If Ukraine’s health sector is to recover, the world has to step up now

By Dr Jarno Habicht, WHO Representative in Ukraine

The world can — and should — play even more of a role now in supporting health sector recovery, a key pillar of Ukraine’s ability to withstand and overcome current challenges and build a better future for its resilient people, Dr Jarno Habicht writes.

Russia’s full-scale invasion of Ukraine on 24 February 2022 has led to the widespread destruction of social and economic infrastructure in the country —   especially in the health sector. 

As of today, WHO has confirmed over 1,004 attacks that have damaged or destroyed health facilities, including hospitals and pharmacies, with more than 100 health providers killed and dozens more wounded. 

As I have seen with my own eyes — including during recent visits close to the frontline and other war-damaged zones — these attacks have profoundly impacted the population’s access to essential health services and medicines.

Despite the devastation, and even as the war rages on, the process of recovery and reconstruction in Ukraine’s health sector is well underway. 

As of June, according to national authorities, more than 600 damaged healthcare facilities have been partially or fully repaired.

Billions are needed just for Ukraine’s health sector recovery

Yet many challenges remain – including the urgent need for additional resources. In February 2023, a joint assessment conducted by the Government of Ukraine, the World Bank Group, the European Commission, and the United Nations estimated that the total amount of funding needed for health sector recovery would be roughly $16.4 billion (€15bn). 

More than $3.6 million (€3.3m) is urgently required to meet needs this year alone, and that was calculated before the Kakhovka Dam destruction, which has now significantly increased the needs.

Last week, the international community convened at the annual Ukraine Recovery Conference in London. In this context, the WHO Country Office in Ukraine has undertaken new research to help inform discussions related to the country’s health sector recovery.

Under this study, we visited four inspiring sites of recovery and reconstruction in territories reclaimed from temporary Russian military control — and where the scale of the damage and destruction has been severe.

A summary of just one of these cases symbolises the breadth of the challenge before us, as well as the opportunities to build back better.

A case of a pharmacy restored to the benefit of the local community

The Apteka 911 pharmacy network is headquartered in the Kharkiv region; it has 174 pharmacies in the city of Kharkiv and the surrounding settlements. 

Much of this region was under Russian military occupation for several months after the onset of the invasion — until fierce fighting with Ukrainian forces between mid-May and early September of 2022.

Since then, however, the bombardment has continued to cause havoc, along with hundreds of civilian casualties. 

At least 58 Apteka 911 pharmacies have been damaged or destroyed; two staff members have been killed, and many others were injured.

After the area returned to Ukrainian control — and despite disruptions to electricity, water, heating, and supply routes — the network used its savings to finance the restoration and re-opening of pharmacies. 

Now, in many settlements, these re-established pharmacies are the only source of health care available to local people.

Innovative models are now saving lives

Apteka 911 has been engaged by government authorities to deliver outpatient medicines under the state-funded Affordable Medicines Programme (AMP). They have also become an important conduit for steering humanitarian supplies towards areas of high need, using their own logistics capacity and local knowledge.

The network is also involved in a range of innovative models, including mobile delivery of medicines, online consultations for patients in recently re-taken cities (which, in many cases, lack health care capacity due to widespread damage), and deliveries of medicines by mail.

The Apteka 911 pharmacy in Tsyrkuny was under the temporary military control of the Russian Federation between February and September 2022. 

During this period, the facility was extensively damaged; equipment and stocks were looted; and medical staff were forced to evacuate. 

Russian troops were forced out of the village in May 2022. However, the area remained a battleground until September 2022, at which point reconstruction began (though the village is still regularly shelled by the Russian military). 

The Apteka 911 pharmacy in Tsyrkuny is now the only pharmacy covering three villages — and it plays a critical role in ensuring population access to essential health care in an area in which several local hospitals and primary care clinics have been completely destroyed.

Ukrainians can’t do it solely by themselves

As the Apteka 911 case highlights, domestic Ukrainian businesses have — alongside the public sector and other organisations — played a key role in re-establishing access to health care in the most war-damaged areas.

It also illustrates a broader pattern: that many investments in recovery and reconstruction have not involved externally sourced funds. They are being led by Ukrainians – the people on the ground.

For organisations like Apteka 911, the only source of capital for such investments is their own savings.

Yet such savings are limited — they will be further depleted as the war drags on. And yet the needs will grow as the conflict shows no sign of easing.

Going forward, then, more external investment and other forms of financial support — including from international organisations, philanthropic organisations, and the private sector — will be needed to continue Ukraine’s drive to health sector recovery.

The world needs to help the health sector get back on its feet

Ukraine had embarked on ambitious health reforms well before the advent of Russia’s full-scale war. 

These reforms laid a foundation that has stood the health system in good stead amid 16 months of war. 

The world can — and should — play even more of a role now in supporting health sector recovery, a key pillar of Ukraine’s ability to withstand and overcome current challenges and build a better future for its resilient people.

Dr Jarno Habicht is the World Health Organisation’s Representative in Ukraine and Head of the WHO Ukraine Country Office.

At Euronews, we believe all views matter. Contact us at [email protected] to send pitches or submissions and be part of the conversation.

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Data Point | The gender disparity in healthcare

The Data Point is a bi-weekly newsletter in which The Hindu’s Data team decodes the numbers behind today’s biggest stories.  

(This article forms a part of the Data Point newsletter curated by The Hindu’s Data team. To get the newsletter in your inbox, subscribe here.)

The difference in the anatomy between various genders implies that diseases and their symptoms may affect them differently. Moreover, some diseases affect certain genders more than others, while a few are gender-specific conditions. Thus, it is imperative to look through a gendered lens for a better understanding of diseases.

Equal representation of genders in clinical trials, and impartiality and unbiasedness in testing and diagnosis help in creating a healthcare system that addresses the needs of all genders.

Yet, various studies conducted in the U.S. reveal that in some fields of medicine such as oncology, psychiatry, neurology and cardiology, the disease burden was higher among women while their share in clinical trials was not proportionate. 

In a study where 1,433 trials were conducted from 0.3 million people in the U.S. between 2016 and 2019, the average share of women was  41.2%. In psychiatry, where women comprised 60% of patients, the share of women participating in clinical trials was 42%. Similarly, the difference was significantly high in the case of cardiovascular diseases (41.9% female participants vs. 49% female patients) and cancer trials (41% female participants vs. 51% female patients)

Gender disparity is also observed in research funding. For instance, according to the National Institutes of Health (NIH) data, the 2023 research funding estimate for substance misuse (a condition more prevalent among men) was $2,583 million while that for depression (a condition more prevalent among women) was $664 million. Similarly, research funding in 2022 for HIV/AIDS, a disease more prominent among men (DALY of 0.361 million in 2015) was $3,294 million, while that for inflammatory bowel disease (IBD), a disease dominant among women (DALY of 0.475 million) was $203 million. (expand DALY somewhere)

To know more about the gender gap in clinical trials and research funding, click here

Women faced the challenge of a gender gap in testing, diagnosis and treatment, which arose from a lack of comprehensive research about conditions dominant among women and biases toward women in healthcare.

In a multicentre observational study published in 2023, it was revealed that the median time taken to diagnose IBD from the onset of a symptom was more prolonged in women than in men. For instance, it took about 12.6 months to diagnose Crohn’s disease (a type of IBD) for women, while it only took 4.5 months for men. Similarly, it took 6.1 months for women and 2.7 months for men, in the case of ulcerative colitis.

NIH data also revealed that funding given for women’s reproductive disorders was significantly lower than that for conditions with a similar disease burden. 

Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic abnormality among women with a worldwide prevalence of up to 21%, depending on diagnostic criteria. Yet, while diseases with equal or lesser disease burden like rheumatoid arthritis, tuberculosis, and systemic lupus erythematosus, were awarded funds worth $454.39 million, $773.77 million, and $609.52 million respectively, the funding for PCOS research between 2006 and 2015 was limited to $215.12 million. 

Thus, a limited understanding of disease further delays diagnosis, especially for diseases affecting women’s reproductive system. 

In the Indian context, the taboo towards menstrual health in society, which extends to the health sector adds to this problem. Endometriosis, a disease that affects roughly 10% (190 million) of women and girls of reproductive age worldwide according to the WHO, is highly underreported in the country. 

Despite persistent visits to multiple gynaecologists over a decade, my journey to obtain a proper diagnosis for endometriosis was marked by significant delays. My experiences of enduring intense menstrual cramps, accompanied by nausea and bowel disorders, were consistently dismissed by doctors who attributed them to natural menstrual processes. Prescription of painkillers became routine without a genuine effort to comprehend the severity of my discomfort or suggest diagnostic scans for underlying issues. Only after my insistence, despite initial reluctance from doctors, did I finally receive a diagnosis. Regrettably, by that time, the lesions within my ovaries had grown larger than the organs themselves.

Even with a diagnosis, treatment options remain limited due to the narrow understanding of this condition. While invasive surgeries like laparoscopic procedures and hormonal medications seem to be the only options, these treatments come with significant side effects and cannot guarantee the complete eradication of recurring lesions.

In an article titled, “Male-centric medicine is affecting women’s health” in The Hindu, the author explains that women are less likely to receive appropriate medications, diagnostic tests and clinical procedures even in developed countries such as Canada and Sweden as the stereotype of the “hysterical woman” continues to haunt women even when they need urgent clinical interventions. 

Therefore, it is crucial to implement appropriate interventions, create awareness within the medical community to mitigate bias and push for gender-sensitive clinical trials and equitable allocation of research funding. These measures are imperative to ensure equal and unbiased healthcare for all individuals, regardless of their gender among other identities.

Fortnightly figures

  • 10.3% was the decrease in India’s merchandise exports in May 2023 at $34.98 billion from $39 billion in May 2022. Imports contracted at a slower 6.6% rate to $57.1 billion, lifting the trade deficit to a five-month high of $22.1 billion. This is the sixth time in the last eight months that goods exports have declined year-on-year, although May’s decline was lower than the 12.6% fall recorded in April.
  • 110 million people have had to flee their homes because of conflict, persecution, or human rights violations, the UN High Commissioner for Refugees (UNHCR) said. The war in Sudan, which has displaced nearly 2 million people since April, is but the latest in a long list of crises that have led to the record-breaking figure. Last year alone, an additional 19 million people were displaced, including more than 11 million who fled Russia’s invasion of Ukraine in the fastest and largest displacement of people since World War II.
  • 1 lakh people were shifted to approximately 1,500 temporary shelters set up as part of the disaster management efforts by the Gujarat State against Cyclone Biparjoy before the cyclone made landfall. Cyclone Biparjoy caused widespread damage in Gujarat’s Kutch-Saurashtra region as it made landfall late on June 15, Thursday. The Gujarat government also shut schools and other educational institutions for the next day as the State received heavy downpours in the aftermath of the cyclonic storm.
  • 4.25% was India’s retail inflation in May from 4.7% in April this year, a 20-month low. The price rise in food items faced by consumers moderated to 2.91%. This is the third successive month that inflation has remained below the Reserve Bank of India’s (RBI’s) upper tolerance limit of 6% after a prolonged streak above it. Base effects from May 2022 when retail inflation was over 7% also played a role in lowering the inflation rate this May.
  • ₹1.13 lakh crore was the third instalment of tax devolution released by the Centre to States, according to the Finance Ministry. This surpasses the normal monthly devolution of  ₹59,140 crore. The additional advance aims to enable expedited capital spending, financing of development/welfare-related expenditure and increased resource availability for projects and schemes of the States.

Thank you for reading this week’s edition of the Data Point newsletter! To subscribe, click here. Please send your feedback to [email protected]

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Meet the people making healthcare more accessible for trans kids

From Ireland to Spain, access to trans healthcare varies dramatically for young people, depending on where in the European Union they live. In some countries, it is virtually impossible.

Just two months shy of turning 18 years old, and over a year after he started questioning his gender, Alex became the youngest person to access trans healthcare at his health clinic in France.

“I was very happy and relieved because it was a crucial moment. I’d just ended high school … and the timing was very important to me,” Alex told Euronews. “Because my voice was starting to change about three months after the first term [of University].”

“And I was very relieved that I could try to live without people noticing that I’m trans.”

The process for Alex — whose name has been changed for this article — to access hormones was a relatively straightforward one.

In France, minors can access gender-affirming care, such as puberty blockers or hormone replacement treatment (HRT). But the vast majority of healthcare officials require a psychological assessment to be carried out, a process that could take up to several years.

In Alex’s case, he was able to move through the requirements quickly because of his parent’s support and his age. But others may find it more difficult to gain access to the same route.

“I just talked to my endocrinologist, and she said that they were forced to shut down the system because there weren’t enough people who want to [provide gender-affirming care]. And because the public hospital in France doesn’t consider it a priority.”

“Now, the wait list is very, very long – between eight months and a year for the first appointment, when for me it was just one or two months.”

Deadliest year for LGBTQ+ people in Europe in a decade

For other young people across the European Union, the experience of being transgender varies dramatically depending on where they live.

In February, Spain passed legislation allowing anyone over the age of 16 to self-declare their gender. That same month, Sweden moved to block hormone therapy for people under the age of 18, except in rare cases.

And while Finland removed its requirement that adults be sterilised before changing their gender markers, Croatia was debating if gender-affirming care should be limited to people older than 21.

Last year was also one of the most violent in almost a decade for Europe’s LGBTQ+ community, particularly for trans people, “both through planned, ferocious attacks and through suicides in the wake of rising and widespread hate speech,” according to ILGA-Europe, one of the continent’s largest LGBTQ+ rights organisations.

In 2022, a trans man was killed during a Pride event in Germany. That same year, a trans woman was murdered in Estonia. And a cis woman (a person who identifies with the gender they were assigned at birth) was killed in Georgia because she was mistaken for a trans man.

There were also at least two attacks on LGBTQ+ bars: one, which killed two people and injured 20 in Oslo; and another in Bratislava, in which two people were killed.

“This phenomenon is not only in countries where hate speech is rife, but also in countries where it is widely believed that LGBTI people are progressively accepted,” said Evelyne Paradis, the executive director of ILGA-Europe.

The organisation added that Ireland, Spain, Norway, Poland, the UK and Switzerland were just some of the countries that reported a rise in hate speech against trans people last year.

Worst country to access trans healthcare in Europe

Access to transgender care — particularly for minors — varies depending on where in Europe a person lives.

In Ireland, it is nearly impossible for anyone under the age of 17 to access trans healthcare, even though they are legally able to do so. This is despite it being one of only 11 countries in Europe that allow people to self-declare their gender. It also provides a procedure for minors to have their gender legally recognised.

It is also ranked as the worst place to access trans healthcare in the European Union, listed under Hungary and Poland, according to Transgender Europe [TGEU], the largest trans rights group in Europe.

At the heart of this contradiction is the country’s medical backlogs. While young people have the right to access care in theory, in practice those trying to enter the healthcare system are faced with a seven-year waiting list. This means access for many people is practically cut off until adulthood.

“There really isn’t any gender-affirming healthcare for trans kids in Ireland,” Moninne Griffith, the CEO of Irish LGBTQ+ youth organisation BeLonG To, told Euronews.

“I have heard that some young people and their parents, out of sheer desperation, are trying to access healthcare abroad and online.”

She added that they regularly go to either Poland or England for treatment, “but without adequate medical supervision here in Ireland, which is something that’s very dangerous and something that we wouldn’t recommend.”

The reason for the backlog, Griffith said, is a combination of Brexit, transphobia and the country’s healthcare system, among other things.

Before the UK left the EU, Ireland heavily relied on UK-based clinics through its Treatment abroad scheme (TAS), a programme in the European Union that allows patients to seek treatment in another member state and still get covered for it through their national insurance. With Brexit, that pathway has now been cut off.

Griffith added that because the trans community in Ireland is so small, it isn’t a priority in a medical system “that is focused, unfortunately, on the acute side of medical care and intervention.”

Access to gender-affirming care in Spain

For young people in Spain, the situation is very different. In February 2023, the country passed legislation that greatly expanded rights for its LGBTQ+ community, particularly its trans community.

The so-called ‘transgender law’ streamlined the process for anyone older than 16 to change the gender marker on their identification documents: for example, changing their gender from male to female. 

Prior to this, people were required to undergo medical treatment for two years and have a medical diagnosis of gender dysphoria before they could change their gender marker.

Spain is also ranked as the second-best place to access trans-healthcare in Europe, after Malta, according to TGEU.

According to Uge Sangil, the president of FELGTBI+, Spain’s largest LGBTQ+ organisation, the protocol for a young person in most parts of the country to access care is relatively straightforward. Their family doctor can refer them to a clinic that will help them gain access to the care they want, be it puberty blockers or hormones.

And if they are very young, they can also easily change their name on their school’s register, even before they are allowed to legally change their identity documents. 

But despite this, some people — particularly young people — can still face challenges to access healthcare, depending on which part of the country they live in.

Healthcare in Spain is a devolved power, meaning rules around trans healthcare vary depending on the region. And in places such as Castilla y León, which is partially controlled by the radical-right Vox party, access is not guaranteed. 

According to Sangil, “Castilla y León is one of the worst places in Spain to access gender-affirming healthcare. And that is because it does not have a protocol in place for people to access care.”

So, in theory, people in Castilla y León have “access to a general practitioner endocrinologist and they can do the treatments, but there is no guarantee that this will actually happen.”

That is because, according to Sangil, access to healthcare for young people in this region depends on if individual doctors want to treat them.

And this is a problem because “we can’t rely on the goodwill of medical professionals.”

‘It’s not about hormones’

Across the European Union — and the United States — transgender minors are becoming a major talking point in the media and the focus of new legislation restricting their access to healthcare.

But according to Alex, while a lot of that conversation is about HRT, people also regularly ignore major parts of the lived experience of trans youth. And, while access to hormones is important, there are also other ways to help young people.

“Most of the time we feel bad because people don’t recognise us as what we are,” he said. “And I think that is the biggest part about being trans. It’s not about hormones.

“I think if people could just say, oh, ‘I’m a man’, [and other people could respond] ‘you’re a man’. I think it would make it […] way easier for us to live.”

“For me, I think when my family started to accept [my gender] and call me by the right pronouns and name, I think that did half or more of the job. It was great.”

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How can the EU unlock the potential of sustainable healthcare?

Healthcare might not be the first industry that springs to mind when you consider the causes of the climate crisis. But with material extraction, supply, and the manufacture of equipment accounting for 40 to 50 per cent of global CO2 emissions, waste within the medical industry is playing a significant role in driving greenhouse gas emissions (GHGs).

If the world is to meet the targets set out in the Paris Agreement, the healtcare sector needs to transition to a circular economy. This means finding new and sustainable ways to use resources to bring about the decarbonisation of the industry.

Many solutions already exist to close the loop and make healthcare a more circular economy, with multinationals like Philips working hard to offer innovative solutions such as equipment recycling.

The European Union is leading the way too, with several initiatives following on the backs of the European Green Deal and the Circular Economy Action Plan (CEAP).

But with healthcare funding in Europe already stretched, can the EU transition to a circular economy without compromising on quality and patient safety?

And as we move towards a more digital future, could money and resources be saved by making healthcare more digital?

To discuss all these issues and more, join the Euronews Debate team live on June 29th at 11 am (CEST) as we discuss these questions with our expert panel.

Meet our panel

Aurel Ciobanu-Dordea, Director in charge of the Circular Economy in the European Commission’s DG ENV

Aurel Ciobanu-Dordea is the Director in charge of the Circular Economy in the European Commission’s Directorate-General for Environment.

Between 2014 and 2022 he worked as the Director in charge of Enforcement, Cohesion and the European Semester in the same DG. Prior to that, he was the Director for Equality in the Directorate-General for Justice, in charge of equality and the fight against discrimination. He joined the European Commission in 2009.

Robert Metzke, SVP and Global Head of Sustainability at Philips

Robert Metzke leads Philips’ activities in sustainability and drives the company’s strategy towards innovation. He implements sustainable business models and embeds sustainable and circular ways of working across Philips.

Robert and his team lead all activities with regard to Philips’ environmental responsibility, with a focus on climate action, circular economy and expanding access to healthcare in underserved communities, as part of Philips’ overall purpose to improve people’s health and well-being.

MEP Sara Cerdas

Sara Cerdas is a Portuguese medical doctor and a Member of the European Parliament. She is a member of the Committee on the Environment, Public Health and Food Safety (ENVI), the Committee on Transport and Tourism (TRAN) and S&D coordinator of the Special Committee on COVID-19 (COVI) and the Sub-Committee on Public Health (SANT).

Cerdas was also vice-president of the Special Committee on Beating Cancer (BECA). Currently, MEP Cerdas is shadow rapporteur of the proposal for Regulation for the European Health Data Space.

Frédéric Rimattei, Deputy Director General at Rennes University Hospital Center

After holding various management positions in major university hospitals in France (Montpellier, Toulouse), Frédéric Rimattei was appointed Deputy Director General of the Rennes University Hospital in 2015. In this capacity, he supervises the implementation of the CHU’s research and innovation policy as well as sustainability, in close collaboration with all of the establishment’s scientific, academic and industrial partners.

A major focus of the CHU’s research and innovation strategy, health technologies and sustainability are at the heart of the considerable investments made by the CHU, in particular within the framework of the #NouveauCHUdeRennes project.

Jeremy Wilks, Euronews Reporter and debate moderator

Euronews science reporter Jeremy Wilks covers everything from climate change to healthcare innovation. He has reported on science research, innovation and digital technology across Europe for over a decade. He regularly hosts live debates both on Euronews digital platforms and at large conference events. Jeremy is the presenter of the monthly Climate Now series on Euronews.

If you would like to submit a question for our panel please use the form below:

How much waste is generated by the healthcare sector in the EU?

According to the World Health Organisation (WHO), around 85 per cent of all waste generated by healthcare activities globally is non-hazardous. This leaves 15 per of waste which is considered hazardous to human health, because it is either infectious, toxic or radioactive.

While many healthcare products, such as needles, bandages and other types of clinical waste cannot be reused, many items of electronic equipment can, and thanks to advances in technology, the lifecycles of equipment and installed systems can be extended too. Refurbishment is often the most sustainable way to upgrade and extend the lifecycle of products, but as technology advances, new products are sometimes needed.

Purchasing eco-designed products is also a great way for healthcare companies to cut their carbon footprint, as they are generally more energy and resource efficient and have been designed so that they can be repaired instead of replaced.

Are healthcare products recyclable?

When products have reached the end of their life, responsible recycling is the best way to reduce their impact.

The Waste Electrical and Electronic Equipment Directive (WEEE Directive) introduced by the EU in 2003, states that the original producer has responsibility for recycling. The Individual Producer Responsibility (IPR) places end-of-life responsibility on producers, importers and brand owners, to ensure that product waste is recovered and reused.

While many brands are on board with a circular economy, more innovation is needed to prevent waste across the lifecycle of electronic products. The StEP Initiative (Solving the E-waste Problem) founded in 2003, with members including Philips and Microsoft, aims to standardise the recycling process, so that valuable components can be easily removed from waste products.

Many healthcare products also come with recycling passports, so that they can be disassembled and recycled safely and appropriately. This is particularly important with products that may contain hazardous materials or valuable components that can be reused.

Is digitisation the future of healthcare?

While expensive medical equipment will always have its place in the healthcare sector, increasing digitisation may also reduce the carbon footprint of medicine and make it more sustainable.

Virtual resources, digital tools and software may also enable healthcare settings to ‘dematerialize’ too. Innovations such as telehealth, where patients have virtual meetings with doctors will cut down on CO2 emissions from travel, while cloud-based services and efficiency-enhancing software could reduce CO2 emissions from computing and data storage.

While technology and recycling methods are improving, with so many problems to solve, from funding crises to an ageing population, can healthcare become more sustainable without reducing quality and safety? Join us on June 29th at 11 am (CEST) to find out what are our experts think.

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Matt Walsh exposes alleged gender transition approval ‘scam’ (video)

We cannot independently verify any of this, but if what he is saying and showing is true… yike.

This afternoon, Matt Walsh dropped a thread allegedly exposing gatekeeper organizations that are not actually gatekeepers:

Not a gatekeeper. Keep that in mind.

So, according to Walsh, they are supposed to be gatekeepers. They are supposed to be part of a long approval process that includes significant checks and balances to ensure that no one enters into this life-altering procedure lightly. But, according to Walsh, some people and companies have completely subverted this role:

Except they are supposed to be part of the process of ensuring it is necessary.

And that is the end of the thread. We will say that we suspect that in truth these people still rationalize it so that in their minds they are doing their patients a favor. The ideology of transgender is that you are whatever you say you are, at least when it comes to sex and gender. So, they probably rationalize their subversion of the process as necessary to get these people the help they think they need. That’s our guess, for what it is worth, but we believe that it is rare for a person to be consciously evil. And make no mistake, if what Walsh is reporting is true, this is evil.

And this even resulted in a tip:

Obviously, we don’t know if any of this is true, but we wouldn’t be surprised if someone does the gumshoe investigation needed to find out, one way or the other. So, with that caveat, the full text says:

Matt, if you send an investigative reporter over to @VUMChealth that is happening today.

A friend of a friend is a nurse who was placed involuntarily in gender reassignment surgical practice (@VanderbiltU has bullied/intimidated her when she asked to move). Based on high volume (VUMC runs one surgeon to 4-5 patients at the same time – Dr just flits around castrating in parallel) she asked how much informed consent/counseling they get. Surgeon laughed. He said he would do it through a drive-through window as long as they’re paying.

VU ramped up their surgical operations after the child mutilation ban in order to make up lost revenue – go look at how haphazard and frivolous they are about castrating/mutilating mentally ill adults. Transing the disturbed is BIG BUSINESS.

Indeed, it is not just the mentally ill. As ‘The Redheaded Libertarian’ pointed out with a meme, autistic people are disproportionately likely to be subjected to transitioning:

Since the picture cuts off the meme, here’s the full picture:

One person responded with ugliness:

That gave rise to a nice comeback:

And she has some cause to say what she said:

Still, while we think people rationalize this as not being just about the money, there is a lot of money in it:

And, of course, that means that anyone who buys health insurance is probably paying for this—not to mention the various types of government health care programs that are required to. It is past time for the term ‘need’ to be defined so it doesn’t just include when people just really, really want something. Indeed, the notion that this is necessary surgery leads to another potential problem:

That sounds like speculation to us. We would hope that the rational principle of ‘triage’ would keep hospitals from delaying cancer care for transitioning surgery, for instance. However, let’s just say our faith in the rationality of the medical profession has been shaken in the last few years. Most medical professionals are probably rational, but there are definite pockets of crazy—the pockets of crazy seem to be popping up in every profession, these days.

Lawyer Ted Frank points out that in a sane world this would at least result in criminal investigations:

Yeah, we aren’t holding our breath, and we are pretty sure Mr. Frank isn’t, either.

Anyway, one thing that occurred to us is that this might be the beginning of bigger plans. The other day we covered how the Daily Wire released Matt Walsh’s ‘What is a Woman?’ for free (for a limited time) on Twitter and how Twitter initially attempted to suppress the movie—contrary to the wishes of Elon Musk. In all of that, Walsh said something that we think might take on new meaning, now:

‘What a great way to ring in pride month.’

Is it possible that Walsh has multiple bombshell ‘events’ he is planning throughout pride month? First, he premiers his movie. Then one of his previously anonymous sources sheds her anonymity. And now this. Could it be his plan to basically carpet bomb the entire month with events like this?

Well, dear reader, we shall keep an eye on this for you and let you know. And if you can support this website in any way, we would appreciate it.


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Ukraine’s health system lies in rubble. Civilians are paying the price

By Christina Wille, Director, Insecurity Insight, and Harlem Désir, Senior VP for Europe, IRC

Every day, Doctor Oleg and his team pack up their medical supplies and depart from the city of Kharkiv in the early morning hours. 

His mobile health clinic tours remote villages in the region where the Government of Ukraine has recently regained control. 

The services Doctor Oleg’s team provide are essential for the bedridden patients they visit in their homes and for those who have to rely on outpatient services because their local health clinics are still buried in debris.

“There are health centres we go to where there’s nothing, just walls… With no heating and no water, we turn on a generator and a heater and see our patients in such conditions,” says Oleg, who witnessed the siege of Mariupol before fleeing with his family. 

“It is often the first time since the war escalated that people have an opportunity to see a doctor. They apologise that they have neglected themselves. They say they are just happy to be alive.”

Attacks on Ukraine’s health system are deliberate and indiscriminate

The winter surge in violence has seen repeated attacks on Ukraine’s civilian infrastructure. 

But while much media attention has focused on the destruction of the country’s energy grid, there has been little focus on the devastation of Ukraine’s health system. 

A recent report co-authored by Insecurity Insight highlights how this has impacted civilians in need of medical care, with harrowing accounts of medical staff operating under constant attack.

The findings reveal that the Russian armed forces and affiliated armed groups appear to be violating international humanitarian and human rights law by deliberately and indiscriminately targeting Ukraine’s health care system. 

Against this background, mobile health units, such as the one run by the International Rescue Committee’s Doctor Oleg, strive to provide essential care. 

Their work has become indispensable as the destruction of health care continues. 

However, no matter how dedicated their efforts are, it is hard to speak of rebuilding Ukraine’s health system at a time when attacks on civilian infrastructure are still disrupting daily life and aid operations.

One out of ten of Ukraine’s hospitals has been damaged

Since last February, the war has caused approximately US$2.5 billion (€2.29bn) in damage to health sector infrastructure in Ukraine, while the total reconstruction and recovery needs in the country are estimated at US$16.4bn (€15bn) over the next 10 years. 

This year alone, almost US$550 million (€504m) is required to save lives and ensure that 14.6 million people in Ukraine regain access to humanitarian health support.

But beyond the numbers is the daily horror for hospital workers and patients as attacks on civilians and civilian objects continue with impunity. 

At the time of writing, the Attacks on Health Care in Ukraine initiative recorded 788 attacks on healthcare in the country since 24 February last year, with WHO documenting 912 such events. 

To date, 322 attacks have damaged or destroyed hospitals, with some being hit multiple times. One hospital in the Kharkiv region, where the IRC mobile team is operating, has been hit five times.

Meanwhile, 100 attacks killed or injured healthcare workers, and 65 ambulances came under fire. On average, there have been more than two attacks on health care each day, and one out of ten Ukraine’s hospitals has been directly damaged by shelling.

This systematic violence undermines all elements of health care provision. Older people are particularly heavily affected as prices of medicines have increased, distances to functioning health facilities and costs of transport have grown, while incomes declined.

Before the escalation, as many as half a million patients were treated every month by health facilities that have now been damaged or destroyed; according to the official UN reports, one in every three Ukrainians cannot access medical assistance. 

Among 32% of the households recently surveyed by the IRC, at least one family member has had to stop taking their medicines because of the war.

Growing age of brutal impunity

The cases documented in Ukraine are part of a dangerous global trend of brutal attacks on health care in conflict. 

Despite health facilities and health workers being protected under international humanitarian law and reinforced by UN Security Council Resolution 2286, all too often, these attacks are carried out with impunity. 

In the absence of accountability, there is no check on the trends of violence or its devastating impact on civilian populations. This has become the hallmark of the war in Ukraine but has also occurred in Syria, Myanmar and other protracted conflicts.

To put an end to the growing age of impunity in Ukraine and in other places around the world, impunity must be replaced by accountability.

Accountability starts with documentation. The UN Human Rights Council and its Member States must renew the mandate of the Independent International Commission of Inquiry on Ukraine on an open-ended basis and ensure funding for its continued functioning. 

The UN General Assembly should also play a greater role in supporting humanitarian affairs by establishing independent fact-finding missions to investigate attacks on healthcare or aid workers.

However, documentation alone is not enough, and it should be accompanied by robust condemnation of those responsible for attacks. 

Strengthening the avenues for accountability is a key ingredient to reducing impunity while monitoring and calling out abuses will only be effective if enforced properly. 

To this end, countries should utilise the legal principle of universal jurisdiction to prosecute violations of international humanitarian law and ensure perpetrators are held to account.

Lastly, with two Ukraine reconstruction conferences fast approaching, donors need to commit to robust investment in a strategy for the Ukrainian health system’s recovery alongside continued humanitarian support for essential medical services. 

People need our protection

There are many tangible steps that donors, international partners and INGOs can undertake to protect people like Doctor Oleg through prevention and mitigation of the risks faced by frontline healthcare workers on the ground. 

It is vital that this practical support responds to their specific local needs and concerns.

The tragic images of rescue workers pulling people out of the rubble of former maternity wards painfully illustrate that people are continuing to pay the highest price for this war. 

This needs to stop. 

No child should be born under a barrage of missile strikes. 

No patient should die buried under rubble from a hospital they visited seeking care and protection. 

No doctor should lose his life while trying to save others. 

Ending violence against civilians and indiscriminate attacks on civilian infrastructure is essential in order for Ukrainians to begin to rebuild their lives.

Christina Wille is the Director of Insecurity Insight, and the co-author of the report “Destruction and Devastation: One Year of Russia’s Assault on Ukraine’s Health Care System.” Harlem Désir is the Senior Vice President for Europe at the International Rescue Committee.

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Florida Bill Doing Best To Out-Worst All Other Bans On Gender-Affirming Care

As Yr Wonkette covered yesterday, and as brought to our attention by the invaluable Erin in the Morning, the state of Florida (Motto: “America’s Useless Appendage”) is considering a whole swath of terrible legislation that if passed, would make life even more miserable for LGBTQ+ people there. It’s understandable, really — there are so many Republicans in the state Legislature, and they all want a turn at proving that they can hate LGBTQ+ folks as much or more than their peers.

Read More:

Florida LGBTQ Hate Bills Want Some Bigot To Have ‘Parental Rights’ Over Everybody Else’s Children

Red States About Five Minutes Away From Legalized Lynching Of Trans People

What IS Gender Affirming Health Care For Kids Anyway, Because Texas Is Super F*cking Lying About It Right?

Today, we’ll take a closer look (again, thanks to Erin Reed) at just one of those very bad ideas, Florida HB 1421, which drunkenly tells other states’ bans on gender affirming care for trans youth, “Hold my beer” before jumping on a skateboard and launching itself into the abyss. A Florida House subcommittee yesterday voted to move HB 1421 out of committee. After hearings in a second committee, the bill is likely to be sent to the full House, where it’s likely to pass. It’s Florida, and Republicans have an 85-35 majority of seats.

It’s not only an extremist bill, it’s also so broadly written that in attempting to outlaw gender-affirming care for minors, it also may make mastectomies for breast cancer illegal and ban hormone treatments for menopause. We can’t entirely guarantee that’s a mistake. The bill doesn’t simply ban gender-affirming treatment going forward: It would force detransition on trans youth. All minors currently receiving puberty blockers or hormone replacement therapy would have to end treatment by December 31 of this year. Such forced detransitioning is almost certain to lead to suicides, not that the psycho bigots supporting the bill care.

As ever: If you’re having thoughts of harming yourself, call the national suicide and crisis lifeline at 988.

This being Florida, the bill keeps getting worse. One provision would allow the state to take trans kids from their parents to “protect” them from getting gender-affirming care in another state.

As with several similar bills around the country, the law also forbids insurance plans from covering gender-affirming care for adults, because the bill’s sponsor, the dubiously named Rep. Randy Fine — a former gambling industry executive, not a doctor — says he believes all medical care for trans people is merely “a cosmetic-type procedure, and not necessarily a procedure that would improve their health.” Yes, of course he’s ignoring the consensus among medical organizations that transition is the treatment for gender dysphoria, and that, yes, it saves lives.

Because the bill bans the state from paying for any gender-affirming care, it would also result in forcible detransition for incarcerated trans people. The bill’s sponsor was very clear on that when another state representative asked. Further, the blanket prohibition on puberty blockers and hormone therapy would probably prohibit some treatments for stunted growth in children. Another legislator said that, as she read the bill, it may ban contraception for minors, although Fine said he didn’t think it would.

HB 1421 also prohibits any changes to birth certificates to reflect an adult’s gender identity. State Rep. Kelly Skidmore (D) had questions about why a bill supposedly aimed at “protecting” children would do that; Fine (again, not a doctor) explained that “your biology cannot be changed,” to which Skidmore replied, “Doctors would disagree. […] You can change your biology. That’s the point of gender-affirming care and surgery.”

Fine then muttered something about chromosomes, which kind of ignores the fact that hormone therapy very definitely changes a person’s biology, what with the differences in hair growth, body chemistry, and so on. But not chromosomes!

Fine went on to explain that gender-affirming care for minors is “child abuse,” although he acknowledged that’s his personal opinion, not actually a law. But co-sponsor Rep. Ralph Massullo — who somehow is a doctor — insisted it was just like “If you chop your sons arm off it’s child abuse,” so there’s a doctor who knows his stuff. Massullo also explained, contrary to the medical consensus, that since gender dysphoria is all in trans people’s heads, they should see a therapist and get cured through good old conversion therapy, which doesn’t work.

The most glaringly insane part of the bill is the former gambling executive’s medically muddy definition of “gender clinical interventions,” a term that isn’t actually from medicine. HB 1421 defines such interventions as

procedures or therapies that alter internal or external physical traits.

The term includes, but is not limited to:

1. Sex reassignment surgeries or any other surgical procedures that alter primary or secondary sexual characteristics.

2. Puberty blocking, hormone, and hormone antagonistic therapies.

The bill allows a few exceptions, such as for treatment of infants born with ambiguous genitalia, and of course for treatments to reverse gender-affirming care, but that’s about it; as House Democrats pointed out, the broad prohibitions on altering “primary or secondary sexual characteristics” appears to ban mastectomies, breast reduction or enhancement, maybe prostate surgery, and who knows, maybe even penile implants for treatment of erectile dysfunction.

But wait! Since it only applies to minors, Fine figured that wouldn’t be a problem. During questioning by state Rep. Christine Hunschofsky (D), Fine was surprised to hear that minors can even have breast cancer, though he remained skeptical of that anyway, and mocked what he said was the “pervasive problem of youth breast cancer.” Probably just an excuse to get top surgery, right sir?

Oh yes, and because it’s so sloppily written, the bill would also ban insurance from covering breast cancer mastectomies — for adults too, since the insurance ban is for all “gender clinical interventions,” regardless of the patient’s age.

Will Larkins, an 18-year-old high school student, testified against the bill, telling the committee members that his transgender friends would be directly harmed by the bill, not “protected.” He begged the lawmakers to at least agree to a Democratic amendment that would allow youth who have already begun treatment to continue it.

“That health care has saved their lives. You will kill them. I am telling you right now — look me in the eyes — you will kill them if you pass this bill and you don’t pass this amendment. […] You will kill them if you force them to detransition.”

The committee rejected the amendment, because there are no trans people in Florida, just punching bags to beat up on for the cameras.

This is where we wish we could tell you that HB 1421 is so obviously unconstitutional that there’s no chance it will pass and be signed into law, but you’ve been here for a while and you wouldn’t ever fall for a hopeful lie like that. We don’t even think they’d listen to our new hero, Grace Linn, that wonderful centenarian wonder woman. But who knows? Bet she’d make a trans lives matter quilt if she thought it would help.

[HuffPo / Florida HB 1421 / Erin Reed on Twitter / New Republic / Image generated by DreamStudio Lite AI]

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Red States About Five Minutes Away From Legalized Lynching Of Trans People

The rightwing war on transgender Americans keeps advancing through red state legislatures, and among the more notable developments is that, as many warned, the bigots who want trans people to disappear have moved, in many states, from banning gender affirming care for minors to attempting to ban or severely restrict healthcare for trans adults as well. It’s just getting uglier and uglier, as Republican legislators compete to see who can use the power of state government to most creatively make trans people’s lives worse.

The bigoted legislation is being spewed like a firehose of hate across the country, and it can be difficult to keep track of. Fortunately, the ACLU and the Equality Federation both have online bill trackers if you want to see what horrible ideas are being floated in your state.

But holy Crom Jebus Bodhisattva Hank Gritt Galactus, these bastards are busy working to genocide trans people by limiting their access to medical care, all the while lying about wanting to “protect” children.

Forget that lie: It’s about making trans people of all ages suffer for the sin of existing.

A quick review of the ongoing madness, in no particular order:


Gov. Tate Reeves signed a bill Wednesday outlawing gender-affirming treatment — puberty blockers, hormone therapy, or surgery — for anyone under 18. That makes Mississippi the seventh state to ban such care for minors, after Alabama, Arkansas, Arizona, Florida, South Dakota, and Utah. The bans in Alabama and Arkansas have been blocked in federal court, and we assume the lawsuits against Mississippi’s ban — all the others — will soon be flying too. [ABC News]

It’s worth noting up front here that genital surgery for minors is extremely rare. Top surgery (mastectomy) for patients under 18 is only slightly more common; in one of its trans panic articles, the New York Times noted there are no official stats, but that 11 leading pediatric clinics in the US reported 203 procedures on minors in 2021; it’s also not something that anyone just rushes into. State laws vary, but nearly all minor patients get extensive counseling and need at least one parent’s permission. [NYT]

North Dakota

A raft of anti-trans bills is moving through the state Legislature, including a ban on gender-affirming treatment, with possible prison sentences and/or heavy fines for healthcare providers who provide such care. Another bill would prohibit changing birth certificates “due to a gender identity change,” unless it’s to correct a clerical error. People who have had genital surgery could change their birth certificates with proof from a medical professional, which is already the state’s standard.

Still another would “define ‘father,’ ‘female,’ ‘mother,’ ‘male’ and ‘sex,’ and would mandate school districts and vital statistics agencies identify people based solely on their sex assigned at birth,” with no exceptions. The state Senate passed a bill requiring parental permission for K-12 teachers to use trans kids’ preferred pronouns. And the state House also passed two separate bans on trans athletes in girls’ and women’s sports (one for public schools, one for colleges and universities), although there have been no complaints from athletes anywhere in the state. [Advocate]


Last week, the Legislature passed a ban on gender-affirming care for minors; the vote in the House was disgustingly lopsided, 77-16, with three Democrats even joining in on bashing trans kids. Gov. Bill Lee signed it yesterday, making Tennessee Number Eight in the nation, along with that stupid ban on drag shows (Wonk link), which purportedly harm The Children.

As always, the bill sponsors insist they want to “protect” kids from being who they are. 97.5 percent of adolescents who come out as trans continue to identify as trans or nonbinary after five years, but the bill’s sponsors pushed the lie that once kids get through puberty, they give up on that trans nonsense and settle down.

As with similar bills, Tennessee’s subjects healthcare providers to criminal penalties for treating trans youth, but the bill includes this bizarre exception: Doctors would be allowed to continue treating patients who began treatment before the bill’s effective date of July 1 this year, but would have to end all treatment by March 31, 2024. Hooray, you have a year to leave the state before your transition is cut off, kids. Shortly after Gov. Lee signed it, the ACLU announced it will sue to block the law from going into effect. [CBS News / AP / Pink News]

Tennessee has even worse legislation on the way, too. HB1215, currently making its way through the state House, would prohibit private managed care companies from contracting with the state’s Medicaid alternative, TennCare, if they provide any gender-affirming health services at all, even for adults. To be clear, this isn’t just a ban on gender affirming care for Medicaid patients in Tennessee: It would ban insurers from contracting with TennCare if they offer such care anywhere in the US.

Even though the federal government covers the majority of Medicaid, state Rep. Tim Rudd (R) explained that the bill was absolutely necessary to make sure Tennessee taxpayers’ dollars don’t fund transgender care in other states. Presumably Rs will now ban the sales of car brands in the state if the manufacturers allow vehicles to be sold to trans people anywhere. [Tennessee HB1215 / AP]


On Tuesday, the Oklahoma House passed its version of a ban on gender-affirming care for trans youth and sent it to the state Senate. The bill includes a special extra Secret Sauce ban on insurance coverage for gender-affirming care — not only for minors, but for adults, too.

The bill’s author, Rep. Kevin West (R), was very proud of his work, claiming that the bill would “protect children and parents from being pressured into agreeing to harmful experimental transition procedures…” although gender affirming care is not “experimental” — at the risk of a tautology, it’s often covered by insurance, and insurance companies don’t cover experimental treatments. And that line about saving kids and parents from being “pressured” — a word that isn’t in the bill text — is a marvelously dishonest construction. Heavens, no one would ever want gender-affirming care; it’s simply that every trans person everywhere was brainwashed.

The Washington Post notes that another bill, SB 129, would go even farther, banning gender-affirming treatment up to the age of 26. The bill was originally titled the “Millstone Act,” a reference to the Biblical injunction that anyone who harms a child should “have a large millstone hung around their neck and to be drowned in the depths of the sea.” The title was stripped out Wednesday, apparently in recognition that Oklahoma is landlocked and the penalty would be impractical. [Oklahoman / WaPo]


In an attempt to outdo all the other anti-trans legislation in the country, Kentucky Republicans in late February introduced HB 470, which independent journalist Erin Reed says “takes nearly every anti-trans youth bill from nearly every state in 2023 and combines them all into one single cruel piece of legislation. It then adds wrinkles not seen in any other state.”

It has all the expected bans on lifesaving gender-affirming medical care for anyone under the age of 18, but would go even farther: It would ban Medicaid coverage, end all public funding for trans youth care, and even investigate doctors and revoke their licenses if they provide gender-affirming care to youth. But there’s even more, as Reed details:

one section would require schools to disclose transgender students’ information to their parents, and another section would ban gender marker changes for transgender youths. A unique provision in this bill would also prohibit legal name changes for youth, but only if the name change is for “gender transition purposes.”

An amended version of the bill passed out of committee and went to the full House for debate (and — spoiler — passage) yesterday. Protesters chanted “Shame! Shame!” as the committee members headed to the House chamber.

The amended version of the bill stripped out a provision that would have been a whole new front in the war on care for trans youth, by banning counseling aimed at helping kids with social transition. Apparently the Rs decided it would be too difficult to enforce, or to defend in court — who knows, really?

The now-deleted provision would have effectively forced all mental health providers to enforce cisgender identity on trans youth, by banning “social transition services,” which the bill had defined as

any encouragement, advocacy, or affirmation including pronouns, affirming a name change, and affirming “sex specific behaviors that vary from those typically associated with a person’s sex.” It then states that mental health counselors are banned from any of this and by doing so, they could lose their licenses.

Eliminating that provision doesn’t make the bill any better; it still includes all the other cruelty, including the non-counseling portions of the ban on social transition, like changing the gender marker on official documents and the prohibition on changing a minor’s name for “gender transition purposes.” Kentucky may have stripped it from the bill for now, but look for future bills that will take the plunge and ban social transition counseling. There’s no reason to think there’s any bottom to the war on trans people.

HB 470 was passed and sent on to the state Senate yesterday. [Kentucky HB 470 / Erin in the Morning]

[Image: Ted Eytan, Creative CommonsLicense 2.0]

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