Why was a struck off doctor able to keep circumcising boys?

Earlier this month, former doctor Mohammad Siddiqui received a five-year custodial sentence having been convicted of actual bodily harm and child cruelty relating to the non-therapeutic circumcision of boys between 2014 and 2019 . He has also pled guilty to administering prescription-only medicines contrary to the law.

Siddiqui ran a 'mobile circumcision service' and operated on boys ranging from neonates to teenagers across the UK, including dozens of children from Muslim and Christian backgrounds.

He was struck off in 2015 for performing "botched and unhygienic" ritual circumcisions. A medical tribunal described his practice as "callous and completely unacceptable".

Nonetheless, he was able to continue carrying out circumcisions: there is no legal requirement for a circumciser to be medically qualified or registered. Non-medical circumcisers are unregulated, meaning a child can, for example, be ritually circumcised on a dining room table, without anaesthesia, with no medical documentation or follow-up.

In one case, a 15-year-old victim of Siddiqui had to be admitted to hospital via ambulance for surgery after he began to bleed following the circumcision.

Police found a "hook and serrated wheel" with rust and skin on it among Siddiqui's medical equipment during their investigation. Many of his instruments had not been properly sterilised.

Siddiqui would often begin the procedure just "a few minutes" after administering local anaesthetic, meaning it would not have time to take full effect.

Crown Court judge Noel Lucas KC said the case showed that "safeguards and protections must now be put in place and put in place as a matter of urgency, to ensure that babies and young children are protected." [Emphasis original]

The grim episode raises numerous troubling questions. Firstly, why are doctors permitted to surgically remove healthy erogenous tissue from the genitals of boys without medical necessity in the first place?

Even if ritual circumcision does enjoy a presumed exemption from the law against wounding, it violates well-established norms of child safeguarding - not least that children should be protected from medically unnecessary surgery.

If parents expressed a strong desire to surgically remove any other healthy part of their child's body, doctors would rightly treat that wish as a safeguarding concern. There is no coherent reason this should not be the case when that body part happens to be the foreskin.

The law does not accept cultural or religion reasons as a defence against other forms of wounding of children: ritual scarification, ritual flagellation and female genital mutilation to name a few.

Unfortunately, permissive guidance from the General Medical Council and the British Medical Association provides cover for doctors to perform this ethically and legally anomalous procedure.

At least the latter admits: "the evidence concerning health benefit from NTMC [non-therapeutic male circumcision] is insufficient for this alone to be a justification".

We should be in no doubt that circumcision is not a mere 'snip' of a 'flap of skin'. The foreskin is a highly specialised structure - akin to the eyelid or the lip – richly endowed with Meissner's corpuscles, the same type of nerve endings which give the palms and fingertips their high sensitivity to light touch.

Indeed, the NHS website lists "permanent reduction in sensation in the head of the penis, particularly during sex" as a complication of circumcision. British Association of Urological Surgeons guidance concludes that reduced or altered sensation will affect 'almost all patients'.

A second question: if a doctor like Siddiqui is deemed no longer able to safely carry out a circumcision, why is that same individual – having been struck off the medical register - legally permitted to continue carrying out circumcisions as a 'non-doctor'?

In effect, being struck off the medical register actively enables doctors who have been deemed unsafe to perform operations to continue to perform the very same operations as a non-doctor. This runs counter to all other legal, regulatory or safeguarding principles and practice.

There is no comparably invasive procedure that we allow non-doctors to perform. Yes, Surgical Care Practitioners exist but they will have some healthcare training, and are supervised by doctors.

Yet ritual circumcision is often performed in entirely unsuitable surgical settings – in the case of one of Siddiqui's victims, on a dining room table – without anaesthesia. A circumcision FAQ from the website of the Jewish Medical Association, a registered charity, states: "No formal anaesthesia is given routinely". The circumciser may have no medical background at all.

To be explicit, this is not a call for the medicalisation of male genital cutting: Circumcision is a surgery; surgery is inherently dangerous; surgeries should only be performed by doctors (or those under medical supervision), and – in the case of non-consenting children – only with medical necessity.

But it does raise a third, and final, question: if Siddiqui has seemingly been convicted of child cruelty related to inadequate anaesthesia, what then of those circumcisions where no anaesthetic is used at all? Surely legal coherence demands those circumcisions also fall foul of the criminal law.

The appalling harm wrought by Siddiqui highlights the urgent need for boys to be protected from circumcision. Religious convictions, no matter how sincerely held, cannot justify the medically unnecessary genital cutting of children.