The dulcet chant of the Pali scripture reverberates around the carved walls of Wat Lanka, the sun’s first rays of the morning reflecting off the pagoda’s gilded tiles.

A steady crowd begins to snake through the temple gates, armed with lavish offerings to relatives lost long ago—rich curries, heaped plates of fried rice, wedges of fuchsia-skinned dragonfruit and twists of oily, sweet bread.

On the fifteenth day of this month, the monks of Cambodia will sit in their ochre robes overnight, chanting the Suttas for Pchum Ben, the annual 15-day national festival for the country’s lost souls, the dead who were tainted with bad karma and trapped in the spirit world.

On this day, according to Buddhist lore, the gates of hell open wide, releasing ghosts, of which some will have the chance to escape purgatory.

By 9am, Wat Lanka is a hive of activity. The pagoda has been set up with tables which teem with offerings of food for the dead, thought to soothe their suffering.

The offerings and celebrations are of a more subdued nature at nearby Wat Thann, flanking the eastern fringes of the city.

Streamers and vibrant flags are strewn across the smaller temple and are an antidote to sometimes pallid surroundings.

The 150 monks of Wat Thann smile and accept pretty vessels filled with petals and lotus flowers in an afternoon offering.

One smirks as a plate of iced coffees is offered and he gingerly sips. In the shadows of the room one of Cambodia’s more tangible ghosts is hovering, watching the worship curiously.

He must be no older than 30 and shows signs of severe autism: repetitive body rocking, wandering aimlessly in circles, avoiding all eye contact. The man was brought to the pagoda years ago, a nun says, after he became too difficult for his family to look after.

Cambodian temples are full of the unwanted and those thrown in the too-hard-to-care-for basket: the mentally ill, the abandoned elderly, the disabled, orphaned children and unwanted animals.

They also play a role in poverty alleviation. Families at the end of their tether and with nowhere to go will often seek refuge in a pagoda, cleaning and caring for the grounds and its inhabitants in return for shelter and basic food.

Long Saroeun must be in his mid-twenties and sits languidly in the lotus position. He migrated on his own to Wat Thann from Takeo at the tender age of 15 and has been a monk at the pagoda ever since.

Outside the temple’s entrance, a small boy fastidiously sweeps the steps.

Saroeun says he and the other monks find it “very difficult” to send away orphaned children that turn up at the pagoda gates. “They are poor, often have no relatives at all and have already had a hard life, most are from the provinces. Where else can they live, the streets? Most of them want to be in a safe, quiet place, and they take advice from us to be good people in society.”

He says there are a number of mentally ill living in the temple grounds and that the social stigma still attached to mental illness in Cambodia leads to sufferers, even those with families, being left abandoned, with the monks expected to care for them. “The cases we have here could not be cured at the hospital at all. They have no family nor relatives, so we will let them stay—this is an expectation in Buddhist culture,” he says.

“It is a great shame, I believe, for the victim, to just be dumped if they have parents. Yes, they get food here, but there isn’t a lot to go around. Medical treatment would be a preferable option, but there are not many services for that in this country.”

The autistic man at Wat Thann seems content. Is the pagoda, with its activity and space, a better place for the marginalised than a sterile psychiatric ward or hospital?

Communications officer for Cambodia’s World Health Organisation (WHO), Sonny Krishnan, says mental health research, although limited, had revealed the pagoda was often the first port of call for those with a mentally ill relative.

Although he agrees the concept of pagoda as refuge is embedded in the country’s social tapestry, he believes the complete lack of mental health services in Cambodia also forces those to seek support from the temple.

“People do hold the belief they can be cured or counselled by the monks, but it’s also reflective of the limited inpatient facilities here. As of 2010, 50 out of 84 referral hospitals offered outpatient mental health services, while 18 of 967 health centres offered that same service. There are only two psychiatric inpatient facilities with 14 beds in the whole country.”

“It’s the Buddhist principle to look after all sentient beings, but it’s a strain on the pagodas themselves, they depend on donations to survive.”

Krishnan said it was “extremely worrying” that mentally ill people were often left abandoned, and said the WHO had uncovered evidence of the caging and chaining of victims across Cambodia’s provinces.

‘The community, particularly in rural areas, do not understand mental illness at all. We seriously need money injected into this area, at a community level, to help build awareness. There is still the perception these illnesses are caused by spirits and exorcisms are still a popular form of treatment,” he says.

Krishnan muses over the “sad beauty” in these refuges for the unwanted.

“The Buddhists don’t turn away anyone—the elderly, cats, dogs, the disabled. I believe pagodas should still be included in a future mental health plan for this country. There needs to be more funding and it needs to be directed at a model using western and traditional practices, at a community level, that’s the only way it can work.”

A report investigating mental health and human rights in Cambodia, issued this year by the US-based Leitner Centre for International Law and Justice, acknowledged the role the pagoda played in mental illness.

“Mental health professionals agree that traditional and religious actors need to be integrated within the broader mental health framework…a combination of traditional and religious remedies also can prove beneficial, particularly where a mental disability is less grave,” it read.

Ket Saroun is a 52-year-old with dwarfism living at Wat Thann. He says his role as a caretaker at the pagoda had empowered him. “Before I felt sad with my body but now I feel strong. I don’t face social discrimination here. I am from Kampong Speu province and had no job, no parents, I was alone. I don’t feel alone anymore. The monks in the pagoda are very helpful to us. There is a peacefulness and quietness I love here,” he says.

Sharon Wilkinson, the former country director of CARE, an umbrella organisation that works to alleviate poverty, says while many pagodas had helped, much was dependent on funding and “the lines of alignment—some are aligned with the electoral political system.”

“They all have a caring capacity which can be quickly utilised though…I think they are absolutely vital in flood situations—often built on higher ground, people can retreat to those areas for sanctuary.”

About a kilometre north of ofWat Thann lies Wat Svay Poper, a small temple with a jarring, fire truck-red building smacked in the middle of the grounds.

A dilapidated makeshift shack has been erected at the rear of the pagoda and three women sit on a grimy floor and prepare food, plumes of burnt garlic wafting from a pan cooking on a small coal fire.

Cheay Yorn, her face creased and crumpled, must be older than 80 but declines to give away her age. She says she has been at the pagoda since the Khmer Regime collapsed.

“In return for staying here, my family and I cook and clean for the monks and other people,. “There are many other elderly people here who have no family—I’m lucky I have family but we are just very poor,” she says.

Kim Vuthy is the manager of Cambodia’s first retirement village in the sleepy commune of Chong Ampil in Prey Veng province, and he believes the elderly are often overlooked in the Kingdom.

His project, The Cambodia Retirement Village, is a small not-for-profit facility supporting five very poor people with 24-hour care, food and medical support.

“There are absolutely no services for them. I understand many end up in Pagodas but there really isn’t much food in many of the provincial pagodas and they are still living in extreme poverty.”

While he understands the importance of pagodas and monks providing social services to the community, Vuthy thinks the government should be making “vast changes” to the funding currently allocated to services for the elderly.

“There are actually more elderly people in Cambodia being abandoned now—as we’re becoming more developed, younger people are moving to the city to work, or overseas, some lost all of their family during the Khmer Rouge regime and we have a rapidly aging population.

“It would be my dream to see both public and private nursing homes in Cambodia,” he says.

Yorn watches on in fascination as Charlie Cristi from Phnom Penh Animal Welfare Society  (PPAWS) plucks each emaciated kitten from a litter of six up individually, squeezing a syringe full of worming medication down the creatures’ throats.

WatThann is teeming with animals, in particular kittens, with most dumped at the temple’s gates and some cruelly bundled into plastic bags and flung over the temple walls.

Yorn says she does her best to care for the abandoned animals, leaving leftover rice for the animals from her already meagre meal each night, but there were simply too many to care for. Cristi says each week that she visits she is increasingly humbled by the women’s sacrifice of food and selflessness.

“These women are doing the best they can do but they already have nothing, and the animals consequently die—I understand it’s sort of their responsibility through living at the pagoda—that you should return the care, but it’s unfair that they want to and often simply can’t.”

A new litter of kittens were dumped the day before we visited Yorn—each sickly kitten with infected eyes glued shut and still too young to feed. “These will most probably die,” Cristi says, “People just assume they will be cared for.”

PPAWS has just embarked on an program aiming to desex all animals in Phnom Penh’s pagodas.

“We’ve desexed one so far and it was successful, but it will all be dependent on funding. Cristi asks Yorn whether she like caring for the cat, and a grin envelops the old woman’s worn face.“I really like them—I think perhaps spirits have entered these animals, they have been reincarnated, so we must look after them. But mostly I pity the poor cats,” she says.

To contact the reporter on this story: Claire Knox at [email protected]

With assistance from Sen David