MEDICAL observers have questioned the decision by one of Cambodia's celebrated hospitals

to close its doors to and not rush first-aid to casualties of the March 30 emergency.

By its own admission, Kantha Bopha II children's hospital in central Phnom Penh made

the call even though three doctors were on-duty when grenades exploded within earshot.

"It is shocking to me that people were bleeding on the ground for an hour without

anyone attending to them," said Dr Georg Petersen, the World Health Organization's

(WHO) resident representative.

"Everyone who was a health-care worker, who was somewhere in the vicinity, or

who was told about the attack very quickly had a moral obligation to try to help

the wounded from bleeding to death."

The hospital's director, Dr Beat Richner, nevertheless remains unrepentant in his

conviction that the hospital decision was "wise".

"Nothing could be done", he said, for those who lay bleeding after the

attack in the park opposite the National Assembly, a few hundred paces from his hospital.

Richner told the Post his staff were "too busy" to attend to the victims,

as his hospital was already overflowing with sick children, many of whom had life-threatening

Japanese encephalitis.

A crowd of wounded civilians, their friends, and relatives, were seen gathering at

the gates of Kantha Bopha II in the wake of the attack, but were refused entry by

hospital guards.

While some have expressed dismay over the hospital's failure to do the minimal in

a medical emergency - deliver basic first-aid - others have questioned the morality

and ethics of the hospital's refusal to admit or treat the wounded.

"There is an overriding moral and ethical issue, because to refuse to treat

someone is immoral," commented one Western doctor. "It is understandable

that a pediatric hospital may not have the proper equipment to undertake major surgery

of adults, but, given the circumstances, the doctors would have been technically

competent and morally obliged to offer whatever assistance they could."

His words were echoed by an official from the Ministry of Health.

"A hospital must never refuse to take-in wounded people," said Kuyseang

Te, director of Minister Chhea Thang's cabinet. "To allow casualties to be evacuated

by cyclo or by moto should not have been permitted.

"We had already notified all hospitals in Phnom Penh - of no matter which specialization

- that if there are cases of traffic accidents or explosions like the one that occurred

on Mar 30, the nearest hospital has to take action," he added. "At least,

it must deliver first aid."

In the general opinion of practitioners, critical minutes - which could have been

used to stop bleeding, prevent hemorrhaging in victims, as well as stabilize, triage

and prepare them for evacuation to hospitals - were lost after the grenade attack.

"If someone with medical knowledge or simple first aid knowledge had intervened

on-the-spot, then surely it would have reduced the mortality rate," said Stephane

P Rousseau, executive director of MEDICAM, a consortium of non-governmental and inter-governmental

organizations working in medicine and public health in Cambodia.

Although a medical code of conduct has yet to be drafted into Cambodian law, observers

also stressed that in certain Western countries - France and Germany to name but

two - practitioners who violate the Hippocratic Oath - by knowingly neglecting to

assist people whose health is in jeopardy - risk imprisonment.

"For all medical personnel, there is an ethical obligation to assist in cases

of emergency or catastrophe, if you happen to know about them," said WHO's Petersen.

"In many countries - even if they are off-duty - it would be illegal for health

personnel not to assist if people are seriously wounded, unless they are totally

pre-occupied with saving lives of others."

But, in the defense of Beat Richner - with whom WHO and other agencies have had their

differences over how to deliver health-care in Cambodia - Dr Petersen added that

another factor should be considered: Kantha Bopha II staff may have been frightened

about venturing into a danger-zone where more grenades might be lobbed.

"People may have been scared," he said. "It is very hard to rationalize

when there are bombs flying about."

In his own defense, and in response to criticism, Richner has written a four-page

letter to King Norodom Sihanouk - who donated land next to the Royal Palace for Kantha

Bopha II - and the Prime Ministers.

"Kantha Bopha has no facilities and no means to treat neither wounded adults

nor wounded children...," Richner wrote.

"The decision of keeping Kantha Bopha II closed was wise. Nothing could be done

for the wounded people. Time would be lost for the patients, hopes would be disappointed,

a dangerous situation could have arisen in front of the huge crowd of people, military,

and police....

"The wounded people were told to go to the hospitals for adults and to hospitals

equipped for surgery....

"Our blood bank has immediately sent 15 blood bottles in our stock Sunday afternoon

asked by the national transfusion center," Richner wrote, adding that: "Two

children, injured by the bombs, are actually hospitalized in the surgical section

of Kantha Bopha I."

Those two children, aged 13 and 14, were transferred to Kantha Bopha I from the Kossamak

Hospital five days after the attack, according to the NGO Licadho.

Richner, in his written declaration, strongly criticized those in the expatriate

community who he accused of interfering with his crusade to provide best-quality

health care to Cambodia's children free-of-charge.

"Unfortunately, some people are abusing the drama of the bombs, even people

of the press, not the Cambodian but the expatriate press, thinking they have the

right to insult Kantha Bopha, the only expatriate NGO project in the health sector

which is really working in Cambodia with a never seen efficiency without corruption...

"There are too many NGOs and too many experts and too many so-called journalists

in Phnom Penh talking and talking and not working, being motivated in their nonsense

talking by people sick of jealousy. By headlines as 'Kantha Bopha closed to victims'

[journalists] touch delicate and very dangerous terrain, transforming victims into

culprits. By their arrogance, by their lack of professionalism, they... risk the

future lives of thousands of Cambodian children."

Richner was not available for an extended interview to answer other lingering questions,

such as: who ordered the hospitals gates be shut? Why weren't any of the hospital's

vehicles scrambled to take victims to other hospitals? When did Richner learn about

the attack, and was he aware of it before he performed an Easter Sunday charity cello

concert at 10:00am - less than two hours after the attack?

While most in the medical community were careful not to openly attack Richner, others

in Phnom Penh's expatriate community were more blunt.

Bert Hoak, an American who on the day of the attack photographed a pair of bloody

footprints leading to the gates of Kantha Bopha II, was incensed by Richner's justification

of what Hoak called an "unconscionable violation" of the Hippocratic Oath.

"People lay out there, bleeding to death and dying of shock, and Kantha Bopha

II did nothing," he said. "They're saying they weren't equipped [to deal

with the injured]... I would say they weren't morally equipped to deal with it."