A new report by Human Rights Watch exposes abuses and human rights violations at Cambodian drug detention centers
At Cambodia's drug treatment facilities, residents, who mainly comprise street children, young glue sniffers, disabled people and some other drug users, are told to "sweat out" their addictions. Security officials operate most of the centres, and daily regimens consist of exercise and discipline - for example, they may be forced to stand on one leg or spend hours chained to a flagpole.
For some at the facilities, their families have paid good money for such treatment - up to US$200 (6,630 baht) a month plus a fee for their arrest. However, the World Health Organisation (WHO) has called the treatment facilities 100% ineffective.
Nonetheless, such facilities have been inspired, encouraged and even funded by Cambodia's neighbours. Vietnam has discussed giving Cambodia youth drug detention centres in the past year. In Thailand, despite the claim to treat drug users as patients and not criminals, the majority of the government's compulsory drug treatment centres are run by military officers and involve morning runs and calisthetics.
But in Cambodia, the rehabilitative efforts often lapse into more extreme forms of abuse or torture. Patients are beaten, whipped, shocked with electric batons, raped and coerced to give blood. In all but a few cases, individuals are in the drug treatment centres by force; either admitted by family members who pay steep fees to have them arrested and rehabilitated, or rounded up on the streets by officials who refuse them due process, and often an explanation of what's going on.
"No lawyer, no trial, no appeal," said Joe Amon, director of the Health and Human Rights division of Human Rights Watch (HRW) of the system. Last Monday, the rights organisation published a report, Skin on the Cable: The Illegal Arrest, Arbitrary Detention and Torture of People who Use Drugs in Cambodia, which exposes the abuses and human rights violations taking place at the facilities, which they call "drug detention centres".
Mr Amon is especially troubled by the lack of judicial process and oversight of the centres, which he interprets as an effort by officials to create a "rights-free zone".
"There is not a single humane impulse behind these centres. It's about social control and profit," he said.
HRW reports nearly 2,400 people spent time in Cambodia's 11 drug detention facilities in 2008. The organisation estimates that almost one in four were below the age of 18, and has documented cases of children as young as 10 being held in facilities alongside adult drug users. Adults were also documented to have been detained at the Youth Rehabilitation Centre alongside children.
The network of centres, which opened in 2006 and are variously operated by Cambodia's Ministry of Social Affairs, civilian and military police, and the Phnom Penh municipality, are growing rapidly according to Mr Amon; the number of detainees increased by 40% in 2008.
The report drew from interviews with 74 informants, the majority of whom were former detainees of at least one of the drug detention centres, as well as officers from local NGOs and international organisations. The Cambodian government did not respond to HRW's requests for information during the course of its investigation. While the Cambodian government also did not respond to requests for comment for this article, the Phnom Penh Post has reported that multiple government officials involved with the centres have denied the reported abuses take place.
On the part of the former detainees, testimony was abundant and damning.
One 16-year-old held at the Choam Chao Youth Rehabilitation Centre reported whippings with electrical cable at the facility. "On each whip the skin would come off and stick on the cable."
Another male detainee, aged 18, was held at a military police centre and forced to give massages and oral sex to officers. He was slapped by a commander on the first instance that he refused to perform it. "If I did not do this, he would beat me ... performing oral sex happened many times ... how could I refuse?"
Gang rapes, sometimes of disabled detainees, were also reported. One woman detainee recalled, "You know beautiful and nice women were taken away to be raped ... after they were taken away, those girls disappeared." The officers spoke openly afterwards and in front of the detainees about their actions.
Beyond the widespread charges of abuse and lack of judicial process in regard to the treatment centres, the HRW report claims officials have been illegally profiting from fees (the service is free by Cambodian law) and in some cases, the fruits of forced labour demanded of the detainees. While it is not universal, some detainees have been busied with construction work and craft projects - constructing plant holders or rubbish bins from rubber tyres, for instance - which are sold in Cambodian markets. Instances of extortion were also reported in the arrest and release process.
The report also stresses violations to detainees' rights to healthcare at the centres, in that treatment is compulsory, unsupported by medical evidence and completely inappropriate according to well-established standards for voluntary, community-based treatment for drug addiction.
Even so, Mr Amon says this unscientific type of rehabilitation, which is based on the misconception that addiction is a matter of drugs being present in the body and that they can be exercised out, is widespread in the region.
Compulsory drug treatments run by security officials, rather than health professionals is also common and on the rise, Mr Amon said.
He said Cambodia's model was inspired, encouraged and in some cases sponsored by neighbouring counties. Vietnam has been especially engaged in the expansion of Cambodia's drug detention system, while a majority of Thailand's compulsory drug treatment facilities are operated by the military with a similar "exercise and discipline" philosophy that involves morning runs and calisthetics.
While such programmes, and certainly the documented abuses, fall far outside the guidelines provided by the WHO and the United Nations Office on Drugs and Crime (UNODC) for effective drug treatment, HRW charges that several UN organisations - namely UNODC and Unicef, which are engaged with responsible agencies in Cambodia - have "systematically denied and insufficiently addressed" the human rights abuses taking place in Cambodia.
Both Unaids and the WHO in Cambodia have strongly condemned the centres.
Unicef Cambodia, which works with Cambodia's Ministry of Social Affairs to improve juvenile facilities such as the Chom Chao Youth Rehabilitation Centre that was included in the HRW report, issued a statement in the days following the report.
In the statement, Unicef said it had carried out reviews in 2005, 2007 and 2008 to ensure children were not violated in the facilities, and that "no major violations were reported or documented in those reports".
The statement assured, "Unicef does not support the establishment of closed rehabilitation or reformatory centres for children in conflict with the law," and pledged further strengthening the monitoring and reporting system to ensure that children in the system are protected.
Meanwhile, Gary Lewis, UNODC's Regional Representative for East Asia and the Pacific said the organisation was "very concerned" by the HRW report, and is now engaging with Cambodian officials to review how the drug centres are run. He highlighted the need to put an end to abuses and unlawful detention, and to ensure that drug dependence treatment is in fact taking place according to basic minimum standards of care.
He said that UNODC does not fund or work inside the drug treatment centres, but at the Cambodian government's request it is helping to develop community-based drug dependence treatment, largely in the form of training officials that drug dependence is a health issue.
"Attempts to treat and prevent drug use through tough penal sanctions for drug users fail because they do not take into account the neurological changes drug dependence has on motivation pathways in the brain," said Mr Lewis.
In terms of drug treatment, UNODC and HRW are striving for the same things - voluntary, medically sound, individually tailored drug dependence treatment. Mr Lewis stressed that UNODC believes drug treatment should not be forced upon individuals, and whether it is an alternative, or in addition to punishment, individuals must be given a choice.
He agreed with HRW that there's currently a shortage of proper treatment in the region, and instead a troubling, increasing trend of interventions including detention, forced labour, "boot camp" drills and practices where detoxification is carried out without any other support.
"There is no evidence base that scaling-up these interventions makes any sense," said Mr Lewis, noting that the evidence shows these environments are incubators for higher HIV risks, and certainly increased stigma and prejudice against drug users: "We need to remember that drug dependence is a chronic relapsing health condition. It needs to be managed within the health sector by people who are professionals and who understand the basic underlying health condition. We need to base our policy - and how we implement it - on what the science tells us."
The HRW data indicates what may happen otherwise: Of the 50-some former detainees interviewed for the Cambodia report, Mr Amon said many were still using drugs.
"No one had had a life turned around, but we did hear the opposite, where a period of detention undermined the social ties they did have," he said. Those that had been admitted by family members are often especially angry, disappointed and inclined to run away. "We are not looking to improve these centres, we are looking to shut them down."
This is the first in a two-part series about drug treatment in Southeast Asia.
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