"Banned by Silence": Provider stigma, systemic decay, and the inaccessibility of gender-affirming healthcare in Morocco

The historical context of gender-affirming healthcare (GAH) in Morocco presents a paradox. While Casablanca emerged as a global hub for such medical procedures from the 1950s to the 1970s, access to care was not available to local Moroccan citizens. Currently, transgender and gender non-conforming (TGNC) individuals experience what can be described as a "ban by silence." Although there is no explicit legal prohibition against GAH, its accessibility is effectively undermined by institutional neglect, inadequate medical education, and pervasive socio-religious biases among healthcare providers. This research aims to generate empirical evidence to inform advocacy and programming related to TGNC healthcare rights. This qualitative participatory action research study is grounded in in-depth, semi-structured interviews with 13 TGNC individuals who have sought GAH in Morocco. Participants were recruited in collaboration with a local transgender activist to foster trust within the community. A thematic analysis of the interviews was conducted to identify significant barriers and personal experiences related to accessing care. This analysis was further contextualized through a comparative review of informal care networks in Egypt and Lebanon. The findings indicate a complete absence of GAH within both the public and private healthcare sectors in Morocco. The healthcare environment is characterized by hostility, with inadequately trained providers often refusing care, attempting conversion therapy, or erroneously citing legal prohibitions. Consequently, participants are compelled to resort to unsafe, unregulated hormone therapies without medical oversight, such as the use of birth control pills. Systemic discrimination in education and employment results in considerable economic precarity, with many individuals engaging in survival sex work. Compounded by familial rejection and social stigma, these conditions render life in Morocco untenable, compelling migration as the sole viable option for safety and access to essential medical care. The legislative void in Morocco operates as a "ban by silence," a phenomenon that remains underrepresented in academic literature. This study seeks to address this gap by documenting the lived experiences of TGNC individuals navigating this de facto prohibition. The research advances a participant-led call for urgent reform, prioritizing three key areas: the establishment of legal and accessible pathways for medical transition; mandatory training for medical staff to eliminate discrimination; and the creation of affirming mental health services. Future research should continue to illuminate these invisible barriers to dismantle the systemic neglect that denies TGNC Moroccans their right to health. • Morocco’s ‘ban by silence’ effectively restricts healthcare access for transgender individuals. • State neglect forces TGNC people to seek care through unsafe and unregulated medical networks. • Providers often deny care by citing non-existent and inaccurate legal prohibitions. • Migration is seen as the only way to safely obtain essential medical care and safety.