Transgender Ukrainians facing “exacerbated” challenges

Activists report that LGBT+ Ukrainians fleeing the war are forced to leave the country illegally and fear for their ability to access health care. Ed Holt reports.

Ukrainian members of the LGBT+ community are facing “exacerbated” trauma, elevated health risks from poor access to medicines, and discrimination, which are forcing them to make dangerous, illegal bids to flee the country, according to activists helping refugees.

More than 11 million people have either fled Ukraine or been internally displaced since the start of the war, according to the UN. The dangers refugees face have been widely documented, with activists reporting that LGBT+ people, especially transgender people, are particularly vulnerable.

“It is always the case that ‘minority stress’ felt by LGBT+ people [under normal circumstances] is exacerbated during a refugee crisis. They are always more vulnerable than other refugees in any refugee crisis, especially if they are more visibly LGBT+, for example travelling openly as same-sex couples. ‘Otherness’ can provoke a very hateful response,” Justyna Nakielska, advocacy officer at the Campaign Against Homophobia in Poland, told The Lancet.

At the start of the war, all Ukrainian men aged 18–60 years were ordered to stay in the country. As refugees began leaving, reports emerged that transgender women were being turned back at the border, often because the gender on their identification documents did not match their actual gender, but sometimes because border guards gave them physical examinations, declared them to be men, and told them they could not leave. LGBT+ organisations that spoke to The Lancet confirmed they knew of such cases.

Anastasiia Yeva Domani, director of Cohort, a non-government organisation that works with transgender people in Ukraine, told The Lancet that actions at the border crossings had led some to resort to drastic methods. “I know some trans women have resorted to leaving the country illegally, but this is not something we would support,” she said, adding how dangerous such attempts could be.

Refugees following illegal routes can be exposed to violence and exploitation. Domani, who has remained in her hometown, Kyiv, since the start of the war, also pointed to the lack of hormone medicines for many transgender people who are refugees, those have been internally displaced, and those who have not been forced to flee their homes.

“In Ukraine there is a big problem getting hormone drugs. A lot of transgender people, including me, have had to pause their treatment for a while because there is no way to get hormones from pharmacies as hardly any of them are open anymore,” she said. Domani added that Cohort and partner groups have set up a network to find and distribute hormone medicines. “Using the internet, and the help of various LGBT+ activists across the country we have managed to get what hormone drugs we can, sometimes from Poland or elsewhere abroad, and distribute them to people who contact us who need them,” she explained.

However, even if problems with border crossings and distribution of much-needed medicines are resolved, once out of Ukraine transgender and other people from the LGBT+ community face other challenges because they find themselves in countries in which LGBT+ communities have faced increasing prejudice, stigma, and discrimination, including within health-care systems.

Wiktoria Magnuszewska, an activist with Polish LGBT+ organisation Lex Q, told The Lancet: “There is a lot of fear among transgender people coming here. This is connected to the general social atmosphere in Poland towards the LGBTQI community”, adding that incidents of violence against LGBT+ refugees in Poland had been reported.

However, LGBT+ groups in countries on Ukraine’s western borders have been working to provide specific help for LGBT+ refugees as they adjust to their new situation. This includes help and guidance in accessing health-care systems—which countries across Europe have made available to all fleeing the war—and for LGBT+ refugees who might be concerned about the reactions of health-care workers.

Julia Kata of the Polish activist group Trans-Fuzja Foundation, told The Lancet: “We are in contact with trans-inclusive health-care providers and work with them to help ensure any transgender people wanting to access medical care can do so knowing they are seeing doctors who view them inclusively.”

Nakielska added that activists were also helping LGBT+ refugees at pharmacies to get any medicines they had been prescribed in Ukraine before they left and that there had been no reports of problems with dispensing prescriptions for hormone medications to transgender people. However, this might not be enough for everyone, according to Magnuszewska. “I don’t know of any instances where an LGBT+ refugee has been denied access to health care here in Poland, but I know there is a fear among some of them that they will face rejection if they try to,” she said.

By Ed Holt