Cambodia 1998

Large scale HIV epidemic National defence and security are the main priorities of the government, which has yet to make the important investments in health and education expected by the international community. The unstable situation in the west and north of Cambodia, delaying planned refugee repatriations from Thailand, was exacerbated after the death of Pol Pot in April 1998.

International staff: 53 National staff: 307 MSF has been working in Cambodia since only weeks after the Vietnamese withdrawal in September 1989. Teams are distributed throughout many parts of the country and their contribution represents a crucial element in the reconstruction of the health system. The following is an overview of the extremely large range of activities carried out over the past twelve months. MSF has been the very active partner of the Ministry of Health (Ministry of Health) for a number of years, assisting it to carry out its health reform programme. Teams are working in the provinces and the districts of Stung Treng, Kratie, Siem Reap Oddar Meanchey, Pursat, Banteay Meanchey, Battambang, Kompong Thom and Kompong Cham, as well as in the capital, Phnom Penh. MSF continues to provide assistance for refugees and IDPs. This takes the form of cross-border operations targeting camps in Thailand and the setting up of transit camps for returnees in Cambodia. MSF is helping to get seven operational health districts underway, each one covering between 100,000 and 200,000 inhabitants. Although the reforms provide a boost to the Ministry of Health, they also conflict with the vested interests of bureaucrats at the Ministry of Finance and in the offices of the provincial governors - who would prefer to retain their roles as the intermediaries in the management of health budgets. As Cambodia opened up to the outside world, it rapidly fell victim to a large-scale HIV epidemic. MSF is doing a great deal towards AIDS prevention by introducing a range of general precautions in the hospitals and by widespread distributions of condoms. MSF distributed more than 1.7 million condoms in 1997 on the basis of the "social marketing" principle. MSF teams are also ensuring medical and psycho-social care for those affected by AIDS and treatment for patients suffering from STDs. The training provided to medical and paramedical staff is another important aspect of this care and treatment approach. In Phnom Penh, MSF is supporting home-based TB treatment through the use of the DOTS method and is implementing a national training programme for laboratory technicians in the Technical School for Medical Care. MSF is also providing technical assistance for the implementation of a national programme to control a type of bilharzia called schistosomiasis mekongi in direct collaboration with WHO and the Basle Institute of Tropical Medicine.