Action points based on findings

·         Provide survivors with direct support and improve access to social protection services.

·         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.

·         Devote resources to reach survivors where they live, as survivors in remote and rural areas continue to face obstacles to access adequate assistance.

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.

Casualties

Casualties Overview

Details and trends

In 2013, the Cambodia Mine/unexploded ordnance Victim Information System (CMVIS) recorded 111 casualties from mines, ERW, and unexploded submunitions. The vast majority of the total casualties (89, or 80%) were civilians. In 2013, 23 (26% of the civilian casualties) were children, a significant decrease compared to 61 (35%) in 2012. Of the total adult civilian casualties, 55 were men and 11 were women. Twelve casualties were deminers, a large increase from just one in 2012. Another 10 casualties were security personnel (there were nine security personnel casualties in 2012).[1]

The 111 casualties recorded in 2013 represented a continuing trend of significant decreases in the number of annual casualties, with 186 recorded in 2012, 211 in 2011, and 286 in 2010. Most casualties were caused by ERW. Antivehicle mines continued to cause a great number 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.[2]

As of the end of 2013, CMVIS had reported at least 64,314 mine/ERW casualties in Cambodia: 19,684 people were killed and another 44,630 injured since 1979.[3]

Cluster munition casualties

Three casualties from unexploded submunitions were recorded in 2013.[4] For the period from 1998 to the end of 2013, 194 cluster munition remnant casualties were reported in Cambodia.[5] However, data collection on cluster munition casualties has been limited and the total number, although not known, is thought to be much higher. Cambodia is considered to be among the states “worst affected” by cluster munitions, with responsibility for significant numbers of cluster munition victims.[6]

Victim Assistance

The total number of survivors in Cambodia is not known. At least 44,630 people have been reported to have been injured by mines/ERW.[7]

Summary of victim assistance efforts since 1999[8]

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. Since 1999, services in physical rehabilitation have been available throughout the country from both government agencies and NGOs.

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. There were more vocational services for survivors in 1999 than in 2013, as programs were phased out due to a lack of funding. There has been an increased emphasis on community-based rehabilitation (CBR) efforts. Coordination among governmental bodies responsible for the provision of victim assistance steadily improved.

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.

Assessing victim assistance needs

In 2012–2013, Jesuit Refugee Services (JRS)/Cambodia Campaign to Ban Landmines (CCBL) and the CMAA conducted the “Survey on the Quality of life for Landmine/ERW survivors” (QLS) in 132 villages of 21 Provinces. The survey interviewed 3,345 people with disabilities, including 1,215 landmine and 417 ERW survivors, particularly in mine-affected areas.[9] The QLS survey teams organized home visits to understand the situation of respondents and provide 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] Based on the QLS findings, a series of recommendations were made to promote the rights of persons with disabilities at the national and sub-national levels.[11] Information and recommendations from the QLS were shared for the development of the National Strategic Plan on Disability.[12]

The QLS built on the experience of a district-level services mapping and guide project created by JRS/CCBL in cooperation with CMAA/CMVIS in 2012.[13] The services guide was republished and widely distributed in 2013.[14]

Some areas in which responses identified the greatest needs in the QLS survey included the following:[15]

·         Only half (51%) have enough food to eat; 14% responded that they had no food to eat and another 13% had very little food.

·         Over half (52%) responded that they did not have enough income to live in dignity.

·         Only 41% of persons with disabilities have identity cards.

·         Only 56% of persons with disabilities are literate (39% literacy among women with disabilities).

·         The QLS also demonstrated that overall, women survivors were worse off than men with disabilities.

CMVIS provided ongoing systematic data collection of mine/ERW casualties, including numbers of survivors and referrals to services.[16] Lack of reliable statistics on disability was reported to be among the main issues of concern for the promotion of disability rights in Cambodia.[17]

Victim assistance coordination[18]

The NDCC is co-chaired by both the MoSVY and the DAC; the DAC itself operates directly under the MoSVY. The NDCC included some victim assistance service providers as well as other disability actors.

The 2009 National Plan of Action for Persons with Disabilities was extended until the end of 2013. The plan was developed based on Mine Ban Treaty victim assistance principles and commitments. The new National Disability Strategic Plan 2014–2018 was launched by the Cambodian Prime Minister on 4 July 2014.[19] The plan was developed by the DAC in cooperation with the United Nations 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.[20] The plan contains four goals and 10 key objectives, all of which are relevant to addressing the rights and needs of survivors.[21]

Ten key objectives of the National Disability Strategic Plan 2014–2018 were:[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, 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.

Disability advocates expressed concerns 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.[23] Similar problems were identified in the joint project document for the UNDP Disability Rights Initiative Cambodia 2014, which listed the following key challenges facing the government implementation of the Convention on the Rights of Persons with Disabilities (CRPD) overall:[24]

·         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 organisations (DPOs) and civil society organisations (CSOs);

·         Challenges facing 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.[25]

At the Third Review Conference in 2014, Cambodia stated that it had faced many challenges to 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.[26]

The MoSVY continued to have 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.[27]

The DAC, a semi-autonomous body attached to the MoSVY, provided technical, coordinating, and advisory services for MoSVY. The Disabled Fund is an institution created under the MoSVY with a mandate to provide rehabilitation services for people with disabilities, to manage the rehabilitation centers, to provide funds for implementing various projects such as support for education and vocational training, to manage job placement services, and to prepare policies for assisting and supporting people with disabilities.[28]

Cambodia provided updates on progress in the coordination of victim assistance at both the Thirteenth Meeting of States Parties to the Mine Ban Treaty in December 2013 and the Mine Ban Treaty’s Third Review Conference in June 2014.[29] Cambodia also included updates on physical rehabilitation and medical services provided to persons with disabilities in 2013 in its Mine Ban Treaty Article 7 report.[30]

Inclusion and participation in victim assistance

In 2013, CMAA engaged 180 persons with disabilities and landmine survivors in formulating the National Disability Strategic Plan, organized by the DAC. Some 30 survivors were also engaged in the QLS in 2013.[31] Through the QLS, JRS in collaboration with CMAA and the CMVIS developed a survivor network in 15 of the 25 provinces in Cambodia, encouraging people with disabilities to understand their legal rights and human rights and to take action.[32]

 

Service accessibility and effectiveness

Victim assistance activities in 2013[33]

Emergency and continuing medical care

No significant changes to healthcare services available to survivors were reported in 2013.

Important factors preventing access to healthcare services for persons with disabilities, according to research by the German Federal Enterprise for International Cooperation (Deutsche Gesellschaft für Internationale Zusammenarbeit, GIZ) and HI, included: a lack of transportation to reach service facilities; fees for health services despite existing regulations exempting persons with disabilities from payment; limited specialized services at community and provincial levels; and a lack of identification cards which would identify poor people and make them eligible to receive free healthcare services. Persons with disabilities often face discrimination from other villagers and officials; sometimes they are called by their disability instead of their name.[34]

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.[35] Services for people with physical disability offered through the physical rehabilitations 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.[36] 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.[37] This issue of inconsistent data may be reflected in comparisons between time periods.

Prosthetic centers provided 1,909 prostheses for mine/ERW survivors in 2013, a decrease of most than half from the 4,151 prostheses provided in 2009, but closer to the number produced from the beginning of the Cartagena Action Plan Period in 2012 (2,584). There were 6,300 repairs to prostheses for survivors in 2013, an improvement from to 2,497 in 2010, but a slight decrease from 8,198 in 2009.[38]

In 2013, 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 1,597 prostheses (1,287 or 81% for mine survivors) in 2013.[39]

In December, the VIC’s grant funds from USAID began to support a process to transform the VIC into a local Cambodian NGO in 2014.[40]

The AAR WCD program increased its geographic coverage through Svay Rieng, Battembang, and Siem Reap with support from LDS Charities. The AAR WCD also increased the quantity of wheelchairs and assistive devices produced, including supply orders purchased by HI and Exceed/Cambodia Trust for provincial rehabilitation centers. All wheelchairs were adapted to individual requirements according to World Health Organization (WHO) guidelines. 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 AAR WCD could provide.[41]

Economic and social integration and psychological support

Persons with disabilities continued to lack equal access to education, training, and employment. Cambodia lacked a national integrated system for psychological or psychiatric assistance.[42] Self-help groups, mostly supported by NGOs, provided local services at the provincial level and were monitored by the CBR network.[43]

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.[44] In 2013, peer support was carried out practically through listening to the stories and life situations of individual persons with disabilities by the teams implementing the QLS.[45] The CMAA proposed to ensure the sustainability of the system established through the QLS with local volunteer focal points receiving non-salary incentives.[46]

Due to a lack of financial and human resources, many vocational training centers were not functioning and there was a need for increased opportunities for vocational training and micro-credit. Since mid-2012 there were only two functioning vocational training centers for people with disabilities in Cambodia, the Panteay Prieb center operated by JSC and the Phnom Penh Thmey center supported by JCIA.[47] The ICRC also helped ensure access to economic inclusion by supporting social workers from MoSVY employed at assisted centers to facilitate the enrolment of 61 persons with disabilities in socioeconomic programs.[48]

A review of the Cambodia Initiative for Disability Inclusion (CIDI) program found that the capacity of beneficiary organizations was strengthened in areas including financial management, reporting, and fundraising. It resulted in the incorporation of disability issues into the strategic plans and project activities of a number of mainstream organizations. The CIDI was also reported to have deepened many partner organizations’ understandings of disability and led to disability being discussed in terms of rights and social exclusion rather than charity. It was not possible to evaluate the impact on individual beneficiaries within the scope of the assessment.[49]

In July 2014 the Cambodian government launched the Disability Rights Initiative Cambodia,[50] a five-year, Australian-funded program aimed at ensuring that persons with disabilities have increased opportunities for participation in social, economic, cultural, and political life through effective implementation of the National Disability Strategic Plan (NDSP). The main goals include support to Cambodia’s coordination of the NDSP, strengthening the capacity of DPOs, improving physical rehabilitation centers, and working with provincial and commune officials to promote disability inclusiveness.[51] The initiative is a joint program of the UNDP, WHO and UNICEF. As part of the Disability Rights Initiative Cambodia 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.[52]
CABDICO continued to support the development of self-help groups and focused mainly on the needs of children with disabilities, inclusive education, and on the needs of parents of children with disabilities. Activities included referrals, awareness-raising, and educational support. Geographic coverage was reduced to two areas, Siem Reap and Kep, due to limited funding.[53]

CDPO focused on strengthening DPOs and provincial Women with Disabilities Forums. Membership of CDPO increased from 52 to 61 DPOs. CDPO initiated a radio program for persons with disabilities.[54]

The ICRC supported the International Olympic Committee and the Cambodian National Volleyball League for the Disabled (CNVLD) to expand the Women’s Wheelchair Basketball Programme in Battambang and to establish a new team in Kampong Speu.[55]

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.[56] However, inaccessibility to public buildings, transport, facilities, and referral systems continued to prevent persons with disabilities from actively participating in social and economic activities.[57] The government continued efforts to implement the law. The full period for compliance in some cases extends to 2015.[58]

CMAA’s gender team continued to implement its Gender Action Plan (2013–2015) and to assess and monitor the equality of access of women, girls, boys, and men to gender-sensitive emergency care, medical care, physical care, psychosocial care, rehabilitation, livelihoods, and legal services.[59]

Cambodia ratified the CRPD on 20 December 2012.