Around half the members of the transgender population in Israel have been physically attacked at least once because of their gender identity and expression, while 70 percent have been verbally abused because of it, according to a new study that demonstrates that the attack last week on three transgender women sitting in a café in the Haifa suburb of Kiryat Haim is hardly exceptional.

The study, conducted by Dr. Ruth Gopin of Clalit Health Service’s Gay Clinic in Tel Aviv, and Dr. Avishai Shani, a pediatric psychiatrist at the Nes Ziona Mental Health Center, deals with emotional changes during the sex-change process. It will be presented at the end of the week at the second annual Talking Health With Pride conference in Tel Aviv that will focus on transgender people. The researchers succeeded in interviewing some 70 transgender men and women on various issues relating to their sex change, including their exposure to violence, emotional transitions, and their experiences as they sought housing, education, employment and health services.

There is no confirmed figure on the number of transgender people in Israel or their percentage of the population. Various studies abroad suggest that they comprise between 0.5% and 3% of the population. Israel is believed to have thousands of transgender men and women, only a portion of whom have “come out of the closet” or begun the process of realizing their gender identity.

This is a very weak population, even when compared to the homosexual population, which has been fighting for their rights and for social legitimacy in Israel for many years. “There’s a lot of stigma regarding transgender people. The situation is not great and we want to emerge from that,” says Elisha Alexander, the director of Ma’avarim (“Transitions”), the organization of the transgender community. “We want to follow in the path of the homos, who in the past would appear only in crime stories and whose situation today is totally different.”

According to the study, 70 percent of transgender men and 76 percent of transgender women reported suffering verbal abuse, while 48 percent of the males and 55 percent of the females reported being physically assaulted.

Nor is it easy for them to find employment. Only 40 percent of them work full time; 30 percent work part-time, while 30 percent don’t work at all. Of those who are working, most (57 percent) are earning minimum wage.

“The difficulties manifest themselves in many ways,” says Alexander. “There are recommendation letters given in the past under another name or gender that an employer refuses to accept, and at times even before that, when an employer hears a voice on the phone that doesn’t match how the person presents himself on his resume. During interviews the situation is very severe and there is serious discrimination. Even if they succeed in finding work, there is hostility from colleagues or customers and people have a hard time sticking with it.”

The health system also lacks awareness of the medical aspects of the transgender process. According to the study, 45 percent of the female transgender population began taking hormones without a doctor’s prescription, buying them on the black market. According to Gopin, “This population, particularly young transgender women, feel that they cannot get the services they need from the health system.”

According to Nora Greenberg, an activist in the community who sees many people through the sex-change process, there has been progress but much remains to be done. “There is a lack of knowledge among the professionals and a lack of willingness in the [health] system,” though the greatest difficulties are social ones, she says.