Intersex youth in Gaza

December 21, 2009

Via CNN World (also detikHealth and O Globo), a news report about two intersex youths in Gaza.

Nadir Mohammed Saleh and Ahmed Fayiz Abed Rabo are cousins and next-door neighbors. With their gelled hair, buttoned-down shirts and jeans, they look much like any other 16-year-old Palestinian boy. But looks, Ahmed says, can be deceiving.

“Only my appearance, my haircut and clothing, makes me look like a boy,” Ahmed says, gesturing with his hands across his face. “Inside, I am like a female. I am a girl.”

Until last summer, both Nadir and Ahmed were — for all intents and purposes — girls. They wore female headscarves, attended girls’ school and even answered to the female first names Navin and Ola.

Both Nadir and Ahmed were born with a rare birth defect called male pseudohermaphrodism.

In passing, I’m not comfortable with CNN’s use of the phrase birth defect; it seems to me to perpetuate the medicalisation and pathologising of intersex people who simply happen to have been born with a phenotype which differs from that which might more usually be expected.

Even the term pseudohermaphrodism [sic] is problematic, given its origin in the nineteenth century, long before the genetic roles of the X chromosome and Y chromosome and the social components of gender identity were well characterized.

However, whatever my opinion of another piece of lazy journalism in search of a snappy soundbite, this next passage certainly gives pause for thought:

There are an unusually high number of male pseudohermaphrodite births in the Gaza neighborhood of Jabalya, where Nadir and Ahmed live.

Dr. Jehad Abudaia, a Canadian-Palestinian pediatrician and urologist practicing in Gaza, says he has diagnosed nearly 80 cases like Nadir’s and Ahmed’s in the last seven years.

“It is astonishing that we have [so] many cases with this defect, which is very rare all over the world,” Abudaia says. He attributes the high frequency of this birth defect to ‘consanguinity,’ or in-breeding.

“If you want to go to the root of the problem, this problem runs in families in the genes.” Abudaia says. “They want to get married to cousins… they don’t go to another family. This is a problem.”

In Western, more developed countries, doctors typically identify and then operate to correct disorders of sex differentiation at birth. But in war-torn Gaza, which has a lower standard of medical care, the birth defect can go undetected for years.

“Some of them unfortunately will be discovered late, when they are more than 14 years [old]. When they have been living as a female and they don’t have menstruation, then they will go to the gynecologist,” Abudaia says.

Abudaia’s first advice to patients with the disorder is to immediately adopt male clothing and hair cuts, and then to plan for a sex-change operation.

There are a few points here: first, do we know for certain sure that 17-B-hydroxysteroid dehydrogenase (17-B-HSD) is due to consanguinity? Or is it that there’s a higher incidence of its occurence under those conditions? None of the information I’ve been able to find online is clear on this point, saying only that 17-B-HSD is congenital, which – according to Princeton University’s WordNet – means “present at birth but not necessarily hereditary”. Nothing about consanguinity that I could find. I’m not saying it isn’t a factor in this case, just that from my research, the idea that there’s a universal link isn’t clearly stated anywhere. So why make the point of using it as if it is? The cynic in me says it’s just another low-level, almost subliminal, framing of anyone who falls outside the default male/female binary as being someone not “normal”. Othering, much?

Second, yet more lazy journalism: “disorders of sex differentiation”. OII’s stated position about the use of controversial and objectionable phrases like this is well-documented and not hard to find online.

Third, Dr Abudaia’s advice seems more likely to invisibilise (and further stigmatise) an already extremely marginalised and oppressed group of people by reconstructing them as members of another marginalised and oppressed group – transsexual people. Which, to my mind, is a tactic which does nothing to help either intersex or transsexual people, or indeed those who self-identify somewhere along the intersection of the two.

Additionally, it seems to me that the path advocated by Dr Abudaia has other implications as well as those around enforced surgery and medical transition; the following quote from the article reminds us that, like transsexual people, intersex people are also routinely subjected to the linking of pathologisation to legal regulation:

Until the sex-change operation is completed, Palestinian officials won’t change the gender on their identity cards to “male,” thus restricting their access to higher education.

My heart goes out to Nadir and Ahmed; by all accounts life in Gaza is hard enough anyway so it’s reassuring to know that they have the support of their families through their transitions. I only hope that the benefits they may gain will far outweigh any negative aspects that may arise if this normalisation has in any way been imposed on them by mainstream society.

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Curtsey to Richard Köhler on the TGEU listserv for the link

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6 Responses to “Intersex youth in Gaza”

  1. Julian Says:

    Thanks for reporting on this, Helen.

    I am specifically interested in Dr Abudaia’s advice : “Abudaia’s first advice to patients with the disorder is to immediately adopt male clothing and hair cuts, and then to plan for a sex-change operation.”

    It is interesting to contrast this policy with Ahmed’s statement, “Only my appearance, my haircut and clothing, makes me look like a boy,” Ahmed says, gesturing with his hands across his face. “Inside, I am like a female. I am a girl.”

    I can’t help but wonder if Ahmed and Nadir had a choice in their transition, or if Abudaia’s advice was taken at face value. It’s rather concerning to me, actually.

  2. Hilary Says:

    Thanks for this! I’ve been waiting for an informed response to this article for a few days, calling it out on both its laziness as well as its problematic causal attributions. One other mention, though, about the work that consanguinity is doing in this article — othering in the service of ethnocentrism, as well, working hand-in-hand with the supposed propriety of the abuses of Westernized countries who, to paraphrase the article, catch these ‘disorders’ at birth. Re: intersex, early non-detection is often a blessing, not a curse.

  3. Helen G Says:

    Julian: That’s an interesting point although I have to say that it hadn’t occurred to me; I read Dr Abudaia’s advice as being part of the usual reinforcement of the Standards of Care. One of the criteria for surgery is 12 months of successful continuous full time real-life experience (see also IX. The Real-Life Experience), and references to such things as “cross-gender presentation” are scattered throughout the document.

    I doubt we shall ever know what (if any) degree of choice Ahmed and Nadir had in the matter and must trust them to know their own minds. Of course societal pressure may be playing a part in this but again, we can only trust that Dr Abudaia is an experienced medical professional capable of providing informed and impartial support. Just because my own experience was of an entrenched attitude of “gatekeeperism” (rather than facilitation) doesn’t necessarily mean that everyone else has the same experience…

  4. Helen G Says:

    Hilary: Thanks for commenting; that’s an excellent point about the role that Westernised ethnocentrism plays in these cases.

  5. shiva Says:

    I’m with Julian on this, only more so: those passages squick the hell out of me. What happened to self-determination? (OK, i know no Palestinian currently has that, and i’m sure that the lack of value for autonomy here is influenced by the wider political/religous/cultural situation, but still, that just makes it worse IMO.) It seems like, by being “treated” with transition to “male” presentation, these people have effectively been turned into closeted trans women (assuming Ahmed’s statement can be taken to mean “he” self-identifies as female, which is certainly what it reads as from a Western perspective).

    These people might be entirely happy with their bodies as they are, or they might experience body dysphoria in either direction, and their preferred gender presentation may “match” their preferred body or it may not, but we’re not told any of this in this article, simply that they are “male” and “should” be “treated” by transition into (biological and cultural) “men”, without any evidence that that’s what they want.

  6. Helen G Says:

    Agreed. It seems to me that it’s the continuation of the practice of enforced genital mutilation (EGM) which has been imposed on many intersex people across many years and in many countries.


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