PHNOM PENH, Cambodia — The patients sit in packed ambulances before passing through metal gates. Once they are inside, they get a number, like C07-22, a thin blanket and a bedsheet, which is meant to be a mosquito net. Lights shine bright at all hours for constant camera surveillance. Each person is given four bottles of water a day and three small meals.
The Cambodian government, racing to contain a raging coronavirus outbreak, has set up a system of forced quarantine centers that patients say are run more like makeshift prisons than hospitals. No one is allowed to leave until they test negative — and most people are stuck for at least 10 days.
Cambodia was a Covid success story until a few months ago. From 500 cases and no deaths in late February, there were 72,104 cases and 1,254 deaths by Saturday — with nearly 900 new cases per day and almost 70 percent of the fatalities coming in the preceding month.
The sprawling quarantine centers are the product of an overwhelmed and underfunded health care system, a jolt of recent Covid deaths and an authoritarian streak that often turns to a robust security apparatus in times of trouble. The Cambodian government has gone from nonchalance to closures to crackdowns.
In April, a law was passed that threatened 20 years in prison for anyone judged to have intentionally spread the virus. During a recent curfew period, security forces patrolled darkened neighborhoods with bamboo canes.
Prime Minister Hun Sen, a strongman who has held power for 36 years, has thundered against anyone who escaped government treatment, eluded quarantine or violated home isolation.
Phnom Penh health officials confirmed this month that 21 Covid “care centers” had been set up across the capital, including state hospitals and various large venues that have been converted to hold the surging number of patients.
Or Vandine, a doctor who is secretary of state at the Ministry of Health, said she did not know how many patients were in the state-run quarantine camps, but that officials were doing all they could to “make conditions in the camps livable.”
Officials rarely talk about the quarantine centers, but they are impossible to hide.
At Koh Pich, a usually exclusive area that means “Diamond Island,” a former event space has been turned into a 1,800-bed facility with patients camped out in crumbling auditoriums, all living on single beds about an arm’s length away from the next.
Many families are inside, with crying infants.
In the suburb of Sen Sok, a gargantuan wedding venue usually reserved for lavish parties hosted by Cambodia’s elite is now equipped to hold 1,500 people and is adorned with clotheslines, trash piles and confinement fences.
And the sporting grounds of Olympic Stadium, a 1960s masterwork by the Cambodian architect Vann Molyvann, now look like an industrial-scale medical center, complete with mobile barracks, isolation facilities and medics in hazmat suits.
The World Health Organization representative to Cambodia, Dr. Li Ailan, said Cambodia’s spike in Covid cases was caused by new, more infectious variants as well as a mix of pandemic fatigue and the false belief that vaccines prevent all infection. She said there were “pros and cons” to the government’s methods.
“While it is important to keep positive people in quarantine centers, it is equally important to provide them effective treatment,” she said. “The quarantine centers have a defined number of people living in each of them, while people with severe or critical symptoms are being treated in the referral hospitals.”
Medical treatment at the Koh Pich center was being administered by young technicians in face shields and full-contact hazmat suits, who distributed packs of cold medicine and routinely doused patients with a disinfectant that smelled like tequila.
Cambodia is at a critical stage of its Covid-19 response, with outbreaks in factories, prisons, markets and small communities, Dr. Li said. “Vaccines are an important tool in fighting Covid-19, but they will not end the pandemic.”
Cambodia’s vaccination program has been praised for reaching 6.3 million of the country’s 16 million people. Yet many of the patients in the quarantine center at Koh Pich had been vaccinated and were asymptomatic.
Thon Nika, a 41-year-old shift manager at a local garment factory, was fully vaccinated in May, but tested positive at work and spent two weeks, without any Covid symptoms, in the Koh Pich quarantine center.
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“The vaccine isn’t protecting us, and there are a lot more cases than they say,” she said. “I watch more than 10 ambulances come back and forth every day. And not only to this center, but many other treatment centers as well.”
The Ministry of Health has denied that the centers are overcrowded. Those who end up there were tested at their workplaces, went to a local public clinic to get checked or were ordered to go to a state-run testing site, where a positive result leads straight to a quarantine center.
“We don’t trust the information that’s out there or the data that’s given to us,” said Khun Tharo, a veteran activist and program manager for the Center for Alliance of Labor and Human Rights. He said more than 700 factories had closed down since last year, leaving more than 500,000 garment workers in the teeth of the pandemic.
“The government has prioritized the economy, not the safety of the workers,” he said. “Workers who are afraid to go to an exposed factory or to a treatment center are being pressured to go back to work. They have no choice, if they don’t go back to work they’ll have no income to survive.”
Phal Lot, a frail, 62-year-old Khmer Rouge survivor who lives with her children, arrived at the Koh Pich quarantine center with an old clunky phone, to call her family, and the clothes on her back. Young women helped her rig up her bedsheet, which kept out the glaring lights.
Phal Lot is among the generation who suffered malnutrition and other horrors under Pol Pot’s regime and long years of war and occupation. As the country edges near what officials are calling a “redline” in the pandemic, the fears associated with that time have resurfaced.
“Deploying security forces to handle what the Cambodian government considers a crisis — health or otherwise — is the only way we know how,” said Ou Virak, a political analyst and founder of the Future Forum, a Phnom Penh think tank. “This doesn’t seem strange at all to a country reeling from a post-conflict era. A lot has changed over the past few decades, but not the people and the infrastructure of power.”
The willingness to comply with harsh, seemingly ad hoc government demands might be hard-wired in the psyche of many Cambodians, he said. Not everyone is bitter about being in the quarantine centers, and a certain camaraderie is born.
Each person is given a Covid test after eight days inside and the results are provided on day 10. Every time a patient tests positive, they are given another three days in the camp. Daily at 6 a.m., a loudspeaker announces the names of those who are allowed to leave. Cheers erupt, dances ensue and extra water bottles are handed to the nearest person who is still waiting for their name to be called.
Rathana Phin contributed reporting.