The Court of Appeal has upheld the conviction of Mohammad Alazawi for carrying out circumcisions on boys at their parents’ request for religious reasons, ruling that fraudulent claims about his medical qualifications nullified parental consent and rendered the procedures unlawful assaults. The appeals court also ruled that even absent misrepresentation, performing circumcisions in a manner significantly deviating from competent non-medical standards, thereby exposing children to unnecessary risks, could constitute wounding with intent. Additionally, the court found that Alazawi’s administration of local anaesthetic without proper medical credentials was an unlawful assault in itself.

Alazawi, who was not medically qualified, offered a mobile circumcision service primarily to Muslim families, conducting the procedures in their homes. His method involved injecting local anaesthetic at the base of the child’s penis, then using a "Plastibell" ring to remove the foreskin—a recognized technique. The prosecution contended that Alazawi fraudulently misrepresented himself as a doctor or surgeon, inducing parental consent under false pretenses, which invalidated that consent and made the circumcisions unlawful under section 18 of the Offences against the Person Act 1861.

The prosecution further argued that the procedures were performed in unhygienic conditions, including on carpets or kitchen tables without sterile coverings or properly sterilized equipment. It was also noted that Alazawi failed to maintain acceptable hygiene practices such as handwashing before putting on gloves, and was aided by untrained teenage assistants. The administration of anaesthetic by a non-medical person was highlighted as a serious breach of safety standards.

At trial, Alazawi was convicted on multiple counts of fraud, wounding with intent, and assault occasioning actual bodily harm. He was acquitted on some counts. On appeal, his legal team acknowledged the safety of convictions linked to fraudulent misrepresentation (termed “route one” liability) but challenged those based on the alleged unsafe manner of performing the procedure (“route two” liability). They argued that expert medical evidence relevant to hospital or clinic standards was inappropriate for assessing religious circumcisions performed at home by a non-medical practitioner, and that none of the children had suffered lasting harm aside from one minor corrective intervention.

The Crown’s counsel rebutted these points, emphasizing the unsafe, unsanitary settings and the illegal administration of anaesthetic as factors that exceeded any reasonable standard for non-medical circumcisers, changing the nature of the act from lawful to unlawful.

The Court of Appeal found no basis to overturn the convictions related to unsafe practice, ruling that the jury had been properly directed and that the convictions were safe. The court clarified that while ritual circumcision is a lawful exception to assault prohibitions, the scope of lawful conduct depends on whether the procedure was conducted by a competent and careful non-medical practitioner without exposing the child to significant and unnecessary additional harm. The injection of anaesthetic by Alazawi, lacking medical authority, independently rendered the procedure unlawful.

The appeal did result in a reduction of Alazawi’s prison sentence, decreasing it from nine to six years. The court delivered its judgment in July 2026, with the original conviction dating back to May 2025 at the Crown Court at Southwark.