Barriers faced by transgender individuals during wartimes: A Case Study of Ukraine
By Jocelyn Livier

Overview
 

The following research includes specific community terms throughout. Here are some common terms and definitions:
 

1. Gender-affirming care: “Gender-affirmative health care can include any single or combination of a number of social, psychological, behavioral or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity.” [1]

2. Transgender: This is a broad term that can be used to describe people whose gender identity is different from the gender they were thought to be when they were born. “Trans” is often used as shorthand for transgender [2]

3. Transitioning: Transitioning, or a gender transition, is the process some people may go through to live as the gender with which they identify, rather than the sex assigned to them at birth. Transitioning can involve medical treatment and hormones, changing names and pronouns, altering appearance and dress, or coming out to your friends and family. Not all transgender people transition. Gender-affirming hormone therapy is an essential part of transition for many transgender people. [3]

4. Hormone Replacement Therapy (HPT): Often known as ‘Feminizing Hormone Therapy’. [4] Gender-affirming hormone therapy consists of either feminizing (estrogen) or masculinizing (testosterone) hormones. Many transgender people take hormone therapy as part of a gender transition to help their bodies and appearance align with their gender identity. [5]

 

For further insight into inclusive language and good practice, visit: https://lgbtq.umd.edu/good-practices-inclusive-language

 

            In February 2022, Russian forces initiated a full-scale invasion of Ukraine, targeting Kyiv in an attempt to overthrow President Volodymyr Zelensky’s government. [6] Despite initial expectations of a swift fall, Russia faced fierce resistance. U.S. and European officials estimated Russian casualties approaching 200,000, while Ukraine had 100,000 killed or wounded and at least 30,000 civilian deaths. [7] Despite minor gains in its 2023 offensive, the frontlines have stabilized for nearly a year now, as both sides entrench, making breakthroughs increasingly challenging. The conflict has resulted in almost 22,000 civilian casualties, 5.1 million internally displaced people, and 6.2 million refugees, with 17.6 million requiring humanitarian assistance. [8] With millions of displaced individuals, the trans community faces a dreadful reality: war times are extremely difficult for those seeking care, aid, and any sense of normalcy. While the exact number of trans individuals living in Ukraine is unknown, the Center for Social Expertise revealed that 7,000 permits for transition had been issued to Ukrainians from 2016 to 2019. [9] That number has been estimated to be outdated and underestimated. Of these thousands of individuals, the war has provided a severe period of instability. While living during wartime is difficult, it poses even more threats to trans individuals. Namely, they face 1). Increased discrimination and risk of harassment, 2). Limited access to healthcare and difficulty accessing humanitarian aid, 3). Documentation and identity issues, 4). Severe mental health impacts, and 5). Limited legal protection.

            Transgender Individuals face an increased risk of harassment and abuse. “Lawful transphobia” has risen significantly in Ukraine since the onset of the war. [10] Although homosexuality is legal in Ukraine, the Pew Research Center revealed in 2019 that 69% of Ukrainians believed homosexuality should not be allowed. [11] This statistic is representative of the general population’s sentiment towards members of the LGBTQI+ community. Additionally, the International Lesbian, Gay, Bisexual, Trans and Intersex Association ranked Ukraine 39th in its LGBTQ human rights. [12] The ranking was out of 49 European countries. [13] Lower ranks are associated with increased harassment and risk against trans individuals.  The harassment is not limited to individuals. Many trans organizations are also facing backlash amid the war. Insight, a prominent Ukrainian human rights public organization that serves as a hub for legal and medical care for all LQBTQI + people has been the target of many attacks throughout the war. [14] In January of 2023, the center was vandalized, limiting the ability of the center to provide care. [15]






 

            The office of Ukrainian LGBT organization Insight was attacked in Lutsk on June 13, 2023. © 2023 Insight
 

 Without ready access to care centers, medicine, doctors, or support, many trans individuals are forced to flee. Oftentimes, however, fleeing Ukraine can be difficult for two reasons. The first is that much of the violence experienced happens when they flee Ukraine and enter refugee camps or other unwelcoming nations. All of Ukraine’s neighboring countries are ranked by Rainbow Europe as being in the lower rung of gross violations of human rights, discrimination, etc. [16] They are all 30th or lower out of 49 countries. [17] As a result, trans people are not being welcomed at border regions. The second issue is having proper documentation to enter these nations or even travel within Ukraine.

            One of the bureaucratic problems faced by trans individuals is the need for proper documentation when fleeing. Many times, documents list a different gender, putting them at risk of denial of entry or travel. [18] People are facing an increased urgency to change their legal gender so that they can flee. [19] A passport with the incorrect gender can make fleeing the country impossible. Furthermore, all able-bodied men aged 18-60 are required to stay in Ukraine and fight, something that can make it difficult for individuals with a male sex assigned at birth, especially as their transition takes on a sudden stop. [20] The war can be more physically tolling for someone who has stopped HRT overnight. Furthermore, Ukraine requires individuals to receive a medical diagnosis of a “gender identity disorder” before legally changing their gender on official documents. [21] Access to medical doctors during wartime is minimal, making these diagnoses rare. Organizations are currently working to recategorize transgender identities under topics of sexual health rather than mental and behavioral disorders. [22] This would allow trans people to change their legal identity without a psychiatric visit. The lack of appropriate gender on legal documentation has led to a myriad of issues during the Russia- Ukraine war.

            One of these issues is extreme difficulty accessing humanitarian aid. Oftentimes, the validity of documents is contingent on a single officer who ultimately decides to approve the documents or not. Denial of humanitarian aid to the most vulnerable is abysmal. Transgender women are 49 times more likely to contract HIV. [23] Many transgender Ukrainians are struggling to find adequate healthcare. One woman shares her experience with Ukraine’s current medical situation. Even with proper documentation from a certified endocrinologist indicating that she had been undergoing HRT for nearly two years before suddenly stopping, she was held at a mental hospital for four days. On the last day, she met with a psychiatrist who said he “did not have a high opinion of people like her,” and made religious comments. [24] He also reportedly refused to call her by her female name. [25] Finally, she was discharged with a personality disorder that did not disqualify her from military service, meaning she was forced to participate in Ukraine’s military. [26] Eric, a 23-year-old transgender man from Ukraine was approved for HRT when just days later, the war broke out. [27] Eric was left with a testosterone shot but no way of administering it. Medical clinics shut down as Ukraine faced a shortage of hormone drugs. People must undergo HRT and stick to their medical regime to avoid negative side effects. Another issue is that HRT is usually administered in increasing doses and requires constant medical monitoring. [28] Not only were supplies low, but so was the availability of medical practitioners. [29] Some individuals have begun to reduce their daily dosage to extend their hormone supply, leading to increased risks including “mood instability, aggravated gender dysphoria, and…more serious health issues.” [30] Others have begun to make their HRT at home and have even begun selling it. [31]As prices have nearly tripled for some hormone drugs, many have begun to buy cheaper alternatives and make their own hormone drug. [32] DIY HRT can also lead to serious medical complications including blood clots and liver issues if administered incorrectly. [33] The average withdrawal takes 2-4 months, with professional medical monitoring. [34]Increased costs, low availability, and difficulty finding a practitioner have made transitioning almost impossible during the war. Without being able to transition and legally change their gender so that it better aligns means an inability to access medical care, aid, and other benefits. It is an endless cycle. “Lawful transphobia” has been aggravated against trans people, impacting their mental health. It is a term used to describe the increased reportings of assaults and harassment on the trans community in Ukraine, often backed by the lack of legal protection. Without approved documentation and enforced legal rights, many individuals are cast aside.

 

​






 

Anastasiia Yeva Domani, a forty-year-old transgender woman from Kyiv, Ukraine. Photo: UN Women/ Tara Milutis

 

            Anastasiia Yeva Domani is one of the many trans people impacted by the war. She is also the Director of Cohort, a two-year-old organization for trans people. She believes the estimated 7,000-10,000 number of trans people is heavily underestimated as many individuals only ask for help during times of crisis such as a war. “...We are receiving requests for help from people we have never heard from before, people who are in dire need of humanitarian, financial and medical assistance” she said. [35] She has also worked alongside her 12-person team to turn her apartment into a makeshift humanitarian aid and medical office. [36] She offers HRT as well. This all comes as Russian military forces began targetting civilian health infrastructures. [37] The organization Cohort, has provided aid and medical care to roughly 950 trans individuals since the start of the war. [38] While Domani recognizes that access to HRT has improved since the start of the war in 2022, she also notes the high prices, with medicine being marked up nearly three times the original cost. [39] Her apartment offers free to low-cost HRT to individuals needing monitoring or help with distribution/access to medication.

            Anastasia is one of many individuals working to alleviate the conditions which trans-Ukrainian people are being subjected to. Although Anastasia’s work has been extremely beneficial to the trans community in Ukraine, very little has been done for Ukrainians in Russian occupied zones. This however, is not because of lack of will, but rather difficulty supporting the community in a zone occupied by a historically repressive government. [40] 18% of Ukraine is occupied by Russia. [41] While the Russian military has been increasing its own aggression against trans citizens, it also means that those in Ukrainian territory are subejcted to worse treatment. [42] In both regions, mental health conditions have worsened. Although no statistics have been released surrounding the impact of the war on the mental health of the trans community, an estimated 30% of Ukraine’s populations is expected to be experiencing symptoms of depression and anxiety. [43] It is expected that numbers for the trans community are higher.

            Although the trans community in Ukraine has faced an increasingly difficult battle to overcome stigma, harassment, and discrimination, the impacts are not an isolated event. In similar war times, the trans community has consistently been under atrack. Examples include Palestine, where “pinkwashing” tactics have been used by Israel to eliminate queer Palestinians. The term is used to persuade people that a queer individual would not be safe in Palestine and must flee to a “civilized” and “accepting” region such as Israel, who incongruously aligns itself with global homophobic policies. [44] The war has made living conditions worse for the Palestinian trans community. Similarly, Ethiopian trans individuals have faced increased social discrimination amid a state of emergency in war regions. [45] Policies there have turned families into monitering tools to crack-down on the trans community. [46] There are many more war zones around the world in which trans individuals are fearing their safety, Ukraine is not an isolated situation.

 

           

 

 

 

 

 

 

 

 

 

References
 

Bandura, R., & Reynal, P. (2023, August 21). Investing in Mental Health Will Be Critical for Ukraine’s Economic Future. Csis.org. https://www.csis.org/analysis/investing-mental-health-will-be-critical-ukraines-economic-future

Bigg, M. M. (2023, February 24). Russia invaded Ukraine more than 200 days ago. Here is one key development from every month of the war. The New York Times. https://www.nytimes.com/article/ukraine-russia-war-timeline.html

Center For Preventive Action. (2023, March 16). War in Ukraine. Global Conflict Tracker; Council on Foreign Relations. https://www.cfr.org/global-conflict-tracker/conflict/conflict-ukraine

De Groot, D., & Monte, M. (n.d.). AT A GLANCE. https://www.europarl.europa.eu/RegData/etudes/ATAG/2022/729412/EPRS_ATA(2022)729412_EN.pdf

Deutsch, M. (2016, June 17). Overview of feminizing hormone therapy | Transgender Care. Ucsf.edu. https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy

Dixon, R. (2023, September 10). In time of war, Russia turns up aggression on transgender citizens. Washington Post. https://www.washingtonpost.com/world/2023/09/10/russia-outlaws-transgender-citizens/

Farbar, K. (2023, February 8). How trans people are caught in Ukraine’s war. OpenDemocracy. https://www.opendemocracy.net/en/odr/ukraine-trans-people-war-lgbt-gender-identity-documents-hormones-zelenskyy-eu/

Hagen, I. van. (2023, March 12). Meet the Ukrainian activist providing hormone therapy to the trans community from her Kyiv apartment. Business Insider. https://www.businessinsider.com/ukrainian-activist-humanitarian-office-apartment-for-the-trans-community-2023-3

Hajdari, U. (2023, August 18). Trans soldier’s attack highlights challenges faced by LGBT Ukrainians. Euronews. https://www.euronews.com/2023/08/18/trans-soldiers-attack-highlights-challenges-faced-by-lgbt-ukrainians

Kilbride, E. (2023, June 15). Ukraine LGBT Center Broken Into, Vandalized | Human Rights Watch. Human Rights Watch. https://www.hrw.org/news/2023/06/15/ukraine-lgbt-center-broken-vandalized

Kottasová, I. (2022, December 3). “I wanted to resume my transition at all costs.” Trans Ukrainians uprooted by war struggle to continue treatment. CNN. https://www.cnn.com/2022/12/03/europe/ukraine-war-trans-challenges-intl-cmd/index.html

Lee, J. (2022, April 8). “Danger everywhere”: War and transphobia create perfect storm for trans Ukrainians. NBC News. https://www.nbcnews.com/nbc-out/out-news/danger-everywhere-war-transphobia-create-perfect-storm-trans-ukrainian-rcna23567

Natalie Vikhrov. (2023, February 23). A year after Ukraine invasion, trans people struggle for hormones. OPENLY. https://www.openlynews.com/i/?id=ea8bc511-5467-4485-a64c-f0676d7d743f

National Center for Transgender Equality. (2016, July 9). Understanding Transgender People: The Basics. National Center for Transgender Equality; National Center for Transgender Equality. https://transequality.org/issues/resources/understanding-transgender-people-the-basics

O’Neal, S. (2023, November 16). Gaza’s Queer Palestinians Fight to Be Remembered. Www.thenation.com. https://www.thenation.com/article/world/gaza-queering-the-map/

Outright Action International, Gender Stream, & RFSL. (n.d.). Advocacy Brief: Barriers to Transgender People Leaving Ukraine During the War. Retrieved January 23, 2024, from https://outrightinternational.org/sites/default/files/2022-09/Transborder%20crossingbrief_EN.pdf

Planned Parenthood. (2022). Planned Parenthood. Plannedparenthood.org. https://www.plannedparenthood.org/planned-parenthood-great-northwest-hawaii-alaska-indiana-kentuck/patients/health-care-services/hrt-hormone-therapy-for-trans-and-non-binary-patients

Rainbow Europe. (2018). Country Ranking | Rainbow Europe. Rainbow-Europe.org. https://rainbow-europe.org/country-ranking

Ray, M. (2023, March 12). Russia-Ukraine War. Britannica; Britannica. https://www.britannica.com/event/2022-Russian-invasion-of-Ukraine

Rushing, E. (2020, March 31). Out of sight, out of mind? Transgender people in humanitarian emergencies. Humanitarian Law & Policy Blog. https://blogs.icrc.org/law-and-policy/2020/03/31/out-sight-mind-transgender-people-humanitarian-emergencies/

Schwikowski, M. (2023, August 18). LGBTQ+ Ethiopians flee in the face of sudden crackdown – DW – 08/18/2023. Dw.com. https://www.dw.com/en/ethiopias-lgbtq-community-face-sudden-wave-of-persecution/a-66571195

The New York Times. (2022, February 14). Maps: Russia and Ukraine Edge Closer to War. The New York Times. https://www.nytimes.com/interactive/2022/world/europe/ukraine-maps.html

UN AIDS. (2022, March 30). Ukrainian activist Anastasiia Yeva Domani talks to UNAIDS about how the transgender community is coping during the war in Ukraine. Www.unaids.org. https://www.unaids.org/en/resources/presscentre/featurestories/2022/march/20220330_anastasiia-yeva-domani

World Health Organization. (2023). Gender incongruence and transgender health in the ICD. Www.who.int. https://www.who.int/standards/classifications/frequently-asked-questions/gender-incongruence-and-transgender-health-in-the-icd

 

[1] World Health Organization. (2023). Gender incongruence and transgender health in the ICD. Www.who.int. https://www.who.int/standards/classifications/frequently-asked-questions/gender-incongruence-and-transgender-health-in-the-icd

[2] National Center for Transgender Equality. (2016, July 9). Understanding Transgender People: The Basics. National Center for Transgender Equality; National Center for Transgender Equality. https://transequality.org/issues/resources/understanding-transgender-people-the-basics

[3] Planned Parenthood. (2022). Planned Parenthood. Plannedparenthood.org. https://www.plannedparenthood.org/planned-parenthood-great-northwest-hawaii-alaska-indiana-kentuck/patients/health-care-services/hrt-hormone-therapy-for-trans-and-non-binary-patients

[4] Deutsch, M. (2016, June 17). Overview of feminizing hormone therapy | Transgender Care. Ucsf.edu. https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy

[5] Planned Parenthood. (2022). Planned Parenthood. Plannedparenthood.org. https://www.plannedparenthood.org/planned-parenthood-great-northwest-hawaii-alaska-indiana-kentuck/patients/health-care-services/hrt-hormone-therapy-for-trans-and-non-binary-patients

[6] Ray, M. (2023, March 12). Russia-Ukraine War. Britannica; Britannica. https://www.britannica.com/event/2022-Russian-invasion-of-Ukraine

[7] Bigg, M. M. (2023, February 24). Russia invaded Ukraine more than 200 days ago. Here is one key development from every month of the war. The New York Times. https://www.nytimes.com/article/ukraine-russia-war-timeline.html

[8] Center For Preventive Action. (2023, March 16). War in Ukraine. Global Conflict Tracker; Council on Foreign Relations. https://www.cfr.org/global-conflict-tracker/conflict/conflict-ukraine

[9] Farbar, K. (2023, February 8). How trans people are caught in Ukraine’s war. OpenDemocracy. https://www.opendemocracy.net/en/odr/ukraine-trans-people-war-lgbt-gender-identity-documents-hormones-zelenskyy-eu/

[10] Lee, J. (2022, April 8). “Danger everywhere”: War and transphobia create perfect storm for trans Ukrainians. NBC News. https://www.nbcnews.com/nbc-out/out-news/danger-everywhere-war-transphobia-create-perfect-storm-trans-ukrainian-rcna23567

 

[11] De Groot, D., & Monte, M. (n.d.). AT A GLANCE. https://www.europarl.europa.eu/RegData/etudes/ATAG/2022/729412/EPRS_ATA(2022)729412_EN.pdf

[12] Rainbow Europe. (2018). Country Ranking | Rainbow Europe. Rainbow-Europe.org. https://rainbow-europe.org/country-ranking

[13] Ibid.

[14] Kilbride, E. (2023, June 15). Ukraine LGBT Center Broken Into, Vandalized | Human Rights Watch. Human Rights Watch. https://www.hrw.org/news/2023/06/15/ukraine-lgbt-center-broken-vandalized

[15] Ibid.

[16]  Rainbow Europe. (2018). Country Ranking | Rainbow Europe. Rainbow-Europe.org. https://rainbow-europe.org/country-ranking

[17]  Ibid.

[18] Kottasová, I. (2022, December 3). “I wanted to resume my transition at all costs.” Trans Ukrainians uprooted by war struggle to continue treatment. CNN. https://www.cnn.com/2022/12/03/europe/ukraine-war-trans-challenges-intl-cmd/index.html

[19] Farbar, K. (2023, February 8). How trans people are caught in Ukraine’s war. OpenDemocracy. https://www.opendemocracy.net/en/odr/ukraine-trans-people-war-lgbt-gender-identity-documents-hormones-zelenskyy-eu/

 

[20] Lee, J. (2022, April 8). “Danger everywhere”: War and transphobia create perfect storm for trans Ukrainians. NBC News. https://www.nbcnews.com/nbc-out/out-news/danger-everywhere-war-transphobia-create-perfect-storm-trans-ukrainian-rcna23567

[21] Ibid.

[22] Ibid.

[23] Rushing, E. (2020, March 31). Out of sight, out of mind? Transgender people in humanitarian emergencies. Humanitarian Law & Policy Blog. https://blogs.icrc.org/law-and-policy/2020/03/31/out-sight-mind-transgender-people-humanitarian-emergencies/

[24]  Outright Action International, Gender Stream, & RFSL. (n.d.). Advocacy Brief: Barriers to Transgender People Leaving Ukraine During the War. Retrieved January 23, 2024, from https://outrightinternational.org/sites/default/files/2022-09/Transborder%20crossingbrief_EN.pdf

[25] Outright Action International, Gender Stream, & RFSL. (n.d.). Advocacy Brief: Barriers to Transgender People Leaving Ukraine During the War. Retrieved January 23, 2024, from https://outrightinternational.org/sites/default/files/2022-09/Transborder%20crossingbrief_EN.pdf

[26] Ibid.

[27] Kottasová, I. (2022, December 3). “I wanted to resume my transition at all costs.” Trans Ukrainians uprooted by war struggle to continue treatment. CNN. https://www.cnn.com/2022/12/03/europe/ukraine-war-trans-challenges-intl-cmd/index.html

[28] Ibid.

[29] Ibid.

[30] Ibid.

[31] Natalie Vikhrov. (2023, February 23). A year after Ukraine invasion, trans people struggle for hormones. OPENLY. https://www.openlynews.com/i/?id=ea8bc511-5467-4485-a64c-f0676d7d743f

[32]  Ibid.

[33]  Ibid.

[34]  Ibid.

[35] UN AIDS. (2022, March 30). Ukrainian activist Anastasiia Yeva Domani talks to UNAIDS about how the transgender community is coping during the war in Ukraine. Www.unaids.org. https://www.unaids.org/en/resources/presscentre/featurestories/2022/march/20220330_anastasiia-yeva-domani

[36] Hagen, I. van. (2023, March 12). Meet the Ukrainian activist providing hormone therapy to the trans community from her Kyiv apartment. Business Insider. https://www.businessinsider.com/ukrainian-activist-humanitarian-office-apartment-for-the-trans-community-2023-3

[37] Ibid.

[38] Ibid.

[39] Ibid.

[40] Hajdari, U. (2023, August 18). Trans soldier’s attack highlights challenges faced by LGBT Ukrainians. Euronews. https://www.euronews.com/2023/08/18/trans-soldiers-attack-highlights-challenges-faced-by-lgbt-ukrainians

[41] The New York Times. (2022, February 14). Maps: Russia and Ukraine Edge Closer to War. The New York Times. https://www.nytimes.com/interactive/2022/world/europe/ukraine-maps.html

[42] Dixon, R. (2023, September 10). In time of war, Russia turns up aggression on transgender citizens. Washington Post. https://www.washingtonpost.com/world/2023/09/10/russia-outlaws-transgender-citizens/

[43] Bandura, R., & Reynal, P. (2023, August 21). Investing in Mental Health Will Be Critical for Ukraine’s Economic Future. Csis.org. https://www.csis.org/analysis/investing-mental-health-will-be-critical-ukraines-economic-future

[44] O’Neal, S. (2023, November 16). Gaza’s Queer Palestinians Fight to Be Remembered. Www.thenation.com. https://www.thenation.com/article/world/gaza-queering-the-map/

[45] Schwikowski, M. (2023, August 18). LGBTQ+ Ethiopians flee in the face of sudden crackdown – DW – 08/18/2023. Dw.com. https://www.dw.com/en/ethiopias-lgbtq-community-face-sudden-wave-of-persecution/a-66571195

[46] Ibid.