Camps Packed in Years of Cambodian Despair

Times Medical Writer Robert Steinbrook, an internist, worked for the International Rescue Committee at the Khao-I-Dang Holding Center near the Thai-Cambodian border in 1983

Site 2, near the Thai-Cambodian border, is a refugee camp where 166,000 Cambodians are packed into bamboo shelters on two square miles of dusty, heat-baked plain. If it were a city, it would be the second most densely populated municipality in the world, ranking behind Manila and just ahead of Shanghai.

Despite the crowding, the border Cambodians are well-clothed and well-fed. Medical care for physical ailments compares favorably to many parts of the developing world.

On a recent visit, it was gratifying to see improved medical facilities and, overall, what appeared to be a smoothly functioning relief operation along the border area where I had worked as a volunteer physician in the spring of 1983.

Yet veteran relief workers are profoundly discouraged by what one termed "an enduring non-solution" to the wider geopolitical problems responsible for the border encampments.

The real tragedies of Site 2 are widespread depression, domestic violence and other manifestations of hopeless despair. Poor mental health is inevitable when people languish in a refugee camp with too little to do and no prospects for the future--a mammoth waste of human potential.

"Everything we are doing is just a Band-Aid until they solve their problem and they can go home," lamented Dr. Christopher Elias, medical coordinator of the Minneapolis-based American Refugee Committee's medical project in Thailand. "We have a generation of children growing up in this place. It's like raising children in a dark room. That's the most scary thing."

Most of the Cambodians at Site 2 and smaller boarder settlements have been in one camp or another for eight years or more. After Vietnamese forces ousted Pol Pot's brutal Khmer Rouge regime in January, 1979, hundreds of thousands of Cambodians fled continuing turmoil and violence.

The border Cambodians, unlike the more than 200,000 of their countryman who have been resettled in the United States and elsewhere, lack internationally recognized "refugee" status. As a result, they are not protected by the United Nations High Commissioner for Refugees and are ineligible for asylum in other nations.

Instead, of the total of more than 250,000 border Cambodians--about 40% of them children under 8--are classified as "displaced persons." They are governed by Cambodia's various resistance factions. Site 2 is under the control of the Khmer People's National Liberation Front, a moderate political group with few guerrillas. Other camps are controlled by the Khmer Rouge and followers of Prince Norodom Sihanouk, a former ruler of Cambodia.

About 20,000 more Cambodians remain at Thailand's nearby Khao-I-Dang Holding Center, although it was officially "closed" by Thai authorities more than a year ago. Some of the remaining Khao-I-Dang residents are eligible for resettlement in third countries but for various reasons have not been taken. The Thais say they intend to send the 20,000 to the border camps but have so far heeded international pressure not to do so.

Relief workers say the border Cambodians' best hope is a reconciliation of their nation's warring factions. This would allow them to return to their homeland. An early December meeting in France between Sihanouk and Hun Sen, premier of Cambodia's current Vietnamese-backed government, is viewed as an encouraging development. But no one is certain whether this meeting will spark further reconciliation efforts.

Site 2 was quickly created about three years ago, after a powerful Vietnamese winter offensive overran prior encampments. Because there is no ground water, about 2,000 truckloads of water must be brought to the camp each week, as well as tons of food and other staples.

Now Site 2 has an air of stability. Unlike its predecessors, the camp is located in Thailand, several kilometers from the actual border, and is believed to be more secure from Vietnamese attack.

Children attend school, although education beyond the early grades is minimal. Some adults work in innovative light industries, on products ranging from water jars to tofu.

Thou Thon, one of the camp's civilian leaders, greets visitors at an elaborately constructed and furnished bamboo administrative headquarters. Nearby are large bamboo structures housing sewing machines, looms and the tofu factory.

But a short walk opens onto the profound concentration of humanity. There are row after row of thatch and bamboo huts, surrounded by the ubiquitous water jars and latrines. An enlarged field hospital was literally being constructed on top of the crowded old one because there was no other place to put it.

Water is rationed; amid the heat and the dust, there is sometimes not enough. Severe skin infections are common. A nurse explained how time and again an infant with life-threatening shortness of breath would immediately get better when allowed to sit for a few minutes in an air-conditioned ambulance or car.

In the face of these obstacles, relief workers point to such accomplishments as the high childhood immunization rates and innovative programs to combat tuberculosis and dengue fever. Severe malnutrition and malaria transmission are virtually absent in the camp.

Most of the primary health care is provided by Cambodian medics. They have become relatively self-sufficient through intensive training programs, such as one conducted by the American Refugee Committee. Patients are admitted, diagnosed and discharged from one ward, for example, without ever seeing a foreign doctor or nurse. "I make rounds looking for trouble," Elias said. "I don't find it."

For the immediate future, relief workers hope to foster as much self-sufficiency as possible in the unnatural environment of a refugee camp. They wonder if enough can be done: "A whole generation needs a refresher course in rice planting and agricultural work," one worker said. Then he stopped to realize that Site 2 has little room for more than tiny gardens.

"Having been here eight years, I don't think that the future is any more tangible," said Ben Thompson, 31, a British subject who is a field coordinator with the Catholic Office for Emergency Relief and Refugees. "Before I leave, I want to feel that I contributed toward some solution for these people . . . . Some people joke when I say that: 'You are going to be here until you are an old man.' "

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