With authorities expressing a desire to extend the Kingdom’s controversial drug war beyond its six-month window, observers say an outbreak of respiratory illness among prisoners in Kampong Speu’s provincial prison last week has underscored the medical pressures created by an ongoing prison overcrowding crisis.

The outbreak came to light when a court prosecutor and a staffer from the rights group Licadho went to investigate the case of five inmates who escaped from a clinic where they were being treated for the same symptoms.

Licadho’s Ung Somith said he found more than 20 other prisoners were also being treated for the illness, which he suggested could have been caused by cramped conditions at the prison, whose medical staff could only provide basic “first aid”. Somith said he was uncertain of the exact nature of the illness, and the Kampong Speu provincial prison chief repeatedly hung up on Post reporters requesting comment on the inmates’ conditions this week.

But with more than 9,000 suspects arrested in the government’s ongoing anti-drug campaign, which began in January, the strain on prisons is increasing, and inadequate health care appears to be the norm, interviews with officials and observers indicate.

Naly Pilorge, deputy advocacy director of Licadho – whose researchers monitor 18 prisons, and whose nurses operate in 11 – said that medical care in the Kingdom’s prisons left much to be desired.

“In comparison to the soaring prison population, there does not seem to be enough permanent working medical staff to treat prisoners, especially in remote prisons such as CC3, CC4, Ratanakkiri and other rural prisons.

Furthermore, there are virtually no medical or psycho-social specialists among medical staff, and the transfers of very seriously ill prisoners to hospitals are often done too late or there are no adequate hospitals close to some prisons,” she said in a message. “The acute gaps in basic healthcare to detainees is worsened by lack of medicine, medical equipment, inadequate diet, poor hygiene, trauma, stress and acute overcrowding in almost all prisons.”

In late 2014, when Cambodia had an inmate population of 15,182, the Kingdom’s then-23 prisons and four correctional centres were already operating at 179 percent of their official capacity, according to a Licadho report. Today, according to Prisons Department spokesman Nuth Savna, the number of inmates has shot up to nearly 25,500, while the number of prisons has increased by only one.

Speaking of Pursat provincial prison, where Licadho dispatches a nurse on a monthly basis, Licadho prison project researcher Mit Samourn explained that the most common health problems reported by prisoners were scabies, numb limbs and diabetes. Currently, said Samourn, the prison has just three nurses for more than 400 inmates.

She added, “the health aid [service] in the prison is not responding to the problem[s] of the detainees”, although prisoners determined to have a “serious illness” could be sent to a nearby referral hospital.

By contrast, Pursat province’s Correctional Center 4, said Samourn and Correctional Center Chief Ouk Kim Chun, has seven medical staffers for nearly 200 prisoners. The prison, however, is still under construction, and will accommodate as many as 5,000 prisoners when finished.

Still, out of those seven health staffers, only one is a “technically skilful nurse . . . who got a certificate and many years of experience”, Kim Chun said. The others “are only those who got training for one or two months”.

“In the future, they will send more nurses to make it equivalent with the thousands of detainees who will be sent here,” he added, without saying when this would take place or how many qualified nurses he expected.

Still, Kim Chun was unperturbed by the prospect of providing health care to thousands of inmates. “I have been in charge here for two years, but I haven’t seen any serious illness,” he said.

Last March, around 800 prisoners from Preah Sihanouk provincial prison were transferred to a new facility almost three times the size of the original provincial prison.

The new prison now holds 900 inmates, but even today, said Maggie Eno – director of M’Lop Tapang, an organisation that meets with inmates to provide job training and relapse prevention services – the facility has only one doctor for the entire prison population.

While seriously ill prisoners are dispatched to Sihanoukville referral hospital, Eno said, “it’s obviously not enough medically trained staff”.

“[When] anyone [is] looking after 900 adults in a confined space, medical care is not going to be high quality,” she added.

Because the inmates her organisation works with are between the ages of 15 and 25, said Eno, they do not exhibit medical problems like high blood pressure that might affect older inmates. However, she said the young inmates displayed “constant” fungal and bacterial skin infections. “You’ll see boils on their skin, especially their arms and their hands,” she said.

Eno believes the prison’s heat and humidity and the inability to shower regularly can turn these skin rashes and boils into chronic conditions.

Preah Sihanouk Prison Chief Sam Phall, however, said the prison employed two nurses for 904 prisoners, but maintained such a ratio was “not a problem”, and that those with serious illnesses would be transferred to the provincial hospital.

Acknowledging that some inmates did suffer from respiratory difficulties and swelling limbs like those in Kampong Speu, Phall insisted that inmates did not always develop health problems within prison walls. Some, he maintained, arrived with “AIDS and high blood pressure”.

Currently, Phall said, only one inmate is receiving outside treatment for a tetanus infection contracted before their incarceration. Phall also said he expected the prison to receive “maybe four or five more nurses” next year.

However, the Prisons Department’s Savna admitted that the shortage of qualified medical professionals in Cambodia’s prisons posed a serious problem. “Is the hospital outside enough?” asked Savna. “It is not enough. But if there is a problem, we send [the inmates] out for treatment.”

When it comes to recruiting more doctors and nurses, he continued, the department did not yet have a plan. “Maybe next year,” he said. “It is hard to find them; those who have real medical skills are working outside.”