Action points based on findings

• Devote resources to reach survivors where they live, as survivors in remote and rural areas continue to face obstacles to access adequate assistance.
• Standardize management systems and improve sustainability and accessibility of the physical rehabilitation sector.
• Increase economic opportunities for survivors and persons with disabilities and develop education and training opportunities that are appropriate for survivors and other persons with disabilities and many survivors who lack education and literacy and have no work or land from which to make a living.
• Improve the physical accessibility of living and working environments.
• Provide quality psychological support services.

Victim assistance commitments

The Kingdom of Cambodia is responsible for significant numbers of landmine survivors, cluster munition victims, and survivors of other explosive remnants of war (ERW) who are in need. Cambodia has made commitments to provide victim assistance through the Mine Ban Treaty.

Cambodia ratified the Convention on the Rights of Persons with Disabilities (CRPD) on 20 December 2012.

Casualties

Casualties Overview

Details and trends

In 2015, the Cambodia Mine/Unexploded Ordnance Victim Information System (CMVIS) recorded 111 casualties from mines, ERW, and unexploded submunitions. Of the total, 100 casualties were civilian, 10 military, and one a deminer.[1] There were six deminer casualties in 2014. CMVIS recorded 154 mine/ERW casualties in 2014,[2] which represented an irregularity from the continuing trend of significant decreases in the number of annual casualties: 111 recorded in 2013, 186 in 2012, 211 in 2011, and 286 in 2010. In January 2017, it was reported that there were 83 mine/ERW casualties, a 25% decrease compared with 2015 and marking the first time that the total annual casualty figure was less than 100 people.[3]

In 2015, 31 (31% of civilian casualties) were children including seven girls and 24 boys, an increase in the percentage of civilian casualties although a slight decrease in real terms from 21% (33) in 2014, 26% in 2013, and 35% in 2012. Of the total adult civilian casualties, 76 were men and four were women.

As in recent years, most casualties were caused by ERW. Antivehicle mines continued to cause a significant proportion of casualties, comparable to antipersonnel mines, following a trend that began in 2010 when antivehicle mines caused more casualties than antipersonnel mines for the first time in Cambodia. This occurred again in 2015, when there were 17 antivehicle mine casualties compared to 13 casualties from antipersonnel mines.

As of the end of 2015, CMVIS reported at least 64,579 mine/ERW casualties in Cambodia: 19,723 people killed and another 44,856 injured since 1979. Of the total 50,998 (79%) were caused by mines and 13,581 (21%) by ERW. Among the survivors injured, 8,982 people had amputations.[4]

Cluster munition casualties

Data collection on cluster munition casualties has been limited and the total number, although not known, is thought to be much higher than reported. Cambodia is considered to be among the states “worst affected” by cluster munitions, with responsibility for significant numbers of cluster munition victims.[5] Two casualties from unexploded submunitions were recorded in 2015 and one in 2014. For the period from 1998 to the end of 2015, 197 cluster munition remnant casualties were reported in Cambodia.[6]

Victim Assistance

The total number of survivors in Cambodia is not known. At least 44,856 people have been reported to have been injured by mines/ERW.[7]

Victim assistance during the Cartagena Action Plan 2010–2014

The Cambodian Mine Action and Victim Assistance Authority (CMAA) delegated responsibility for the coordination of victim assistance to the Ministry of Social Affairs, Veterans and Youth Rehabilitation (MoSVY) and its support mechanism, the Disability Action Council (DAC). Despite hopes for improved national disability representation following a long restructuring process, the DAC was placed directly under ministerial authority in 2010. The focus of coordination changed from survivors to broader disability needs when the National Coordination Committee on Disabilities (NCCD) replaced the Steering Committee for Landmine Victim Assistance in 2009.

Survivors had increased opportunities to access free healthcare programs. However, emergency transportation to save lives was not widely available. Through NGO efforts to expand services and geographical coverage, physical rehabilitation improved in both quality and in the number of services available from existing service providers. Physical rehabilitation services have been available throughout the country from both government agencies and NGOs. However, since the handover of the physical rehabilitation centers to MOSVY, there has been a reduction in available services and in some cases, persons with disabilities or NGOs assisting them are being asked to pay for assistive devices.

Gradual improvements were made in the availability of employment opportunities, social inclusion activities, and accessibility of existing services. Inclusive education programs provided by the government and relevant organizations increased. Vocational programs were phased out due to a lack of funding. There has been an increased emphasis on community-based rehabilitation (CBR) efforts.

Reaching survivors in remote and rural areas remained a challenge for service providers and generally these populations did not receive adequate assistance. Many survivors lacked education and literacy and had no work or land from which to make a living. Overall, they received little or no support and did not have full access to social services and healthcare.

At the Mine Ban Treaty Third Review Conference in June 2014, Cambodia stated that it had faced many challenges in providing victim assistance under the Cartagena Action Plan 2010–2014, including limited financial support and limited human and technical resources for the implementation of both international and national obligations for persons with disabilities, including mine survivors.[8]

Assessing victim assistance needs

Throughout 2016, the Jesuit Refugee Services (JRS)/Cambodia Campaign to Ban Landmines (CCBL) and the CMAA continued to undertake the “Survey on the Quality of life for Landmine/ERW survivors” (QLS), which was begun in 2013.[9] QLS survey teams organized home visits to understand the situation of respondents and provided peer counseling, raised awareness on the rights and needs of persons with disabilities including survivors, and engaged local authorities and service providers to support and promote the rights and dignity of landmine/ERW survivors.[10] Information and recommendations from the QLS were shared for the development of the National Disability Strategic Plan (NDSP).[11]

CMVIS provided ongoing systematic data collection of mine/ERW casualties, including numbers of survivors and referrals to services.[12] Lack of reliable statistics on disability was reported to be among the main issues of concern for the promotion of disability rights in Cambodia.[13]

A working group for monitoring data on services received by mine/ERW victims was established in May 2015. It is led by CMAA and members also included the MoSAVY, the DAC, and physical rehabilitation centers.[14]

Victim assistance coordination

The National Disability Coordination Committee (NDCC) established in 2009, was co-chaired by both the MoSVY and the DAC; it included some victim assistance service providers as well as other disability actors.[15]

The DAC, a semi-autonomous body attached to the MoSVY, provides technical, coordination, and advisory services for the MoSVY. The Persons with Disabilities Fund, an institution created under the MoSVY, has a mandate to provide rehabilitation services for people with disabilities, manage the rehabilitation centers, provide funds for implementing various projects such as support for education and vocational training, manage job placement services, and prepare policies for assisting and supporting persons with disabilities.[16]

At a more local level, relevant actors include a wide range of the Provincial and District Offices’ of Social Affairs, Veterans and Youth Rehabilitation (PoSVY/DoSVY); provincial, district, and commune bodies; and village chiefs. In some specific areas, there are Commune Disability Committees, supported by NGOs.[17]

The National Disability Strategic Plan 2014–2018 (NDSP) was developed by the DAC in cooperation with the UN Economic and Social Commission for Asia and the Pacific (UNESCAP), the Asia and Pacific Centre for Development (APCD), the Australian Agency for International Development/the Australian Government Department of Foreign Affairs and Trade in Cambodia, and other national and international organizations.[18] The plan contains four goals and 10 key objectives, all of which are relevant to addressing the rights and needs of survivors.[19] The NDSP itself notes that it represents a continuation of the implementation of the National Plan of Action for Persons with Disabilities, including Landmine and ERW Survivors 2009–2011, which had remained in place by extension through 2013.[20]

The NDSP was launched by the Cambodian prime minister in July 2014.[21] Ten key objectives of the plan are:[22]

1. Increase economic opportunities for persons with disabilities;
2. Provide quality health services and physical and mental rehabilitation services;
3. Increase legal services and interventions to address discrimination, abuse, threats, and exploitation of persons with disabilities;
4. Strengthen and enhance freedom, personal security, and disaster risk reduction;
5. Ensure access to education and vocational training;
6. Promote the participation of persons with disabilities, including with advocacy and information;
7. Ensure the involvement of persons with disabilities in social activities including culture, religion, sport, arts, and entertainment;
8. Develop and improve the accessibility of the physical environment, means of public transportation, information technology, and communication;
9. Ensure gender equality and promote equality of women and children with disabilities; and
10. Strengthen and enhance cooperation at international, inter-regional, regional, sub-regional level, national, and sub-national levels.

The DAC is responsible for monitoring and reporting on the progress of implementation of the NDSP to government as well as proposing revisions to the plan in order to respond to the needs of persons with disabilities according to the resources available.[23] 

The NDSP is the basis of enforcement of Cambodia’s core legal commitments to disability rights: the Law on the Protection and the Promotion of the Rights of Persons with Disabilities; the CRPD; and the Decade of Persons with Disabilities in Asia and the Pacific 2013–2022, Incheon Strategy: Make the Right Real.[24] Disability advocates expressed concern that, if the new strategic disability plan lacked a corresponding state-allocated budget and was based on limited existing human resources, its goals could not be adequately implemented.[25] 

In June 2015, it was reported that no institutional and financial arrangements had been made for the implementation of the NDSP. Furthermore, the relevant ministries and agencies had no developed prioritized action plans, and such inaction “might eventually result in NDSP remaining as an aspirational document with no concrete action to improve the quality of life for persons with disabilities.”[26]

A national workshop to review the implementation of NDSP was held in December 2015. Government agencies, NGOs, and private sector actors shared their progress in implementation of plan, the Law on the Protection and the Promotion of the Rights of Persons with Disabilities, and the CRPD. It was also apparent that some ministries were not aware of, or did not yet understand well, disability-related legislation, policies, and guidelines and that more awareness raising was needed.[27]

Cambodia has a relatively complex governmental structure for implementing the rights of persons with disabilities. In addition to the MoSVY, DAC and NDCC, the DAC Secretariat, the Department of Welfare of Persons and the Persons with Disabilities Foundation have specific roles and there were also many committees, sub-committees and working groups. Due to overlapping functions of the various institutions, in practice accountability was often ambiguous. Most did not meet regularly and their effectiveness was reported to be “questionable.”[28] The joint project document for the UNDP Disability Rights Initiative Cambodia 2014, listed the following key challenges facing the government’s implementation of the CRPD overall:[29]

• The lack of clear division of roles and responsibilities for the multiple government units with disability responsibilities;
• Low levels of knowledge and experience within these government units;
• Limited commitment to ensure the meaningful participation of disabled people’s organizations (DPOs) and civil society organizations;
• Challenges facing the MoSVY in facilitating coordination with other ministries;
• Relatively low levels of government funding for government units with disability responsibilities; and
• A lack of reliable data on disability.[30]

The NDSP contains many goals and objectives relevant to mine/ERW survivors, including implementing the national disability strategy for 2014–2018, “including people with disabilities by mines” as well as implementing the national policy on disability through the Disability Action Council; strengthening the implementation of the Law on the Protection and Promotion of the Rights of Persons with Disabilities; promoting enhancement of rights and welfare of the disabled according to the CRPD; improving the quality and efficiency of the disability fund; enhancing welfare for persons with disabilities; supporting poor people with disabilities with availability of funds; continuing implementation of community-based services; and providing employment opportunities.[31]

The MoSVY has core responsibility for disability issues and rehabilitation services. Several other ministries were involved in disability issues, including the Ministry of Health, which promoted physiotherapy services; the Ministry of Education, Youth and Sports, with a Special Education Office responsible for promoting inclusive education for children with disabilities; the Ministry of Public Works and Transport; and the Ministry of National Defense.[32]

The government launched the Disability Rights Initiative Cambodia (DRIC), a five-year, Australian-funded program, in July 2014.[33] The DRIC is aimed at ensuring that persons with disabilities have increased opportunities for participation in social, economic, cultural, and political life through effective implementation of the NDSP. The main goals include to support Cambodia’s coordination of the NDSP, strengthen the capacity of DPOs, improve physical rehabilitation centers, and work with provincial and commune officials to promote disability inclusiveness.[34]

Carrying out the DRIC is a joint program of the UNDP, WHO, and UNICEF, through four components:

• Component 1 (UNDP): Supporting Government implementation of the CRPD.
• Component 2 (UNDP): Supporting DPOs to raise the voice and protect the rights of persons with disabilities.
• Component 3 (WHO): Supporting rehabilitation systems strengthening.
• Component 4 (UNICEF): Inclusive governance and inclusive community development.

By 2016, the mid-term review of the initiative found that due to changes in the Australian aid program and budget cuts the “DRIC in its present version, however relevant or effective, may not be feasible to maintain in the long run.” When considering the budgetary situation of DRIC on the whole, including the funding allocated during the first two years of the initiative as compared with the outcomes achieved, the mid-term review found, “it would appear that it has been an expensive programme, raising concerns about its cost-effectiveness.”[35] By Mid-2015, decreased funding due to currency fluctuation of the Australian dollar was already a concern for the DRIC’s successful operation and UN implementing agencies had revised their budgets and reduced activities in work plans in consultation with the donor, Australia. They also looked for additional resources to fulfil components 3 and 4 of the initiative.[36]

Through component 3 of the initiative, the WHO is supporting the development of the government’s ability to manage the rehabilitation sector by building the capacity of key rehabilitation sector stakeholders, increasing government involvement and rehabilitation sector leadership, and establishing a coordination mechanism.[37] In 2016, it was reported that the DRIC was “largely on track in achieving the stated outputs, with the exception of component 3 which is the most complex and challenging.”[38]

The Cambodia Disability Inclusive Development Fund (CDIDF), managed by UNICEF, is part of the broader DRIC program. In order to achieve the rights of persons with disabilities, the fund aims to increase capacity of and collaboration between decision makers, civil society, and communities by providing funding through international and national NGOs and community-based organizations.[39] It applies only to certain geographic focus areas in about half of Cambodia’s provinces.[40] In 2015, six NGOs had grants approved through the UNICEF-managed CDIDF: Caritas Cambodia, Handicap International, Komar Pikar Foundation, Krousar Thmey, Capacity Building for Disability Cooperation (CABDICO), and Phnom Penh Center for Independent Living.[41]

Cambodia provided an update on victim assistance at the Mine Ban Treaty Fifteenth Meeting of States Parties in 2016.[42] Cambodia also included updates on physical rehabilitation and medical services provided to persons with disabilities in 2015 in its Mine Ban Treaty Article 7 report.[43]

Inclusion and participation in victim assistance

JRS and the CMAA developed a survivor network in provinces in Cambodia, encouraging persons with disabilities to understand their legal and human rights and to take action to access those rights.[44]

Many organizations included survivors and persons with disabilities in the provision of services.

Service accessibility and effectiveness

Victim assistance activities in 2015

Emergency and continuing medical care

No significant improvements to healthcare services available to survivors were reported in 2015.

Less than 1% of the population had voluntary health insurance. Some NGOs offered community-based health insurance. This covered less than 500,00 people in 11 provinces, but targeted people who are not poor.[45]

Physical rehabilitation, including prosthetics

The physical rehabilitation sector included 11 rehabilitation centers; the Phnom Penh Component Factory, supported by the ICRC; the Cambodian School for Prosthetics and Orthotics (CSPO); and the Technical School for Medical Care.[46] Services for people with physical disability offered through the physical rehabilitation centers were inadequate to meet demand. Furthermore, financing mechanisms for rehabilitation services, including funding pathways, were unclear. A lack of a standardized information system for the rehabilitation sector in Cambodia made it difficult to monitor the total numbers of people receiving services.[47] A consultant was hired with the financial support from the ICRC to develop procedures and tools for the implementation of quality assurance within all MoSVY-managed centers. The MoSVY continued to try to implement the Patient Management System as a common rehabilitation center management tool, with the financial and technical support of the ICRC.[48] This issue of inconsistent data may be reflected in comparisons between time periods. 

In 2015, the ICRC and national authorities were reviewing the preliminary findings of a study on how the orthopedic component factory in Phnom Penh could be enabled to operate independently.[49]

In 2014, 10,178 mine/ERW survivors received services from physical rehabilitation centers, including prosthetics, orthotics, and repairs to assistive mobility devices.[50] This was similar to the 1,909 prostheses and 6,300 repairs reported for 2013.[51]

The ICRC continued to improve the accessibility of rehabilitation services by providing direct support for the beneficiaries (reimbursing, together with the Ministry of Social Affairs, the cost of transport and of accommodation at the centers), as well as by supporting staff training, outreach programs, and networking between the rehabilitation centers and potential local partners. ICRC-assisted centers provided 1,224 prosthetists for mine/ERW survivors in 2015; a slight decrease from 1,647 prostheses (81% for mine survivors) in 2014 and a slight increase from 1,597 prostheses (1,287 or 81% for mine survivors) in 2013.[52]

In 2015, Veterans International in Cambodia (VIC) reregistered as a local NGO in Cambodia.

An AAR-WCD program increased its geographic coverage through Svay Rieng, Battembang, and Siem Reap with support from LDS Charities. Due to many organizations having reduced their activities and physical rehabilitation centers being handed over to government management, there was an increase in the number of persons with disabilities needing wheelchairs and assistive devices compared to the limited number of wheelchairs that the AAR-WCD could provide.[53]

Economic and social integration and psychological support

The prevalence of post-traumatic stress disorder in Cambodia is substantially higher than global averages. It was reported that there was a lack of activity to address this challenge with “just 0.2 per cent of the total health budget spent on mental health and no planning for psychologists and social workers in health sector human resource planning (in addition to psychiatrists and psychiatric nurses).”[54] A lack of awareness, understanding, funding, human resources, and leadership, as well as poor coordination of groups working in mental health were reported to be among the biggest challenges to accessing adequate psychological support.[55] 

There were only two functioning vocational training centers for persons with disabilities in Cambodia, the Panteay Prieb center operated by JSC and the Phnom Penh Thmey center supported by JCIA.

Water, sanitation, and hygiene

Water supply and sanitation was included in the national strategic development framework for Cambodia (2013) and there is a commitment that by 2025 every person in rural communities in Cambodia, including persons with disabilities, will have sustained access to safe water, sanitation, and hygiene (WASH) facilities.[56] Several NGOs, including JRS and its survivor network, the DDSP, provided accessible toilet facilities and drinking water specifically for persons with disabilities, including mine/ERW survivors. However, the need remained extensive. In 2015, the DDSP and WaterAid-Australia produced guidelines and a checklist for disability-inclusive accessibility and safety audits for WASH.[57]

Laws and policies

The 2009 Law on the Protection and Promotion of the Rights of Persons with Disabilities prohibits discrimination against persons with disabilities. The law also requires that buildings and government services be accessible to persons with disabilities.However, inaccessibility to public buildings, transport, facilities, and referral systems continued to prevent persons with disabilities from actively participating in social and economic activities. The government continued efforts to implement the law.[58]

Some key provisions of national legislation are not in accordance with the CRPD, and the national disability law has not been amended by the MoSVY to ensure it is compatible with the CRPD. Though this is clearly the role of the ministry, the DAC, in accordance with Article 6 of the National Disability Law, is responsible for proposing revision to the national law.[59]

A 2010 sub-decree to the Law on Protection and the Promotion of the Rights of Persons with Disabilities requires that persons with disabilities make up at least 2% of the public sector and government departments with more than 50 employees. Private businesses with more than 100 employees have a quota for employing persons with disabilities as 1% their staff according to the sub-decree. Both the public and private sector were expected to fulfil the quota by 2013; within three years from the adoption of the sub-decree. By 2016, there was still “no accurate data” on how many persons with disabilities were employed overall, but some 1.3% of civil servants in 40 government agencies were persons with disabilities.[60]