Doctors’ Law: Circumcisions

1. Alazawi v R. [2026] EWCA Crim 947 (23 July 2026) – penalties for contravention of criminal law. The Defendant’s sentence on appeal was reduced to six years’ imprisonment. Case Summary:

1. Background and Offences

1. Mohammad Alazawi, who was not medically qualified, performed non-therapeutic male circumcisions on babies and young children, mainly within the Muslim community, at the request of parents for religious reasons.
2. He provided a mobile service, conducting procedures in family homes.
3. He was indicted on 51 counts, including fraud, wounding with intent (section 18), assault occasioning actual bodily harm (ABH), offences under the Human Medicines Regulations 2012, and possession of articles for use in fraud.
4. He pleaded guilty to several medicines offences and was convicted after trial on 20 counts, including fraud, wounding with intent, and ABH.

2. Prosecution Case and Trial

1. The prosecution argued two main routes to liability:
   1. Route One: Fraudulently claiming to be a doctor, which vitiated parental consent and rendered the circumcisions unlawful.
   2. Route Two: Performing circumcisions in an unsafe and unsanitary manner, exposing children to unnecessary risk, making the acts unlawful regardless of consent.
2. Evidence included testimony from parents, expert witnesses (a surgeon and an anaesthetist), and materials seized from Alazawi.
3. The defence argued that Alazawi did not claim to be a doctor, performed the procedures safely, and was unaware he was not permitted to administer medicines.

3. Sentencing

1. Alazawi was sentenced to a total of 9 years’ imprisonment, with sentences for fraud, wounding, and medicines offences structured both concurrently and consecutively.
2. The judge highlighted the scale of offending, deception of parents, unsafe procedures, and unauthorised administration of medicines as aggravating factors.

4. Legal Issues and Appeal

1. The appeal challenged both conviction and sentence.
2. Key legal questions included:
   1. Whether it was proper to allow the jury to consider Route Two liability (unsafe procedures by a non-medical circumciser).
   2. Whether expert medical evidence was appropriate for assessing non-medical religious circumcisions.
   3. Whether the administration of anaesthetic should be considered separately from the circumcision procedure.
3. The Court of Appeal found that while the use of medical standards to judge non-medical circumcisions was problematic, the unauthorised administration of anaesthetic by Alazawi was so far from what a competent non-medical circumciser would do that the convictions were safe.

5. Outcome

1. Conviction: The appeal against conviction was dismissed. The court held that the use of anaesthetic by a non-medical person was sufficient to render the procedures unlawful, regardless of other procedural shortcomings.
2. Sentence: The appeal against sentence was allowed. The Court found the original 9-year sentence excessive due to double-counting and overlap between offences. The Court of Appeal reduced the total sentence to 6 years, with all sentences to run concurrently.

6. Broader Legal Context

1. The judgment discusses the legal status of ritual circumcision, consent, and the boundaries between lawful and unlawful harm in the context of cultural and religious practices.
2. The court noted the lack of regulation for non-medical circumcisers and suggested that clearer standards or regulation by Parliament would be preferable.