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Link to UNCHR
(E/CN.4/2001/NGO/63)
COMMISSION ON HUMAN RIGHTS
Fifty-seventh Session
Item 10 of the Provisional Agenda
ECONOMIC,
SOCIAL AND CULTURAL RIGHTS
Written
statement submitted by the Asian Legal Resource Centre,
a
non-governmental organization with general consultative status
Health Care in Cambodia
1.
The Committee on Economic, Social and Cultural Rights has
observed that, "Health is a fundamental human right
indispensable for the exercise of other human rights. Every human
being is entitled to the enjoyment of the highest attainable
standard of health conducive to living a life in dignity"
(E/C.12/2000/4). This statement is reinforced by article 25(1) of
the Universal Declaration of Human Rights; article 12 of the
International Covenant on Economic, Social and Cultural Rights
(ICESCR); article 10 of the Declaration of Social Progress and
Development and article 8 of the Declaration on the Right to
Development.
2
According to the Maastricht Guidelines (1997) States are obliged
to respect, protect and fulfil social, economic and cultural
rights. These are delineated: "The obligation to respect
requires States to refrain from interfering with the enjoyment of
economic, social and cultural rights... The obligation to
protect requires States to prevent violations of such rights by
third parties... The obligation to fulfil requires States to
take appropriate legislative, administrative, budgetary, judicial
and other measures towards the full realisation of such rights."
The Guidelines state that, "Failure to perform any one of
these three obligations constitutes a violation of such rights."
Furthermore, "Violations of the Covenant [ICESCR] occur when
a State fails to satisfy what the Committee on Economic, Social
and Cultural Rights has referred to as 'a minimum core
obligation to ensure the satisfaction of, at the very least,
minimum essential levels of each of the rights [...]. Thus,
for example, a State party in which any significant number of
individuals is deprived of ... essential primary health care...
is, prima facie, violating the Covenant.' Such minimum core
obligations apply irrespective of the availability of resources
of the country concerned or any other factors and difficulties."
The Guidelines conclude, "As a matter of international law,
the state remains ultimately responsible for guaranteeing the
realisation of these rights."
3.
Article 72 of the Constitution of Cambodia (1993) adopts these
international principles: "The health of the people shall be
guaranteed. The State shall give full consideration to disease
prevention and medical treatment. Poor citizens shall receive
free medical consultation in public hospitals, infirmaries and
maternities." Sadly, such guarantees mean little to people
whose right to health is being violated daily. In spite of
international efforts, the country has not yet recovered from the
Pol Pot regime's tragic legacy.
4.
A few indicators from the United Nations Development Programme's
Human Development Report 2000 highlight the status of Cambodian
people's health: life expectancy at birth is 53.5 years;
infant mortality is 104 per 1,000 live births and 163 per 1,000
live births for under age 5; maternal mortality is 470 per
100,000 live births. Additional figures from the 1998 report
reveal that 40 percent of children under age 5 are underweight,
64 percent of the population is without access to safe water, 86
percent without access to sanitation and 47 percent without
access to health services. The cumulative result, according to
the 2000 report, is that 27.7 percent of the population is not
expected to survive to age 40, and 46.6 percent is not expected
to reach age 60
5.
In September 2000, the Asian Legal Resource Center conducted an
investigation into Cambodia's health care system. It
confirmed the poor state of the Cambodian people's health
and found that this was due to a lack of funds, the poor quality
of medical service, corruption and public distrust of doctors and
hospitals.
6.
The average salary of a Cambodian doctor in a public hospital is
US-20 per month. Consequently, doctors in public hospitals
refuse to see patients with no money, even in the emergency room.
Medicine from donor countries that disappears from hospitals
reappears in the black market.
7.
Medical staff are unevenly distributed throughout the country. 87
percent of people live in the country's rural areas but only
14 percent of Cambodia's medical staff are based there. Some
staff outside urban areas are illiterate or semi-literate. The
lack of health care professionals in the countryside has
implications for rural poverty. In Srey Santhor District, Kompong
Cham Province, the Asian Legal Resource Centre found that among
farming families who had lost their lands, in 44.6 percent of
cases the loss was precipitated by illness preventing farmers
from working their fields.
8.
Denial of the Cambodian people's right to health is felt
intensely in everyday life. The Asian Legal Resource Centre
witnessed an accident, for example, involving a seriously injured
motorbike taxi driver. When an ambulance arrived, the man refused
to go to hospital because he had only 300 riels (US$ 0.08) in his
pocket. Without enough money, he knew that he would only be sent
home upon arrival, consequently he insisted on going home rather
than to hospital. This incident was not unusual; while in the
capital, the Asian Legal Resource Centre heard the following
cases.
a.
A young woman reported that her friend fell off her motorbike and
suffered concussion. Her friends took her to hospital, where they
were instructed to register her for a fee. When they said that
they didn't have money the staff turned their backs and the
patient was abandoned. While they cried for help, the patient
came to and a doctor said she would be all right. She went home
and died that night after vomiting blood.
b.
A man in his early 50s testified that after a hand injury
received while working on a construction site swelled and became
discoloured he borrowed some money and went to a hospital.
According to the man, "Soon after the doctor's
examination, I was taken to the operating room. The doctor
neither explained anything to me nor asked my permission: my hand
was cut off at the wrist with an electric saw."
c.
The 30 month-old baby boy of one woman had a high fever. At the
hospital staff asked whether she had money, whereupon she showed
500 riels (US$ 0.13). After some perfunctory questions she was
told to give the money in exchange for some tablets, which she
believes were asprin, and instructed to feed the baby three per
day. Two days later the baby died.
d.
A young man working as a garbage collector in the central market
explained that after his wife delivered their first baby she lost
consciousness. Taking her to hospital, he was told to pay 3,000
riels (US.77) and register at the reception desk. The man
continued, "I only had 500 riels at that time and told them
so. I was told to wait until someone called me. I was not called
by anyone though, even after my wife died in the chair of the
hospital waiting room."
9.
These cases clearly illustrate widespread denial of the Cambodian
people's right to health. With spending on health amounting
to only 0.6 percent of Cambodia's gross domestic product,
health care in the country is unlikely to improve in the near
future. The Cambodian government is failing to meet its
obligations to both protect and fulfil the right to health of its
people. It is failing to prevent violations of people's
right to health by doctors and other health care staff and is not
taking legislative, administrative, budgetary, judicial or other
measures to reverse the present situation. While lacking in
financial resources, the Government of Cambodia could
nevertheless begin by re-channelling spending from other areas,
such as the 2.7 percent of gross domestic product used on
defence, towards health care.
10.
The international community also has a responsibility to ensure
that the Government of Cambodia upholds the right to health. In
addition to reminding the government of those obligations under
the Constitution and the ICESCR, which it ratified in 1992, the
international community can provide financial and technical
assistance. Additional support would be a small price to pay. The
United Nations' efforts to promote the civil and political
rights of the Cambodian people during the past decade will
otherwise be of little use to a people who are being killed and
maimed by a system that is denying their right to health.
Posted on 2001-01-30
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