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It is astonishing how Quranic verses and Islamic teachings can often be mined for arguments in alleged “support” of unlikely candidates, such as the trans* community. Iran, which is hardly a bastion of LGBT rights, endorses sex reassignment surgery (SRS) in a misinformed bid to curb homosexuality—conflating gender dysphoria with attraction to the same sex. Saudi Arabia has a Center for Corrective Surgery dedicated to intersex cases, mostly dealing with infants. And both Bahrain and the United Arab Emirates have legalized SRS in recent years, though not without emphasizing its “corrective” nature. As Brian Whitaker, a journalist and regular commentator on LGBT issues in the Middle East, rightly explains, societies so rigidly based on gender binaries seek to eliminate “gender ambiguity” through corrective surgery.

Countries that promote SRS want to preemptively allay societal fears of gender pandemonium, or a gradual erosion of the culturally sacred value of male-female duality. The governments of the Middle East appear to have largely heeded the words of the late Egyptian Grand Mufti Muhammad Sayyed Tantawy, whose fatwa on SRS makes it permissible only when “a trustworthy doctor advises it,” and “not permissible to do as a mere wish to change one’s sex from woman to man, or vice versa.” In other words, the fatwa “medicalizes” the issue of gender dysphoria. The question is whether such a narrow conception ultimately aids the transgender community or, ultimately, harms it.

There are many problems with the “medicalization” approach toward gender issues, not least of which is that it only permits trans* persons to act on their rights if they have “indeterminate” sexual characteristics. Conversely, it excludes all those whose sexual characteristics are unambiguously male or female. In other words, surgery and therapy become available to those with visible biological issues, but remain unavailable to those with gender dysphoria.

Consider the case of twenty five year old Bahraini bride, Zainab, who after taking a mandatory medical test (required of all couples seeking to marry), discovered she possessed hitherto undetected male chromosomes. After completing SRS in Bahrain and Thailand, Zainab—now named Hussain—sought legal recognition for the sex change, which was granted by Bahrain’s Higher Administrative Court on “medical” grounds. Similarly, in the United Arab Emirates, a federal decree issued in 2016 allowed for corrective surgery only in the presence of both medically-determined “sexual obscurity” and gender dysphoria; the latter alone would not suffice as grounds for surgery. And at Saudi Arabia’s King Abdulaziz University, which has performed SRS on more than a thousand patients since its establishment in 2007, resident doctors emphasize the presence of ambiguous reproductive organs or hormonal imbalances as criteria for sex reassignment surgery. The president of the center, Dr. Yasser Jamal, told the Saudi Gazette that his team had “rejected several requests for [changing] sex because we thought those cases suffered from psychological problems,” like gender dysphoria.

Such “medical” barriers to treatment mean that many trans* members who cannot or do not wish to undergo surgery inhabit a legal gray area that leaves them vulnerable to persecution, particularly when compounded by the social stigma surrounding non-conforming gender expression. A 2008 study by Human Rights Watch (HRW) on the situation of Kuwait’s trans* community, for example, investigates the impact of a 2007 amendment to a legal clause on public decency which, among other things, outlawed “imitating the opposite sex in any way. The HRW report highlighted cases of physical and sexual assault against trans* persons by police officers and civilians alike, who have been known to shame and blackmail transgender women in particular. The HRW report also documents cases of doctors refusing trans* patients treatment, as well as employers informing potential employees that they do not hire their “type.”

It would be disingenuous to read recent legislative developments in favor of SRS as “progress” for transgender rights and freedoms, particularly in light of the frequency of unlawful arrests, humiliation and torture of trans* individuals in the Middle East. The scant measures introduced by some Middle Eastern governments for the legalization of gender reassignment surgery has, nonetheless, potentially laid the early foundations for broader acceptance of trans* persons; dysphoria may one day be recognized as the medical disorder it is, whether anatomical or psychological. While currently, trans* tolerance rests on deeply problematic assumptions, positive change in the future—including full access to surgery and therapy, and sympathy rather than antagonism and social de-stigmatization—is very possible.

Until then, the trans* community has every right to protest their lack of rights and freedoms, which will remain woefully absent without widespread public awareness and concern.

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