MacDonald Laurier Institute
Are gender interventions helpful? First do no harm!: David Zitner for Inside Policy
From the Macdonald Laurier Institute
By David Zitner
Canadian public health bodies are lagging far behind peer nations in calling for evidenced-based approach to gender-affirming care.
Public health bodies in Europe and the United States are sounding the alarm, calling for serious research into the safety and benefits of youth gender transition interventions. On August 12, the American Society of Plastic Surgeons became the first major US medical association to challenge the consensus of medical groups over “gender-affirming care” for minors.
Meanwhile, systematic reviews of evidence conducted by public health authorities in Finland, Sweden, and the United Kingdom concluded that the risk/benefit ratio of youth gender transition ranges from unknown to unfavourable.
According to a US study, each stage of gender affirming treatment – social affirmation, pubertal blockade, administration of cross-sex hormones, and sex reassignment surgery – poses harms and risks that are not fully disclosed to minors and families.
Regulators in Europe and the UK have already reacted accordingly, with more emphasis on psychosocial support over medical interventions.
Canadian regulators, on the other hand, have been mum on the need for evidence-based treatment and they have not even insisted that proponents of aggressive treatments track the long-term physical and mental health outcomes of gender-affirming interventions.
Doctors and parents trying to support children with gender issues are faced with important, sometimes conflicting, moral and ethical dilemmas as they try to help distressed children while avoiding harm.
For most established treatments across the various areas of medicine, researchers have studied the chances and types of benefits and harms, the research is accessible, and patients can choose based on their own values and subjective assessment the anticipated benefits and risks. It is entirely different for those who consider gender-affirming interventions.
Parents acting as agents for children with gender identity issues are in a particularly desperate situation because of the absence of reliable research identifying those children who will someday detransition. Too many parents will likely feel deeply aggrieved when they realize that what might have been a passing fancy of childhood or adolescence produced permanent, irreversible harms.
In pursuing gender-affirming care, doctors and parents simply cannot avoid harm because the evidence is insufficient to identify those who might benefit from aggressive therapies and those who will be harmed.
Unfortunately, this absence of reliable scientific research does not prevent people, including Canadian regulators, from expressing strong opinions in favour of aggressive gender interventions.
Some adolescents experience gender fluidity and uncertainty as they grow. From time to time, a person might change how they feel, expressing their identity one way and subsequently another. Such persons might dress and accept the identity compatible with their genetic identity (male or female) at one period of their life, and at other times identify with or express an identity incompatible with their genetics. Like other emotional preferences, they can change over time.
A British Medical Journal article commenting on the Cass Review emphasized that anyone who genuinely cares for children should recognize that “gender medicine is built on shaky foundations.” Citing numerous articles in peer-reviewed pediatric journals, it concludes: “The evidence base for interventions in gender medicine is threadbare, whichever research question you wish to consider — from social transition to hormone treatment. Of more than one hundred studies examining the role of puberty blockers and hormone treatment for gender transition only two were of passable quality…. Intervention studies — particularly of drug and surgical interventions — should be designed to evaluate relevant outcomes with adequate follow-up.”
Despite the opinion of some professional gender-modification advocates, evidence of benefit is scant. On the other hand, the risk of aggressive gender-transition interventions include changes to fertility, bone, and cardiovascular health, and growth. It simply must be said that tampering with a young person’s hormone levels and appearance leads to dramatic, and often permanent, harmful biologic changes.
Canada’s peers are waking up to the dangers of gender-affirming care for minors and the threadbare evidence on which it has progressed thus far. Where is Canada?
Canadian public health bodies and regulators should follow other international bodies and insist on evidence-based care following the systematic study of the benefits and harms of aggressive gender interventions. Until that study is complete, we must insist that doctors remember their obligation to “do no harm.”
David Zitner is a senior fellow at the Macdonald-Laurier Institute. He has participated at every level of Canadian health care including clinical practice, research, administration, governance and patient and professional education.
Business
Canada’s struggle against transnational crime & money laundering
From the Macdonald-Laurier Institute
By Alex Dalziel and Jamie Ferrill
In this episode of the Macdonald-Laurier Institute’s Inside Policy Talks podcast, Senior Fellow and National Security Project Lead Alex Dalziel explores the underreported issue of trade-based money laundering (TBML) with Dr. Jamie Ferrill, the head of financial crime studies at Charles Sturt University in Canberra, Australia and a former Canada Border Services Agency officer.
The discussion focuses on how organized crime groups use global trade transactions to disguise illicit proceeds and the threat this presents to the Canada’s trade relationship with the US and beyond.
Definition of TBML: Trade-based money laundering disguises criminal proceeds by moving value through trade transactions instead of transferring physical cash. Criminals (usually) exploit international trade by manipulating trade documents, engaging in phantom shipping, and altering invoices to disguise illicit funds as legitimate commerce, bypassing conventional financial scrutiny. As Dr. Ferrill explains, “we have dirty money that’s been generated through things like drug trafficking, human trafficking, arms trafficking, sex trafficking, and that money needs to be cleaned in one way or another. Trade is one of the ways that that’s done.”
A Pervasive Problem: TBML is challenging to detect due to the vast scale and complexity of global trade, making it an attractive channel for organized crime groups. Although global estimates are imprecise, the Financial Action Task Force and The United Nations Office on Drugs and Crime (UNODC) suggests 2-5% of GDP could be tied to money laundering, representing trillions of dollars annually. In Canada, this could mean over $70 billion in potentially laundered funds each year. Despite the scope of TBML, Canada has seen no successful prosecutions for criminal money laundering through trade, highlighting significant gaps in identifying, investigating and prosecuting these complex cases.
Canada’s Vulnerabilities: Along with the sheer volume and complexity of global trade, Canada’s vulnerabilities stem from gaps in anti-money laundering regulation, particularly in high-risk sectors like real estate, luxury goods, and legal services, where criminals exploit weak oversight. Global trade exemplifies the vulnerabilities in oversight, where gaps and limited controls create substantial opportunities for money laundering. A lack of comprehensive export controls also limits Canada’s ability to monitor goods leaving the country effectively. Dr. Ferrill notes that “If we’re seen as this weak link in the process, that’s going to have significant implications on trade partnerships,” underscoring the potential political risks to bilateral trade if Canada fails to address these issues.
International and Private Sector Cooperation: Combating TBML effectively requires strong international cooperation, particularly between Canada and key trade partners like the U.S. The private sector—including freight forwarders, customs brokers, and financial institutions—plays a crucial role in spotting suspicious activities along the supply chain. As Dr. Ferrill emphasizes, “Canada and the U.S. can definitely work together more efficiently and effectively to share and then come up with some better strategies,” pointing to the need for increased collaboration to strengthen oversight and disrupt these transnational crime networks.
Looking to further understand the threat of transnational organized crime to Canada’s borders?
Check out Inside Policy Talks recent podcasts with Christian Leuprecht, Todd Hataley and Alan Bersin.
To learn more about Dr. Ferrill’s research on TBML, check out her chapter in Dirty Money: Financial Crime in Canada.
Immigration
ISIS and its violent Central Asian chapter are threatening Canada and the West with jihad. Hussain Ehsani for Inside Policy
From the Macdonald Laurier Institute
By Hussain Ehsani
Recent terrorism-related arrests in Canada and the wider West are evidence of the resurgence of ISIS, and especially its ultra-violent Afghanistan wing… recently revealed internal memos by Canada’s Integrated Terrorism Assessment Centre (ITAC) highlighted ISIS’s growing role in inspiring domestic terrorism
Ten years ago, the Islamic State of Iraq and Syria waged a holy war that threatened to engulf the wider Middle East. At its peak, ISIS conquered nearly 200,000-square-kilometres of Iraq and Syria, inspiring thousands of jihadis to join its crusade against the West.
It took a global coalition of 87 nations and groups, led by the United States and including Canada, to defeat Daesh for good. By December 2017, the damage was decisive: ISIS had lost more than 95 per cent of its territory. The coalition members celebrated the defeat of ISIS and thought it could no longer pose a threat, in the Middle East or anywhere else.
The moment lasted only a short time.
Recent terrorism-related arrests in Canada and the wider West are evidence of the resurgence of ISIS, and especially its ultra-violent Afghanistan wing. At the same time, recently revealed internal memos by Canada’s Integrated Terrorism Assessment Centre (ITAC) highlighted ISIS’s growing role in inspiring domestic terrorism, and in particular, potential “lone Wolf” attacks against Canada’s Jewish community.
The memos – issued on June 24 and July 10, 2024, and later obtained by media – were prescient: On July 31, Canadian police detained two alleged ISIS-affiliated men in Richmond Hill, Toronto, apparently based on a tip from French intelligence. In September, the RCMP in Quebec – working with the FBI – arrested a Pakistani national on a student visa for allegedly plotting an attack on a Jewish centre in Brooklyn, New York. These events were especially shocking since it was widely believed that ISIS was confined to Iraq and Syria. But ISIS is clearly influencing a new generation of terrorists around the world. Indeed, it’s suspected that ISIS inspired, and possibly directed, a plot to attack the Jewish community in Ottawa last February. Police arrested two Ottawa youths in relation to the alleged plot and charged them with attempted murder.
American authorities have also thwarted ISIS schemes, resulting in the arrest of ISIS-Tajiki operatives in the US earlier this year. The arrests continue: On October 7, the FBI apprehended an Afghan national and a juvenile co-conspirator for allegedly planning an attack under the Islamic State banner on November 5 – the day of the US presidential elections.
These US arrests point to a new trend: the rise and global reach of the Afghan branch of ISIS, known as the Islamic State-Khorasan Province (ISKP). Some background is necessary. ISIS officially emerged in 2014, following rapid territorial gains in eastern Syria and northwestern Iraq. Rooted in the ideology of Salafi Jihadism, ISIS sought to establish a “Caliphate” governed by a strict interpretation of Sharia law. The group declared its leader, Abu Bakr al-Baghdadi, as Caliph in June 2014 after capturing Mosul, Iraq’s second-largest city. This marked the height of ISIS’s power, controlling large swaths of Syria and Iraq.
As ISIS entrenched itself, it began expanding its influence beyond Iraq and Syria. Various affiliates, known as “provinces” or “wilayat,” emerged worldwide. Pledging allegiance to the central ISIS leadership, these groups dedicated themselves to establishing a global Islamic State.
That is one reason for the group’s resilience and recent resurgence. The ISKP was one of the most deadly branches to emerge. Founded in southeastern Afghanistan in 2015 on the border with Pakistan, ISKP immediately sought closer ties with the core ISIS group in Syria and Iraq to gain legitimacy and embolden its fighters and middle-rank commanders to conquer more territory. Those efforts came up short, and ISKP failed in its first years to win ISIS’s support.
Since then, ISKP has redoubled its efforts to impress its ISIS masters – and in many ways, it has succeeded. The group is now among the strongest of ISIS’s adherents.
Turning Point
The collapse of the former Afghan Government on August 15, 2021, was the turning point, when a host of transnational extremist fighters were released from prisons of Afghanistan. Aside from rejoicing about the withdrawal of foreign troops from Afghanistan, they prepared to take up their “holy duty” to expand ISIS’s regime. ISKP initially in 2015 drew its fighters from disaffected and wayward elements of the Taliban, Haqqani network, and Pakistani Taliban. The release of an additional cohort of Salafists (Sunni fundamentalists) aided its recruitment.
ISKP moved quickly to expand its influence and operations. The first attack in this new era was devastating: it stormed the Abbey Gate of the Kabul Airport on August 26, 2021, killing 170 Afghan civilians and 13 US soldiers. The US Department of Defense later released a report that Abdul Rahman al-Logari, one of the prisoners released on the day of Kabul collapse, was behind the Abbey Gate attack.
The message was clear – ISKP was on the march.
ISKP on the International Stage
To gain “formal” admission to the ranks of ISIS’s provinces, ISKP would have to show initiative and capability, not just in Afghanistan but in the wider territory of Khorasan: Iran, Tajikistan, Uzbekistan, and the eastern part of Turkmenistan.
To do so, it had to find new targets. Traditionally, the Hazara community, the most persecuted ethnicity in Afghanistan, was the main target for Islamist groups, along with former Afghan security forces. They remain primary victims. However, ISKP’s range of targets and ability to strike them has grown. It added new targets in Afghanistan, attacking the Russian embassy in Kabul in September 2022, and a Chinese facility in December of the same year. Then it started reaching beyond the borders of Afghanistan: ISKP has carried out terrorist attacks in Central Asia and plotted a number of them in Pakistan.
Targets even farther away have now been hit. In January 2024, ISKP executed a complex attack in Kerman, Iran, at an event commemorating Qasem Sulaimani, the former commander of the Iranian Islamic Revolutionary Guard Corps (IRGC) Qods Force, killed by US forces in 2020. On March 22, 2024, it hit a concert hall in Moscow – an operation that took the international community by complete surprise.
These operational successes mattered, but ISIS’s core leaders in Syria and Iraq demanded signs of ideological subservience as well. Under the leadership of Sanaullah Ghafari (also known as Dr. Shahab al-Muhajir), ISKP worked hard to prove that its propaganda machine is an engine of ISIS Salafist ideology.
ISKP uses fluency in a variety of languages, including Urdu, Russian, Tajiki, Uzbeki, Turkish, English, and Pashto, to spread its message. It seeks to extend its ideology to other fighters in the region in order to recruit transnational Salafi Jihadists. It has already recruited a vast number of terrorists from the ranks of the Islamic Movement of Uzbekistan in the north of Afghanistan. ISKP also exploited propaganda and demand from the diaspora of Uzbekistan and Tajikistan to plot attacks against Western countries.
The attacks and ideological efforts seem to have worked. ISKP now appears to have become the operational wing of the core ISIS group. After the ISKP attack on Moscow, an ISIS spokesman released a 41-minute audio message praising the attack by “Mujahidin” and called on other “dormant” provinces of the “Caliphate” to rise up and follow ISKP’s example.
The terror spreads
ISIS leader Abu Hafs al-Hashimi al-Quraishi has more work in mind for his prized ISKP group. His priorities include freeing jihadists detained in Syria and attacking targets in Europe and North America.
In Syria, Al-Quraishi has encouraged ISIS terrorists to redouble efforts to attack the Syrian Democratic Forces, a US-backed Kurdish militia in the country’s northeast, and try to break detained comrades out of SDF-run prisons. These facilities host thousands of ISIS fighters, including women and children. Given the success of ISKP’s operations and recruitment, ISIS is likely trying to implement the same tactic of jailbreaks in Kurdish territory in Syria and Iraq, to replenish its ranks.
ISIS spokesmen have also called for all Muslims to attack Christians and Jews in the broader West.
In September 2024, Türkiye’s domestic security agency (MIT) arrested Abuzar Al Shishani, who allegedly was plotting an attack on Santa Maria Italian Church in Istanbul in early January 2025. According to MIT, ISKP recruited him in 2021. The arrests in Canada, the US, and Türkiye are proof that ISKP’s reach is growing.
How can Canada fight back?
Canada and its allies in the West must act now to counter the terrorist threat posed by ISKP and ISIS. Fortunately, the RCMP and other Canadian police forces halted the recent spate of planned domestic terror attacks. However, stringent immigration screening is also crucial to keeping Canada and its allies safe. The Canada Border Services Agency needs to be ready to deal with the ISIS/ISKP threat.
To that end, Public Safety Canada should examine ways to enhance inter-agency targeting and intelligence sharing. A task force consisting of Immigration, Refugee and Citizenship Canada, Canadian Heritage, the Canadian Revenue Agency, and FINTRAC – given their respective roles in immigration processing, countering disinformation and anti-terrorist financing – could help to ensure maximum coordination against the group.
Canada must also guard against the threat ISKP/ISIS poses to religious and minority communities in the country. ISIS’s call to target Jewish and Christian communities presents a special challenge. The Jewish community is particularly vulnerable due to the rampant antisemitism seen at pro-Hamas, Hezbollah, and Iran rallies across Canada. But Christian sites, like churches, are also vulnerable. ISKP/ISIS are also likely to target Muslim groups that speak against its violent ideology.
Canada should collaborate with international partners to support communities and groups opposed to ISKP/ISIS. These include the Hazara, Kurdish, and Yazidi communities in Afghanistan and Kurdistan, as well as allies in the Kurdistan Regional government, and the Syrian Democratic Forces. Canada should also support initiatives led by the Kingdom of Saudi Arabia and other Gulf Cooperation Council countries to strengthen the voice of moderate Islam in the Middle East and Central Asia. Such initiatives require careful diplomacy with allies and a range of partners. That is what Canada will require to counter the evolving threat of ISIS and ISKP.
Hussain Ehsani is a Middle East affairs analyst with expertise on the Islamic State and al-Qaeda in Iraq and Afghanistan. He is currently exploring the foreign policy relationship between Saudi Arabia and Canada. In addition to MLI, he also contributes to the Jerusalem Post, BBC Persian, and The Hill.
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