Health Care in Cambodia

Because Cambodia's population density is quite variable - some provinces are isolated and mountainous (Ratanakiri), and some are populated and fertile (Battambang) - the country's health care needs and services vary greatly. Cambodia's population is approximately 8 million, with about 800,000 people living in the capital, Phnom Penh.

Under Prince Norodom Sihanouk and the French, a basic but rudimentary health care system was in place. During the Sihanouk and Lon Nol regimes in the 1960s and up until 1975, bombing and guerrilla warfare raged in the countryside, especially near the Cambodian-Vietnamese border. Population shifts occurred from east to west, and from rural to urban areas. During this period, the population of Phnom Penh swelled from about 25,000 to more than one million.

From 1975 to 1978, the Khmer Rouge attempted to return Cambodian to a model agrarian society. There were widespread and continuous population shifts from urban areas throughout the country. The entire health care system was destroyed: equipment, supplies, and personnel, along with major infrastructure: transportation, power, water, sanitation, and irrigation. One of the greates losses was people: of a population of about 7 million, 1 to 3 million are estimated to have died under Khmer Rouge rule. Many of those who perished were people with higher levels of education. Only 45 medical doctors survived, and of those, 20 left the country. Only 26 pharmacists, 28 dentists, and 728 medical students remained in Cambodia in 1979.

In 1979, the Vietnamese-backed Heng Samrin government, the People's Republic of Kampuchea (PRK), was faced with a disastrous situation. But reconstruction began, and now health is one of the government's five priorities.

Lack of adequate water, sanitation, education, transportation, and communication have caused huge problems in the development of the health system. The most common diseases in Cambodia today are related to problems with water and sanitation. In 1979, many people who came form the countryside to Phnom Penh were unused to urban living. Efforts are still being made to educate the population about health and hygiene.

People in remote villages in the provinces have difficulty obtaining health care. Besides geographical and physical barriers, trained health personnel from Phnom Penh are reluctant to be isolated in distant locations. Many provinces lack antibiotics and other medicines; many do not have cold storage facilities, so vaccine distribution, already difficult due to transportation problems, is next to impossible.

During the last decade, continuing warfare has caused further population movements. Thailand now shelters 325,000 refugees from Cambodia. Other Cambodians travel temporarily to the Thai-Cambodian border area to trade or to look for gems in Pailin. The PRK's K5 (border defense) program created temporary population movements to the border area, which have affected the spread of diseases such as malaria and tuberculosis.