On Monday morning, Dek Sarun was waiting for patients inside the Phsar Doeum Thkov health centre, but none showed up.
“We have no clients today,” the psychiatric nurse said in his small office tucked in the back of a building that houses a community-based drug treatment centre.
The centre is one of more than 170 nationwide that provides mental health and addiction services to drug users trying to get clean – when it has people to treat.
Since the start of a drug crackdown at the beginning of the year, the government has pledged to send “light” users to public community-based treatment facilities. With their families promising to take the suspects to treatment, they can avoid Cambodia’s overcrowded prisons or infamous involuntary rehab centres.
But despite there having been 17,387 drug-related arrests during the crackdown as of Monday according to statistics from the National Authority for Combating Drugs, Dr Chhit Sophal at the Ministry of Health said just 2,873 people have used state-run community-based treatment services this year.
Among those, some have volunteered for treatment on their own without having been caught up in the drug crackdown – like one 15-year-old yesterday whose mother took him to the clinic for help – meaning as a percentage of those arrested, those being diverted into treatment is even smaller than it appears.
In all, 79 percent of users who received some form of drug treatment ended up in much-maligned rehab centres. These involuntary drug detention centres were found to be rife with abuse, sexual violence and forced labour by a Human Rights Watch investigation in 2012.
Sophal, who is the director of the Health Ministry’s Department of Mental Health and Substance Abuse, attributed the low number of drug users getting treatment at the community-based centres to a lack of awareness among law enforcement and prosecutors about the location of the facilities, as well as lack of understanding among residents of the benefits of alternative drug treatment.
“[The Ministry of Health] will put more logos [and] signboards [and] pano[rama]s at health facilities to make the services visible, [and] educate and encourage people to refer [drug users] to health services as community participation,” he said, adding that collaboration between local authorities and law enforcement would also be needed.
Yim Sobotra, chief of the Department of Mental Health and Substance Abuse at the Khmer-Soviet Friendship Hospital, said the number of drug users coming into the community-based centre at the hospital’s campus has been very low, an average of just three patients each day.
“Most of them were sent by their parents,” he said.
Hang Sokheng, 25, was brought on Monday morning to the centre for treatment by his sister Chenda Money, 34. Sokheng has used crystal meth for years but has thus far avoided arrest under the crackdown, although he did end up in the notorious Prey Speu detention centre in January.
“I just want to recover,” he said. Klok Huot, director of the Department of Health at Oddar Meanchey province, said most of the 17 patients treated at community-based centres in his province had been referred by police – a number he also noted was low given the number of users in the province.
Sou Sochenda, a program manager with the NGO Khana, agreed patients remain scarce, but she said the Ministry of Health had made more efforts to make improvements during the second half of the year.
“The Department of Mental Health and Substance Abuse is developing the [standard operating procedure] of community-based treatment with participation from all key stakeholders in the community, particularly law enforcement officials, and creating referral systems in the community level,” she said.
The Health Ministry this year set up a committee to revamp community-based drug treatment centres and counselling to specifically respond to the drug crackdown. A new pilot model will be implemented early next year at Meanchey referral hospital, she added, with a methadone clinic that will offer counselling, treatment and other related health services.
“The [government] is making positive progress toward the public health approach dealing with drug users in Cambodia,” she said.
Phil Robertson, deputy Asia director of Human Rights Watch, expressed doubt, however, that the mentality around policing and treatment has changed.
“Some officials say they are committed to action but nothing ever happens – the same old rights abusing catch and hold them in prison system prevails,” he said in an email.
Meas Vyrith, secretary-general of the National Authority for Combating Drugs, was abroad and unable to comment for this story. Khieu Sopheak, spokesman for the Ministry of Interior, declined to comment on the law enforcement side of the crackdown.
Since the drug crackdown began, the prison population has swelled by around 36 percent to 30,000, according to Nuth Savna, spokesman for the Ministry of Interior’s General Department of Prisons.
“We need to manage the numbers by transferring” inmates, he said.
Savna said he didn’t know how many suspects were diverted to community-based centres, but maintained that mere drug users were sent to rehabilitation centres, while traffickers were sent to jail. However, it is common practice for courts to convict anybody found with drugs in their possession for “trafficking”.
“Rounding up ordinary drug users and criminalizing them as dealers sends them on a one-way trip into detention facilities where rights abusing guards and huge over-crowding means they will face months or years of inhumane conditions because of their addiction,” Robertson said in an email.
He added that Cambodia’s use of facilities such as Prey Speu, “where drug users receive no treatment, but face torture and worse from guards, show how bankrupt the system is”.