Essay 2

Contemporary Cambodian Society

Cambodian society today is a complex interplay of social forces that include pre-revolutionary cultural and social patterns, DK and PRK communist/socialist influences, and the repercussions of the recent re-opening to the world with the reintroduction of a market economy and a form of democracy. This essay provides a brief overview of some of these influences. First, we discuss some of the social consequences of genocide and initial efforts to reconstitute society in the aftermath of DK. (This includes some discussion of the PRK period, though for more detail on the PRK the reader may look back to the PRK section of the Essay One). Second, we examine the dramatic economic changes in the 1990s, particularly after the UN Peacekeeping mission. Third, we explore some of the social problems that remain, including: growing landlessness, a lack of effective health care, and over exploitation of natural resources (in background essays we also examine problems with the education system and the issue of landmines).

Emerging from DK

During the DK period, all aspects of the Khmer social and moral order were disrupted or destroyed. Families were separated, often to different communities, or even to different parts of the country. Older children were sent off in mobile work teams. All of the familiar and comforting forms of social hierarchy, the blessings of monks, respect for the elderly, veneration of the monarchy were overturned in a whirlwind of violence and hunger. Death was ubiquitous. Almost every family lost a mother, a daughter, a grandfather, cousins, aunts and uncles.

On the other side of the maelstrom, the Cambodian people rebuilt their lives. Between 1979 and 1989, Cambodia struggled to rebuild with almost no outside resources and in the face of military occupation and a civil war. As the Vietnamese secured control of the country, they allowed freedom of movement (although they did not allow people to reenter the cities immediately). People began to return to their native villages looking for surviving family members.

People report being initially elated as they realized they were free of the hated Angka. Daran Kravanh tells of the moment people were told they could "go home," " We looked at each other and repeated the words. Gradually the words sank into our ears and we walked away hugging each other. We hardly had any energy, but we danced and sang songs we thought we had forgotten" (Lafreniere 2000: 154).

The roads were filled as rail-thin people retraced their routes of forced relocation back to their home villages and towns. In Ellen Bruno’s beautiful and moving film "Samsara" she gives vignettes from this period. The Khmer were then, the narrator points out, a "people in passage." We hear the story of a man who comes back to the city to search for his wife and children, but finds his house occupied by strangers. He is turning to leave and he spots a message scrawled on the gate in charcoal, "Husband, I am alive. Find me living in the old factory near the market" (Bruno 1989). In another scene a woman tells of her dead brother coming to her in a dream and asking to be reborn into the family. Shortly thereafter a relative has a baby and he is the spitting image of the lost brother.

The harvest in 1979 was mostly lost; Khmer Rouge forces burned crops in the field, destroyed some food stocks, and carried what they could. Starving people broke into rice granaries and gorged themselves on what they could find. The international community initially gave some emergency aid to the Phnom Penh government, and food aid was distributed along the Thai border. Some went for food aid and then returned to Cambodia. Others were fleeing ongoing fighting between the Khmer Rouge and the Vietnamese, or fearing a Vietnamese-backed regime that would also be communist, chose to flee the country. Refugee camps grew along the Thai-Cambodian border until they held hundreds of thousands of Khmer. Some would end up staying for more than a decade.

For the vast majority who went back to their villages and towns to rebuild their lives, the going was not easy. Because of the Vietnamese invasion, Cambodia was placed under an embargo on international aid (see Mysliwiec 1988). This included bilateral aid from Western countries, as well as funding from international institutions such as the Asian Development Bank and the World Bank. Throughout the 1980s, except for some assistance from the Soviet Union and eastern block countries, Cambodia was on her own. This meant that much of the infrastructure destruction of the war years went unrepaired.

The People’s Republic of Kampuchea (PRK) government did begin to rebuild the education and health systems. They searched for anyone with education who could immediately begin to teach. As the education system was restarted, they took new graduates and immediately turned them back to teach the grades they had just finished. The universities restarted first as language training schools, so that graduates could immediately be sent abroad to Vietnam, the Soviet Union, Cuba, India or Eastern Europe for training in technical areas. The universities did not formally reopen until the end of the decade (see background essay on education).

As the PRK government was struggling with just providing food and some basic social services, they were also fighting a war with their allies the Vietnamese against the Khmer Rouge, who had withdrawn to the Thai border, and non-Communist resistance forces that had formed in the border camps. This meant other kinds of strains on society. Men were taken away through conscription to serve in the army. During the mid- and late 1980s, civilians were also taken to border areas to work as laborers clearing land to secure the border zones. This work, known as K-5, was extremely unpopular. Many of those who went returned with malaria or as amputees.

Agricultural production under the PRK was collectivized. There were several types of "Solidarity groups" or Krom Samaki that pooled labor and other resources such as draft animals and shared the products of their labor (see Frings 1993). While these arrangements may have been viewed favorably initially by some people, particularly widows and others with no farm labor in the family, the krom samaki were unpopular generally. By the mid-1980s most communities had quietly returned to farming their own private plots, though a formal return to private property would not take place until the political changes in 1989 (see also Essay One, People’s Republic of Kampuchea).

Throughout the 1980s people focused on survival. The threat of a return of the Khmer Rouge was still on people’s minds, and the PRK government constantly stressed this possibility to legitimize their regime. Even in the late 1980s this fear and uncertainty remained obvious in rural areas. When I first arrived in Cambodia in 1989 rural people would ask me if I thought the Khmer Rouge could return to power. Aid workers said that rural people were unwilling to plant new sugar palm trees; they took so long to grow, who knew if one would still be there to benefit?

Many people lived in rural areas before 1975 moved to the cities, especially to Phnom Penh. The pre-war city population had been dramatically reduced by the deaths of "new people" during DK and by refugee flight to the border. People who came to the city could claim any housing they took up residence in. Multiple families would sometimes live in a single house, occupying different floors, courtyards or gardens. People clamored for government jobs, though they paid almost nothing, for the security that they provided. Besides a paycheck, jobs in the bureaucracy offered commodity distributions of goods such as rice and cooking oil, and sometimes even housing.

For those who joined the PRK government at the local level, there were definite benefits. Judy Ledgerwood and John Vijghen (2002) have recently written about changes in decision making at the local level of Cambodian society over the last three regimes. Local level leaders, subdistrict and village leaders were chosen for their political reliability, their literacy and their willingness to serve. They, like the newly established local militia, teachers and infirmary staff, were not paid salaries, but received a portion of the produce from the solidarity groups. Villages had three member ruling committees, with a chairman, a vice-chairman and a secretary. Committee members were responsible for overseeing the activities of the solidarity groups, including control over food distribution.

The top-down structure of the PRK and the creation of a new layer of administration in the form of the solidarity groups meant that village headmen and committee members had greater control at the local level than their pre-war predecessors. They were responsible for control of the population at the local level during a time of civil war and a new form of agricultural production. This meant, in part, that they implemented some very unpopular programs including: collecting a percentage of the harvest for sale to the state at fixed prices, selecting young men for conscription and civilians for K-5 service. Village committees also approved certificates of "good behavior" that allowed people to travel, start businesses, enter government service or marry. Subdistrict level police and local militias were also on the lookout for contacts from resistance factions along the border including the Khmer Rouge. All of these factors together meant that local level officials were more powerful than their predecessors, as central government reached more closely into daily life than in the prewar years (though not as extensively as during DK) (Ledgerwood and Vijghen 2002).

There has been some controversy among Western academics, journalists and development workers regarding the nature of Khmer society in the aftermath of the DK regime. Some have argued that Cambodians are so traumatized by the events of the war years and the DK period that social relations have effectively collapsed. People no longer take care of one another, they do not know how to properly raise their children, and no longer help one another, even within families. Some scholars have further suggested that Cambodian villages before the war were not "true" communities, and thus it was not a question of whether or not pre-war patterns were being reestablished, but whether Khmer had ever formed social communities that offered mutual assistance and support. I have critiqued this literature elsewhere (see Ledgerwood 1998, Ebihara and Ledgerwood 2002), arguing that Cambodian village life has returned to pre-war patterns, albeit with some important changes.

Building on the work of May Ebihara, who conducted ethnographic research in Cambodia before the war in 1959-60 and again in the 1990s, we can begin to understand some of these changes (see Ebihara 1968, 1987, 1993 and Ebihara and Ledgerwood 2002). Cambodian society is organized around bilateral kindreds, that is groups of people who are related through both of their parents to a rather large group of people. Social status is based on family background, age, sex, religious piety, and wealth (though there was often little social differentiation in rural communities) (See the background essay on women and social status in contemporary society). Marriages were arranged by parents and were viewed as the joining of families, rather than just individuals. Usually marriages were to people who lived in nearby villages, or the same village. This meant that rural villages were clusters of people who were mostly all related to one another by blood or marriage. People often say that they know someone is "bang p’aun," a kinsman, without being able to say how exactly they are related to one another. People have known one another since birth, have grown up with each other’s idiosyncrasies.

Within this extended group of kinsmen, how close people were to one another personally could depend on a range of factors including age, common interests, physical location of their house, how well they got along, and so on. People made their own networks of social relations within a web of possibilities cast by kinship and residence patterns. These networks included links to local and sometimes more distant political patrons (see background essay on Social Hierarchy).

These social networks were crucial to cooperation in wet rice agriculture. During certain times of the year people need to cooperate to accomplish important tasks within a limited period of time. When the rains come, the fields must be plowed and seedbeds planted. Then once the rains are sufficient, the seedlings must be transplanted into the fields, an incredibly labor intensive task. When the fields are ready for harvest, everyone again works together to bring in the crops. The labor for such tasks is usually pooled through a system of labor exchange, referred to as "pravas" or "pravas dai," literally an exchange or exchange of hands. People say they "juoy knea tov ving tov mok," they "help each other back and forth." Large groups of women will assemble and transplant all of one family’s fields one day, then move to another family’s fields the next. Cambodian rural villagers would also provide other kinds of mutual assistance, pooling resources to pay for medical emergencies, to pay for life cycle rituals, to help someone who was in trouble. It is this kind of assistance that is said to have disappeared in the wake of the Khmer Rouge period.

There is now clear evidence from several areas of the country that this is not the case (see Ebihara 1993, Ebihara and Ledgerwood 2002, McAndrews 1997, Kim 2001, Vijghen and Sareoun 1996). People are again doing labor exchange, though there are exceptions. Kim found that in Siem Reap province near the Angkor monuments, where many farmers also work for wages at the ruins, there is an increase in wage labor for agriculture (2001). In Angkor Borei district of Takeo province, where farmers grow flood recession rice, they must hire outside farm laborers from beyond the area because all the rice comes ripe at once. They do not have the labor power available, or the time, to employ traditional methods of exchange (Fox and Ledgerwood 1999). But in most rural areas, people are helping one another out of necessity as they did before the revolution.

It is generally true that people are poorer than they were before the revolution. Landholdings averaged 2.2 hectares per family in 1961. In Svay, the village where Ebihara conducted her research, families held an average of .88 hectare, with a range of from .6 to 4 hectares (Ebihara 1968:221). In 1989 the national average was 1.2 hectares. In Svay in 1992, 70 percent of families held less than a hectare with a range of .3 to 2 hectares (Ebihara and Ledgerwood 2002:287). This was not long after the land distribution in 1989 and the amounts of land were still relatively even from the distribution. Everyone was poorer, but there was less disparity between families. Throughout the 1990s some differentiation in wealth is beginning to reappear, and some families who had land are now landless (see below).

Ebihara was struck by the differences in physical living conditions and material wealth when she returned in the late 1980s and early 1990s. During her research in 1959-60, villagers had lived in sturdy wooden houses raised on stilts. Those structures were destroyed in the war and by the Khmer Rouge, so when she returned people were living in huts on the ground. As living conditions improved in the 1990s, people again built wooden houses on stilts (often with help from relatives abroad or in the city), but in many cases these structures did not match their prewar dwellings.

So if people appeared to some observers, both Westerners and Khmer, to be helping one another less than they did before the revolution, this can be explained in part by the fact that they had less to share. It may very well be that the hardships of the DK period made people more likely to look out for themselves first – and there was less to go around as well.

At the end of the 1980s, dramatic changes were taking place in the world. The collapse of Eastern Europe and the break-up of the Soviet Union brought about tremendous change. The Vietnamese withdrew their military from Cambodia in 1989. While the Vietnamese had been welcomed as saviors from the devastation of the DK period, in general Cambodians were pleased to see them leave. The four Cambodian factions met in a series of negotiation sessions that resulted in the Paris Agreements of 1991. While these negotiations were underway, there was an atmosphere of tremendous optimism in Cambodia. People felt that if there could only be peace, then there could be a return to the stability and prosperity that people remembered from the prewar years. The return of Norodom Sihanouk after the signing of the agreements in 1991 bolstered this optimism.

Buddhist prayers reappeared on the radio and the restrictions that had been imposed on religion under the PRK were lifted (see Background essay on Buddhism). Many of the restrictions on individuals disappeared as well. For those foreigners living in Cambodia, it became possible to have open relationships with Khmer friends, without fear that they would be followed or questioned for their contacts with a westerner. These new freedoms had limits, however. An early move to establish an independent political party was crushed, and student activism to protest corruption was put down with violence (See Essay One, State of Cambodia). Overseas Khmer began to return in significant numbers, bringing with them vitally needed cash to help out relatives and rebuild temples.

The coming of the United Nations Peacekeeping forces in 1992-93 fed this hope in certain ways, but also brought disappointments. The mission did bring about improvements, including the repatriation of refugees from the Thai border, some infrastructure rehabilitation, more security in rural areas, and most importantly a credible election (see Background Essay on Elections). But UNTAC also had many failures; the mission did not bring about peace, it did not disarm and demobilized the combatants. Nor did it "control" the administrative structures of the parties to the Paris Agreements as it was supposed to have done (See essay on the UN mission). One thing that UNTAC did do was pump millions of dollars into the Cambodian economy. While much of the money went to the overseas UN personnel, it also went as paychecks to Khmer UN workers across the country, and indirectly to Khmer who rented houses, sold food, ran bars and so on.

This was also the time period when HIV/AIDs was introduced to Cambodia. UN Peacekeepers were traveling back and forth to Thailand for "R and R" and may have brought the disease from their home countries. The border with Thailand, which was in the midst of an AIDs epidemic, was opened. Returnees from the refugee camps, from military encampments and people who crossed to do trade could all have brought in the virus. At the same time, UNTAC employed hundreds of mostly young men to be interpreters and staff at their facilities throughout the country. They also provided a transportation infrastructure in the form of planes, helicopters, boats and UN vehicles. Suddenly a young male population had money in their pocket and mobility. The sex industry exploded, to service the UN staff, but also to meet the demand from newly prosperous Khmer clients. This combination of factors contributed to one of the fastest growing rates of infection in the world.

Throughout the 1990s you could see people’s lives improve materially, in the cities and in rural areas near the cities. People had better clothing, bicycles or motorcycles, radios and televisions. Though there is still little electricity in rural areas, there has been a dramatic growth in the number of television sets; these small black and white sets operate on batteries that farmers take to the market towns to get recharged. Some of the more dramatic social changes that have taken place since the end of the DK period have occurred in the last ten years with the change back to a market economy and an opening of Cambodia to relations with the rest of the world. The next section addresses these economic changes, while the one that follows deals with problems that remain.

Cambodia’s Economy in the 90s

Cambodia’s economy has experienced drastic changes since the late 1980s as it underwent a transformation from a centrally planned economy isolated from the capitalist world to a free market based one with substantial assistance from Western industrialized countries. This transformation connected Cambodia’s economy to the force of globalization as foreign investment and international assistance has flowed into the country. These developments have brought tremendous growth as well as challenges to the economy.

Since 1993, the Cambodian government has placed great effort on formulating economic policy aimed at attracting foreign investment and assistance. These efforts appear to have had some success. In 1994, the government adopted a relatively liberal investment law that included, among other things, a 9 percent rate tax for corporations, tax holidays of up to 8 years, exceptions for import duties, and no charges for repatriation of profits (Sophal Ear 1997: 85). This investment law has brought a large quantity of foreign investment in the service sector, hotel construction, and the garment industry. The rise in construction is accompanied by growth in the tourism sector. The number of tourists visiting Cambodia increased rapidly over the last ten years climbing from 5000 per month in 1991, to 15,000 in 1996, to 315, 242 for the first five months of 2002. This is good news for Cambodia, a country with limited industrial base, because tourism is an important source of hard currency earnings.

Since the signing of the Comprehensive Political Settlement on Cambodia (known as the Paris Agreement) in 1991, the international community has provided significant financial and technical assistance to Cambodia. By the end of 1990s, Cambodia received close to $ 2.5 billion dollars in foreign assistance. With foreign assistance and economic restructuring, the Cambodia economy has grown substantially albeit from a low base. For instance, Cambodia’s GDP grew at 7-8 percent in real terms between 1994-1996 (Tith 1998: 112). Although the rate of growth declined in subsequent years (and particularly immediately after the 1997 coup), the rate of growth remained between 4-5 percent in 2001 (Cambodia Development Review 2002 6(2):14).

The most striking growth has been in garment production, which has grown rapidly given the previous conditions of this sector. In the 1980s and early 1990s, the garment industry produced only basic materials for domestic consumption such as skirts, blankets, scarves (krama) and some medical materials. Even this production was of low quantity. From these beginnings, the garment industry has now become the leading manufacturing sector employing over 160,000 workers, almost all of them young women from rural areas. Garments now represent 70 percent of the country’s exports. These exports increased about 13 percent in the last two years from a total of $985 million in 2000 to 1.1 billion in 2001 (Cambodia Development Review 2002 6(2): 14).

The growth in this sector results from a number of conditions. First is from favorable terms of trade Cambodia has with the United States and the European Union. The United States and the European Union together imported over 97 percent of garment exports from Cambodia. The second is from low labor costs in Cambodia. In the so-called "race to the bottom," Cambodia is currently among the most attractive places to employ seamstresses. The garment factories grew mostly in Phnom Penh and surrounding provinces with investment from companies based in Hong Kong, Taiwan, China, Singapore, South Korea and the United States.

However, long-term growth of this sector remains uncertain. First, the low skilled workforce is a limit on quality production. A second problem is the possible rise in competition. Cambodia could lose her comparative advantage in textile production, given that Vietnam was recently granted Most Favored Nation status by the United States Congress and China was finally approved for admission to the World Trade Organization. Not only does China have a more highly skilled workforce, but it also has better raw materials and a long established textile industry.

Overall, by the late 1990s and early 2000s, there was considerable evidence of rehabilitation, reconstruction, and development activity. However, the rate of growth during this period might not be sustainable. First, Cambodia is heavily dependent on foreign assistance, a financial inflow that will not last indefinitely. For example, in 1999, foreign aid financed over 90 percent of public infrastructure development (Cambodia Development Review 2000 4[1]). As such, unless domestic sources of capital, such as increased tax revenues and private savings, materialize, sustainable economic development will not be realized. Second, recent economic growth has produced unequal distribution and growth skewing toward urban areas. Economic benefits are felt only in the city, increasing an already evident gap between rural and urban areas. Goods and services such as cars, restaurants, and communication services are available only for the wealthy in urban areas. For example, a survey in 1996 revealed that 67 percent of urban people used some sort of electricity while only 3 percent of rural citizens had access to electricity (Curtis 1998:81).

Overall, development in the agricultural sector has been slow. This in turn affects the overall GDP growth and socio-economic well being of the country. With proper management strategies and implementation, the agricultural sector could help to absorb the rising number of new entrants into the labor market. It is estimated that there will be about 140,000 new entrants into the labor market in 2002. However, if the economy continues to growth at 5 percent per annum, modern sectors such as service, tourism, and manufacturing might be able to create only about 30, 000 new jobs per year. As such, the remaining 110,000 new workers might have to find employment in agriculture and the informal sector in urban areas. Given the slow growth in the agricultural sector, high unemployment could result.

The current condition of the Cambodian economy must be seen within the country’s recent historical context of the Khmer Rouge radical Maoist-Stalinist policy, the international isolation in the 1980s and over twenty years of civil war. Assessing the country in light of these developments, Cambodia has made a great deal of progress, for it now has a functioning economy, a workable, yet limited, transportation system and linkages to the globalized world.

However, future prospects for the country depend upon the success of significant government structural, economic and institutional reform. The government has to undertake consistent economic strategies, including fiscal reform, in order to reduce its total reliance on international assistance in long run. It needs to reform the process of exploiting forests and other natural resources. Institutionally, the government needs to reform the judicial system, establishing sound legal and regulatory frameworks, and regulate the banking system. These are the sectors deemed to be crucial if Cambodia is to be attractive to foreign direct investment. At the present, despite liberal investment laws, Cambodia has not been able to attract "well established international companies" that will contribute to long-term economic growth because Cambodia does not have a reliable legal and regulatory framework and banking system (Curtis1998:109).

Not Everyone has benefited: Some problems that remain

The country remains very poor by any economic indicator. GDP per capita is about $270 dollars. Life expectancy remains at about 50 years old. A report by a United Nations indicates that about 1/3 of the population lives in poverty. A recent study by UNICEF and UNDP indicated that one half of Cambodian children are malnourished. The dramatic growth in wealth for some individuals has been primarily located in Phnom Penh, and especially among a tiny percentage of the population who occupy key government positions.

Much of the billions of dollars given or loaned to Cambodia since the UN period have been siphoned off through corruption. In addition to foreign aid money, the elite have also been enriched by diverting money from state coffers into their own pockets. This includes taking direct payments to approve logging concessions, bribes to waive taxes on imported goods, and bribes to look the other way and allow drug smuggling and human trafficking. This latter includes the trafficking of women and children for prostitution as well as the smuggling of Chinese nationals through Cambodia to Europe and the United States. The loss of income to the Cambodian government means that there are limited funds available to improve crucial government services such as health care and education.

Uneven development has left many rural Cambodians, who make up of 85 percent of total population, in poor conditions. These people rely upon agricultural production for their livelihoods. However, rice production has remained low. Growth in the agricultural sector has been low because of lack of investment in both infrastructure and production. The soil in general has low fertility and the use of fertilizer is limited, consisting of only about 1/3 ton per hectare. In 2000, agricultural production grew only 0.5 percent. Although the government has emphasized the need for rural development in its overall economic rehabilitation plan, action has yet to be taken in these areas. To use Curtis’ words, the government’s rural development program offered only "a long wish list of things to do, achieve, or accomplish, all geared to "provide," "to improve," "to foster," or "to upgrade," (1998:62), but no substantial tangible outcome has been achieved.

The government has not resolved a number of critical issues related to the agricultural sector; chief among them is land ownership.


Cambodia historically has been a country of peasants who owned their own land. In fact one of the issues for Marxist revolutionaries was whether Cambodia was ready for revolution, given that most farmers were landowners. Only in the northwest of the country, particularly in Battambang province, were there significant numbers of tenant farmers and landless (see Becker on Hou Youn 1986:78-79). But as noted above, most farmers have only about one hectare of rice land and yields per hectare are low, only about one ton.

After the collectivized agriculture of the DK and PRK periods, land shifted back to private holdings in the mid- to late-1980s. At first this was done informally, but in 1989 the government again allowed private ownership of property. People were given 0.16 to 0.18 hectares per person in the area where Ebihara and I conducted research. Since the land varied in quality, farmers were often given several small parcels, rather than connected sections. In this village the distribution seems to have been done relatively fairly, though in some areas of the country, particularly along rivers and in other prime locations, there were allegations that the best land was taken by local and provincial authorities for their own uses or for sale.

The legal framework to grant land titles was passed three years later, but was never implemented. The cadastral system was overwhelmed and never really functioned. Today the fact that only one percent of rural households currently have full legal rights to their agricultural land, means it is extremely easy for corrupt officials to take payments for the issue, or multiple issue, of land titles (CDRI policy brief June 2000). While a new Ministry for Land Management was established in 1998 to deal with these problems, and a land law is under debate in the National Assembly in 2001, no law had yet been passed at the time of this writing.

An important Oxfam report (2000) on landlessness documents an overall landless rate of 13 percent, or one in eight families; for female headed households the figure was 20.85 percent or one in five (Biddulph 2000:6). Landholdings varied from province to province with 83 percent of villagers in Svay Rieng province in the southeast having one hectare or more of land, while in Battambang the rate was only 42 percent. The rate of increase in landlessness between 1984 and 1999 was 420 percent, with a prediction that the steep increase would continue. The causes for this increase included population growth (many landless families who had never had land were newly married couples [41 percent]) and the return of refugees from the border areas (15.5 percent of those who had never owned land were returned refugees).

Of those who had owned land and lost it, 44.6 percent said that the cause was illness in the family (see health issues below). Eighteen percent said that they had lost their land because of a "lack of food;" and 5.1 percent said that they had lost the land to indebtedness (2000:6-7). The study’s author points out that these answers may conceal more than they explain, since indebtedness, health problems and lack of food are likely all related problems (2000:13). Another 13.1 percent of those who had had land said that their land had been "expropriated," by provincial authorities (37 percent), by the military (37 percent), and by local authorities (10 percent) (2000:14). The relationship between health care costs and this explosion in landlessness is a clear one, and means urgent steps must be taken to improve health care nationally.


Health care services are nearly non-existent in most rural areas. While the health care system is suppose to be free to all citizens, in fact at all levels health care operates on a fee for service basis – money up front. State operated clinics at the district level sit empty, doctors and other staff hold their "real" operating hours separately and charge fees. The care and coverage in these clinics varies widely, often depending on whether or not a foreign aid organization has taken an interest in a particular facility. In some instances, such organizations provide supplies, drugs, and equipment and may supplement staff salaries. Health care is best in the capital, Phnom Penh, where much of the international aid in the health sector has been focused in the last ten years. Most Khmer doctors would not consider taking a position anywhere else in the country outside the capital.

It is common knowledge among Khmer that admission to medical school and promotion through the program are based on a series of bribery payments rather than on any competence at medicine. This does not inspire confidence in the medical system as a whole. People who can afford to do so travel to Vietnam, or if they are wealthy, to Thailand or Singapore for medical care.

A large-scale study on demographics and health completed in 2000 was held for release in 2001, apparently at least in part because some of the findings were so abysmal. Some of these findings include:

      infant mortality remains at 125 per 1,000 births, meaning one in eight Cambodian children will die before the age of five,

      in the last five years only 38 percent of women had antenatal care provided by a medically trained person,

      some 40 percent of children aged 12 to 23 months have had all their vaccinations, 38 percent were partially vaccinated and 22 percent had received no vaccinations,

      19 percent of children under five were reported to have had diarrhea in the two weeks prior to the survey (almost half of these had been given oral rehydration therapy as treatment, the other half had been given rice water) (National Institute of Statistics 2000:19).

Faced with a medical system that is inaccessible, both in terms of distance and cost, rural people are forced to self medicate with expensive, often inappropriate or even dangerous drugs. A market seller or local "injectionist" usually recommends the drugs. Besides the obvious dangers of taking inappropriate medications, or being unable to afford the correct dosages, another danger lies in the fact that up to a third of the drugs on the Cambodian market are fake.

Three examples of stories of Khmer personal friends of mine will serve to demonstrate the nature of the health care system. A poor young man is having severe stomach pains and goes to a hospital in the city. He is given a list of drugs, which he buys at a local pharmacy. These include two kinds of anti-depressants and an injection of B vitamins -- nothing to address his condition. A farmer has a severe medical attack, probably a stroke. He is taken first to the local hospital and then to a hospital in Phnom Penh. He is being treated in the hospital but the family runs out of funds. He is told to leave. The family takes him to a temple on the outskirts of the city where they try prayer and curing rituals. They are waiting for him to die. When friends pool money for additional treatment, he is taken to the district hospital where he makes a nearly full recovery. A young man falls off the back of a motorcycle and hits his head during an accident. He is taken to a Phnom Penh hospital where the staff refuses to treat him without up-front payment. The family runs through the night collecting gold and cash from relatives. They return and pay the hospital staff who begin treatment, but the man dies before morning.

In desperation, Khmer families will often go into debt to try to treat a family member’s illness. Borrowing against land holdings or selling land in order to pay for medical expenses is a shocking problem, some 44.6 percent of those who lost their land said that the cause was an illness in the family (Biddulph 2000:11-12).

HIV/AIDs is also a health crisis in Cambodia with infection rates estimated at 3.5 percent of the population. An estimated 8000 adults and some 200 children have died of AIDs with the number expected to rise to 40,000 by 2005 (Phnom Penh Post 2001:1). The only good news on this front is that awareness of the disease is now nearly universal, with most people having some knowledge about what can be done to avoid infection (National Institute of Statistics 2000:27).

Natural Resources

The livelihoods of rural Cambodians are also threatened by a loss of access to common natural resources such as forests and fishing areas. In the 1970s, forests covered 70 percent of Cambodia, today less than 30 percent is forested and the remaining areas are shrinking fast. More than 70 percent of Cambodia’s forests have been sold as private concessions in the last few years, with rampant illegal logging by military units and powerful regional authorities (see Talbott 1998). According to the environmental watchdog group Global Witness, the problem in Cambodia had reached alarming proportions by 1998:

Between November 1997 and February 1998 four independent consultancies, funded by the World Bank, undertook the individual technical assistance projects. Their reports in May 1998 confirmed everybody's worst fears.

Concession management was abysmal, corruption endemic and logging out of control. They estimated that 4.7 million m3 of  timber had been felled in 1997/8, of which 95% was illegal. Most disturbing of all, they stated that Cambodia's forests would be commercially logged out by 2003. These reports, which were supported by Global Witness' independent findings, laid the template for forestry reform

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Some reform was forthcoming in 1999 when Prime Minister Hun Sen announced a crackdown on illegal logging that effectively shut down illegal sawmills around the country. Global Witness was invited to serve as an independent monitor of forestry concessions, and international donors agreed to fund this effort.

But the results of this reform have been limited. Global Witness reports that although illegal logging is now being reported, little or action is being taken against the violators (see for example the conflict between Global Witness and Everbright CIG Wood Company reported in the Phnom Penh Post, January 19-February 1, 2001). The government has alternatively cursed and praised Global Witness’ efforts to monitor and report illegal logging (see Phnom Penh Post, June 8-21, 2001). Global Witness reports that companies are still able to log illegally "with impunity."

A similar process of privatization and over-exploitation now threatens the crucial fishing industry. The Fisheries department has dramatically expanded the auctioning of fishing concessions, resulting in over fishing and destruction of fishing stocks through the use of illegal methods. Further, because of logging and other human encroachment, the areas of flooded forest around the Great Lake that serve as vital spawning ground for fish are now down to less than 39 percent natural vegetation. Declining fish harvests could spell disaster for a rural population that depends on fish from the Great Lake and rivers for most of their protein needs.

The Great Lake and river systems in Cambodia are also under threat from a much more distant source. A series of dams currently under construction on the upper Mekong in China may alter the annual cycle of flooding that reverses the Tonle Sap River and replenishes the Great Lake. This could devastate the fisheries industry in Cambodia (Fackler 2001).

(Other areas for concern include landmines and the education system, please see linked background essays on these issues).


Significant problems remain for the vast majority of Khmer who live as subsistence farmers in rural areas. But this is now the third year of peace, and the benefits of this "peace dividend" are only just beginning to be felt. It is now safe to travel around the country without being harassed by soldiers charging "fees." There is no conscription. The demobilization of the a portion of the nation’s military forces began in 2001 with some fanfare, though it is alleged that these early groups were in fact people who had already left the service some years before. If the process continues and begins to actually reduce the numbers of soldiers on the payroll, government funding could be diverted from defense into other areas, including health and education. Further, there are movements underway to try to shift some of the foreign aid expenditures out of the urban centers and into rural communities; the Ministry of Health for example has in their planning documents a focus on district level, community-based, health facilities.

Social relations continue to change. In urban areas, the kinds of patron-client relationships that link individuals within government ministries, in military units or in business dealings are more focused in these "modern" times, on direct payoffs in money and other resources. Urban Khmer twist the old Buddhist adage, twer bon ban bon, twer bap ban bap (if you do good, you will receive good; if you do bad, you will receive bad), and say, twer bon ban bon, twer bap ban lan chih (if you do good you get good, if you do bad you get a car to drive). It seems obvious that the only way toget ahead is to get into the system in a position to take benefit from the corruption. Underlings provide payments to theirsuperiors to be awarded their positions, and in return they expect a cut of any corruption that comes through their department. To not take the money is just seen as foolish, and worse, it will cause others to distrust you.

Vijghen and I have recently argued that patron-client exchange relationships are still an important part of life in rural communities – and that such exchanges are still underpinned by Buddhist ideals about karma, merit and proper behavior (see Ledgerwood and Vijghen 2002). This is true in part because leaders in rural areas are still very much interdependent parts of their community, linked by kinship ties and agricultural exchange relationships. They are "farmers among farmers" who need one another.

There are also new social forms in the area that political scientists refer to as "civil society," the forms of institutions between the level of the family and that of the state. These include Non-governmental organizations (NGOs), a form of organization borrowed from the west, but rapidly being modified to the particular Khmer circumstances. These local NGOs are undertaking a range of activities, from small-scale development projects in rural areas to advocating the protection of human rights. In some cases these organizations are basing their activities not only on Western notions of rights and freedoms, but also on Buddhist ideas of compassion and equanimity (see Ledgerwood and Un, in press). There are a new range of social possibilities, born out of the peace, economic development and liberalization of the 1990s. The dramatic growth in women’s organizations and open discussion of women’s issues is just one example.

A new generation of Cambodians is now reaching adulthood that did not live through Pol Pot’s nightmare. A new fashion trend among young people is to dress all in black, as the Khmer Rouge did; but today this reflects not political beliefs, but a mimicking of fashion styles in Paris. In the age of global markets and television, the influences on Khmer society will be wide ranging. It remains to be seen how this new generation will choose to reshape society in the aftermath of thirty years of war.