Expert Group Meeting and Seminar on an International Convention to Protect and Promote the Rights and Dignity of Persons with Disabilities
Bangkok, Thailand, 2-4 June 2003

Materials:

Seminar Documentation
Online resources

CAMBODIA PARTICIPATION PAPERS

Regional Meeting and Workshop on an International Convention to Protect and Promote the Rights and Dignity of Persons with Disabilities,

Bangkok, 2-4 June 2003

I.  Current Situation of Persons with Disabilities (PWD)

1. Definition of Disability

With reference to article 2 of the Draft Legislation on "The Rights of People with Disabilities" which is being developed by a Legislation Working Group, "a disabled person" means a person who loses any physical organ or capacity or suffers from any significant mental impairment, such as loss of limbs, quadriplegic, visual or hearing impairment or mental disabilities, etc which significantly affects their capacity to participate in social activities and they are required to have a certified document of disability issued by the Ministry of Health. The category and level of disability will be determined by the Government Sub-decree [1].

There was some identification of grade and categories of disability specifically for disabled soldiers stated by the Government. However, there has been no official definition regarding the classification of types of disability for PWD in general in Cambodia until a "Socio-Economic and Behavioral Pilot Survey on the Situation of the Disabled Persons in Cambodia" was conducted during March-June 2000 [2], an unofficial agreement was made in the classification of disabilities into eight types of difficulties as follows:

1. Seeing difficulties or visual impairment
2. Hearing difficulties or hearing impairment
3. Speaking difficulties or deaf/speaking impairment
4. Moving difficulties or physical impairment
5. Feeling difficulties
6. Strange behavior or mental impairment
7. Learning difficulties or intellectual impairment
8. Fits

There is not available and or official definition of the above types of disabilities in Cambodia. However, effort has been made in this regard in conjunction with the World Health Organization-WHO amended definition of the disability.

2. Current Situation and Problems Faced by PWD

The recent history of Cambodia has left a legacy of high numbers of PWD of all ages and conditions. The devastated health and social services as well as educational facilities have neither the financial means nor the human resources to cope with the overwhelming needs of Cambodians with disabilities. The rehabilitation services are still limited to support PWD, especially services to address the needs of children and women with disabilities. The Government's long-term goals are to develop, implement and manage a national strategy for the prevention of disability and for the rehabilitation of the disabled, based on an integrated participatory and decentralized approach to services delivery. The immediate goal is to ensure the maximum number of PWD receive appropriate services and support so as to enable them to live with dignity and to be integrated within the community to the best extent possible.

There is no universal PWD registration system set up in Cambodia.

3.  General Conception Towards PWD

More than 85% of Cambodian people follow Buddhism. People believe in "Kama: Commit good receive good, commit bad receive bad". In Buddhist theory or teaching, disability is the outcome of a bad thing, which a person made in his/ her previous life's course. People have also been taught to have mercy for the weak. On the other hand, there is also a belief in good and bad luck and this relates to an action of a person when he/she does good action against others good luck would be brought to that person. Therefore, most Cambodian people prefer to give donations or charity to the poorer people and disabled beggars. However, such compassion and support of people has decreased due to suffering and the breakdown of community spirit by the prolonged civil war and devastation in the country. Though the above concept might be regarded as a good system to support PWD, however additional approaches would enable PWD to stand for themselves in society equally and considerable attention is being given to the empowerment of PWD to be included at all levels of decision making.

4.  Disability Awareness

A major factor restricting the full participation and equality of opportunities of PWD is the prevalence of perceptions and practices, which prevent them from functioning as full members of the society. Often the abilities of PWD are not recognized. They face social and economic marginalization, discrimination, and have very limited access to resources. Therefore, they find their opportunities for full and equal participation limited. Also, Public awareness and mass education campaigns on the inclusion of PWD in the country's mainstream development program, by mobilizing the private sector and the community for eradication of discrimination are almost non-existent.

Public awareness campaigns are needed to overcome inaccurate stereotypes that PWD cannot be productive members of society. Public awareness should promote the respect of the right of PWD. It should also focus on the abilities persons with disabilities possess. The involvement of the Buddhist community could be a valuable support for public awareness and mass education to change the society's mindset and negative attitudes towards PWD.

At the present, a study on Disability Awareness Programs has been coordinated by the DAC. Its main objectives are to assess the current activities on disability awareness, which are being implemented by some organizations, to identify gaps and to develop a comprehensive national strategic plan for disability awareness program in a systematic, coordinated way in Cambodia.

5.  Training and Employment

Skills training, income generation and job placement is an important factor in the rehabilitation of PWD. In Cambodia PWD typically come from the poor and poorest segments. For these PWD it is of high priority to be able to gain an income for themselves and their families. Programs in training and employment can be divided into the following categories.

• Provision of vocational training (which can include literacy, numeracy and small business management)
• Referral services to training providers and employers
• Production of crafts for the local market and export through production workshops or independent producer groups

Follow up after the graduates have left the centers has gained an increasing importance in most programs. Follow up takes the shape of regular visits to the graduates work place, the provision of start up equipment and – in some cases – the provision of loans or grants. PWD meet some specific constraints in their aim to gain an income.

• Self-employment usually requires access to credit facilities. Poor PWD find it particularly difficult to access credit.
• PWD often face discrimination, when it comes to employment. The belief in their abilities is very low.

In addition, skill training for PWD meets the same constraints as the mainstream service providers.

• The labor market is very limited. Employees are often hired because the owner trusts them and not because they are particularly qualified.
• Employees are paid very low salaries, often not meeting the minimum expectations and needs of job seekers.
• Most PWD live in rural areas, where economic activities are limited.
• Micro-enterprise promotion requires people willing to be entrepreneurs. This can not be assumed for everybody.

6.  Poverty

In Cambodia, the measurement of poverty is based on a poverty line that takes into account food consumption that provides at least 2,100 calories of energy per person per day and a small allowance for non-food consumption to cover the basic living items like clothing and shelter. The nature of poverty in Cambodia has been identified as following: a) impact of the Khmer Rouge Regime and the legacies of war on the population, b) lack of opportunities, c) vulnerability, d) less access to public services.

PWD form one of the most vulnerable groups in Cambodia, and have very limited access to education, skills/vocational training, job placement, income generation opportunities and other available social services. As a result, many are extremely poor. Income generation for PWD thus not only contributes to establish a sense of dignity and self-confidence among PWD, but it is also directly linked to poverty reduction and development. Many view disability as a condition of occupational disadvantage which can and should be overcome through a variety of policy, measures, regulations, appropriate programs, and services. Equality of treatment, mainstreaming of training and employment opportunities and community involvement is central pillars of the multi-sectoral approach.

7.  Accessibility

Cambodia’s built environment contains many obstacles for PWD. The majority of public buildings have inaccessible entrances and exits. Toilets are usually located upstairs in small cubicles and never have supporting handles. Some of the larger hotels have accessibility features e.g. lifts, wide doors and corridors. However, most smaller hotels and guesthouses are inaccessible. Problems are similar in hospitals and schools. Higher level institutions typically have several flights of stairs. Features which should be accessible include entrances, exits, door handles, handle rails, floor surfaces, corridors, toilets, escape routes, elevators, and staircases. External environment barriers include obstructions on footpaths, uneven or no footpaths, street vendors and cars on footpaths, no kerb ramps, steps etc.

Awareness of accessibility for PWD is minimal outside of organizations working on the promotion of the rights of PWD. However, some adaptations to the built environment and the external environment can be achieved at a minimal cost with creative thinking and careful consideration given to people’s needs. PWD experience difficulties in moving around the numerous obstacles of the built environment on a daily basis. Therefore, PWD and organizations representing them should be consulted from the early planning stages.

At present the responsibility for building and construction permits is not clearly regulated. Also, the legislation on disability is still in a draft form. Hence, it is difficult at this stage to place responsibility for the implementation and monitoring of accessibility features on a specific government body.

8.  Education

Education is a human right and a basic need. Education in Cambodia however, has suffered greatly from past political, social and economic turmoil. The Khmer Rouge Regime (1975-79) oversaw the almost complete destruction of the education system.  Cambodia has made significant progress in the last decade in recovering from the years of war and turmoil.  The eighties and early nineties are best characterized as a lengthy phase of emergency relief focussing on the opening of schools and the emergency training and deployment of teachers.  The early nineties featured a growing emphasis on Government led policy reform.  It is only in the mid to late nineties that it can be said that the transition from emergency relief to reconstruction and development has been made.

Education for all persons in Cambodia is imperative. The limited capacity and resources of the general education system, particularly in rural areas has resulted in the majority of learners being excluded from education opportunities altogether. This naturally results in illiteracy and low skills amongst children and adults with disabilities, ultimately contributing to reduce employment opportunities.

For PWD formal and non-formal education are among the services essential for child survival and development and a vital means of empowerment and self-help. To date education programs for PWD have been implemented solely by NGOs and focus on children with disabilities. A limited number of special schools and classes exist, as do a few community-based initiatives. Collectively these services only provide provision for a fraction of children with disabilities in Cambodia, and are concentrated mainly in urban areas. These programs cater almost exclusively for children with physical disabilities and sensory impairments. A non-quantifiable number of children with disabilities (mainly children with physical disabilities) are intrinsically included into the mainstream education system however the present school environment does not facilitate integration. At present, the national policy and pilot inclusive programs for promoting educational opportunities for children with disabilities have been coordinated by the DAC in close collaboration with Ministry of Education, Youth and Sports (MOEYS).

9. National Census

In Cambodia, the last national general population census was taken in 1998. This census aimed at providing a picture of the social and economic conditions of population at all levels. Unfortunately, there was minimal data on PWD had been collected. There has not been any separate national census on disability, neither registration system of PWD set up in this country.

II. National/International Laws and Regulations Related to PWD

1. National Laws and Regulations

* Cambodia does not have separate disability laws at the present, but disability issues have been addressed in some existing Cambodian Laws and Regulations. However, draft legislation on "the Rights of PWD" is being developed. The draft law aims to promote integration of PWD into mainstream development programs/activities which includes health, accessibility, education, vocational training, employment, etc. to ensure the protection and promotion of the rights of all PWD and prohibition of abuse and neglect of these PWD and discrimination against them.

Note: The legal documents shown in the above table are listed based on hierarchy of legal status and followed by the date of issuance.

2. International Legal Binding and Non Binding Documents

a)  International Legal Binding Documents

b)  International Legal Non Binding Documents

* Cambodia is one of the leading Asian countries that is a signatory and recognizes most of International and Regional instruments (meaning Declaration, UN Resolution, Treaty, Covenant, and Law) that can be used to protect the rights of PWD.

Source: The Compendium of Cambodian Laws Volume III, CLRDC, 2000
Landmine Monitor, Cambodia 2000
ASEAN and the Banning of Anti-personnel Landmines, Landmine Monitor 2000

Note: The list of the documents in the tables:3.2.1 and 3.2.2 is made based on level of involvement with PWD and followed by the date of issuance.

III. National Policy/Strategy and the Present Situation Regarding PWD

1. Health Care for PWD

The following has been extracted from the National Policy on the Health Care for Elderly and Disabled People, Ministry of Health, February 1999.

Goal: To foster and strengthen health care of PWD with the integration of national prevention into the existing mainstream health care and to enhance and work cooperative with the other ministries especially the MOSALVY, Bilateral and International Organizations, and other NGOs. Objective: To prepare the Cambodian people for a healthy PWD and to improve the health status of PWD.

Key Strategies to successfully implement the above policies are as follows:

Prevent and control of diseases which cause disability in order to decrease the prevalence of hypertension, diabetes mellitus, heart disease, stroke, chronic lung disease in the Cambodian population and to promote oral health, eye care and mental health of PWD through primary prevention.

• To improve the basic knowledge on health care for PWD to the health staff at all levels.
• To promote this health system through mass media with some help from IOs, NGOs, and from the Village Development Committee.
• To orientate communities, the families of PWD on the fundamental knowledge in health care and to strengthen warm relationships among family members by providing facilities to support and encourage families and communities in order to improve the quality of life, their longer-life and well-being.
• Strengthen the basic health care for PWD in the communities by the village health volunteer.

These are the first steps of the National policy for health care of PWD through the health care delivery system. The focus of this policy is to preserve much care and well-being for PWD that will be enhanced by a range of support program from the Ministry of Health (primary and hospital care) and MOSALVY (community based rehabilitation), other institutions such as Ministry of Finance, Ministry of Interior, Ministry of Rural Development, Ministry of Women Affairs and Veteran, and other NGOs/IOs partners.

The provision of care to PWD must be identified on the quality of care through primary prevention. This is the first priority of this policy and then the secondary prevention must focus on the communicable and non-communicable diseases in the young old people, which cause disability. Rehabilitation, using community-based approaches to meet the health care needs of PWD, will be promoted.

2. Identification and Early Intervention

In Cambodia, disability identification and early intervention are still weak especially in the rural areas due to the lack of resources, disability awareness, low education of people at community level and the absolute poverty. However, effort has been taken through the following activities.

3.  Prevention of Disabilities

Prevention of disabilities in Cambodia incorporates different elements such as promotion of primary health care, improvement of hygiene and sufficient nutrition, vaccination, mine and UXO awareness, and weapons reduction.

According to Cambodia Socio-Economic Survey 1999 by the Ministry of Planning, showed that ill health and diseases had been the principal cause of disabilities in Cambodia. Congenital disability is reported as the second most important cause of disability in the country. Landmine explosions were the cause of disability of 10.8% of the disabled population of Cambodia. The cause of disability of more than one out of ten in the country as a whole is reported as war or conflict. More than three times as many males as females have been disabled by the combined causes of landmines and war and conflict. 

As Cambodia has recently emerged from the prolonged war and conflict, the lack of basic health care, malnutrition, bad hygiene, landmines, battles, and poverty have been regarded as serious causes of disabilities in Cambodia. On the other hand, it is reported that disabilities caused by traffic accidents are increasing especially in Phnom Penh due to the rapid and uncontrolled increase of the number of vehicles/cars and motorcycles, and weak enforcement of traffic laws. The compulsory use of seat belt in vehicles and helmets for motorcycles has not been enforced.

4. Education

Even though, a reliable count of the current disabled population is not available, however, it is generally accepted that Cambodia has one of the highest rates of disability in the world and that approximately 21% of the disabled population are children. The most common types of disability among children in Cambodia are Polio, hearing and visual problems and problems relating to the brain such as Cerebral Palsy and emotional and behavioral problems.

The current world concern with Education for All and the Convention on the Rights of the Child (CRC) is leading many countries to consider this issue in terms of integrated/inclusive education (IE) [4]. Within schools, integrated/inclusive education is an approach which aims to develop a child-focus by acknowledging that all children are individuals with different learning needs. Through an IE program, teaching and learning can become more effective and relevant and meet the needs of all children, not just those with disabilities. Therefore IE will be beneficial for all schools, although all schools may not be beneficial for all children. As a catalyst for change IE provides not only for school improvement but also for increased awareness of human rights and a reduction in discrimination.

Although, efforts have been undertaken to promote Education for All including children with disabilities, however educational opportunity for adults with disabilities is still minimal. PWD experience lack of accessibility, appropriate support and encouragement of their families and community, and face with marginalzation and discrimination. In addition, they even face with the barriers made by the state, public and private sectors. For instance, the recruitment criteria of students for higher education and of teachers for public pre-schools and primary schools imposed by the MOEYS, according to Council of Ministers' decision No. 1356 sCN>Gv /1995, 223 sCN>Gv /1997, 872 sCN>Gv /1997 835 sCN>Gv /1998 and 39 Gyk>Rbk /1999, stated that ".... recruitment must be made among candidates of either sex, of Cambodian nationality, who have clear biodata, good health and free of disabilities, ..."  

Therefore, to successfully implement and achieve the goal of UNECSO World Declaration on Education for All, the following points have to be taken into consideration: review, improvement and impose the Government legislation and policy, accessible schools and communities, disability training and awareness raising and external support and resource requirements.

5. Governmental and Non-governmental Social Services Regarding Technical Aids, Accessibility, and Other Outstanding Issues

Most services of physical rehabilitation have been provided by NGOs in collaboration with MOSALVY. These  include: training of prosthetic and orthotic technicians, the production of components for prosthetic and orthotic devices, rehabilitation centers for the fitting of prosthetic and orthotic devices, the production and distribution of wheelchairs and tricycles, and training of physiotherapists for placement in hospitals and rehabilitation centers

Initially, most service providers promoted their own technology. However, the production of prosthetic and orthotic devices as well as the training of technicians have now become more standardized. Recently, the physical rehabilitation providers organized themselves in the DAC Physical Rehabilitation Committee, which aims at ensuring maximum equitable distribution of quality physical rehabilitation services to all physical disabled persons in Cambodian society. Sub-Committees exist in the areas of P&O, Wheelchairs and Physiotherapy. The Physical Rehabilitation of PWD meets several challenges. The high number of amputees, despite a recent reduction in new mine incidents, will demand the regular replacement of considerable number of artificial limbs for many years to come. In the absence of Government allocation to the sector, the long term financing of the physical rehabilitation services remains unclear.

The future role of the MOSALVY in the physical rehabilitation of PWD will be a crucial factor for the sustainability of services. Presently the Ministry provides a considerable number of its own staff to NGOs. However, the Ministry has no operational budget, which leaves services being completely financed by foreign assistance.

6.             Medical/Occupational Rehabilitation (Institutional / Non-institutional Care)

In Cambodia medical rehabilitation is under the joint responsibility of the two ministries namely MOH and MOSALVY with unclear terms of reference (TOR) and insufficient co-ordination and collaboration. That is why a Specialized Committee on Medical Rehabilitation was established in mid 2000 with the main tasks as described above. When a person gets injured he/she needs to be sent to the hospital for treatment and or surgery, after medical/surgical treatment he/she will be referred to rehabilitation workshop or center for rehabilitation services to maximize his/her ability to live in the society.

Often health professional, such as medical doctors (including surgeons), nurses, physiotherapists and other allied health professionals do not receive adequate training in disability and rehabilitation. In addition most of the training is focused on hospitals and large institutions. Therefore it is felt that more appropriate training should be included in the training of health professionals and community workers in all countries including Cambodia.

In addition, it is recognized that to provide comprehensive rehabilitation services requires close links between hospital based services, rehabilitation centers and services within the community. Therefore in Cambodia it is felt that the following aspects need to be strengthened:

• Early identification and treatment of disease, illness and trauma thus minimizing the degree of disability;
• Development of appropriate Physical Medicine and Rehabilitation Services based on the specific identified needs of Cambodia and
• Mainstreaming of rehabilitation services into PHC and community services

There are 8 vocational training schools/centers in Cambodia (3 in Phnom Penh, 1 in Kandal province, 1 in Kampot, 1 in Battambang, 1 in Pursat, and 1 in Kampong Thom). Those centers have operated with support and close collaboration with World Vision, Mariknoll, AAR-Japan, UCC, JS-C, JCIA, CWARS and others. So far 3,493 PWD trainees have been trained in different skills in which 1,751 of the graduated have paid job or set up self-employment businesses in their own villages. However, these services can only meet a small percentage of the PWD needs. Job placement cannot be guaranteed after training, as there are no specific incentive, quota system or legislative instruments promoting the employment for PWD.

Community Based Care (Group Home, Foster Home for abandoned and orphaned children with disabilities) has been initiated by DAC in partnership with YWAM and MOSALVY. A similar project is being initiated by MOSDALVY for street PWD in Phnom Penh to re-integrate them into community. Community based activities are being developed and promoted in Cambodia as the most appropriate and sustainable approach for equalization of opportunities and inclusion of PWD in the development of their country.

7. Promotion System/Services for Employment of PWD

The Cabinet Resolution No 181/SSR is the only regulation relating to the strategy and policy of the government on promotion of services and employment for PWD. It was implemented by Ministerial Proclamation No 02/PRNN. Under, these papers regime for PWD has been set; provincial rehabilitation centers and vocational/skill training centers have been established; and other line ministries including the National Bank have been ordered to take appropriate measures to promote employment of PWD. Concrete action has not been taken yet due to Resolution 181/SSR was issued during the previous regime by the State of Cambodia and it is not well fitted with the current system. However, it still remains a principle document regarding policy guideline on employment for PWD while a new one has not yet been developed.

The Labor Law has not stipulated measure relating to the employment of PWD. Therefore, efforts are being made in term of promotion such as the disabled regime and benefits are already set for civil servants. The government has tried it best with its limited resources to promote awareness and ability of PWD through sporting activities. Organizing the Handi Sports Day on yearly basis will contribute to the promotion of employment of PWD showing abilities of PWD. 

The following initiative has been taken to promote job opportunities by Local NGOs, Government, IOs, and private sectors, with technical support from ILO, are seeking to form a Business Advisory Council that is able to:

• Advise training centers to include PWD in their program and to update curricula to more effectively match with the current practices.
• Advise on current and future job opportunities and requirement, which all companies should be approached for job placement.

A project called Rural Development and Income generation for PWD in Cambodia has been initiated by the Disability Action Council funded by UNDP through World Rehabilitation Fund. The aim of the project is to promote self-employment of PWD in rural area by conducting survey on the existing income generation activities to identify gaps and potentials.

ILO's Disability Resource Team, in cooperation with MOSALVY implement activities on work place accessible for PWD, promote job placement for PWD including credit scheme and a modest allowance or grant to disabled trainees after graduation. Other activities such as follow up, monitoring, counseling, and promoting self confidence of PWD in mainstream society.

8. Community Based Work with PWD (Community Based Rehabilitation)

In Cambodia community based work with PWD has been the chosen approach of most of the agencies working with PWD. Some organizations work with specific groups, such as those with a particular disability, or disabled children. Others include all age groups and disabilities. Despite the heterogeneity of the agencies, certain aspects of their work are agreed within the sector to be fundamental to community work with PWD. These core common elements are: raising awareness on disability issues at individual, family, & community level, promoting self esteem and capability of PWD, promoting inclusion of PWD within the community, promoting opportunities for employment, referring on and making links between PWD and agencies (Government & non Government), providing family and community support.

The term Community Work with Disabled people (CWD) was chosen by representa­tives from the sector to describe this type of approach in a simple and unambiguous way. It embraces the term Community Based Rehabilitation, and avoids the conceptual difficulties surrounding CBR.

CWD staff and programs face particular constraints of accessibility in terms of availability of services. In the past widespread coverage was impossible due to political instability. This is improving now, but certain problems remain:

• security – landmines, robberies, kidnapping, insufficient staff to travel in pairs
• transportation – poor roads, weather conditions, large distances, lack of vehicles
• lack of co-operation with local authorities – local politics, lack of transparency, expectation of gifts, etc.

Point of Contact:

Mr. Ouk Sisovann
Executive Director
Disability Action Council (DAC)
#28, Str. 184, Sangkat Chey
Chum Nas, Khan Daun Penh
Phnom Penh, CAMBODIA

Tel: (855-23) 215-341 or 218-797
Fax: (855-23) 214-722
E-mail: dac@bigpond.com.kh

P.O.Box 115
Phnom Penh
CAMBODIA

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1 Draft Legislation on the Rights of PWD, Provision I, Article 2, 2000

2 Socio-Economic and Behavioural Pilot Survey on the Situation of the Disabled Persons in Cambodia", December 2000

3 The Cambodia Daily, Monday, February 19, 2001

4 Integrated education is the term used to describe the process of bringing children with disabilities into mainstream schools. Inclusive education is a wider process of integration, incorporating the ideas of access for all (other disadvantaged groups as well as those with disabilities) and the accommodation of the mainstream school to the diverse needs of all children.

Copyright (c) 2003 AIMS/VisionOffice.
Last updated 05/18/03. Contact: facilitator@worldenable.net