PHNOM PENH — Like so many older Cambodians, Nim Dynat experienced the horrors of the Khmer Rouge regime and struggled for decades to overcome them. The killing of her husband and being forced to marry another man she did not know left a deep trauma.
And like most victims of the murderous 1970s regime, she has had to face this heavy mental burden alone with almost no external help. “I always felt sad. I tried to forget the bad things and listen to the Buddha’s laws so I feel better,” said Nim Dynat, 78.
After the regime’s collapse, she left the forced marriage and raised her children alone on a small farm in Psar Samaky Village, in Kampong Speu Province’s Kondorl Dom district, where there are few government services, let alone a mental healthcare clinic.
It was not until around 2016 that she had an opportunity to attend several psychological counselling sessions that were being organized by the Transcultural Psychosocial Organisation Cambodia (TPO). The NGO offered this support to some of the 3,865 victims who registered as so-called Civil Parties in order to participate in the Khmer Rouge Tribunal proceedings.
“They let us get together to answer a few questions. They also make us have fun and eat together… But it was not enough,” Nim Dynat told VOA Khmer.
Another Civil Party, Khy Savey, 55, from Banteay Meancheay Province, said she “never received any” counselling during the trials, adding, “Even though I need it, I don’t know what to do.”
The two women’s situations are indicative of the victims’ continuing lack of access to mental healthcare despite deep-seated trauma.
FILE - Cambodian Buddhist wait outside the court hall before they attending the hearings against two former Khmer Rouge senior leaders, at the U.N.-backed war crimes tribunal on the outskirts of Phnom Penh, Cambodia, Friday, Nov. 16, 2018
FILE - Women arrive at the entrance gate to the Extraordinary Chambers in the Courts of Cambodia (ECCC) for the trial hearing on evidences of forced marriage and rape during the Khmer Rouge regime, on the outskirts of Phnom Penh, Cambodia August 23, 2016.
A traumatized population left untreated
Ever since Cambodia emerged from decades of civil war in the 1990s, the impoverished country has struggled to meet the widespread psychological and physical healthcare needs of its society, which lost an estimated 2 million people to murder and starvation during the Khmer Rouge’s 1975-79 rule.
While the Cambodian government initially made efforts to preserve and construct dozens of symbolic memorial sites, such as Buddhist stupas and museums, to provide a degree of public healing, meeting the vast psychological needs of the victimized population has been largely left to individual non-government organizations like TPO.
The United Nation-supported Khmer Rouge Tribunal has provided a degree of legal justice to victims and fostered public discussions about the regime’s crimes, but the long-running court has not lived up to early hopes that it would provide victims with reparations, such as access to mental and physical healthcare, to remedy their suffering.
The tribunal is approaching the end of its work and some advocates for the victims are calling for a renewed effort to provide greater healthcare services for the ailing and aging group of survivors.
“[T]here is no time better than now to explore ways to help the victims of genocide… Healthcare is one way we can restore the dignity and humanity of victims,” said So Farina from the Documentation Center of Cambodia (DC-Cam), where she heads a project to advance the rights and health conditions of survivors.
“In partnership with the government, civil society should assume the lead for facilitating projects that empower survivors. Empowering survivors in their health and welfare does not have to be costly to be effective,” she told VOA Khmer in an email.
‘Huge gaps in assistance’
So Farina said mental health care services “have been largely unavailable” to victims despite long-running programs by TPO. The NGO, she said, “has done tremendous work helping victims in this area…but there are still huge gaps in assistance.”
“This is a circumstance that must change because the effects of genocide are not limited to the survivors. In fact, the failure to adequately address mental healthcare in a post-conflict society has a cascading effect in society, impacting not only families and communities but also future generations.”
She added that a new pilot project by DC-Cam aimed to improve welfare of victims by raising public health awareness and facilitating access to health services in communities across Cambodia.
FILE - A woman prays at the Choeung Ek memorial during the annual "Day of Anger" where people gathered to remember those who perished during the communist Khmer Rouge regime, outskirts of Phnom Penh, Cambodia, May 20, 2018.
While the country’s destroyed healthcare system has slowly been rebuilt since the 1990s, Dr. Yim Sobotra, chief of the Department of Mental Health at the Khmer-Soviet Friendship Hospital in Phnom Penh, said the government lacks mental healthcare services to meet needs of the general population and has no specialized programs for Pol Pot’s victims.
“Being tortured during the Khmer Rouge, while our people also suffered all kinds of family break-ups and massacres, could lead to post-traumatic stress disorder [PTSD]. This feature may require specialists in PTSD to treat those people separately,” he told VOA Khmer.
A 2009 study in the Journal of the American Medical Association estimated about 14 percent of Cambodians who were at least 3 years old during the Khmer Rouge regime had PTSD, while a quarter of this group also reported having a degree of physical disability.
TPO is Cambodia’s main psychosocial services organization and has foreign donor-funded programs that have reached thousands of Khmer Rouge survivors. TPO’s psychological support includes organizing self-help groups, counseling by telephone and “testimonial therapy.”
The latter involves a victim writing up painful memories with the help of a councilor, which are then read aloud by a Buddhist monk during a ceremony that is attended by survivors and local community in an effort to publicly acknowledge suffering, remove stigma and restore the dignity of victims, according to TPO’s website.
TPO’s executive director Dr. Chhim Sotheara told VOA Khmer that Khmer Rouge survivors were aging and therefore their needs in recent years had increasingly focused on “general illness more than their mental health.”
TPO’s support for Khmer Rouge survivors includes projects for victims of torture and of gender-based violence, as well as special projects to counsel several hundred victims who were Civil Parties or trial witnesses at the Khmer Rouge Tribunal.
No healthcare remedies from Khmer Rouge Tribunal
The tribunal is unique as it is a hybrid Cambodian and international court, and because it included a legal innovation that granted victims recognition through a role as Civil Parties in the trial proceedings, where they enjoy rights broadly similar to the prosecution and the defense. A total of 3,865 victims were registered as Civil Parties and are represented by a team of 20 international and local lawyers.
After the tribunal’s inception in 2006, there were hopes that this would allow victims to meaningfully participate in proceedings. While hundreds of Civil Parties attended some court sessions, there was little funding support for organizing meetings between Civil Parties and their lawyers, and their communications have largely broken down in recent years.
FILE - In this Oct. 19, 2011 file photo released by the Extraordinary Chambers in the Courts of Cambodia, court officers of the U.N.-backed war crimes tribunal are seen through windows during a hearing of former Khmer Rouge top leaders in Phnom Penh, Cambodia. (AP Photo/Extraordinary Chambers in the Courts of Cambodia, Nhet Sok Heng)
Civil Parties were initially also expecting to ask the court for collective reparations for victims and they made such a request in Case 001 against S-21 torture center chief Kaing Guek Eav, also known as ‘Comrade Duch.’
A key part of their reparations request was that the court should oblige the state to provide victims with free psychological and physical healthcare, transport to medical facilities, funding for education about the Khmer Rouge, as well as build memorials and pagoda fences at S-21, according to a recent research paper written by Michael Karnavas, a former criminal defense lawyer at the tribunal.
The tribunal rejected these reparation demands and offered no healthcare support, however, arguing that “it cannot impose legal obligations on the Cambodian Government, and that the Court lacks the resources to fulfill such obligations,” wrote Karnavas.
The tribunal has cost more than $300 million and has sentenced three defendants, ‘Comrade Duch’ in 2010 and top Khmer Rouge leaders Nuon Chea and Khieu Samphan in 2018, to life imprisonment for war crimes, genocide, torture and other crimes. Only Khieu Samphan still survives and his final appeal is scheduled for September.
Having reviewed the Cambodian and other international tribunals investigating severe crimes, Karnavas concluded that broader transitional justice initiatives, rather than judicial procedures, are best suited to provide healthcare remedies to victims. He recommended more such initiatives be launched in Cambodia through partnerships of NGOs, the government and international donors.
Nim Dynat, the Khmer Rouge survivor, said she had little hope that the state or court would offer her any financial compensation or free healthcare in the near future. Her last wish now, she said, was to see a permanent memorial site constructed in her community inaugurated with a Buddhist ceremony to commemorate all victims.
“It would be a building to place the items of those who have been [abused]… a temple or a big stupa with images depicting the massacres and misery,” she said.