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ICD11 is a stride toward depathologisation of trans people, but more is needed

Statement
Strasbourg 27/05/2019
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“The removal of gender identity from the list of mental illnesses in the 11th version of the International Classification of Diseases (ICD-11), adopted by the Assembly of States of the World Health Organisation on 25 May 2019 is a welcome and overdue development for trans people all around the world,” said the Council of Europe Commissioner for Human Rights, Dunja Mijatovic.

The pathologisation of trans people has served to justify serious violations of their human rights over the years, including attempts to “cure” them through conversion or reparative therapies; psychiatric evaluations, and sterilisation. In many countries, legal gender recognition is only possible upon medical diagnosis.

While the removal of gender identity from the list of mental illnesses is a positive step, several concerns remain with the ICD11, and I call on WHO member states to continue improving the text to promote respect of human rights.

Such concerns include the term “gender incongruence” retained in the ICD11 which may lead to interpretations suggesting abnormality, as well as the continued listing of gender incongruence in childhood in the ICD.

I particularly regret that no progress was achieved in the ICD11 toward depathologisation of intersex people, and that terms such as “sex development disorders” continue to appear in the text. Language in the ICD Foundation suggesting sex “normalising” surgeries remains, which is of major concern. The Commissioner recalled that medically unnecessary sex “normalising” surgeries on infants and children can amount to inhuman or degrading treatment. My predecessors, much like FRA, PACE, and the EP have recommended to ban such surgeries, and condition them upon the free and fully informed consent of the intersex people concerned.

Health professionals implementing the ICD at the national level have a pivotal role to play in ensuring that trans and intersex people are not stigmatised and discriminated against in the medical sector, and in fulfilling their right to health by ensuring access to quality health care. I call on states to increase capacity building and training of health professionals in matters related to LGBTI health care.