to ensure that child labor is reduced consistently in communities, and not just among children currently working in cocoa, has gained recognition. efficiency and safety in cocoa production contributes to increased incomes. Application of methods to reduce accidents and illnesses caused by occupationally unsafe production technologies helps to simultaneously reduce the loss of income from such events. While awareness of the dangers of child labor has increased in both Côte d’Ivoire and Ghana, forced labor remains a subject that is not sufficiently covered. Awareness raising on subjects such as how and where to report child labor and forced labor and available grievance mechanisms for community members is still too limited. There is still scope for better collection and consolidation of data at local and national levels on child labor and forced labor reduction initiatives and their impact on informing decision making. Data gathering and sharing of data to ensure that lessons learned,

implementation challenges identified, and good practices were used to inform future efforts was a challenge repeatedly identified throughout the research. Although the various multistakeholder platforms discuss some of the data, the concrete use of data for planning still needs greater attention, using methodologically appropriate means. The need to strengthen technical and logistics capacities at a local level to provide services to cocoa communities remains clear. The reduction of dependence on nonstate actors (international development agencies including foundations, NGOs) instead of on local government to provide services is necessary for long term sustainability. For this purpose, increased funding of local government services is key to enabling direct work with and sustainably of communities on child labor and forced labor reduction. Together with technical strengthening and support for logistics, including transport, impact of child labor and forced labor reduction initiatives will be exponentially increased, particularly if accompanied by improved infrastructure, such as schools, health provision structures, and improved roads. There are increased efforts to involve and strengthen workers’ organizations and FBOs, but their potential to contribute to addressing child labor and forced labor is not being fully realized. Although not all cocoa farmers are members of cooperatives and other farmer associations, many are. Efforts to encourage more farmers to organize and formalize them are underway, thus increasing the reach of workers’ organizations and FBOs. The necessity of increasing focus on including their voices and their local representatives to contribute to reduction of child labor and forced labor in cocoa is evident. This research found that there is still scope to improve the functioning of the CLCCG. Some aspects are similar to the need to join in streamlining the multistakeholder platforms. However, it is crucial to expand membership of the CLCCG to create greater diversity of inputs from key stakeholders. Further, as is relevant throughout all initiatives, the more concrete integration of specific forced labor reduction methods and initiatives can be scaled up The conclusions and recommendations presented in this research require a comprehensive and flexible approach to implementation. Continuous verification of the effects of the steps undertaken to reduce child labor and forced labor will be necessary on a regular basis and in an integrated manner. Recommendations are clustered around eight thematic types that this research identified as needing more focus and streamlining for initiatives to achieve greater impact on reducing child labor and forced labor in cocoa in Côte d’Ivoire and Ghana. The thematic areas and main focus of key recommendations are briefly summarized here. Detailed recommendations, their priority level, and main proposed responsible entities for their implementation are listed in the “Conclusions and Recommendations” section of the report.

American Institutes for Research® | 2024. 120p.

An Evaluation of the Safe Harbor Initiative in Minnesota – Phase 4 Supplemental Materials

By Wilder Research

In the decade since Safe Harbor became Minnesota law, the state has built an extensive network in response to the sexual exploitation of youth, and more recently human trafficking, both sex and labor. The network spans from state and local government to Tribal Nations and community-based nonprofit programs. Founded on a public health approach within the Minnesota Department of Health (MDH) in recognition of the significant health and social impacts created by exploitation and trafficking on populations, Safe Harbor also partners extensively with entities in public safety, human services, and human rights, including the Minnesota Department of Human Services (DHS), the Minnesota Department of Public Safety (DPS) and the Minnesota Coalition Against Sexual Assault (MNCASA) to offer a comprehensive multidisciplinary response. State law requires the Safe Harbor Director, based in MDH, to submit a biennial evaluation of the program to the Commissioner of Health under Minnesota Statute Section 145.4718. The purpose of the evaluation is to ensure Safe Harbor is reaching its intended participants, increasing identification of sexually exploited youth, coordinating across disciplines including law enforcement and child welfare, providing access to services, including housing, ensuring the quality of services, and utilizing penalty funds to support services. The Safe Harbor law passed in 2011 and after a three-year planning period called No Wrong Door, the Safe Harbor system was fully enacted in 2014. In the years since, Safe Harbor has submitted three evaluation reports to the legislature, beginning in 2015. Each evaluation was conducted by Wilder Research at the Amherst H. Wilder Foundation (Wilder) under a competitive contract with MDH. The evaluation process is an opportunity to hear and learn from trafficked and exploited youth as well as participants from a variety of disciplines who respond to the needs of these youth on a daily basis. For the current Phase 4 report, MDH contracted with Wilder again while MDH’s Safe Harbor Program produced accompanying evaluation materials. As a result, this Phase 4 Safe Harbor evaluation draws from complementary background reports that are combined to represent a variety of perspectives from both outside and within the Safe Harbor network. These resources not only evaluate Safe Harbor’s activities, but also address these activities in the context of significant current events including the global COVID-19 pandemic and the civil rights movement in Minnesota, as well as around the nation and world, in the wake of George Floyd’s murder. The supplemental evaluation materials, containing expanded findings, data, and appendix are contained in this document. All findings focus on the Safe Harbor network and activities between April 1, 2019, and June 30, 2021. The Wilder data collection and analysis took place between January 1, 2021, and June 30, 2021. The MDH data collection and analysis took place between September 1, 2020, and August 1, 2021. Between January 2021 and June 2021, Wilder interviewed grantees, multidisciplinary partners, and youth clients, and also surveyed youth clients to evaluate Safe Harbor. Wilder submitted its report including several findings and recommendations to MDH. Wilder found evidence for outcomes related to multidisciplinary partnership and access to services, including culturally specific services; the factors contributing to Safe Harbor’s impact; gaps and challenges; opportunities for improvement; and the pandemic’s impact on service provision. MDH analyzed the provision of the statewide Safe Harbor Regional Navigator component and the reach of the Safe Harbor Network to identify and serve youth, as well as availability, accessibility, and equity of Safe Harbor supportive services and shelter and housing, in addition to training for providers. MDH then submitted a Phase 4 evaluation report to the legislature including combined findings, recommendations, and conclusions. Summary recommendations are listed here, but included with further detail in the legislative report and within the supplemental evaluation materials included in this document: Recommended actions: ▪ Increase stakeholder ability to identify youth. ▪ Expand protections and services regardless of age and remain flexible in identifying service needs. ▪ Increase and improve access to services, especially for youth from marginalized cultures and greater Minnesota. ▪ Support more diverse and consistent staffing. ▪ Increase amount and cultural appropriateness of technical assistance, education, and training provided. ▪ Increase prevention efforts (by decreasing demand and identifying risk factors). ▪ Support improvement of more continuous, comprehensive, and robust outcome and process evaluation as well as inferential research. ▪ De-silo the response to sex and labor trafficking. ▪ Increase youth voice and opportunities within Safe Harbor. ▪ Heal organizational trauma to better help organizations, staff, and clients. ▪ Improve equity by conducting a cultural needs assessment with several cultural groups as well as strategically directing allocations of funds and resources to culturally specific groups. ▪ Strengthen relationships within the public health approach. ▪ Further promote government agency collaboration.

St. Paul, MN : Minnesota Department of Health, Safe Harbor, Violence Prevention Unit, Health Promotion and Chronic Disease Division 2021. 130p.