HEALTH CONDITIONS IN CAMBODIA'S PRISONS

Physicians for Human Rights American Refugee Committee

Columbia College of Physicians & Surgeons

Physicians for Human Rights Boston + San Francisco

Clopynpht ( c ) April 1995 by Physicians for Human Kights A11 rights rcsenTcd. I'rir~ted in thc Irniked States of A~ncrica.

T-ibrari of Congress Ca!czlog Card Nwnbcr 95-68458 ISBN: 1-879707-18-7

C'ovcr design: Glen11 KI I~L~Y I~UAI Communications

I n jet photo: Innlc~tr i l l t-rll door, I'rr~\l V P ~ Q Priror~. 771r ~cindo\t* !.i rlw onl! s o r r nf' lr,yhr ( : p l ~ l \ . ~ ~ t ! i i I ( l f l O ~ ~ I!! / f l P ~ P 1 1 .

Phys~cians fur Human Rights ( P t I R ) 13 an organ17ation of health p ~ c ~ i ~ s s i n r ~ a l s . scier~tijts, and c o n ~ ~ r n e d cir i~cns which u x s the knowledge and (kills of 111u rned~cal and fcrrrnric' s c ~ mctx& to ~nvest~gate and prc\+snt violat ion\ of rn ternational hi1 111an ngll t s rid humrln~tar i ~ n ],AM.

Since 19x6, I'HR rnrmbcrs h a w w u r k d to stop torture. di sappearanc,cs, and pol~~ical k l l l i n s \ hy govcrnmcnrs and o p p s l t ion g roups to I lilpruve health and 5;initai-y condi tiorls 111 prison r and detention ccnlerc; to invert ipatt: the physical and psyc hol~7:lc.Y conseq ~ ~ C T I C C E of' i iolatio~~s ol' hurtiani tarian law in i n tcrnal and ir~lcrnatlc~niiI COII tl ic ts : d~1'c:?CI r n d ~ c a l i ir~~tral it? and 111c right of C I vi1i;inx :~nd con~hariinth tu rccci L c t-t.~sdii;il ciirc d ar~rlg ti~ncs 01- war: to protect 11eallh ~ ~ r o t ' e s s i o ~ ~ a l ~ uho are i'iuti~ns of \*iolatintls ol' t ~ u t n ; ~ n r ight \ ; and to preimen~ ~ncclical c o n ~ ~ ~ l i c i l v i n torture ail(! othcr abusr\.

PHR cnr~duct$ cducariona! and [raining prcqects for hzalt!i protkcsic~nal~. rrieniht.rl; of thc jn~!iciarv. artd hui?lnn rights ~ d v c ~ a t c s on the application of r-nctiic~l 311ti fc)ri ,r l~ii skills i n the invu\tig~t~nrl ot' \.ic-llai!o~~s of human r~ghts. PHK l-ralich its actions ijn thc I :nivcrs;h

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Dcclaratinn of Hurna~l Kighls mil othcr inltlmational h~1nlal.t rights and hiir~~;~r~~titr~:in ;igrei.mcnls. Thr clrganization a~lhercc; tu a policj of strict i m p ~ r t ~ a l ilq m d i .j coni.crried M i th the mcd ical conscq~icnc.es ot' hurnarl n g h ~ s abuses rcg.irdlcss of' thc idtolopjn of' t I I C (? t't'c~~diily, cot'trnmcnt o r group.

I'I1:irlcs (l:!cmcr~ts. hl. L). 1,s 1)rcsi cie111; Chrola Ei9cnhci-g. PI1 . D, is \'i;.c, I ' ~ L \ s i~121;(: Ilrl ; Stove.: I , , I ~ ' i ~ i ' ~ ~ t l i - c I ) i r ~ ' ~ f ~ r : Susanilah S i rk in is Dcpi~tv Dirc'ct~or; Kart Hannihal 13 hlc'~~!i~c*r\!li[) ~ t l d T i l i ~ ~ a t i ~ ~ r i C'oordi~la~or: Gina VanJtr1.i~op is T ) c ~ ~ c l n ~ ~ i u ~ ~ ~ ~ r Dircctnr: I3nrllara .4! o\ic i h Scnior Pro~mrn 12sso~ i i i t ~ ; k'inccnt Tacopino, hl . I > . I \ \i ch5rcril Rc'g!~)r~a\ 111 I-r~:or; anil (-'lyiic C . SIIOM . P4.11. i5 SCII~OT I ; L ~ T C J I < I ~ ' C'otl\~l\tar~t

l ' l ~ \ , ~ i ~ i , ~ i - ~ \ t'or H u m i n Rights 100 H o q ls~oil Strcc t, Sui t t t TI12 T 3 0 ~ t O l l < 3I:l 0: 1 lo '1-2: : ! 6 l 7 ) 695-0041 I--ax: (6i 7 ) h95-0107 L: mail: p l l r~15aGigc. api..org

Thc .A~llcrican Kt.( ugce Uoi~lrni ttee (:ZRI') is a pr iva~c , nun- proli t , non-ssctari211 s u l u ~ ~ l a r y agcnct \4 hich work$ for the su rv r~ al, health, arld well-being o t ' rcfugct>. displnccd pwple. arid others affected :hy event\ 17e)011d their control. Tt ~ o r k s with rcftlgses arid o ~ h o r s to rchuild productive 11vcs of dignity and gurposc, strii,ing always :il respect t l x values of rhohe it scrves. ARC' ];as provided nledlcal care, both prevcr~tive mi! curative. and medlcal training for refugees and Iwal populations i n numcrou5 ,4l'riC;~rl. Asia!] and 1'urr)pc;tn i ~ u n trics.

ARC \sas :r~i~ially cstahlishzd in 1979 to assist i n the r t ' s~ t ( l c ' i ~~~ t l t 01' rcf:igee f';irniiici i n the hlinneapolis and rl!icago areas and to send a r~~cdical tc;jrll to '1 11aiI:tncl 10 a\\isl rofuyecs t'rt71i1 Iac l c and Cainbdia. AKC's \c.opt quicklv t.xp;lrldzd lo n(1dri.s~ lllc 11ceiis of rcfr~gees in first as) lum countries.

hlnrc recent1 y . ARC: has ir~iriated health car2 progri\Il:i i11 rcse~t lemcrlt cuurl trii.3 as part u l ;in ciforl 10 bring about a srablc and marc pcrmnt?cnr sol ut i r~ t l [u rhc 171-ohlcrn+ f i i ~ c d 1,v rchrurtlccs arid t t I C 10c;iI pop~~lations. -l'i~c~c: yrogrl-lm\ empha\i/c. rlc.vult?j~mcnt sir,itt.gi~s !hat are sustair~able. This lits i n wit11 IIKC-S rni\s~on of w~vh i t lg f o r thc sc~r\ iva!. hcd?iil and \vc\l-heii?g of ' rcfugcc's and sccki 112 to etr!pclumtr r tlc111 to r c h u ~ Id p r u ~ l u z i i ~ c 1 1 ~ ~ 3 .

Anrtlo!l\i J . Ko7,lo\r 3bi i j I'rch13~tit arid V h i z i IT\ecuti; 2 Ot ' f j~ i '~~ : hnrcn Jotinsun l:lsl~a;ll y I c I-lirector r i ! ' Iorcrr~atior~si I'ropram\; hllarl K. I-Iolr~:stcn I S L)ircitor ni' 1 jriarlce and !ldrnir:i\tratio11: aucj hI icliael J . Kci11t.v i s Ilireu~or o f I k l rlopmc111 d ~ ~ d I'i~hl ic' :I t'f'a~rh. T3ri;iil Hcidc.1 is Co111::ry i l~rcc-lur . Car-rlbodia: hI\ . K h o u S r ~ r n a l l ~ c a \ . i I \ .:\ssistntlt C'cl~lntry L3ircctor. ( :arnbodi;t.

11 lncrr cari l?ct '~l~t 'e Corn tnit t t ~ 2.U-L Yicolltr :l\~cnuc 50~1111 hlinneapulis. >IN 55434 'rci : ( 6 1 2 ) 872-7000 ] :ah: (61 2 ) S71-330~i

Prisoncrs in any society are vul r~erahle to our ~ ~ c i r s t ~mpulses. Kcmm.cd iron1 public view: thcy may be denicd adequate food and health caw, housed i n insani t l ry and dcgrad~ng conditions, or s~ibjectcci to cruel disciplinary practices or torture. Opcnncss is the best preventive of such abuses. But many governments are u n w ~ l l ~ n g tu opcn their jails lo publlc scrutiny.'

'l'hc prlson conditions u r ~ c n bed in this r t ' p r l . 1i101~gIi appat l ~ n g , are n o t s ~ ~ r p n s i n g . I:an~t~odia is a war-lorn ctluIitry strib-ing ro rcbuild i n the fate of c o n ~ i n u ~ d conllict. and i t s prisons are hardly a priority.

Ijailv i i fe for most Carnbodiani i b a rtruggle to sur\,l\,e ngiunst t r t .~~ l t .~~dous odds. ! The Unitcd Naliorls Dcvcloplnc.:~t l'rogram me ranks Crlmhadia as 136th of I td! coirntries 111 tcrmx of' " huruan dcvelopnlcnt. " 1,ife expectr~n~y at birlh is bc luu 50 yearc (cornpared wilt1 K . 6 for thc rc~iclri o f Snuth-r;lst Asia and Ocmi?iaj.' hlorc thdn half o l C',irr~hodian hou~eholds are h~.;lcicd by widowcd or abandorlcii women. Thc ~rddihonai extcnclad family support svste~n 1 x 5 bccn destroyed. "One in t i ve c'hildrt'n dies bclclrc thc apt: of tiryc \,cars, most1 v R S a i ~ l l i l ~ l l of vac~ine-pre\~enlahIc discastls, dcng~~c. . and dehydration d u e to diarrl~ca. hlatcrnal ~nortijlity ranks among chc highest in thc world.' Cambodia hcars thc ('~irthc'r d i i t i r ~ i t i r l r ~ of Ilavjng one r3f thc world's highest Icvcls ot. annual risk of ~r~fcct ion hv ~ubercu lo~ i s .~

-' Set , \ n w 1:. Golcli~lcl, "Tuhcl-culr)~r.; and Pair crty In cam hod^^. " t z ~ t i m o n h~.fi>rc ttw C r ~ n g r c . - - ~ ~ > ~ \ ~ l Hunger C ~ u ~ , ~ i s . I ,chruar>- 1 0 , 1944.

', A ~ ~ , o r d ~ n g t l > Ihc U'r)rlcl H r s l t h Organiu,ir.r~i, rhere Mere 15.589 nl.\c L~.L, . ot tuhc~i ulr his ( T B I in Cambcdia i n 14Y.t. \\hic.h i s the hi;lll,.t rate (1) IIL.N T H c a w s in tht \\(.~rld

,Iftar near)!, t;l:crllj. :,:cars c3f iirmtd co~ l f l i c t , C'amhrdia's r icc paildick ~ n c i rcj ,~du,~)l ; arc rww littered w i t h t~urtdreds of tl~ousands of land mincr; and 11nexp1r)dcd urdr~ancc. ' Thchi. ind i rc r i rn ina :~ rc1111lnr.t~ 1.4 war s o n t i n ~ ~ c to ki l l or maim kiindreds C'amtlndians rach ycnr. - l ' t lq0 have also lctt largc trac[s of land b1ightt.a: r~lak~t?g ~t imp~l>5iblc tor t';irr>lcrs to work their land.

Against this backdrop of discase. poverty, ana war. onc coul;I arguc that making III~:ITOLL'~I~CR:S rn priw?113 is a c ~ s t ( : 'a l l~hi) i \ ~ - I I I C I I I ~ ~ [ d o [ICN cause e.icc.ssi\e suffering. . L.ach ol' t~rnds i s no tscusc for arq g o ~ . c r ~ I ~ ~ I t i l t tn utbiccr its ;;ri/cn\ rn suhh l ln~~r , cclnd~r~n;l\ that no t r3nls i i t ~ l a r c r l ~ ~ t ~ i : i ; ' r ~ g h t s but 111ini mai s:andards 01' dcceniv as u cll . '

'rhis rcpo1-! docuinenrs a p ~ t t ~ i - 1 1 C I ~ ~ ~ ~ i s t r ~ a ~ l ~ l c t l t C ; 1 1 1 1 0 ~ - ~ d 1 ~ ' 3 prb\(>[ji tllat ~ r ~ c l u ~ l c ' ~ btlatirly\ of ric.taincc5 d u r ~ n g intct-roga~iol~; cx;reulc cwcrcrt*wdiny: s:~acklir~c .. and othcr illegal !uuans of p h y j ~ c a l r~.hlralrIt: dcsa;;rng l)\~ildincs: :.nd c ~ i t ~ r t l u u i ~ i g scytiLe j : \ t ~ ~ r n s and ol~ci~ ceu,cr.h. I kc\e ~~71l(iitionc;. coupted i v i t h thc lack of accc5c (of' pn;c!ricrs lo prnpcr meclical care, 11,th I. r ~ , s u l tcil In a 171;l: i n~ . i Jcncc ,,r bcriljcrj, r ~ i l ~ c r ~ ~ l w ~ ~ , r c % ~ . \ ~ r r i ~ i e cii;irrhca, a~ici 5k.111 cl~i~asc!,.

Tjv a:!!. ac.i:cl-,xed 3!~11darc l \ , whc':her thca Cn~tcd Natio~i\ St;lrl~i;tr,~i 3li1l.1nirrn Ru.cs l ~ i r ti:: ' l~rc,iri~~ctir r r i Pr~,rmcrs. aduptld hv C:arbndia i n iC392. or dii) o i h c r critct-ia. thi ' prlsnn i r l11~ll!ii7rl5 d ~ 3 i r j b c ~ 1 I I I r l l i j rclxlr[ tail !)claw rllc 1 2 ~ ~ 1 r:i' J C L ~ tic; . Hoi i > - ~ \ o I I ; ~ ~ ) L I ~ ~ . ~ I I ~ J I . I ; ) ( L,I:L~. t t?ix 5t~1d-j L V L 1 1 t j 1 !IAL c ~ C L ~ I I cot-tducrcd x.it!lt:ult t!.e ful l zonpdr a:~cbtl o1' thc i ' a -nhoil~ar\ authoritlcs, tt'r hopi ' thc t'itiding~ url'icrltcil Peru uill lllotlipt I nc ra i~ ihod~nr; ;occrnrricbnt ru ir~iti;?tc rrn1lic4iatc~l~ ~:t ' t ;~rt~\,f ; ~ n r l t l l i ;~- l ; i r l~ 1~risurl rciot-.i~s.

Betlvccn March and J u l y of 1934: a mrdical t e a r n as~~1l1hlc.d by Phvhician\ i t ~ r H u m a l l Rights ( P H R ) . the P r o g r a r n 111 H r ~ i n a r ~ Rights ;ind hicdicirle of C ' o l ~ i i ~ ~ h i a i'c7llcgc P I - Physicians & Surgeons, and the :lmerican Refugee ('curl 1n1 r tui: (ARC') \ i u ~ l i e d heal111 condltlorls i n thirtccn prisons throughou~ Carn b d i a . ' 'Po obtar n ii hr~l;?d gccyraphizal sample, thc team cisited tivo prisons i n thc capital o f Phnom Penti a t ~ d clei.ct~ 11-1 Carl~bodia's

1 11 twenty-one provirizes. Thc invcsligation was coriduckd i n cc~>rd~i!,ttion u i ~ h I he Priwri Assi~tance Progranl of tne United Nat~cins Ct'ntrc lor Human Rights i n I'ii~nbodia (UNC'HR)l l and wit11 the L'ooperaticln of the Prisons Department of C'ambodin's 121i11i\lry ol' Interior anci National Security (hsrclnaftcr the hlinistry oi In~cr ior) , Tn addl t i o i ~ . tile rnedic;il team met on two crccaslons with hiam R u n i ~ e r l g , bI. 11.. U ndersecri.Iarv of S tatc for Health ;it the hlirlistry of Health. ro coortlinare thc t'stigal~rln.

In each p r i s o n , 1!1c trlarn presenrd n ttircc-iiay s~n l i i~ , i r o i l h i ~ r n a n nghtk for pris.m officers, Ilirh-ranking pol i cd ~wrsonncl, and j u d ~ c ~ ~ l ofiiuial?;. I .l,iistsrl of- t i i t r~ frctlrl tllc Prirorl D e p a r t ~ ~ ~ c n t acco~npan~si i the tear11 on cat-h t isi t and ~ ~ . C I . C I prcwr11 during h r i c l i ! ~ g $ with prov~nulal author~lies.

TI:c 111diual tcarrl Ir,ren icu'cd prov ~nii;ii policc authon t l e h . prison dircc.tc!r.s, provincial g~wcrn ~ncn t offic.i;il\. pri si7n uihccrs, 2nd ~rl~lIa!i.s. :'\L*CC>$ to the I>rison ';;lei l ~ t ~ c s arld prisonci-5 % a \ u n h i r i d c r e d and i r r ~ l I ruilcd ~n all inmnces. u.lr h tllu ~ ~ i c p t i 0 1 1 ol' I'rjliie- Jtidiciairt. (PI) pnwn \n P h n o m l ' c~~h . whcrc l11e ICAIII requl red addit ioil;tl ~.i.lorciinaiion w ~ t h police dficials i n :hc i;ipltal in szcurt. repcarcd access. '1-11t tcaln was iinahlc io I 11 \,esligatc.

' In O L L ~ I I ~ L * ~ I W 4 . 5hd;Ia hl PO~~I I ILI I I . \ \ I l l ) L I I I - ~ : L ~ \ tlw I ' r ~ ~ g r ~ i n ~ In I I i i t ~ l . i r ~ H.iglit? A ~ I J \lL,Ji.:i~~~, t1:c C o l u m h ~ ; ~ Cilllcg? rlt. P h y s i ~ , ~ a ~ j x k Surgc.c~ri\. rncl w ~ t h I'ctbrr r n r ~ d l i f lr, t j t : t ~ c Prt - o r 1 ~ , . J . ~ A ~ L L , Prorr-iiin nt t11;. Cnited S;itiun\> Ccntrc Iilr 1 l u n j a n R~ght.: 111 C'ati~ho(l~;i ,i!iJ I 3 1 1 x 1 K C I ~ L l 1 ) I I \ \ < Xrn;.r-~, arl Krttlgc.,. '', lrlltntttcc 10 arranyc 101 I ) r . Giihricl Utter tnsrl ILQ \ k t 1 1 h ( I J I t h t y l ~ n n . t i n - ~ c s \ m ~ . i i t of i~ea l t t l , ~J[I. .~IIIC'I:I ~ I I CLIT I~~X:L \ :~ ' \ r r i ,on\ .

I . I ? pn.;on and I'J pl-lbon ::rc I~?iatc.rl In tilt. hL,nrl of I'h~iorn Pcnh. ' 1 r y r I . ~ ) I I ~ \J.L,I' 11: r r ~ ~ , prclx 1n . a i;~\.ility tor ,- r~l i l ~ c ~ i i l trl~tl;. i3r-l\tlnc,rL L n ( m n a, Troprunr P h l o l ~ g priw:1, cr l r i~r l~nnl) rviLrr~.d ( 1 % ;is TS. In rura l Iiljrnpirrl:. Charn pro\ In,-',. ij;tttiimban; pr ikl):~ 111 Hatramhang provln,,~:: P r ~ r l i t pnkon in l'ur-:~r plt!\lnc.t.: Kr~rnl~or?g 541~1 pn.kr)n in K o l n p ~ ~ l l ; SOI:I prr,;Inzc>: Sitrrr Reap p~ lhrln In S I L . ~ Real, pr(r1:lli.c.. Kc~nrpong Cham y n w n 111 Kr)tr~l>l > I ~ C (;llarn [ , I ( > \ lnl L,; SL ;i! K ~ . - n r prl\l>n Svay Rireng l ~ ~ i ~ \ ' i n v c : ;ind Konlpong C'tl hnang pn.kon In L,!nipong Chhrlang y1!11 l r i~ ; . . NII lnllr !nry prlbonh or detzntldn r'aC~lrt1r* drc 1 1 1 i l 1 i c l d in t h r ~ t u d y . I 'hc t , r~ l> - I>rl.;rln i ~ l r rrul~tar) pct w 1 1 1 ~ l 13 in tlw -1 oul S11.11~ c I ~ - t r ~ , t tit t'hn~)m Penh. T h ( j ~ i g l i th f nlr~Ji..al !earn I I \ I ~ ~ . J the pnhon 1 b 1 1 three o ~ ~ i ~ ~ j ~ ~ l ~ s . i t ~ , a - n61i ~i~c.luclcd In the ] , I - L + ~ ~ F ~ in \ ,es t~gat lun. '4 " \ t t . lc (~l tung ii icil i~> " lrlr r clntrgr;iticm OE t;h:~icr R(~LI;'L. dct;-,,rl\i \ :rl I'i~tionl Pcrlh 13 11, ,i i l a s s ~ f i d a> a yri-on ty t t l r g ~ n ~.rnrnent and lihc-~+ 1.2 \va\ nt)l in~iuclccl in rhl-

priron conditions i n Areas of Carnbodia that were controlled hy the Party o f Democratic Kampuchea (the forlllal nanlc for the Khmer Uoi~gc), nor Isurc data available on such prisons. Similarly, therc was no i n forttiation o n conditions in cliu~dcstine prisons."

In each province thc tcarn visited thc provincial hosp~tal and interviewed thc director and staff o i the hospital or, i n sonlc cascs, provincial o f t i c ia l~ of the hlinistry of Health. it 'hen possiblc police, or pr ism healrh officers charged with health care in the prison were intemicwed. Iiitcrnational and Cambodian r~ongovern mcr,t;lI human rights organizations and age~lcics pro\ iding hcal t l ~ semici.3 i r ~ thr prisons were also crlntacted in r a ~ ! ~ province.

7'hz mcdical team bnefed the local prison director un the mcthod of sclcir~on of a rando~n sample of prisoners, and on the team's rquiremen:~ for pr~vatt: inten.~cws. Apprux~suately f i ve percent of innlatcs here sclcc!d f rom each prlsun vjsitccl using a set of random numbcrs gcneratd by misrocomputer (Epi Info 5.0 1 ). :I total of eighty-six prisonerc parl~cipated rn tht: sturiy. T h c numbers 7~ c:c rnan~~all y coilntcd through the prison rcgister. all(! lrimatcs who ni.itchhed thc random nunlher were ~dentificd.

The meciica1 team did not d i i~ l~ lgu i sh hstwccn ccl~~t'ictcd and unconviuted prisoners in thcir inten!icu,s. Prisoners ivrrc unlv askcd about thcir status and chargcl, i T any. at'icr the intenicu. 'i-he ch r l r~es against the prisoners rangad from pctty theft to murder. None of tllc randomly-szlccted priso~lcr-3 had been charged with political otknseh or claimed ro be political prisonrr\.

l'risoncrs randvmly se1ectt.d for the ~ntcrvrcw wcre asAed ~f they uould like to participate m d werc hrier'cd on Lhc intenizw proccss. 111 no 111slancc c l ~ d a priwncr declinc n n intcmicw. although phj-s~cii l sxaminalion was declined f o I l o \~~ng Ihc Inwn icw by une Ternalc 111 tnate. I r ~ ~ c r v i c w ~ took place outside vf hearing range of prison officers in an arca sclecrcd by the medical team withi rl o r i nlmediately ou tsidc the priwn compound. Liaison ufficer~ with tJw hlinisrry of Tntcnor wcrc always outride of hearing range during tht. in~ervicws.

Thc medical tca111 u5cd a slruc1u:cd que+tionnairc: (scc Appc:ldix A) for thcir inten ~ c w s adaptcd for use i n Cambodia frnm a qt~estic?nnairu dei iscd by Pi IR to srlldy health uond~rrons i n prison\ i n Haiti and in Israel nrld Lhc Occapied Tcrritoric$." 'l'he questionna!rc. which Ma\ translated into K h m c r b) rune o f the team m c ~ ~ ~ b c r s . W J ~ based on

' See R i t ' I - 1 R i r i t i , I l i Rcporr r > l ' thc S~.~,rctary G~.n~ . ra ! . I!nitcd hat~onbC;~,neraI A s c ~ ~ r i h l y Rcpor~ Ar33i635. h'ovcmhcr 3 , 1993 for a rtport un c~ne \ t . i i ~ t prison. D e t a l j ~ or1 olle clanll~.\t1112 prihon Lr'crC repc~rtcd by Kaii. Tha!er In thr f'!~notn Pr:,rh Por!. J u l y 1994.

the guidelines for prison care set forth in the United Nations Standard Minimum Rules for the Treatment of Prisoners (see Appendix B). When necessary, the quchtionnairc was administered in Vietnamese with interpretation by a UNCH R team mcnlbcr.

Members of the medical t c a ~ r ~ were Gabriel Otterman, M.U., who ~ o r L e d i n Cambodia from January to June 1994 as a Clinica! Fellow i n Human Rights arld hledicine, Center for the Study of Sociery and Medicine. Columbia College of Physicians & Surgeons, New York, and Senior Arsistmt Kesldcl~[ i n hledlclnr. Children*, ~ a \ ~ l l a l . Boztun: Sin Kim Horn, a medic and coordinator of the Heal th and Human Kightc Edi~catiotl Project of thc American Refugee Committee in Phnorn Penh. Cambodia; Sam Sophsap, A medic and coordinator of the Health and H r ~ n ~ a n Right5 Eriucat~on Project oi thc Amencan Refugee Committee in Phnom Penh, Cambcdla: and Ste\,sn Spencer, h i . D . , F.A.C'.P, a P H R consultant and the former Med~cal Director. New Mexico Corrections Department. New Mexico. Between March and J u l y 1994. Kurnar Vcndantlla~n frost\ the Program in Human Rights and Medicine of CoIumbia Collegc of Physicians & Surgeon$ :isiivc'd he rl~r'dical team.

Dr. Otterman returner1 to Cnnibd ia i n January 1995 at the i n \ itatinn i l t tllc LrNCHK Prison Assistance Program. Resulla of the medical team's lnvesllgatlon were prt3\cnteci i n a four-day seminar on "'The Srale oi' Cambodian prison^" in Phnom Pcnh on January 24-27, 1995. The seminar was co-sponsored by the Ministry of Interior, thc Ministry o f - lus i i~s , and UNCHR. Kepresentatives from the Ministry of Health, the hlinistry of Justice and rl?c Ministry of Intcrior participated i n the seminar, as did rcpresentati ves oc proviricial governors, and offices of provincial police commissioners. Intcrnatiorlal and Carnbod~an nongovernmental agencies providing health services in the prisons wcrc also invited to participate. " Dr. Otterman and representatives from ARC conducted follow-up visits to sir prisons: PJ and T prisons in Phnom Penh. Takrnao prison. Koinpong C'hhnang prison, Pursat prison. and Hattambang prison.

I d "State nf Cambodian Prisons," a four-day szrmnar hcld in Phnom Penh, January 24-27> 1995, spi,nxt,rc.J by the Prison Assistance Program, Cambodian Office r)f- tht. UlrJ Centre for Human Right>, the Ministry of Interior, and the Ministry of JusIi~t.. Sw "Dwlarrlt~c)n on the State of Can~hodian Prrsons" ln Appcndls C.

~ ~ ~ m b p ~ . of the prisot~ers ill thr prisons s ~ ~ r v e y r d arcor-di~tg to prison rcccrt-ds tile 1 ilnr the nlcdic.ni t car11 visits.

1 # o f Ilctai rice V i c i t Date # Case I L'risoners S t ~ ~ d y

( ( 1 I Svny Kieng 6R 2 6 32 4 3; 1 /93 6 I I I I I I

1 6 l I J r c y S a r 1 47 1 0 1 5 / 2 ? 1 4 1 1 56 1 9 - 7 Kg. I lhhnang 46 3 3 13 3 5! 17/94 \

R ~ i c : 111 thc case stlid, r~uiribcr o f Xh thew ;ire: 4 Victnan~est. ( 1 I 'cnl~lc, 3 ul;ilc, 1 Sing;l]?~:rc rllalc: 5 Ca!-l~t,odian t;.tl-ralc.i

kist111 Population f 995 Kumbcr of prisor~crs according t o prison records al Ihe date of thr visit

I 1 1 0 Kompong Sam

!in s : l m ~ ~t pr~sto!: Date Fc '~~ IJ~c 1 i Ier : i i l~r .~ j CI-GiT

I l 1

Pursat ? , ' l i05 1 31

S 1 c 111 Kciil)

60 I 18 4 1

7 0 9 2; 2 1 6'6!94 1 -t 6/20/34 1 7 8

PRISON C0NI)ITIOSS A S D THE TREATMEST OF PRISONERS

Since the UNTAC period, Cambodia has had one of the lowest incarceration ratcs in the world, approximately twenty-one prisoners per 100,000 population. However, it is likoly that the numbers of those incarcerated for criminal offe~~ses will increase as the Cambodian govcrnmcn t reforms i t s judicial system. There are already indications that rhe prison population has begiin to rise at an alarming rate.

The Koyal C;o\'cmmcnt of Ca~ilbodia maintai~is twcnty-four civilian prisons throughout the coclnlry. 111 January 1994. I h e P n s a n Dcpartmcnt of !he M i r ~ ~ s t r v of Tnterior reported that lhosu l'a~ililiei held I .779 prihoners:" 01' these. h6J inmares (37 %I j had been sentenced ancl 1.115 (63%) \

is often cunsiderabIc traffic of visitors. The nlcdical team mcmbers wcre allowed to meet with prisoners i n Ihcir cells vr strnll with i n m a w about thc courtyard. One dncs not ~ r c e i v e an clvrrall ~dversar ia l relationship betwwn the prisoners and lhc guards: ra!l~zr, cooperation appears to be the norm. Svrne prison compounds. likc Prey Sar and Battambang, have attractive courr yards shaded by large tropitril tree\. ' I ' h i 5 outward appc:il disguises the n d l e s s suffering ot' inmates Illat takes place wl th i n.

On April 20, 1994, a large number of priulncrs cscapcd frorn the Iic>nlp)ng Cham provincial prison through the rotting tilc rrwr'.'" The lntnates had bccn r.rou8ded into the more sccure cel!s, leaving others ricatby enjpty . The F'ri9on Dircctvr arid h i s two deputies wcre both dctnoted in thc afterinath of the escape. I n a follow-lip L l s i t to Kclmpnrlg Cham prison in January 1995. U N C H K staif r c p r t a d ~llai sixty prisoners arc nok kept i n a higher security structure utlder conditlun\ of extremc oivcrurowdin~. Thcsc 11ci+, cells art: in a building that was planned as a prison infir~nary , but h;ls now been co~~vertsd i n l o a cell block.

I n Komyclng Chhnanp? prison, 111e rcar or the main Frcnch ('olotl~al hui ldlng contai11s holes in thc hrick wall through which pnwners ha\ c. c \ capd . ?'lit. rrlcdlual t a r n ohscnlcd that each hole had a nt~rncral abme it ranging frrbrl~ onc to ti\ t.. Primn offic'crl; explained thar rhc n u ~ l ~ b c r c refer tu thc nr~nlbcr c ~ f prisoners who havc cscapcd thri)c~;h that p.lrticular opening. Two of thc cell\ in the inain huild~ng ucrc not in ilsc duC ?o the lack of' sccure cell walls. Security g u ~ r d s ~r~~iicared th;it thcy rout~nclv shackled prl scltlurs dccmcd to he a sccuri!j risk in t h ~ s :incl other priwlns.

Takmao prlson in handal prc~vinic 13 locatcd nn thc outl;l,ir!h ot P h n o ~ n I'cnh. Originally an old cnttoll-u ool factory. thc l'acilirl; was convcrtc.cl 111 tu a prisn!? i n the 1980s. A n iron-har grid i j fastened a s a rl~akcshift cri i ing atop brick walls. Overheid, a tile roof provides mini I : I ~ cover d~ i r ing the rainy wason. In the Casility, pnsoncr5 arc ruutinely subjectcrj K\ 5evcrc overzrowding and prolonged h o u r \ of con fi llt.i~~en t I I I cage-11 ke stri1cturc.j for thcir initial years of ~rnprisnn 171cnt.

Mvsl of t hc C:amboclinn prison officials ill t c n ~ i ~ w c ~ l bv the medical tcarll accepted and supprtcd the basic cr,ncepr$ that arc ir~lportanl to prison henlt 11 care and uoritilrnl with [he Sta~liIai-d hliniinui?i I iules: adeq~tate space, ventilation. lighr. itn nit at ion. r:iitrition, iind access (o nlcdical c;irz.

Durir;g thc invcsligation in 1993, the team found that condi!ions in the Pol~ue- Judiciairc (PJ) Prison, czt in the ht.irt of the capitnl of Phnorn Prnh. w r c : u ursc than any other prison t h e y had vixited in Cambodia and clearly i n iloiation (IT tht. St,~rldard hlin' ? m u m

T h e exact numher nt' t.,>capcd pnwjncr.; ua\ not c>onlirrried by p n u m ( r i i i c ; ~ I < , hut 1, rhtlnlxtt~xl at ~ f t ~ t ! - fl vc.

Rules. The prison, built in 1937 as a short-term p l i c s lockup designed for thirty to forty Inmates, was housing 2 16 prisoners at the tlme of the team's vibit i l l hidy 1994. Overcrowding was so severe that some inmates reported having to sleep on the overflowing latrine. Thc inmates rccei\wi only one meal a day consisting of rice and llrin soup. D~arrhea and skin diseases, such ah scabies. fungal infections, and abscess were commnn, and prisoner-on-prisoner \ jolence was high.

After their second visit to the prison, a consensus wat reached among teain members that it would not be appropriate to delay reporting, and the t a m decided to release a preliminary repon on conditions in P3.31 The rewrt callcd for the immediate closure of the prisotl pending renovation of the sewage facilities. The report was made available to the Cambodian government and garnered attention in the local and international press.

In June 1994, Cambodian h a d of state, k ing V o r d o n ~ Sihmock, responded to thc report in a lettcr from his residence in Beijing (scc Appendix FI. 'She letter callcd on \he government to "release, for humanirarian reasons, the very sick prisoners.. .and more particularly Ihose who, in general, F,ave not corn~ni~ted serious crimes, or ~,iolent crirnes."

Within a month, the Cambodian government had begun to rehabilitale the facility with financial support from the Australian govern mcnt, arrd technical asslstancc from the international Committee of the Red CI-oss (ICRC) and the Prison Assistance Progra~r~ of IJNCHR. The goiernment gradually transferred over 150 inmates, releas~ng some fifty prisoners, to Icss crowded facilities in Prey Sar, Tropeung Ploeng, an^ T3. In-kind I enrtvations undertaken by thc Koyal Cambvdian Government at the three pnson i where prisoners were rccervd.

The medical team was invited to tour Pd Prison with prison ufficials In February 1 9 9 tr) review the renovations that were undertaken by the Royal Government of Cambodia. The prison population lrad not exceed& thirty male inmates during the intenrcnir~g period. No lnnger were detainees held in the corridors. The cells were regularly cleaned with antiseptic solution and were newly w:hjtcwashed; ventilation and light had dralnaticall y improved, with barrcd doors replacing solid metal dmrs, and witldows were enlarged. Structural changes were made to the cells to allow prisoners to sleep on elevated platforms. ?'hc sewage systum had been completely ovcrhaulcd and the latrines wcre clean. lnmatzs were now provided with mats, uniforms, and supplies to maintain personal hygiene. M ~ ? l s were provided twice each day.

" S S ~ Appendix E h r the PI I R report, Hralrll Cwdiriorls rn Police-J!uiicinirr Pri.ron: .4 P r ~ l i r r r i r ~ n n Rcpot-r, which was r~ lused ~~mul taneous ly with u report on PJ pnhcln by the Un~tdJ N a t ~ o n \ CcnLrc tor Human Rights in Phnom Pznb. S e e United Nations Centre For Human Rights. PJ Prison: A Sigrt@cor~r H u r ~ ~ n n RigJ11.s i.rsut*, P h n ~ m Pmh, \ lay 1993.

Number of clinical encounters ui th prisoners in P j prison hy m o ~ ~ l h , 1994. Thr numbers r c f l t ~ t the reduction O C prison population during governrnunt- ordered reform in June 1994.

February

March -.

April - hlay

Jun?

Sdptenibcr

Octobc'r -

TOTAL 1,374

(Fron~ Rt~pporf < , -o t~ \~ i / i ( ~ i~ i l ~ l . r P I / PI l j - t ) ) f , M d t x ~ n k du hlondr. 1'tmo111 Pcni:. January I'1u5). Kcprinted u'lth pc.rtnlh\on

1'3 Prison Renovat ions

Upon returning to T3 Prison in early 1435, the medical team found that the renovations, undertaken in-kind by the Prison Department w11h assistance from the Austra)ian Government, were evident. Clvcrhaul of the city water supply. which allowed [or shortages only during the dry soasun, included access to greater volr~mes and instal la ti or^ of a rescrvolr. According to the prison director at 'I'.?. the amounl of water u,as now adequate despite a substantial i~~crzasc in the number of inma~rs. A n infirmary wa5 opencd by the international medical organizaliorl, Mkdesins du Mclnde, in Dccembcr 1994. The prisorl dissctor stated that there was added stress with the transfer of approximately ti-inery innlates from 1'1 during the summer months of 1394; however, thc prison officials w,erc eqclipped 10 provide for thc increase in popula~ior~. The prisvn director cited a n e e d for further rer~or~ations."

'' An overhaul r l l t h ~ hvwagz c>htcn~ at T3 1.s n d d . t.ocd shnrtagc,, result~ng trom the drla)t.d relcaw ;rt food allowanccc hy the central govcrnmrnt to the Pnwn Depaflment. are drs~rthzd lalsr In th~.: report

Prison Administ rat ion

Prison adniini stratinn in C7ambodia i s ~iirrcntly under t h r crrr~ trol of thc police rathcr than the Ministrv of Justice, which rcfiectc the lack of a subs~ar~tive transition i n golrcrnment fro111 thc pcriod of thc SOC regime."

Of thc twenr v - f i ~ u i civilian prisons i n f amhc~l~a . thrcc are unacr ~ h c direct adn~inistratiur) of the I1riron Departmen1 cut' thc Ministrq* of Interior. 'I'ilcrc prisons are 'r.7 Prison i n Phnnrn Penh, Prcy Sar Prison 111 Kompclng Spwu prtnrinc.e, ar~d Troptung I ' l~ lo~~g

!cmatn. Prison ( a l w Lnoui~ as T5) ill rural Kornpong Charn prnvincc along thc L ~ o r d ~ ~ r with V - The latter facility is a highcr- sc(uri ty prison for convicted prlsoncrs. '1-hc rsmai ning twenty- nne jlrisons art iinder control o f local Deputy C ' c m ~nissioners o i Police. to i v ? ~ i l r ~ ~ the dircctclr of each prison ruports. The pro\ irlcial policc (om missioner ha5 broad a~~thorily i~~dcpcndent 01 central Ministry o f Interior administration.

'The iidrnin~stration or C,ambcxila'5 prisons exist\ In a slatt. ot- t lux and co~lfuslurl ;i5 t l~c resy~orlcibllity for t h o prisr7ns and rhc priwners rests u .~ th thrcc ~ninistriu~. Ir.cal got'crnin~llt, and i c i ~ ,~ l policc co~npt.t ing f o r cuntrol.

Tn F c k r r i ~ i r ~ 1993. rhc Koyal C;ovcrnmcnt issued a d i r c ~ : ~ i i , ~ . sal lcd Or cli na~lcc 3 1 ," which, a l t h o ~ r g h ~ntcnded ax a me;lsurc of' ~ r ~ i ~ l r i t ~ o n from policz tn ci\:il ad1ninistr;ition. 0111) added to cr)n l u s ~ o r ~ ovcr IIK go\ c.rnr

According to the UNCHR report,35 the duties of the inspe~tor include two site visits each month and verification of numbers of pretrial detainees, living conditions, segregation, sanitation, and health matters. Though the medical team was able to verify the practice of inspections in the provinces, i t discovered that the role of the Ministry of Justice is largely ineffective, as prosecutors' reports appear to be treated as internal correspndence among judicial authorities and are rarely seen by Ministry of Interior personnel .3h

I n January 1995, the Ministry of Interior props& a change in the administrative structure of the Ministry itself -- the Department of Prisons would be removed from the Police Department and reyort directly to the Department of General Administration of the Ministry." With the exception of salaries and promotion, all matters regarding prisons are now proposed to be outside police administration. This policy has yet to be implemented.

Prison Population

The following are demographic data dtlrived from the mrdical team's siirvey describing the prison population:

Gender and Age

Eighty-six inmates wcre intemiewed: 81 men (94%) and 5 women (6%). ' f h s mean age was 31 wars (range 16 to 57. standard deviation (SD) = 7.3).

2! -30 3 I-li) 4 1-50

ACC t year?)

35 C l r ~ i t d N B ~ I O ~ S Czntre for Fluman Rights in Cambodia, St~:!c of C'irmhrdrtrm P~.i.r,~t~s, p. 20.

'' General Na Sainp H~eng, "lhe Adrn~n~drdt~on o f Pnsons," a yrrrcntat~on ar the ycnlinilr "State 17t Carnbd~an Pnsons, " Fhnom Penh, January 2 5 , 1905.

Nat iorlality

Ninety-three percent were Cambodian nationals, 6% Vietnamese nationals, and one inmate held citizenship in Singapore (n=86).

Ethnicity

Khmer 89 %

Ninety-seven percent identified themselves as Buddhist, 2 % as Muslim, 1 % as Catholic (n = 86).

Marital and Family Status

Sixty-four percent were married, 22 % were single, 12 % were divorced or separated, and 270 were widowed (n=86). Sixty-three percent had childrcn, 37% stated that they had no children (n =86). Of those who had children, the mean ~iutnbcr was 2.8 (n =54, SD= 1.8).

Education

The mean number of years of education was 3.4 (n=86, SD=3.1). Twenty-seven percent reported no education, 46% completed some primary school, 23 % some secondary school, and 3% were educated by other means (n =85). None of the prisoners had attended higher education beyond high sc hml.

None

I.cvel o f cducar ion

Literacy

Eighty percent reported ability to read (n =86), and 66% reported being able to write (n = 86).

Tin~e in Prison

'Thc mean nurnber of months s e n d ar the time of the intcniew h a s 33 (n =86, SI3 = 37). For prctnal dctainees inlewiewed hy IJNCHR. the median pcricld of current incarcerati~n whilc. awaltlng lrial was five months. tha~~gh 19 % nf pretrial detainees were nfiartirrg crral for more thar~ tumc-l~.e rnclnths (n =3h). Two of the prisoners rsponcd impr~sonment f ~ 7 ~ 108 months (rime years) without tnal .3Y

Rule 8(a) of thc S~ai~dard Minimum Iiules provides: "In an institution for both Inen and women. Ihe pat of thc institution sut aside for women shall he under 1F.c authority r3 f a rcsponsiblc wornan officer who \hall hr~ve the custody of the keys of all o f - thar part o i the institulion."

Tn violations of these s t a ~ ~ d a r d s , won-lei1 inmatcs. in prisons studiul by thc medical tram. are ~ i n d c r t h c supcn,~>:on male pnson guards. In genera: Ihcre is ilnimpedcd access to umc)mcn pri enners. 111ah1rlg t hcsc pnsaners particular1 y vult~erablc. to a h ~ ~ s e . Onc woman, ir~carccrated in a I'hr~om Pfnh prison and intcniewud for the study. reported being raped repcdlcdlq by two pol ICC c!lt-,ccrs ift~ring rntcrrugalion in Kornpung Cham province i n 1 W2. A n~alc prisoncr in Phnom Pe~lh, 2130 in the studv sample, rccounteil that 111s wiuc, whu had bccn rcsentlj ruicascd from derer~tion. 11ad b c c ~ rapcd hv intcrrognt ing pol iCc of'f?cers.

According to blinistry of Interior rocords and the results of' r hr: I'HR sunlcv, M,orncn ~mnpr i sed npprosl t~~alcly 5 ')A of the int-r~atc poprrlatian. In gcncrr-11, a,ornt.n u urr afforded hcttcr living vondi t ims than incn, and in most pn sons wcre not sul)jectt.cl to scvere n\,crcrcl\vili np . ?'ypically. women were hi-used 111 one scll, exzcpt i n Kompvng Clmm prison :vhcrc they here wparatcd hy cthn~clly: thrw l.cfnalu prlsoncrs of V ictnai-11t.s~ etl~rlic~ ty u crc hnurcd in onc c.t.11: six K h m e r iemale inmatcs were housed i n a ,?'lother ccll.

Prison officials frcqucntly stated thal fcmale ininales were g i i m greater t'rccdoin thai~ I I I . TIIC ~ncdical tsanl clhwruxd thar u,omen w r c Icss rcqtriuted in their ~llovcmerts orl thc prison grounds than 111en. HOWCL'CT. it] the ~ t l i d ? sample. only o11c wornan out of l'our u ; i s allowcd to work. Givcn the sn~al l numbcr o f fc~nalc inmates, this d td 11or di l f c r >tat~~tic.aIIy (1.r11il tlic perccntagi: ol' rlicn 1% Ilo i~ crc ill l~ lwcd rr ork (p =U. 23 1 xilggc5tlng that, i n rcgard to access to work, \

The Case of N.T.

N.T., a 23-year-old ct l~nic V~ctnarnese woman held ill a provincial prisvrl Ilrar t Ile border of Victnam, illuxtratcs tbe nsks women face when they are not propcrly scy;iraIcd from male inmates and guardh . At thc timc of the inlerview, N.T. had sewed tim years of A fourteen-year scntence for allegedly n ~ u r d c r ~ t ~ g a child in hcr care. She had no contact u ith her family, who live in Vietnam, nr)r with her own two yorlng children.

N.T. lived i n a cell umith two other female inmatcs in thc same building as malc prisoners. During t h e ream's visits. thcrc was no door to tht: w.orr1~11's cull and prison giiarcls had unimpeded acccss to the cell. The latnne inside t he omen's cell UYI.; in full v ~ c w of the prison guards a r m s thc hall.

N.T. works in thc prlsun cleai~ing the kilchsn art.,i. cclr,k.lng (or p r ~ w n officers. and laundsrlng their clolhes. S t ~ c is occa~iunall y paid onc tl~ousand rrel ( h o u r I r . S . $0.30) by the prison director fur washing clothes. but otherwise shc is no1 cnn1pzt:~attd for her labor.

N.']'. . u ho was vlsihly fearful during our inlen leu. rcpcd~cdly dcnicd !hat she umas ever sexually abused by prison officials or inmates. Slie did. howclrcr. disclose lu thc team that she h a s sut'tcrlng f'rotn a chronlc purulent ~ a g i n a l discharge (thc prlson has 110 gynecologic serviccs for uo~ncr l ) . 'I-tlc tear11 subsquen tl y learned frtlrn thc local h t~rnan right5 organi7atiotl. LICA LIHO. that N.T. had utldcrgonc thrcc therapeutic L~bortio~i:, dur ing the term of imprisonment.

Juveniles in l)etent iotl

According to Rule S(d) oK thc Standard hIitiimuin Rules, "young prisoners 511;ill he kept separate from adul is. " The ~ncdical tram found that juveniles were i nadcquatcl~~ segregated.

Defi11t.d ac; indil-iduals Icss than cigh teen years old. lluven I tes ~o111pri sc' @lie pcrccll t of the medical tuarn') study population. '[he hlinistry of I n l c ~ i o r did not h a w 111 tbrrnation on the number of juvc~iilcs it1 dctcntion. A separate cell at T3 pl-i>on wa5 uscd c\c.liisi~cly Ibr iuver~iiss in J u n e 1934. At the tirne of the ~ncdical tcain's v is i t . I l ~ r e ~ ' , \ u~e r~~ lc ' s is'cre detained in this scll under the supervision of an adult rnale prisoner. l'he three uzre hzing held for ptty t h c A . scning sentences fro~n six t c ~ tcn rnonths.

On a follon-up visit to T3 prison in Februarv 1995, the medical team lcarnrld that juvenile$ w2rc 1'10 Iongcr segregated horn adults. Five inmates under the age of' eigh~een were mixed with the gcncral population o f the prison. The p r i s o ~ ~ director told the teal11 il~ar due to the incroasc in inmate pp~i la t iun . i t was no longer possible to designate a cell specifically Sor juveniles.

Two juveniles were cncountercd in Prey Sar prison during the mcdrcal teain visits and tivo others w r r e intcn~icwed irl PJ prison. The latter rcplrtedly h ~ d bccn repeatedly beaten hy older prisoners and were later trarlsfcrred to T1 pnson. Nvrre of thcse jut,eniles wrrt. receiving any form of vocatioilal training or education duri tlg their impnronment.

Undcr Transitional l a w in Cambodia, only children over (he age of thirteen can bc held in prctrial detention. In K u n ~ p o n g Chhnang prison, rllc in~~es t~ga t ing team found an eleven-year-old boy detained ~ ~ l t h his mothcr. Both were accused of jtealing gold from a marlict stall. T t ~ c y \.s-ere all housed i n a large cell with two oth?r wornen prisoners and werc accornpan~ed by these women's children; a six-year-old girl and a three-y ear-old boy. Further i nvestigattun by UNCHK rcprcsentatlvcs revealed that rcl ilible eycu itness accounts. ohtained by ;l human rights organir.ation. placd the mother and child clscwhere at the t ~ m c of the allcgcd theft.

The prowcutor and judge aontendcd that tile child was reported to be sixtcc!~. while the mothcr and the child s t ~ t c d to thc i l ~ ~ d i c a l tcam that the child uas c1cvt.n. Physlcal cx;ir~~inatioti of the chiid by thc medical tear11 u'ab consist en^ i r ~ r h his stated aye of elevcn. Afrcr the UNC:HK team petitioned the examining judge, and the mcdicd t an ) c ~ r r o b o r ~ ~ t e d the child's approxi~nate age, the judge agrccd to confirm the child's agc with the teachers a! the local school. The icdlowing day the chi ld was released from custody and chargcs wcr t dro!>pcd. Ile remained in the prison with his siblings arid inother for scimCral days mt!l the charges agajrlst the 111other tvert: also dropped for lack oi evidence.

H . H . was a ~ixtcen-year-old prisoner i11 Battarnha~ig prison i n ten.icu2d by the rned~crtl tear11 i n February 1992. The local court found him guilty of ~ h c theft of an old bicvclc and scrltenued h l n ~ to six months' 1mprison1nci:t i n Dccrn~ber 1393. Thc hoy was l~o~lsed i r ? a cell with eighty-four adulr male pnsuners. Prior tn his arrest hc did not attend 5chool and lived primarily by climbing trees to harvest ccszonuts. He reported that hc cannot rra(1 or writ^. HI: h i ~ d no money for schwl supplies.

As a result of ~ ~ u r i t y concerns i n the arca ot' Battamhang, the priwners were bclrig Ict out of t h e ~ r c.cllh for bricf periods only." T I . H. s ta~cd that yard time had recenlly dccrcasud from t\so fif'rccn-minute periods a day to t i v ~ ) five- r n i n u ~ c pcriods pcr day.

On the day ot' the intcnreu, H.H. h a s punished for smoking rna:Ijuana that soinc pr~sone~'rs had purchased from a pr lkon p a r d . A prison officer forced H.H. to statld i n the

I I The annual ~ r m c d clashes hc.tuern forzcs I ~ l ? a l to thc Khmer Rthirgv and Ro!~i Co \ ,d rnm~.n t F'orcel; wcrc occurring In ihc. wcstcm c l~- t r !~ ts of' Battamhang prtivinzz. Thew n~ilitar! uc,tlvrtiz:, c l~d n o t appclar to affwt daily l ~ l c i n tht city of Ba:tilmhang, thouch wert: u i r d by prlst)n offizla\s ah ju.;t~fjc.ation for a d d 4 sccurity mcasurc.; in the prl.;r)n

courtyard under direct sunlight for one hour. That afternoon he was to bc further punishcd. though he did not h ~ u w what that puriishmcnt was to be.

When the medical team intewiewul h im, H . H.'s hci~d was s h a w d as a sign of mourning. He told the physicians that his oldcr brother had died ten day\ earlier from malaria, while scnling in the military. The youth mas rlot rclzased from prium to 0bsen.e religious rituals. He told the team that he was worried about fdrniIy visits being restricted because of wcunly concerns. Supplemental f c m l provided by famllics was prepared regularly by inmates, although this practice uas discontinued ten days earlier by the prison dircc~or, who again cited security concerns.

Young Children in Pr.isons

Children accompa~ilcd thc~ r dctai~lcd rnothers in several prisons. In 'fnLrnao prl\olj. for instance, a thrcc-year-old child l~vccl wirh h ~ s niothcr who uas serving A wnrcnce for murder. The c h ~ l d was born u hi l r :he rnothcr was i n dctenr~on, and had I I ~ cd i n the prison since birth, The rncdicai tcam fnund thc ch11J to be well-nourished, though verbally delayed. Although the hl l lM team provided mdica l scniccs i n Takmao prison, t h r child had not been immunized.

During a visit to Kotnpcmg Chhnang prison in hIa\ 1994. a female inmate. IJ-P. , approached the medical t a m . U.P..?6, was arrested i n 1987 and con\ iitcd of the n~ilrder uT a child. She wah suntcnccd to eighteen years i n prison. She complained to the team of abdominal pains and distension of the abdomen. She reprtcd [hat shc had seen personnel at the pro\,~ncial hospi tat. ;uld that an abdominal tumor was diagnowd for u hich she was receiving n o Ircatl~~cnt. Physical examination of the woman r~vcalcd what appenrcd to hc a gravid utcrus at sccond scnizhler of pregnancy. though the prisorlsr denied that th is war possible. Slic dcnicd scxual abuse or 111istrea;ltrncnt by prisoi~ ofiicers or other prisoilcr\. The team cor~racted the local hospital and adviscd prctlatal care.

In February 1995, the mcdicd learn returncd to find U. P. with a four-month-old infant boy. The mother was allowed to rctl~rn to hrr home during thc firla1 two 1nonl11< o i the pregnmcy, and delivered the baby at home. She had returned to the prison with the child to complete her scntcncc fullowiiy a s e ~ en-rntlnlh furlough granted by prison nfficers. The child appeared healthy and well-nourished on examlnatlun. He rcccivcd rnd~cal care and immunizations at the pruvincial hosp~tal. U . P. way worricd bcc.ati3u stlc dwsrl ' t receivt' food supplements as shc nurses, nor are there nutritional supplclncnts avai lat~li: 10 he child.

Treatment of Prisoners

Torture

-l'orture4" and cruel, inhuman or degrading treatment arc strictly forbidden by Articlc 38 of the Cambodian Constitution," Rule 3 1 of the Standard Minimum R ~ l e s , ~ ' Article 5 of the Code of Conduct fbr Law Enforcement Officials," and numerous ~n ternational human rights instrument^.^ In 1992, Ca~nbodia ratified the lnlernatiorlal Covenant OII Civil and Political Rights" and the Convention against Torture3"- international instruments which prohibit torture.

Y1 Tor-turc is defined as "any act by whic*h szvc.rc pal11 or suffcrlng, u t ~ c ~ h c r pt i>sl~al 0 1 rnzntill, it, intentionally inflicted o n a pcrson fijr 3uch purposes a.s obtaining f rorn h ~ r n or a th~rcl pcrkrln inf-ormat~on or a ;onfe>>ion, p u n ~ \ h ~ n g hirn for an rlzt h e or a third person has comrruttt.d o r i \ \u\pt.ctr.d o f ha \ , inp cornmittt.d. or, intimidating or coercing him or a thlrd person, or for anj- rrascm based on d~scrirnlnatlnn of any kind, u-hen suzh paln or suft'rririg I S int1ii.tt.d by ot at thc 1n.itlgatlo11 of or w ~ t h tht. c.ot1st.rlt or ac.qulz\ trfiitrncnt that aggravate.; prlni5hrnznt o n ;i d~.~;i~ncca t - I luman R~ght.; pro\ i d c ~ thal "ntl c!nc \ h ~ l l bc. nc.'k undc-r ~ t s irin~in;il l aw. The qamc \hall apply to an attc~npt to conirnit torturc and to a n act hy any pcr5on M t ~ i i t i con

MISTREATMENT DURING INTERROGATION A N D CONFINEMENT - Beating or torture during 63 %

Shackld during confinement 52 % I -+I I Solitary confinement in 1 29 % 1, I

k u n i s h m e n t or dark cell -- 2- - 11

Pretrial Detention and In terruzaliori

The medical team foiind a conltistcnt pattcrn uc mistrcrt tn~eri t of dt.:ai:irzs dur ing interrogation and prelrial detenlicn. Sixty- t hree perccnl reprted mi streatmci~t (beatings or torture) during i n tcrrogat~on (n = 83). Forty-four perczn t rcported that their hcal th deteriorated during interrogation (n = 82). O n l y Ihrw yrisoncrs requested mcdiual al t t 'nt iun during interrogation (n =%I). Clnc receivcd no rcspnsc. another u,as reiuced med,cnl carc, a rhird was referred to a hospital for radiologic evaluation.

Ninetv-eight peri:enr ol' prisvncrs rrportcd intcm-oga~~rm { n = 8h). 1:igIlry-forlr percent were questioned at the police statjon, 2 % by thc mil i tary , 6 % wwcrc interroga~ed in court, and 7% 111 prisur~ (n =84). Ninety-three pcrcerlt were :nterrog~tcd by polizc,. 2 ?l hy inillrarq. and 5 % by j~dic ia l or'ficials (n=83).

The following case of two dctainecs arrested in Ko111pong C h i n 1 pro\ I!IW in April 1994 ~llustrater the trcalment u i prisoners during the peril?d n i a r c s t rirld intcrrogatinn:

Tvvo rwwlv-rrnnsfcrrcd dctalnccs had arrl.rtd iin thca ~ n o n ~ i n g u lth f:csh uuunds tha: required immediate nlcdical attention.

'l'lic ~neciical team privately interviewed and examined the ncw detainees. 'l'he first prisoner !#I 1, 34 vc;xrs old, told i.s rhat tbe gang was on i ts W i i ! 10 rriitl a~ld rc>b a village tn.0 days before their detention. l'hcre were tlvc tnen in the gang i v ~ t h autom;tic weapons hidtlet~ in a cart. Suineo:lc: t~ad informed Ihz I ~ a l rnrlrtary ol the;r plarls, and .a unit of sclldicrs %a\ waiting for them along t h e road to the village. ?'he gang w,as surpr~scd by thc: am'3ush. and rhree of them m a ~ a g e d to flec, leaving thc twci who Ncrc arrcqteci.

Their arms were bound with kr01ntr17 scarves and they werc taken to the surrounding iorcst by five or six soldiers. TIIC t w o prisoners were separated. Prisclncr # I was standing lipright and while still bound. was told that he was to be executed by gunshot ir~~rnediately. Two of the soldier5 told him to star1 walking. He was shot from bchlnd by an AR-47 at a distance uf about three mctcrs. A single bullet entered thc left triceps arca exiting the xltcrror shoulder.

Prisoner #2 was with four othcr soldizrs in a separate aru of the f c~ re~ t . Hc heard [he shots and hc l i ekd that his fricnd had bccn killed. He was beatcrl and kicked repeatedly by t he \oldiers on the h a d and chest. -Then he waq told lo stand againsi a trec and was shot from behind with all 4K-47. A siliglc bullct cntered t t~c left dorsal fc1rearm and exited the pa!mar forearm.

On physical oxamination by thc rnedical team, both prisoners wore found to haw ir!juricr that wcre consistent w,i th their accounls. I'risoncr #2 had facial irlj uric\ (:om the healing and bruises on his chest. 'I'hc n~edical t eam arranged for thz rwo nlcn to be transferred, esuurled h y armed g~~rcrds. to the nearby provir~cial huspital that afternoon. Thi. wounds were dchrided and inspecled by the surgcon on duty. A radio!ogic examination of prisoncr # I revealed a c o m y l e ~ shattrr~ng fracture of the left hurncral h a d . The t a m was assured bv the treating physicians that both men would rcceivu an~ibiotic thcrapy. The mcdical t k n l rewived infi3rrnation in February 1995 whirh indicated [hat both prisoners had roco\,erecl following treatment at the Kampong Cham hospital , although prisoner # 1 had resid~ral dpfunction of the affcctd arm.

'I-he case u i Y. 1,. , interviewed by thc mediual team in Takmao prlsotl In April 1994 nrld Fcbruarv 1995, ili\lstralos the use of extra1 rtdicial an~putatiorl by K h u m (currlmune) police officials. Y. I . . was arrested i n a village in Kandal provinct clri a mid, day in hlarch 1994 for allegedly attempting to steal a motorbike with two ac.c.ornplil-cs. -1'lic uwncr of the nlotorbike nlcrted the Khum policc. who fircd weapons toward the uould-bc ti~ievcs. 'l'wo of the allcgzd robbcrs fled thc scene, and Y .I, . waq apprehended by three K h u m officers and heid at the K h u m poIice station.

Ncarby di\trict poljcz were summoned by the gunfire and arrived on 1hc scene approxi matcly t h i r ~ y mirlutcs following the arrest. The district officers left teniporaril) atid Y.T.. rernai11e.d i n the custody of three or four Khum officers. his hands bound behind his back with a krornah scarf. Onc officer, who allc~edly reehed of alcohol. brandished a machcte. !uok Y. t. out into a public area in front of the police jiatlon, a~id applied a single rndchete blow to the right hand of Y. L. Several villagers reportdly ~l itr~essed ~ h c incident. The distr ict police rcturned to the villagc and [ransferred the prisoner to a district jajl.

The result of the attack on Y .t. was complete amputation of t h r c e digits. and incomplete a r n p ~ ~ ~ a t i o n of the index finger of his dominant right hand. The i~icdical team cxamined Y .L. one r~lonth after the event. The MDhl ~nedical t a m dcbrided rlecrotic tissue and providcd oral antibiotic lreatment on a number of occasions. Thc wound had healed w-c:I

with medical attention. Y .L. had spent eight mor~ths under crowded conditions in the cage- like facility. At the time of a follow-up visit to Takmao, the prisoner appeared pale, wasted and depressed. He was tried in December 1994 and received an eigh t-year sentence for attempted robbery of a motorcycle.

Ninety percent of the prisoners that the medical team surveyed reported that no health professional was present during the interrogation (n - 8 I } . Three pcruent said a physician was present but reportedly observed the interrogation and did not participate or prevent the beatings from occurring,47

Beatin~s bg Prison C;iiards

Beatings by police guards i n PJ prison were independently reported by several male prisoners. One officer in particular was known to enter the prison regiilarl y while inebriated and randomly beat inmates and extort money.

A common practice in Svay Rieng prison was to force prisoners to stand ior prolonged periods in thc sun while carrying heavy objects such as bricks. 111 several prisons the practice of "pointing the finger" was prevalent, when prisoners were forced to stoop i n direct sunlight and circle around a point on the ground until they collapsed.

I n Pursat prison, private interviews with a number of pricnners d u r i n g an unannounced follow-up whit in February 1995 produced reliable e~ ldence that beatings by prison officers - - including thc prison director -- had occurred i n Seplelnber 1993. The incident followed an attempted escape by three prisoners. The prisoners vlmere punlshed for not alerting the authorities to the planned escape. The prisorl officers removed all the prisoners (approxi rnately twclve inmates) f rom their cells, and hound their hands with rope early in the morning on Scprembcr 30. Thcy were lincd u p i n thc courtyard and bcatc11 with a switch and a heavy stick receiving several blows each. ?'he prison director reportedly bcnt the prisoners as well.

One inmate, S.P. , was singled out for punishment that same morning. He was apparently identified as the instigatur of the escape attempt. A number of prisoners recounted that prison officers bound S.P. ' s hands wilh rope. S.1'. was then repeatedly kicked in the chest, head, and abdomen, and lashed with a nylorl whip and wooden stick by

4: Pr~nciplt: 2 o f the Principles of hlrdical Ethics rtlevant t o the Role o f HL.;llth Pzrsonncl, particularly Phys~cians in the t'rotcctlnn of Prisoner:, and Detainees againht Torture and Other C'rur.1, Inhuman nr llegrading Treatment or Punrshnlcnt states: "It is a gross contra\.ciition of md ica l ethics. a5 well as an offense under appllcahlc: international ~nx l rumcn l~ , t i ~ r hcallh pcr.;onnzl, particularly physician.;. to enyagc. a ~ l i v r l y or passiveI>', in acts which constitute parhu~pation in, complicity in, incitcmcnt 10 o r attrmpts to ci)mmit torture o r other cruel. inhuman or degrading treatment or punishment. " ''

three or four officers. He lost consciousness and was coughing up blood. At 10:00 am he was camed back to his cell. 'fhis attack was witnessed by other inmatel who themselves were hubjected to beatings. hlonths later, S. P. compla ined of continued daily hemopty sis (a cough productive of blood). Physical examination by the medical team i n J a n u a r y 1995, five months after the beating, revealed parallcl linear scars c,n h is lumbar area consistent with beatings with a blunt instrument, as described by a number of witnesses.

C.T., a reprelentative of the prisoners at Svay Rieng prison, hirr,sslf a former police of:iccr, toId the m d i c a l team that prisoners are regularly subjcct lo randurn beatings. He natncd one prison officer who is a particularly frequent common offender. Hc stated that 80% percent o f prisoners have be11 beaten during incarceration, and that bealings occur anywhere In the c i > m p u n d . Prisoners arc bcaten with mctal, with wooden poles, and with a special ~riangular-shapcd shck. 'There 1s no particular pattern t o the injurics inflicted. Beatings can occur c3n tllc head, to thc face, or on any part of the extrernitics. According to C.T., there were several rccenl beatings that were witncsscd, and later confirmed. by other prisoners.

Detcntjo~~ arld Torturc Under Artlrlr 4 Outlawine PDK

I n late 199-1, Article 4. a law banning the PDK party, was passed bv the National Assc~nhl) . An amnest) u as granted which prevented in~plcriler~talio~l o f thc law until January 15, 1995. The medical tram learned that prIwncrs were hcing dcrained under Article 4 .

The mcdical tazm leari~cd during a v ~ s l t to Hathrnbang prison i n February 1995 that lhrce prisoners were hcld under chargcs of ac~ivilics o r membership in the I I K . Ot~e of the prisoi~crs interviewed by the rneclical team gave crediblc tcsti trlony of torture by the arresting mi l i t an u n i t . He was a 20-year-old farrner from a westcn: dis~rict of Batla1111)ang province. :lccor(iing to the prisoner. Kivc days prior to his transLer to Uattarribang prison, he was out i n tl-lc hills, unarrnetl. 111 an area ncar his i.lIlagc trappirlg an~mals for food. H z was accon~panied by his brother-in-law who was aiso dctairled at Battarnbang prison and rntcn'~ewed by the r rnn l . The two had been apprchcrldzd by a military pa:rol and taken to an arrnv base.

The pr!\otlcr recounted that he was lnterrogatcd for fii c days at the military bast arld war repea~cdly bcarcn ancl torrurcd. The ~nrerrngating soldicrs r~ghtcned a rope around his hcnd w i t h a metal rod that. ivhcn rotated. uould tighten the rnpc fur thcr . H c repeatedly drnird that he uas a 111cmhc.r of the PDK. and as he did so, the ropc was 1:ghtcncd around his hCacl. 'Thcie sehslons u 11u!d iast about twenty mi~iutes cach t i rne and oi.uurrcd daily for five days. He was also bcaten w i t h a ucwden club.

Physical uxatrl~nalion o f the prlsonrlr by the tcarn i n early Fcbruary 1995 showcd in-juries consister\r with the accounts of his torture. A seven-centlmctcr rope burn was noted

above both eyebrows. Biack and blue linear bruises. ten centimeters in length, were seen in the subscapular ;ma of the left of his back, consistcr~t with whipping with a wire. Multiple bruises on dl four extremities wcre consistent with bcatings with a wooderl stick.

0vt.rcrowding and Prolonged Hours of Confinement

Sevcre overcrowding is a regular feature of all prisons in Cambodia. Inmatcs are packui into cells, while nearby cells remain empty because they require rninilr repairs, such as a new door or window bar. The problern of overcrowding is exacerbated bv the lack of security regimes i n prisons, resulting i n prisoners being confincd lo thcir sells for prolongud periods without cxercisc.

In several prisons, new arrivals were subjwtzd to v r i o d s of extreme overcrowdir~g with Iittle floor space. I n Prey Veng prison, thc team ~nspected one ccll for incoming inmates that mclasured 01 x 1.5 meters. Tt contained four pr~surlers who had been detained there for over a 1110i1th. These priso~iers were unable to lie doun \~multaneously. There uas no latrine in the ccll, and only one hour per day in the courtyard was perm~tted.

Tht PH K suney found ~ h c mdian lime i n hours prisoncrs bere all(-ucd out of their cells each dav was lcss rhan 1 (n =40, range O to 8) . Ovcr one qudrtcr of prisoners in the study were con fined to thcir cells e~ thou t any yard time (27%. n =40). 11: several prisms. entire blwks of inmates wcre prot~ibited yard time. Round-the-clock confincr~ent was thc practice for many prisn~~ers in 'I'ak~nau, PJ, and Prey Veng prisons.

'I'aknlao prison has a cell block with twenty-eight cells, each approxi rnately 3 x 1 .5 meters. Two prisoners were confined to cach (ell and wcre ilvt allow cd out of the cclls. Prisonrri here deraiilcd in t h~s manner for up to two years bci'or? they were transferred to larger group cclls. During a folloiv-up visit ro 'rakmao i n February 1995. the sn1aI1 cells held ~b.ree prisoncrs each.

'I'he PHK survey f o ~ ~ n d the m a n floor space per prisor~er i n the prison sy~tcrll was approriniatcly 2.5 rquare meters. Nine percent were provided with no mats and slopr on concrete or dirt floor. One perccnt were provided with a mattresk, while 85% u w e provided nirh a straw n u t (n =86).

MEDIAN SPACE PER PRISONER IN

1 Pray Sar

T3

PJ

4.0 m2

2 .8 m2

0.7 m2

Accorditlg to Rule 33 of thc Standard hlinimum Rules, "ins~rumcnts of restraint, such as handcuffs, chains, irons and straitjackets, shall nevcr be applied as a punishment. Furthermore. chains or irons shall not he used as restraints."

'l'here was evidence of the current use of shacMes in Kompong Cham, Kompong Chhnang. Pursat , Siem Reap, Battambang, Tropeung Plcleng ('K.5). and T3 prisons. Thc investigating team were givcn shazkIing devices by prison officers in Kompong Cham, Pursat, and Kornpong Chhnang prisons.

In Pursat, prison evidcncc suggested that l n c o m ~ n g prisoners were resrrained day and night with an iron shackle on one atlklc fastcncd to a three-meter-long iron bar that was drawn across the cell. The prisoners were rernovcd from the restraints tw~crr each day for a feu. minutes during meal time.

Pnson of fic~als at first denied the LISC of shackles in Pursat prison; howevcr, when confronted u ~ t h reliable evidence that shackles were in iact in use. p r imn officers revealed the location of the shackles, and provided the learn with t h u anklc H tt~ngs. A follow-up visit to Pursal Y r i m n by he medical te(im wi th UNCHK in Februar) 1945 st~owcd no evidence of t t ~ c practice of shackling. Prisoners reported that the practiit. was d~rzontinued immediately following the medical team'^ initial vislt.

I n Kompong Chhnang pnkon, inmates who were believed to be at risk f o r cscaps, or ivhn had attempted escape, were shackled at night - - two or three prisoners together. crtch w t h a ringle leg i n the shackle -- with the use OF w d c n home-made stocks.

Dark C'ellslSolitary Confinement

Punishment by solitary confinement is usually dccided by [tic Prison Director. Twenty-eight pcrcent of prisoners surveyed had been held i n solitary cor~tineruenl during their detention ( n = 84). Fifty-two percent of those had been shackled d u r ~ n g solitary confinement, lnmates in Takmacr prison were subjected to solitary confinement in a dark ccll for disciplinary offenses. According to Rulc 3 1 of the Standard hlinimuin Rules, ". . . punishment by placing in a dark cell, and all cnicl, inhuman, or degrading punishme~lts shall he cclrr~pletel y prohibi tcd as p ~ ~ n i s h m e n t s for discipl~nary offenses. "

U\c of ~es t ra~nts and solitary punishment cells uas c \ ~ d t ' t ~ t in a number of prisons as well. I n Prey Veng p r i ~ o n , inrrlates described a dark ccll u'n~ch they ~iickt~arned " ~ 6 . "'" Prisoners were confincd to T6 for escapc attempts or orher disc~p!inary offcn~es. The ccll had no light source, arid had no wir~dow for ventilation.

" Several of thc prl.;ons In Canthdia carr) the des~pnaticln T, as In the ccntral prihrm T3 in Phntlr11 Penh

During one visit to Tahmao, the team interviewed one prisorier w h o had been in solitary confineinelit fur r~irie dajs for "yelling out to h ~ s friend." The solitary cell is alongside others i n the cell blwk and is the samo s i ~ e as the other sells, The punishlnent cell has a brick ceiling and a 70 centimeter x 20 centimeter openirlg for light and ventilaton at the bottom of the door, whilc thc othcr cellr in thc blwk art. well-1 cntilated N ~ t h iron bars on the ceiling. I h e hcat inslde the cell was considerably greater than thc ambient temperature. which was well above 40°C during the team's inspcctmn.

I

Prisoners attcrnptitig to escaw Tropeung I'lceng p r i m werc p u n i 5 h d with shackling.

I In hlay 1994, five prisoners attempted to escape while they wrcre uorking outside the prisor~ I compound, but werc captured arid se~srely beatcrl hy p l i c e u n t i l thcy bled from the :msc and

mouth. Polrce officials encouraged other prisoners to continue beating thc five upon their return to their ccll. The escapees were then stripped to their ii~lderwear and shackled for a month, day and night i n soIitarv cells. The prison provided :hem N ~ t h only one chi rd of t h c .

! nornlal ncc rat~on. rcstrictcd t k i r drinking waler to one l i k r cach day, alld rc\~rictrd thcir bathing to clnct elery tumo weeks,

1 111 Tf; prison, in Junc 1934, onc prisorler was shacM4 in a dark cell fur i w u weeks

after ir was discovered that he was carrying money: a violatiun of prison rulcs. His clothes were carifiscatcd and he was placed i n the dark scl.: naked, with a tfiird of thc u ~ a l daily rice ration. Drinking watcr was restrictd tu uric liter per day, and bathing was possiblc o11ly twice during the two weeks in thc dark ce;I.

In most caws of solitary confinement, there is no access to the latririt. ,ilirl prisoners are forccd to relieve the~nselvcs in buckets.

,4 visit LO tiarnpong Cht'tnang prison i n Fehruarv 1995 by thc rnd~cnl tear11 and UNCHR revealed that one prisoner had been confincd ;o a solitary dark ccll and shackled with the sainc woclden i r l s t r u ~ l ~ e n t s f(>r a period greater than a week, bur Icss :ban two weckc. The pnsoner had allempttd cscapc and was recaptured and placed it1 thc prlniihrnent ccll. 'I he p f w n officers dcnied that t h i s was t;iking place; howevcr, the inior~r~arior~ from privalc interviews with several inniates confirmed the ongoing use of dark cells and shackling.

E~~vironrnental IIealth arld Sanitation

[,at r i n ~ s and Diarrhea! Diseascs

In rnany of the prisons, the iatrims, bu!lt by [he ICKC WA'I'SAN project with the assistance c?f other nongovcmment;ll organ~zations, ~orthiitccl of a ccmcnr structure connected to a septic tank. Watcr i s transported by hand from a u~ell, stored in a conta~ner, a n d p c ~ ~ r c d over the iatrinr: Ibr llushing. The m u r l umber of prisoners per latrine was ? 5 (11 =79. SD- 19). Ninely-chrec percent reported some access to the latrine, but i t was Iirnited to certain tirncs of rhc dzy. Suven percent had nu access to latrine< npcn sewage systcms in ~ h c cells consisted of a bucket or similar plastic container jn =85).

In Kompong Cham prison there were no latrines available to the prisoner>. The san:tation system cor~$l\teri of boxes of dirt . Many of the prisors reeked of human exurcnwnt. sincc fhesc conthincrs here crr~plied infrequently. It; solnc pnja:is. such a5 l'~c]r Vcnp. pnstlnerq voided directly through the ccll door inlo opcn sewers il l t l ~ c courtyard during 1irnr;s uhen auxss to the liltrine was not avarlahlc.

PI prison i n Phnom Penh sxper~snced scverc' p r r ~ h l c ~ l ~ s u i t h ;In occri7rowzng hepti: system despite renovat~ons bj l the ICRC in 1993. The bloated p r i s o ~ ~ population created Hrater shortagck and sn uvcrwhc1nizd x w e r that en~pticd waste lrlto thu cell%. 111 Kompong Clihnang prlson. the area betwwn the cells was clcancd infrequentlv. and was slrcwn u r t h garbage and littered w ~ t h s!nrld~ng p o l s of water.

S.XI y-si pcrc:nt of inmate\ rcporred having a t least ut1e djarrhcd cpiwde, most likely due to ~lrlsanitat-y fcjod preparation and water supply. in the month pr'or to our in:en.iew (n = 85 i. They ~uifcrcd a nwan of four days of diarrhea ( n = 56 , S1> = 2.5) . Scveral repurtcd repcatcri bloodv or inucvus stool5 suggcstjvc of bacterial dy scntcrp.

Purjtled watar was 1101 widely zvailabls for thosc with episodcs of diarrhcii: c l ~ i l v twenty-eight p~rccnl o f pnsoncr? u:ere able to obtain or prepare boiled water for ornI rei~ydration pilrposcs f n = 8 5 ) .

Glci;n the tropical clitr~atz il l Cainbod~a, frcqiicnt bathing is a ba\ic neces

-- --- MEDICAL COMPLAINTS

66 %

Scabies --- 39 % ------ Tingling and isg cramps 3 1 %

---- Symptoms of malaria 2iTu -

, -- Prolonged cough 12%

5 % were diagnoxd with dry beriberi -

Half of ~ h c prisoners suwcyd were supplied with soap for h3th11'g aid washing c l o ~ h ~ s (n -86). Non? nf the prisoners was supplied with sanilarq. papcr (11 =56).

The survcycd ?risoners reported that approxirnatcly half of' the ibatcr suppl;; for the prisnt~s comes irorn wells (provided In large part by the 1CRC NrATS.4N progran~). The city iiatcr supply of Phnt!m Prnh proiides water to "1'3 and PJ p r i ~ n n populalions. comprising oirer a third of the u lncyed inmatcs. Eleven perc.cnt of prisoi~crs consulnc w;%ter that origi~lates from a lake. river. or rrwrvoir . Vv'a~ur deprivatiun was tiotahlc in I'J prison and i o T3 prlson d u r ~ n g the dry scahon, u hcn wafer prcswrc irl thc tit\, syFlcrr was rou!lnel\, cut b2c k.

The tnos: frequent prisunur c~>rtlplainr rolahng to the enl-~ro~~rncrit I 11 I:IC prlhor~s uas tt7c presuncc of ratc or mice. corurtlon vcctors ~ ) i flea-bo-nc I-rrrr~-ran disc as^,>. which th-erc reprtcd in eacP of the prisc3ns \*isltud. hinscuitv and c~ckroach inlest~ticln u t r c al\o r ~ ! i n ~ ~ : o n l y nc?red i n all prixcms. Prisnncr+ f rcq~.~cnt ly coinplainsd of bcd-lousc ink~tatirwa.

Sc.vsral nt t hc prisoner$. W I I C ) were cxamincd by the r~crlical tmm. prccen t cd f'ri t ~ ~ a l ;nfec~ions, scabics, skin abaccsscs. and heat rash. 'Thirty-nin; p c r z n t rcportcd hh\ . i t~g icabicc v;hilc 111 prl.\on (11-y 73j. l , l t r ) - t i k e pcrccrlt c ~ i tl:csc prl>vrwrs UCI-c trc~lcil wt1 I , c .ah~; . i r i~s (11 = ! 1 ) . I ' h ~ r t y pcricnr rcw3nul h a ~ t i n g athcr 5 k i n prvhlcn~i s ~ ~ c h as fi~ng;i! i11fri :i0115 o r : l b , j ~ - t 2 5 ~ ~ : < .

1311~ pri\onor ; I \ S'enl Rcar) pnlvincc. not 111 [he study sdrnple. b a s b c i ~ l g lrc'dr~d fo r [c l l r r l jv ~ v i t h I ~ I ~ n~edis ine , prcwidr~l 11)' ; ~ r r inizrc~atlonal no t~~o i cr:>lntl~trtl nrganimt ~r'ln. It ii 1 1 ; ~ ~ C I M - I I b i ) ~ 1113~)~ othc'rs ~ u f f t r f d fro111 t h i s co:ldi t io~l , tl1~'lllgh tht' in~llnte had hccri irlcarccmtcd for ~ur: ycn1-s prior to dingnclsis and treatmrnt, l-cprosy. like t~~bcrculosis. is sy)rc;ld through corltacl u - ~ d s r L~onditions ot' cotl f i riclucnt and o~ crcrou c i r ~ g .

Food and Mutritinn

In October 199.1. t t ~ e Royal Gov,crnmznt of (-'amboclia, i n an c ihr l to c.o~ilpctliate t i ~ r I nilalion, ir~crcasccl thc t r l d allotrr:crll for pr15ollcrs. I rorll !IN) I

T3 Prison from January Itlrol!gl\ Dccernber 1994

,4(l;ip1 ed f i -o i~ i Riipporf CIP Cot~,~~~i![/ti~ j u . s /'ri::otf, hIi5icci 11 5 d ~ i h,fc~~(l t -> PI1 IIU 111 I'm 11, l a i ~ u a r y 1995. Kcprinted umirh permission.

-

1

,r System % Leading diagl\~si$ in each category

( O of visits in the catagory) -. --

1

'?%

1 7 ?A

13

13%

6 f" /c

6~

- < I 3 ..

4 PC

7 , ' (

3 - I;: ,( 1 I" - r

q i- . r .-L---.

Skin diseases

L r , nuse & throat --- Infextioi~s diseases

--- - Parasitic diseases

Vitamin deficiency

Ncurapsj1z hiatric

Gen i tou~ ina r~ - - Pu: monary

Gastrointestinal

McsculoskeIetal - Cirdiac - Other

Fungal Cermatitis 33 70, scabies 16%

Phawngi ti s 53 %

> U p p e r respiratory lnfcction 53 %, tuberculosis 26%

Intestinal 55 %

BcriSeri 83%

-----

- Tn\~>n~nia 54 %, hmdache 3:;:

Urz th r~ t i s 57%

Hrorlchitis 54%

Ci;i~trocnteritis 62 % -

h third of the survejed prlwners (31 %, n =86) cornpla~ned of cingllr~g or r~urnbr~css of the lower extremi tics and leg cramps, symptclrns suggestivu of drv bcribcri. a n u tricional defic~ency o f thiamitic. Thiamine i s cc~ntarned In adequate arr;oullts In rice h u s l i , but the husks arc removed by ?he milling prlrrrs that produces polished ~ h i t e ricc prai*idcd t o the prisoners. Upon physical rxdrnination by the medical team, four inrna~ch (Five perccnt of the prison survey population) cxhib~ ted signs consistent with [he diagnoii < of dq benberi. Thc pnroncrs' diet consistrng of rnilled rice and a thin sour soup \i i r I! Iow caloric rntakc, combined with inactlvi ty and frequcnt d i a r r h e ~ . resulting i n the preclominancc of dry berihcr~ over the cardiac o r ' '~ . ,c t ' ' forin.

The n~edicai team did cncounrer at i a s t nnc case of wet bcrihcri, howcver. 'The tc;lrr u - a k ahlied by prison of3icials to examinc a 33-year-old prisoner (1:c)t rclected for the hurvey j iri Kornpor~g Cllhnang prison who had pitting edema of the llwer extremities. He complained of t'il:iyue and shortness ol'brcath. He had nn prior history o f ~ ~ l d i c a l problems. Histow and physical cxaminatic)n irl this case was consistent with wct bcrihcrr . -l'l~c rncdiu;~l t a m r~*commcndcd irn~nediarc rcferral to thc pro\.incial hospi t i l l . 'I'hc fca11 Ieanlcd o n a rcturn i isit to the prison two weeks latcr that (he prisoner had bee11 rcfcrrcci to thc hospitiil, hut after waiting for hours thc pri5oner war n o t seer1 by rncdiral staff and was returned to thcl prison. His mcdical corldition had not iniproved, and thc prison d~r~%ctor was ndv~sed or the urgency of cc~nsul tation with the local hospital.

One o f the jninatu3 ill Svay Kieng pnwn examinud for t h ~ S ~ L L ~ Y ~ n d diag11ost.d with d r v bcribcri had pc>l!~~;curopathy and findings c j f wasting, a~axia. arid cognirii t. impa~rrrlclnr. These physical sign\ are f u t u r e s 01- #'crnickc-Kcrrsakoff t.nceph;tlcopath~, a marc global ncuropatl~ y associated with szverc ihiamine dehcicncy .

Dzsp~rz thc incruawd pcr capita allotrncnt fnr iood. thc d i ~ ~ r c i t l a i ~ ~ ~ d nu t r i t ~ ~ ~ ~ i a l l y mdrgiw1 10 dcl;~.icnt. unlcsj supplemented by family n l t~ l~bc i - s . I'risrlrlcrs in all prisons clcscrihcd a perpetual state of hunger. Sornc ir~matcs in ~ h c provinces arr ~ ~ k l e to supplcrl~er~t the diet with grtcnc, and vegehhlcs cultivatcd by the prisoncrr in communal or individual gardtlns. In some cases. prisoncrh were also ablc lo raise poultry i n or around provi~~cial prisonh. although Inost 20111d riot afford i t .

Delays i n arrival cof govcrnmcnr r ' d allocations t~ Katnpong Som yrisoll in September 1994 resul tcd in stvere i ' d hhortages and, according to IJNC:FIR, rlcar stawatior of snnle prisoners. ?'his event prornpted a change in thc distribution rlir~cls st) that pristx oificcrs f r r ~ r r ~ each province art. no& sent to P ~ I I O I I I I'cnh at thc: C I I ~ o i cnsh month to rccci\,c thc i r allotment based o!r thc prison populat~c)ri.

Thc lllrdical tL im Icarncd 11, cad.; Fehruar) t h a ~ [he food L~llocatior~ duc c111 I l ecemb~r 30, 1991 had not yet bccn rccciked b j pnsoi~ director\. 'I'hc hI~n~,lrk of t ~ n a n c c had not releaceci the hiidget to thc Dcpartmen~ 01- f'ri sons. 7'he Ilirector of he P n 3011 Dcpar~nlcn t reported that hc had borrowed five nlillinn riel (US$ 1.9201 rclr t t~c prl\oII food budgct. P r i w n directors in -13 and Tak:nao prisons luld thc t u r n thnt thcy ucrc rayidly depleting

food supplies. Prisoners con~plained that thcir food ratinns had dczrcarcd during the month of January 1995, and conlplained of worsening hunger; numerous cal;es of hcrihcri were seer1 by the medical team in Takman prison.

The prison dircctor at Takmao indicated that, due to food shortages, he was forced to supplement the prisoners' diet with cwunuts that grew in the compound. Tllc rncdical t a m ohsenled a prisoner, said by his cellmates to be n~entally i l l , eating coconut husks i n order tcl alleviate constant hunger.

Thc primn i i i r~ ro r s at 1'3 and Takn~ao reported resorting to loans trom mar bet monevlendcrs ID buy focxl for the prisons. At T3 prison. a one-million-riel loar; (US$ 385) wa i horroucd at a month1 y interest ratc of fiw p r c e n t . The rrlonctary a1 lui,ncnr for i~wd was s ~ ~ n i l a r l y delayed i n all prisons in Cambodia.

Nor~go?.crnrne~-ltal groups. contacted by thc medic~,il Ic.ai11. rcported donations of tools to the prisorla Irl S ~ e l n Reap provincc for cultivar~on of gardcnr. In some prisons these gardcns serve as an Important source of supplernrln~l !clod. Hurnan rights groups ~ I I the pro~,ince reported that the garden lools were suhscq~~ct~l l y sold by prison ofticcrs. Icaving the garden fallow. In Pur \a1 prison. prison o f f i c i ~ l s ~lcnied prlsiwcrs access to previously cultivated gardens t mmcdr;-~r~lv cwlsidr. [lie prison compound, c.i t ~ n g a lack of well water.

I Over half ( 1 t' rhc prisorlzrs s~rrvcycd (62 % 3 rcportcd experiilllcing n igh tivnrcs ( n = 85) . with a meal! of 3 nightmares a c h week (n=43 , SI l=2 .4 ) . Sevenry-tuo prrcent of these pristlncrs are affcctcd by t h e nightmares ( n = 53). h iany rcportcd 11 ~ ~ ! ~ l r n ~ t r v s i+ i r t ~ \,ioltnt

I cilaicn t that included shootings, tororc. and mirtrcatmcnt uf prl i o ~ l t r h , hlal~h pri5onsrs also : rcportcd dreaming of ghosts or uf tl~c dcal h s 13 t' fanlily mctnhcr3. t ltw prl\oticr reported

having nightniarcs four or five times a u,cck. t"inr)th . \I. .I R . cl ,il "-The H a r ~ , a ~ d '1'1auma Quzst~unn.i~ru: Vi111rIut ~ n g a Crosc-Cul tural Instnlment for h.icasunnc Tofiurt-. Traurn,i. dnd I'r l , t-tra~~n~atiz Srrvs> Disorder in Irlrl~)c.t~~ricst. Ktfugccs, " Jo;4r?1rrl (f ;?!hilk, Ph .D. .ind Jar11r.s Lavcllc, L1.S.U'. . "Tht Psychosoc.~al Impact of War Traunla and Tnrture on Southe~t.1 .,2

not rhcy wuuld bc treated proprly tor iilnesses. and ahout being alorlil and no[ knowing h o l ~ , long they would bc detained.

Fi tty-five yrcent reporlid being able ti) work (n =87). Seventy-thrzc percent were allowcd religious activity in pricon (n=82) s ~ i c h as lighting incense or candles. In some prisons, vrrits hy nuns and monks were permit;&.

lnrnatcs dtycndcd or) contact with family n-.cmh~rl; for food supplements and fi-IT thi: prrrchase of inedicincs. -4In)nrt all of thc survcycd prisoticr3 (95%) statcd that they were allnu.cd farnily vtslts (n =77) , ~ h o ~ ~ g h orlly 75% h ~ d contace w t h t h i w hmilics (11-85 1 . Thc n u i n r l un~he r ofvisrts each month was 2.7 (n=5@. S D - l,l!i). 'rhc mean Icngth of v i s i t s was scventwn minutes ( r ~ = 58, SD = 15). Over hzl t' of thc prisoners ( 5 5 '7, ) had contact u:ih U N T A C , ICKC or other hrlrnarr rights officials whill: in pri lion (n =P). : Z ~ O L I ~ hall' ( 3 I % l receii-cd, or wei-2 allowed to rtceivc. rr-ratl.

Bccausc o i the rcnlotr: location of rropc\~~:e Plwng prism, adjaccnt to lhe Victna~n- C:arnbudir! border and r l x t y -six k~lomeiers frorti the town uf Knri~pclng C h a n ~ . famil ,: i , i 3 i t s were particular1 y dil'ficult . Kelalives had to c ~ b r i i i ~ ~ authori7aticln frclrrr riic IucL~l Lk unl (comm~lnu or subdi$trict) and Sect ~cln authnnr~es jet-orc ~isi t ir lg rhe priwners. Farnil! irisil> there occurrsd ?.pprLlxiinatcl~ oncc every rhrw niont 11s.

Fnllowitig thc detcrioration In thc sccurit! sl ti~ation i n hl;ti 1994. ~IICI' forces Iuyal t r . 1 the PIIK Iauncl~crl 3 military clffensivt- against thc Ruynl Gavcrnrnt~n t haw3 i n P ~ i l j [I a13d Ijattamhang. pr l\i'llicr\ i n Hattaml\anp pr r~v i i ~ce ucrtl not permlt!t.d clul of their cells or rtl1ou.r.d c o n ~ x l n,i tk tht'ir famil ics. L,etter\ wcr~ . not pcrmi ttcd at that tim?. Accijrdir~g 111 pnwncr accourl t s . this policy cased durirg thc ran! seawn. whrll a r ~ r c d cot~fl ict dccrcasr~tl. In Fcbnl:irj 1935. {hc pol~c!? of Iimitir~g f-a~llilv :isit? and rcstrictin? !ark1 1 1 111c rcs~rnlcd. i'rrsnrre-s trcrc at?r)wud o ( ; t of thcir cellc fnr only jive 111it;l;tcs ~wic'e edcI1 d3y a1 !hi' L~I~IC of

-- :he rtldoicai rthartl's tirltoit,-up ~ , i s ! ~ . ~ h e pri~i3n director told thc te.lm :hat th lc p o l i ~ ~ W ~ I S r\corlssdiry given ti12 wctirif. sitiia!ii?~ in 1 1 1 ~ pro: IJ)c'c.'"

'' ?$I i~teil J u \ J ~ t - ~ hr*tlt ccn thc Rh)yriJ C8 >\-~.r l~rncnt lt>r;L-< .inJ Vorcr \ IL); al tn th; K l i u ~ c ~ Roi lgc i x l r - c or~gc>in~+ r : ] the f j r \xr1.;tzrn dlslr~:t-; ot t3:1tr;1rnhariy p r r b \ i n ~ c at ~ t c t ~ m e ( 3 ' thr. team'.; \ is i t In 2:irIb \ , ; . h ~ - ~ ~ l i ~ - y lO(35. r\[>n: 4 ~f t h c i:;tir~t> u ; i s u ~ t h ~ r h ~ - t n t > kilornrtr.r\ t>t Bathrnbany tilu-n ~ t r c l i , a r ~ ~ l th15 d!d n(l: O ~ ~ ~ L I U l i e qpcar to cl~sr \ i~t JA,~:,. I r f t . .

COSTENT OF NIGHThlARESIRECLRRENT DREAhlS 7

Dreams of spirit (4)

Dreams of being shot (3)

Dreams of torture (2)

that other orironers attacked orisoncr

1 Dreams of his house in Vlctnarn - 11

' 1 Dreams of being shcated 1 1 I I

1 1 Dreams that someone comes in house and kil)s him 11

I Drcams house i s being robbed

' 1 Drca~ns of parents having problems I+ 11 Drc-arns of relatives dying I I )/ 1)rrams (hat daughter died )I Drwnlr that he i, drowning (1 Llrmrns his house is burrled 'I (I I Dreams of being aiocked I 2

'I'he prohlcrii of pnat\ner-011-prisoncr violcnct: var~cd greall y i n C'arnhndia's prisonh. PJ prison *;is di5tinguishcd froni olher prisons by a high Icvcl or violence. Due to the >evere ( ~ v e r c r m ~ d i n g , rcsrricted amour] t5 of food, and water dc~~riva~ic>n, two-tli i rds (66 % ) of prisontr\ at PI reported being t~er~ten. cjr hei11g subject to thrcar 5 arid in t I mid,~tion hy othcr priscjt~crs. Several pnsontlrx repor~cd that t ' i a ~ ~ _ c h t s rugularl p eruptcd oircr control of the mragcr wrlter supply. I n ~ h c prison population as a wholc, ~ w t l ~ t y - u n e jvrcent rcported hei112 subject to beatings. inti rnidatior, 1,r t h r e a ~ s by vther innlalec ( n - $ 5 ) .

1-he orgalifation of prison heallh care was in flux a! rhe time ~ t ' our investigation. Under I!NTAC. health care in some prownces was coordinaied or pmvidcd by Uh'TlZC human rights officers; however this was not consist en^.^' Wi;h the e rd of the UNT.4C ~ n a n d ~ t e , there remaiced no systern in placc for the provision o i health senices i n thc prisons.

The mediczl team Inct with the governmcnl officials i n Phnom Penh rcs~sc?nsible for health care delivery i n thc prisons -- Dr. Irn Sophorn. technical director, and D r . kern Pl~un, rncdical director, i f ihc Health Depanrncnl of ihc Minislry nf ihe interior.

On ~ w o ocanons, the ~ncoical team also toured rht: hospital in Phnur~~ Pcr-th. now cdled hlonivnng Hospital, but better known h~ i!s previous dcsignatinn as Horpital 180. 'l'hls faciiity is, admir~istered by lhc Hedth Department c!f the Mirlistr?' of Irlter~or, md xervss policc nffi~ials as wcll zs yrirolle:~. Thc hospital? located in ccniial J'h:joi!~ Pcnh behind the pulicc compound wliich houses PJ prison, resembled a ghost rawn. I'l-rerc we'c threc prisor~ers u.110 were inpatients a1 :he hospitil at the 1:rnt: of the tour; two tlad b t x n rans sf erred for heni,optysis. A prison guard ivas asleep i n thc adjacent hospital rvuin.

The Ministry of llmlth is the other goircr 11111entaI agency responrihle fi3r health In thc prisons. The medical learn met un ;wri isccaslons with Dr. hlam Runheng. Underse~retaq ot' State for Health of !he M1:listq of Health.

A c c ~ r d i n g to R,lle 2? fit' the Sundard Minirnum Rule>, each prison hhould have at ;cast m e qllalificd medical officer who has some knobledge of psychistry. According to the Mirristry of Interior, cach prlson has a designarud medical officer. The team found that medical officers, a'lhuugh we1 1-mwling, wcre often p u r l y !rained and universally ill-equippcll to provide even nlinimal health serv1;t.q I n a nrr:nber of yri 5011s i.isitec bq th,n tmm. there was ilo kcalth officer in e v i d c n x .

Fur t j - th rw percent of tbe prisoners suneyed by the rncdical learn, reponer: receiving health sen.lce-s by h e ~ l t h professionals, sdch as first-atd officer3 or nurstng as.sista:ts, and 17% 54. n l t r w Only 2% described senices provided by a yl~ysician. Thirty r>tlrc~nt slated that there wcre no providers in the prison, 2nd scxcn pe1ccr.r d ~ d not knou8 ( n = 8 h ) .

'' Unjtcd Nationc Transitional Authority In CarnhcI~a, iiurnan Riphh Cornponznt Frnd R z p ~ r t . p. 24

Rule 24 of the Standard hiinirnum Kulcs requires that the medical officer s e and examine every prisoncr as swn as poss~ble after hrs admission and thereafter as necessary. In the team's study. only eleven ~ r c c n t of the prisoners survey& urldcrwent physical cxarnination upon arrival to prison (11 = 85) . Those who unduwen t an adn~~ission phyhical cxamination werc principally in Plinom Prnh area prisons (six our of n i n e respondents). where services were provided by the nongovernmental agencies hlDhl and LICADHO.

Eigh ty-two percent had never undergone physicaI examination in prison ( n = 85) . Thirty-one percent of inmates knew the name of a health professions\, while 69% could not identify a health professiorlal by name (n=86). Eighty-thrcc perccnt of respondeiits (n=77) statcd that the prison kept no md i ca l records.

The prison health officers prei'errcd to refer prisoners to Calmette Hospital in Phnom Penh. where nlcclizlnes and services here rnore rcadily availabk t'rorn intcrnat~onal agcncic\. This reflected the lack of courd~nation hcrueen the agcncres responsible for hcalth care i n pri soil.

There werc two dca~hs ill PI prison at the tilrle of tlic medicill team crlsi t . Tlic physicians at the HeaIth Dcpartmcnt, though nomil~ally reipunrible for health care I n rhese prisons, were ilndware of thc two ciealhs.

Tlir fo l low~ng infclrrnation was obtained from inlen ~ c i r s lt i th the TJcputy Di rcztor at YJ, and with thc hlinistrl; of Interlor hcnlth staff at the prison. Further information was ohhitied from the ~ncdizal staff u i the Canlbcldian h a g u t : for the Promutio~i and Dsfensc of Human Rights (LICADHO). The rncdlcal learn was not able r o coniirm rl~e ehazt dales of the rniTiatc deaths, though repc~rtedly they occ~rrrtd around hlay .3 1. 1994.

Mom Visalrani. a previoudy -hea l thy 20-year-old malc, had hccn dctai nu1 a1 PJ for approsimateIy one month. He had been surgically trcated by a11 hlDM:J,lC:AD C-IO rncci~cal team for multiplc s h t ~ absce~ses or "furuncles." A few days prlor to his dcalh he was mated with oral antibioiics for the same problem, On thc i n c ~ n ~ i ~ ~ g of his dcalh, he devslopcd siiddcr~ generali7cd pair) and ~ h c ~ r t n e s s of breath whllt. tnucrcising. Hc was r x a m ~ n e d by the prison nurse who found no fever and na particular abr~urmalrt!. The prisoner dred of respiratory t'ailure In his cell roun thercafter.

Chheung Yannak, a previously h c a l ~ h y 29-'car-olcl male, u a s detained a1 IJJ for approximately ~ w o tnonths bcfore h ~ s death. At the time of a v i s ~ t by the PHR invesliyati~ig teain an May 9, 199.1, he had developed protracted ldlanhca and f c ~ ~ c r s . The PtiR ph) sicians found hi in to bc profoundly wasted, depressed. and modcratcly dehydrated. Hc was transferred to Calmctte Hospital for further trealrnent after he itas diapnoscd wlth typhoid fcvcr and had bwi~ refuscd medical treatincnt whilc in thr: pnson. H c was trealcd with intravenous rel~vdration and antibiotics and returned to the priwi~ tu o days after admission. H I S coniitlon dctcrioratcd over thc follow ing da) i. and aftcr examination b y the

nurse he was sent back to Calmettc Hospital for further evaluation and trcattncnt. He reportedly was dead on arrival at Calmette.

Though i t is rlot possible to cstabli~h the cause of death in these two cases is not possible to establish without furlhcr j~ivestigation, both pnsoncrs suffered from diseases which were acqulrzd within a relatively brief pen& and can be directly arrrihuted to the extremc coi~ditions in the