Two days after giving birth, Sek Khorn brought her baby to Angkor Hospital for Children (AHC) on a Tuesday evening in September 2012. She didn’t have an appointment, nor did she approach a doctor – instead striking up a conversation with a woman whose child was in the intensive care unit. Eventually, Khorn asked the woman to hold her infant so that she could go to the restroom. The woman took the baby in her arms, and Khorn hurried out, leaving the hospital for good.
Khorn’s child had been born with Down syndrome and with a cleft palate, the likely reasons behind the abandonment, said Sorn Sokchea, a senior technical officer with the hospital’s social work unit.
“She didn’t ask us for help . . . She planned to drop responsibility of taking care of the child,” he said.
Such abandonment of children remains a relatively common phenomenon in Cambodia – so much so that AHC has its own branch of its social work unit devoted to addressing cases of children left at the hospital, the only facility to do so in the country despite evidence of a widespread problem.
Following the abandonment, staff in the hospital’s 13-member social work department, of which two members focus solely on child abandonment cases, contacted 192 health centres in four provinces – Siem Reap, Banteay Meanchey, Oddar Meanchey and Battambang – in an effort to trace down the mother via the health centre where she gave birth to the child.
After two weeks, they found her.
According to the Ministry of Social Affairs’ 2016 inspection report, there are between 20 to 30 children, mainly with severe disabilities, referred by private clinics and hospitals to state orphanages per year in Phnom Penh alone, said Bunly Meas, a spokesman for Unicef in Cambodia. In the provinces, there are typically 10 to 20 children left at hospitals or health centres annually.
Samnang didn’t land in a state orphanage, and wasn’t given up for adoption, thanks to the intervention by AHC.
After the hospital located his mother, staff explained to her that Samnang would be able to undergo surgery to fix his cleft palate when he reached six months at no cost. The hospital also offered to pick up other costs needed to meet the baby’s health needs, while simultaneously getting the child used to a special bottle to feed him.
Khorn was connected to an NGO to help her build a proper home for her and her child, and the Sre Thnong village chief in Siem Reap province offered to give her a little piece of land on the outskirts of the village where she could build the home.
“She visited [the hospital] two times before she decided to bring the baby with her,” Sokchea said.
On a recent sunny afternoon, Samnang’s tiny fingers held on tight to his mother’s hand as they walked about 2 kilometres down a dirt path to reach their home, which is only accessible by foot.
Samnang, now 4, walked with no clothes or shoes on.
Approaching their home, he burst into excitement, giggling and pointing to their small home, where his mother gave him a cold shower.
Khorn, who delivered Samnang through a traditional midwife, said he was born with a very “abnormal” mouth, and some people in the village told her to “just abandon the baby somewhere or kill him”.
“I kept the baby there [at the hospital] because of his mouth. I was afraid he might die,” she said, saying she did not intentionally abandon him, an account the hospital staff disputed. “I would never follow [the other villagers’] ideas. Even though he is mentally disabled, I wouldn’t do it.”
She said after the baby had been at the hospital for weeks, and staff from the hospital came home to talk to her, they asked her if she could still remember her son. Eventually, she took him back. Today, the hospital is still helping her to cover the cost of transportation should he fall ill so she can bring him for care.
“Having him is like having 10 people in the house,” she said. “He is always active. Seeing him being healthy is my happiness.”
When Sokchea, 35, began at AHC in 2011 in its social work unit, he was quickly struck with the inadequacy of how the hospital handled cases of abandoned children.
For him, social work was an obvious calling because of his past. As a child, his growth was stunted from folic acid deficiency, slowing his development and opening him up to neglect by other children.
“Children around me discriminated [against] me, ignored me,” he said. “I felt isolated, lonely. I was hungry for friends, but I had no friends, and I didn’t have the opportunity to play with children my age.”
At the hospital, Sokchea could see himself in the children who ended up unwanted in the hands of strangers.
Before 2011, when a child was abandoned it was up to the staff or other patients to step in to find a home.
Staff would go around the wards, telling people: “There’s a baby in the hospital, anyone want [the baby]? You can adopt.”
“That was the previous procedure,” he explained on a recent morning in his office at the Siem Reap hospital. “If nobody adopted, the nurse would just make a call to the orphanage and send [the child] straight away to the orphanage.”
Sokchea had a different viewpoint on how to cope with the issue, and began to make changes right away. It is now up to members of the hospital’s social work unit to trace down parents.
If they locate them, the hospital offers whatever services they may need to care for their children, including counselling, food and financial support.
If the parents still refuse to take the child back or the mother has a mental illness that prevents her from safely caring for the child, the next step is to find an extended family member to take him or her. Only then does formal adoption enter the equation.
Since 2011, the hospital has seen 46 cases of child abandonment at the facility. Though the numbers may be especially high at AHC because it provides free care, the phenomenon is nationwide.
With the lack of a countrywide approach to deal with these cases, some hospitals simply give up the children for informal adoption, send them to state orphanages or refer them to the Ministry of Social Affairs, officials and experts say.
Sorn Sophal, director of the Phnom Penh Municipal Social Affairs Department, said the department had six cases last year involving the abandonment of babies, all born with a deformity or disability, such as large heads and mouth problems.
The cases are referred to them from hospitals across the capital. He said there are no concrete statistics on how widespread the issue is because the hospitals usually give the children to NGOs.
“We only get children who were not preferred,” he said.
Ros Sokha, head of the child welfare department at the Ministry of Social Affairs, said there are no countrywide statistics of children abandoned at hospitals.
Children are only sent to NGOs that officials know can care for them, he said, but didn’t specify the names of the organisations. The disabled children are sent to state orphanages if there is no alternative, though a shortage of social workers complicates their care.
Tim Thanny, director of the Kampong Speu provincial referral hospital, said he believes protocol calls for abandoned children to be sent to the National Pediatric Hospital or to the Kantha Bopha hospitals if they are in a serious health condition. He said the last case of child abandonment at the hospital was five or six years ago when a woman who gave birth out of wedlock left her child.
“At the time, the midwife asked to adopt her daughter,” he said. “She felt pity for the baby so she adopted her.”
“In the last three to four months, people have asked me if there are any abandoned babies [at the hospital],” he said. “I have told them no, but if there were, I would give [the babies to them], but we would also inform the police and local authorities.”
Ngin Saorath, executive director of the Cambodian Disabled People’s Organisation, believes that there needs to be legal action taken against parents, coinciding with an effort by the government to help abandoned children.
The United Nations Convention of the Rights of Persons with Disabilities, to which Cambodia is a signatory, says a state needs to take all “necessary measures to ensure” disabled children have full enjoyment of human rights equal to other children.
“From a human rights and disability rights [perspective], it’s totally inappropriate for the rights of the child [to be ignored because of disability],” he said. “It is totally wrong.”
Aimyleen V Gabriel, technical manager for child protection at World Vision, also pointed to the UN Convention on the Rights of a Child, which “enshrines the right of every child to family care or when the family is unable to provide for appropriate care, the child is entitled to a family-like care”.
“As a signatory to the Convention, the Cambodian Government holds itself accountable to the fulfillment of this right and other related provisions,” she wrote in an email.
Under Article 321 of the Criminal Code, abandonment of a child under 15 is subject to one to five years in prison and a 2 million to 10 million riel fine (about $500-$2,500), if it threatens the safety of the child.
However, Chin Malin, spokesman for the Ministry of Justice, said prosecutions for child abandonment are “not common in Cambodia”, but exact figures could not be supplied as of press time.
Meas, of Unicef, said the organisation is working with the Social Affairs Ministry and NGOs to implement recommendations laid out in the Alternative Care Policy, which was established in a ministry prakas.
The policy outlines six steps for preventing and addressing abandonment, including having local commune councils educate residents about the issue. If a child is abandoned, the local Commune Committee for Women and Children is supposed to search for the parents or guardians.
“Unicef believes that placing children in institutional care institutions – even the safest places – should be the last resort,” he said.
Another priority highlighted in the prakas is proper documentation so that records of abandoned children are kept and cases reported to the government.
Sokchea believes the model used at AHC should be followed at hospitals around the country.
“We value what we are doing, but we are not sure if people have the same values,” he said.
As a result of those values, Samnang is getting the opportunity to live with his biological mother, even if it’s not always easy.
“He only knows how to say mommy and daddy,” Khorn said as the 4-year-old played with a red BMW toy car.
“I wanted to bring him home,” she said, after he had undergone two surgeries at no cost, including one to fix his cleft palate.
But others haven’t been as fortunate as Samnang.
Two months ago, a baby was found in a trash bag in Kampong Thom and was transferred to AHC before passing away the next day.
And as of mid-June, the hospital hadn’t been able to locate the parents of a 4-year-old disabled girl.
“We cannot find the family. We don’t want to send her to an orphanage,” he said.
“But right now, we don’t have anyone who wants to adopt the child.”