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‘Shameful’ lack of treatment

SOK knew what would happen. He had seen it before: The beatings and humiliation at the hands of detention centre guards; the military-style drills and backbreaking labour; the endless nights sleeping on the floor in mosquito-infested rooms, packed cheek by jowl next to street kids, beggars and drug users.

Sok, a heroin user, knew all this, but he still chose detention. While other drug users were fleeing from police street sweeps last year, Sok willingly walked into a controversial drug rehabilitation centre in Phnom Penh and asked to be locked up.

“I didn’t know what else to do. I just wanted to get clean,” Sok said in a recent interview, during which he asked that his full name not be used.

Sok’s situation highlights the overwhelming challenge Cambodian drug users face when trying to quit. Only a handful of voluntary options exist, provided by a small number of NGOs.

For most others, the only answer is detention in one of at least 11 government-run drug rehabilitation centres – facilities that Human Rights Watch accused in a report last week of subjecting their detainees to abuse and providing only minimal treatment.

But although rights groups and some UN agencies have criticised the rehabilitation centres, observers say the international community has been perilously slow in pointing Cambodia in the right direction.

In the meantime, recent evidence suggests Cambodia could be aligning its treatment policies with neighbouring Vietnam – where forced treatment is rampant, and where there are almost 10 times as many compulsory centres.

Nowhere to go
Addiction experts say there is a brief window of opportunity during which drug addicts decide they want to quit. Fail to step in with immediate treatment when a drug user hits rock bottom, they say, and the opportunity can evaporate.

The World Health Organisation recommends voluntary treatment centres, where drug users can access services with few barriers.

But when addicts ask for treatment at Korsang, the Phnom Penh-based harm-reduction NGO that works with street drug users, Holly Bradford, the group’s founder and technical adviser, has few options.

“Korsang has nowhere to refer drug users for proper treatment,” Bradford said. “Even if you are loaded with money, your options for well-established, scientifically proven, internationally accepted drug treatment protocols ... as far as we know, are zero.”

Critics say compulsory treatment does not work because it relies on the removal of drug users from their communities. When they are parachuted back in after their release, they face all the triggers that pushed them towards drug use in the first place.

“You’re mixing with the people you were using drugs with before. The people you were buying drugs from before,” said David Harding,
international coordinator for drugs programmes at Friends International. “People relapse almost immediately.”

Currently, the drug treatment centres fall under the control of a jumble of authorities with minimal addiction expertise, including City Hall, the Ministry of Social Affairs and civilian and military police.

Sao Sokha, deputy commander in chief of the Royal Cambodian Armed Forces and the national Military Police commander at the Ministry of Defence, said military police never wanted to be put in charge of running drug treatment centres.

“Our military police officials have no experience in drug treatment,” Sao Sokha said. “But parents of drug users give them to us because they trust us to educate their children and change their habits.”

Sao Sokha, who rejected the HRW report’s allegations of rights abuses in centres run by military police, said he, too, would like to see standardised procedures for drug treatment.

“I also support having standardised treatment,” he said. “But we do not have it yet. Until then, we cannot close” existing rehabilitation centres.

‘Vital alternative’
If the international community had a strategy aimed at setting Cambodia on a different path, H83 was it.

The H83 project, run by the UN Office on Drugs and Crime (UNODC), was conceived as a model for community-based counselling, treatment and rehabilitation services that authorities would build on to develop other such facilities.

But the project had trouble getting off the ground. H83’s October 2005 start date was pushed back after two successive project coordinators backed out at the last minute, according to a revision summary of the project obtained by the Post. The US$1.14 million project is now slated to end in March, and there are differing opinions on what exactly it has accomplished.

UNODC Project Coordinator Anand Chaudhuri said that, as part of H83, a pilot intervention programme was established to benefit 50 villages hit hard by drug use.

“We’ve got outreach teams who meet with drug users and their families on a regular basis to provide emotional supports,” said Chaudhuri.

A recent project brief Chaudhuri provided to the Post also states that H83 has succeeded in enhancing the capacity of local service providers, including health practitioners from 12 health centres and nine referral hospitals.

“In three years, we have a non-punitive model,” Chaudhuri said. “How many countries can claim that? Hats off to everybody here in Cambodia.”
The original project description for H83, however, suggests a more ambitious plan.

That project document, obtained by the Post, called for the establishment of four “full-service” drug abuse service centres, including two in the capital, where drug users could seek structured counselling, treatment and rehabilitation from trained staff members.

The project’s original end goals also called for a significant scale-up in those services.

“The number of people receiving … services during the lifetime of the project will increase from the present level of zero to several hundred persons,” the document stated.

Project organisers also envisioned 300 students each year undergoing training to learn drug abuse treatment services.

And the project aimed to provide authorities with “a viable alternative to the jailing of apprehended drug abusers”.

Gary Lewis, the UNODC’s Bangkok-based regional representative, declined to discuss specifics of the H83 project because the agency was preparing to share its evaluation of it with the government.

“We learned some lessons. Some things we got right; some things we got wrong,” Lewis said.

Other UN officials who work on the drug issue in Cambodia, however, said they were concerned the project had not been given the support it needed to succeed.

“I have made it clear to my colleagues that I think it’s shameful the lack of effort that has been in place,” said Graham Shaw, the WHO’s technical adviser on drug use in Cambodia, who blames the UN as a whole for the current situation.

“The UN has been advocating for community-based treatment as an alternative. But Anand has been stuck out there all on his own, and the rest of the UN has been too slow to make it a much broader programme of intervention. It’s been a drop in the bucket, you might say.”

2015: a ‘challenge’
Authorities have called on the UN to help establish alternatives to the current drug rehabilitation centres.

On January 19, a week before the HRW report was released, NACD head Ke Kim Yan met with UN officials and proposed phasing out the controversial facilities by 2015.

But sources with firsthand knowledge of the meeting framed the proposal as a “challenge” from Ke Kim Yan.

“He agreed community-based alternatives should be strengthened,” said one source, who asked not to be named because he was not permitted to speak to the media.

“But he was also very critical of the UNODC treatment project. He was issuing a challenge: ‘You need to help us develop treatment in 350 communes so we can close all but one of the centres by 2015.’”

Meanwhile, evidence shows that Cambodia has looked to its neighbour, Vietnam, for help. The Post has previously reported that authorities are planning to build a national treatment centre in Preah Sihanouk’s Stung Hav district, using Vietnamese resources. Last month, a Vietnamese delegation helped train local health staff “to become experts to cure addicted people” by using a controversial detoxification medication, Bong Sen.

And a statement issued by the Vietnamese embassy after a September visit by Vietnamese Deputy Prime Minister Truong Vinh Trong touted the bilateral cooperation on drug policy: “Vietnam is prepared to meet any requests by Cambodia to help it prevent and combat drugs, including sending Vietnamese experts to Cambodia to build detoxification centres … and providing medical equipment and Vietnamese-produced medicine to help drug addicts kick … their habits.”

According to a 2009 WHO report, Vietnam has more than 100 compulsory treatment centres, which hold 50,000 to 60,000 drug users for periods of two years at a time.

ADDITIONAL REPORTING BY CHHAY CHANNYDA

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