After the Justice Department asked for U.S. District Judge Richard Berman to release grand jury testimony in the case against Jeffrey Epstein, the judge received an anonymous letter from one of the late financier’s many victims. “I come forward to you today in disdain, disgust and fear of how the United States of America’s DOJ has handled the promise to release the ‘Epstein files,’” this victim wrote. “It has been a very difficult time for me personally, mentally and emotionally dealing with the circus around the ‘Epstein Files’.”
Indeed, amid the news of a prison transfer for Epstein accomplice Ghislaine Maxwell, and the latest developments over whether documents will be unsealed, the victims are still suffering all the same. While much of the focus lately has been on the prominent figures that may have taken part in the sex trafficking scheme, we must never forget to focus on the health of the victims. We must confront more than criminal wrongdoing; we must also reckon with the lifelong physical and psychological devastation wrought on the victims.
Victims typically enter exploitation during critical stages of their physical, emotional and cognitive development.
The stories of survivors and those trafficked by Epstein and his accomplices cannot be reduced to scandalous headlines or footnotes in celebrity exposés. Their experiences demand national reckoning and action to protect future children and bring justice to the victims.
One Jane Doe, speaking in court in 2019, testified that she and the other victims “will always carry irreparable damage and pain throughout our lives after this.”
Victims typically enter exploitation during critical stages of their physical, emotional and cognitive development. Many children are targeted simply because they are children: young, naive and vulnerable. Young girls who become victims of sex trafficking have been tricked or forced into sexual exploitation by acquaintances, employers or even family members. Epstein’s victims were coerced by wealthy and influential men and women. Staggering power imbalances make self-escape nearly impossible. In the case of Epstein’s victims, that is adult versus child, man versus girl, wealthy versus poor.
In the federal charges brought against Epstein, the victims were stated to be as young as 14. Abuse during these years disrupts brain development, impairs memory and learning capacity, damages self‑concept and identity, and limits trust in others. Survivors often carry shame and stigma, face social rejection, interrupted education and reduced economic opportunity later in life.
Once caught in the web of a sex trafficking scheme, the young girls are treated as commodities, being used, sold and violated repeatedly. They suffer not just one-time trauma, but a systemic and chronic assault on the (still developing) mind and body.
Victims of sex trafficking often live with lifelong physical consequences. They may have endured repeated physical violence: rape, beatings, burns, fractures, infectious exposures and more. They face high rates of sexually transmitted infections, including HIV, and elevated risks of cervical cancer, infertility, pregnancy complications and unsafe abortion injuries. Some victims experience chronic pain, untreated injuries, malnutrition, dehydration, traumatic brain injuries and complications from untreated infections that persist long after their escape.
We owe survivors long-term, trauma-informed health care. And they should receive material support to rebuild their lives. Sex trafficking survivors face an epidemic of psychological devastation. Traffickers use coercion, manipulation, emotional bonding and isolation to target their victims. They exploit children’s desire for safety, love and stability, only to use those needs against them. Many victims form trauma bonds, a psychological survival strategy that can look like loyalty or silence from the outside, but is in fact a symptom of deep, systemic abuse. As a result, victims are more likely to experience post-traumatic stress disorder, severe depression, suicidal ideation, anxiety, dissociation and personality disorders. One study of trafficked minors found that over 50% had been diagnosed with ADHD, nearly half experienced depression and others suffered from anxiety, conduct disorder, oppositional defiant disorder, bipolar disorder and psychosis at far higher rates than other at-risk youth. This year, Virginia Giuffre, a survivor of Epstein’s trafficking operation, died by suicide. Her family wrote: “She lost her life to suicide after being a lifelong victim of sexual abuse and sex trafficking.” Not every survivor will suffer from every condition. But each one lives with unique injuries, losses and scars. Their pain cannot be captured by a diagnostic checklist. They need both human compassion from us as individuals and a structural response from us as a whole. Our responsibility does not end with the prosecution of perpetrators. Legal justice is essential, but insufficient. We owe survivors long-term, trauma-informed health care. Clinicians should be trained not only in medical management but also in how to restore dignity, support autonomy and avoid re-traumatization. Treatment should include protections against retaliation and social shaming. And survivors should receive material support to rebuild their lives. This includes access to affordable housing, SNAP, education, childcare, contraception, employment and mental health care. The sexual exploitation of children is not just a heinous crime, but a public health catastrophe and a moral collapse. It demands not only justice but health care and humanity. We cannot let the headlines overshadow the victims. We must act not only to prevent this from happening to any children in the future, but to also build a world where victims feel supported and empowered to take back their lives.
Anahita Dua
Dr. Anahita Dua is a vascular surgeon, associate professor of surgery at Harvard Medical School, and the Founder and Chair of Healthcare for Action. 
