Earlier this month the Malaysian Health Ministry launched an original “arts” project. It invited young men and women to enter a video contest on “the harsh side effects” of being gay and trans by submitting videos to warn the public against them. The condemnations weren’t long in coming, but the ministry explained that it was merely an exercise aimed at increasing young peoples’ awareness of issues related to sex and sexuality, and there was no intention of offending any gender group.

Malaysia is not the only Muslim country in which being transgender is considered an illness, and not just any illness, but one brought on by Satan. On his home page, islamqa.info, the Islamic legal sage Sheikh Muhammad Saalih Al-Munajjid, answers a question about Muslim law’s attitude toward someone who seeks gender reassignment surgery after doctors agreed that it’s necessary so that he can marry. “A person is forbidden to change what Allah created. If the Lord created him male he will never have children,” responded the sheikh. “Indeed, there are doctors who violate this rule to appease the deviants and to deceive them into thinking they can become women. But such a man will never really be a woman. If a person feels inside that he is of another sex, that’s not a reason to change sex he must be satisfied with the will of God and treat his soul with faith and obedience.”

Al-Munajjid is one of Islam’s most active online preachers and religious scholars. He has published dozens of books and frequently appears on television. In other words, he is not on the fringes, but rather someone who represents the main stream in orthodox Islamic discourse.

In Pakistan Islamic scholars have also ruled recently that “The best way to heal this illness is to force transgender people to marry. Regular sexual activity will make them forget their illness.”

The oppression and persecution of transgender people in Muslim countries is based not just on religious law, but also – primarily – on social norms that regard those who “don’t like their gender” or who are “sexually confused” as not just sick and deviant but also dangerous people who bring shame to their families.

Egyptian media recently reported on a father who murdered his son because he wanted to change his gender. In less dramatic cases, young people look for ways to leave their native lands and move to the West. Nada al-Qadi is one of them. Her story was recently told on the website Rasif 22. She is pictured there in full face and tells of her desire to find a “sexual shelter” in Egypt or elsewhere.

Through her story one can learn about the lengthy process those seeking gender reassignment surgery must go through to do the surgery legally. There are only two official institutions in Egypt permitted to approve such surgery – no other hospital would dare perform such an operation without permission because of the legal problems that would ensue.

A special committee of the Egyptian physicians association and the most important Islamic law center in Egypt, Al-Azhar, must together approve the request. But because there are no clear criteria or regulations that obligate these institutions to make decisions in a timely fashion, applicants can sometimes wait years before their case is even discussed.

As in any field with lengthy legal bureaucracy, Egypt also has a “fast track” for transgender people. There are private clinics, dubbed “stairwell clinics,” where sterility is dubious, the medical equipment is paltry and the person doing the surgery is usually a specialist in some other field. According to data published by the Egyptian newspaper Al-Wattan in 2014, an operation under these conditions cost 16,000 Egyptian lira, which in 2014 was worth around $2,000. Today $2,000 is 36,000 Egyptian lira, a sum equal to around 25 average monthly salaries.

Another burden is the inflated cost of the drugs transgender people must use to facilitate the sex-change process. Given all this, one can understand why an estimated three in 10 transgender people in Egypt commit suicide.

There are aid organizations that provide transgender people with emotional and legal assistance, the latter primarily dealing with changing one’s documents after gender reassignment.

These nonprofit associations operate through social networks but do a careful vetting of all those who make contact to assure that they aren’t government agents or anti-transgender activists. These groups also help homosexuals and lesbians who suffer persecution. But these groups don’t have much power or money, and are forced to maneuver between various legal clauses that, while not prohibiting same-sex relationships, do forbid the promotion of “abominations,” which in the eyes of the law is what LGBTs do.

The police could raid the offices of these groups at any time to obtain the names of “suspects.” In fact, police limit their focus “only” to those areas where LGBTs are known to gather.