Country Background the Kingdom of Cambodia Is

8/14/2019 Country Background the Kingdom of Cambodia Is

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Cambodia

Country background

The Kingdom of Cambodia is situated in Southeast Asia between latitudes 10 and 15 North and

longitudes 102 and 108 East. ( See Appendix 1 - Map of Cambodia ). It is bounded on the westby Thailand, to the north by Laos, to the east by Vietnam and to the south by the Gulf of Thailand. Covering an area of 181,035 km 2 it is home to a population of some 13.6 million, 8%of whom live in the capital Phnom Penh, 10% in other urban areas, and the remaining 82% inrural areas. Cambodia is divided administratively into 20 provinces and 4 municipalities.

Topographically, the largest part of the country, about 75% of the total, consists of the Tonl Sapor Great Lake basin, the Mekong Lowlands and Delta which divides the country from north tosouth while the remainder is dominated by the mountains to the southwest, north and northeast of the country.

The country lies completely within the tropics and like the rest of Southeast Asia the climate is

monsoonal with distinct wet and dry seasons of relatively equal length. The southwest monsoonbrings the rainy season from mid-May to mid-September, and the northeast monsoon flow of drier, cooler air lasts from early November to March.

The total annual rainfall average is between 1000 and 1500 mm, but the amount variesconsiderably from year to year. It is heaviest in the mountains along the coast in the southwest,which receive from 2500 to more than 5000 mm.

The Tonl Sap Lake provides a huge source of fresh water. During the late wet season theMekong River backs up northwards into the lake increasing the volume of the lake tenfold at theheight of the flooding. As the flooding abates, the flow reverses and the level of the lake dropsleaving the surrounding area as marshland unsuitable for agriculture and resulting in a gradualsilting up of the lake.

Agriculture, employing 71% of the workforce dominates the Cambodian economy, with a further21% employed in the service sector and 8% in industry. After 30 years of conflict, the country isimpoverished, many of the government sectors are rebuilding, and the transition from a centrallyplanned to a market economy has been an added burden. Some 36% of the population is livingbelow the poverty line and 20% below the food poverty line (2005 World Bank povertyassessment) and the country has some of the lowest human development indicators in South EastAsia.

Water resources and supply

Cambodia is well supplied with water resources. Surface water, mainly from the Mekong River

supplies most of the eastern parts of the country, while the Tonl Sap River supplies the west andcentral parts of the country with drinking water and water for cooking. These two systemsprovide ample good quality drinking water when compared with WHO guideline values, andrequire only basic treatment such as disinfection. The surface water used as a drinking watersupply, is often the same as used for bathing, washing clothes, and disposing of waste products.Like other tropical countries, these surface waters are affected by the seasonal conditions andduring the wet season regularly inundate the flood plains surrounding the rivers and theirtributaries.


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The Tonl Sap Lake also represents a huge natural storage covering 2,500 km 2 in the dry seasonto over 13,000 km 2 at the end of the rainy season, but is subject to re-suspension of particulatematter and contamination with chemical discharges from industry, and from pesticides andfertilizers from agriculture particularly during the wet season

Of the total urban population of Cambodia of some 2 million, nearly half live in the capitalPhnom Penh while the remainder are distributed across 23 urban centres. These provincial centresgenerally have access to surface water from the river systems in unlimited quantities however thecoverage of the piped water supply in these towns is as low as 15%, with service restricted to thecentral areas of the town. Rural areas utilise streams, lakes, and ponds, and groundwater resourcesfrom tube, pipe and dug wells.An analysis of water supply coverage in rural areas has been undertaken and has highlighted thediscrepancies between sources of data due to differing definitions of what constitutes a safewater supply, and what conditions need to be met in order declare a source suitable forconsumption. The study found that the standardisation of definitions and specifications must beapplied across the supply sector and consistent training materials made available to agencies sothat they may operate and coordinate under a set of universal standards.

In most areas groundwater is available in abundant quantities throughout the year, although it iscommonly high in iron requiring treatment before disinfection, and this has been a major issuewith some of the provincial water supply works. Fine sediment can also be a problem and the useof groundwater may in certain areas be environmentally sensitive.

More than 81% of the countrys population is rural, and close to 60% of them use groundwater.Its use is common in rural areas accounting for over half of supply from dug wells and boreholes.Hand dug and open wells are widespread but with increased rural development drilled wells withhand pumps are becoming more common. The remaining supply is from rainwater collection -26% in the rainy season falling to 1% in the dry season, and surface waters (16% in the wetseason and 26% in the dry). In contrast, only 6.7% of Phnom Penh consumes well or bore waterwhile 81% have a reticulated system and a further 10% use tanker trucks. The high rainfall also

provides a reliable source of quality drinking water during the wet season through harvesting intanks and rainwater collection jars.

The responsibility for the provision and supply of drinking water falls to three main bodies, thePhnom Penh Water Supply Authority (PPWSA) who are responsible for drinking water in thecapital city Phnom Penh, the Ministry of industry, Mines and Energy (MIME) who areresponsible for drinking water in urban and provincial sectors, and the Ministry of RuralDevelopment (MRD) who are responsible for drinking water in rural areas.

Construction of water supply and sanitation facilities began in the late 1970s, when the focus wason the provision of emergency water supply facilities in areas where security conditions werefavourable. As national security and political stability was restored, attention began to shift

towards long-term development and in the last 20 years significant results have been achieved innumber of areas, including the water supply sector.


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The WHO/UNICEF Joint Monitoring Programme in its Country, Regional and Global Estimateson Water & Sanitation gave a 2002 estimate for Cambodia as shown below:

Improved Drinking Water CoveragePopulation

Total Urban RuralImproved Sanitation

Coverage

Total(thousands)

Urban%

Rural%

Total%

HouseholdConnection

%

Total%

HouseholdConnection

%

Total%

HouseholdConnection

%

Total%

Urban%

Rural%

13,810 18 82 34 6 58 31 29 1 16 53 8

Water and Health

Although water is essential to sustain life contaminated water may contain a variety of bacterial,viral and protozoan pathogens and helminth parasites that can cause disease in humans.Epidemiological studies have confirmed that nearly third of human faecal samples have one ormore parasites, contracted primarily through ingestion but also through contact with water duringbathing or washing.

Infectious waterborne diseases are still endemic throughout Cambodia and the bacteriologicalcontamination of drinking water is the most important health-related concern. The ruralpopulation use water for drinking or for preparing food and are in contact with it during washingor bathing, so there are serious risks from human pathogens transmitted orally by consumingcontaminated water. By failing to provide adequate protection of water sources and effectivetreatment opens the community to the risks of epidemics of intestinal and other infectiousdiseases including diarrhoea, dysentery, typhoid fever, cholera, hepatitis, parasites and gastro-enteritis.

Compounding the situation, sanitation practices in rural Cambodia are often poor, and whilesanitary conditions in the central districts of the largest urban areas have improved, adequatesewage disposal is nonexistent in most rural and suburban areas,

Infectious water related diseases are transmitted primarily through human and animal excreta andthe use of such unsafe water, poor sanitation, and low hygiene awareness, acts to increase levelsof sickness and contribute to a rise in the incidence of poverty indicated by high infant mortalityrates.Toxics algae have been detected in Phnom Penh's raw water and sedimentation tanks and in theTonl Sap River in the late dry season, and can produce toxins and release them into drinkingwater supply.

Pressures on resources and supply

Chemical contamination of water supplies also pose a health risk to populations particularly with

prolonged periods of exposure, although in terms of water quality, water pollution in Cambodia isnot yet considered a significant problem.

In 2000, MRD and MIME conducted a nationwide survey on the chemical quality of urban andrural drinking water sources with technical and financial support from WHO. Over 100 drinkingwater sources representing thirteen provinces were sampled and analysed for more than 80chemicals and pesticide compounds by a certified laboratory in Australia. The survey reportedthat the chemical quality of most urban and rural drinking water sources was generally goodalthough nitrites and nitrates were detected at elevated levels in several locations and


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contaminants such as barium, chromium, fluoride, lead, manganese, molybdenum, and seleniumwere also found but appeared to be exceptions to the general trend. No pesticides were detected inany of the samples.

Iron and other aesthetic concerns like hardness proved a significant issue for many ruralconsumers of groundwater who often complain about the taste, smell, colour, hardness, orturbidity of their water

The most significant finding of the survey was that of naturally occurring arsenic in groundwaterfrom certain areas in Cambodia. The element was detected at levels above the WHO guidelinevalue of 10 g/L in five of thirteen surveyed provinces. Some 9% of the randomly selectedgroundwater sources were found to be affected by arsenic.

A field assessment of over 5,000 samples using existing survey data was put into a databasetogether with geographical information and estimations made that some 19% of tube wells wereconsidered at risk, affecting around 30,000 in a population of 1.6 million.

As a result, an emergency Arsenic Mitigation Program was begun involving all the key ministries

related to the water supply sector. These ministries were to conduct a situation analysis, includingan arsenicosis survey, commence a national testing program, and conduct mitigation trials and anevaluation of field kits.In parallel they were also to develop information and educational materials and developappropriate policies.

The situation analysis involved examining the distribution of arsenic and constructing risk mapsand associated health implications. It also considered various mitigation options such asalternative water sources (surface and groundwater) and forms of treatment, such as arsenicfilters.

To determine the high-risk areas, guidelines and decision trees for undertaking testing, reporting,

the potential for mitigation and for education purposes were drawn up for the well testingprogram. This program was to undertake testing of every well in at risk areas to identify thosewith the highest priority for mitigation. The reliability of field kits used was tested, with generallygood results particularly in the lower ranges, and all wells tested will also undergo confirmatorytesting at overseas laboratories.

The arsenicosis survey was a cross- sectional study of all household members by trained face-toface interviewers using pre-tested questionnaires. The chosen study area was Kandal provincewith a population of approximately 1 million persons. Information was gained on tube wells usedfor cooking and drinking including the wells age, depth, ownership, and the arsenic status of thewell from test data. The survey indicated 62 suspected arsenicosis patients with signs of melanoma, leuco-melanoma, keratosis and nodules but this requires confirmatory testing of the

clinical signs supplemented by biological and urine testing.

Through the recent introduction of tube wells in Cambodia, exposure to arsenic is likely to havebeen relatively short but may show the potential for an increased disease burden in future if notaddressed early.The key is to prevent exposure to arsenic immediately using alternative sources, water treatmentand other mitigation strategies, including educational material for distribution to villages andschools


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The emerging problem of arsenic however remains less of an immediate threat thanbacteriological contamination, and switching to less safe surface water supplies would have anegative impact on the levels of water-borne disease. Consumers themselves are also concernedabout insufficient supplies of water, (particularly during the dry season) and turbid water in therainy season. There are concerns also that the aesthetic qualities of some supplies that may directconsumers to less safe alternatives.

Water quality surveillance and monitoring

As described in the previous section the main agencies responsible for water supply are thePhnom Penh Water Supply Authority (PPWSA), the Ministry of Industry, Mines and Energy(MIME) and the Ministry of Rural Development (MRD).

The procedures for water quality monitoring also differ from one department to anotherdepending on their purpose. The PPWSA and the Ministry of Rural Development (MRD) are themost efficient and conduct regular testing. Some limited testing is carried out by MIME andMinistry of Health (MOH). The PPWSA has implemented several water quality monitoringactivities including the routine quality control of the treatment process, general water qualityanalysis and quality control of the distribution network within Phnom Penh.

MIME is responsible for monitoring the water quality of urban water supply systems outsidePhnom Penh and provides some technical assistance to other public and private drinking watersuppliers. The Technology and Standards Office of the Department of Industrial Technology(DIT), which operates under MIME, analyses and certifies bottled water quality formanufacturers.

MRD is responsible for community water supply in rural areas through the Department of RuralWater Supply (DRWS) and Department of Rural Health Care (MRD) who concentrate mainly oneducating communities on water use, hygiene education, and the safe use and maintenance of facilities and household latrines. Some rural water quality testing is carried out but capacity islimited and only simple parameters such as As, pH, iron and salinity are measured using portableon-site equipment.

Apart from these three main agencies there are several other agencies with responsibilities forwater quality including MOWRAM who are responsible for the management of national groundand surface water policies and water resources, particularly for irrigation, and who are aparticipant in the development of national drinking water quality standards.

The Ministry of Health is responsible for research into waterborne diseases, and the NationalCentre for Health Promotion (NCHP) is engaged in health communication and educationactivities. The Ministry of Environment (MoE) is responsible for the protection of waterresources and catchments and the monitoring of water pollution, at least in part for human healthprotection.

The MRD is mandated to improve access to safe water supply and sanitation services in ruralareas and in 1995 MRD issued the "Water and Sanitation guidelines" and in 2001 the "PolicyFramework for Rural Water Supply and Sanitation Sector" and this RWSS Policy was approvedby the government in February 2003. Other ministries have also contributed to a "Draft Law onWater Resource Management" and water pollution control is subject to a sub-decree issued inApril 1999 by the Ministry of Environment who are committed to developing a national action


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plan for prevention of pollution of water sources by establishing national standards for pollutionsources, including wastewater discharges to public areas or sewers.

The responsibilities of the government institutions are mostly separate but there are some areasthat work collaboratively and there is a degree of interaction between the agencies, which holdseminars, meetings, workshops and training courses. At these joint events provincial experiencesare shared and work plans for monitoring drinking water are jointly developed, but inter-ministerial cooperation is generally not well practiced. In addition at least 25 non-government andinternational organizations are involved either by providing wells, simple treatment facilities, orsome who have some analytical capacity, while the Asian Development Bank and World Bank provide grants and loans, and international organizations and NGOs collaborate with, and supportthose national agencies .

Water Quality Standards

With so many agencies involved in drinking water quality there were inevitably several waterquality standards in use that have different priorities and purposes and the standards used werederived from various overseas standards. Drinking water quality standards adopted in Cambodiahad been mainly adopted from international standards or guideline values, partly donor driven, orfrom historical usage, with no reference to the actual situation in the country. Various Frenchstandards and WHO and EU guidelines had been used and values used by neighbouring countrieshad also been used to allow for regional comparisons.

In 2001 an inter-ministerial committee named the "National Committee on Drinking WaterQuality" began work on the National Drinking Water Quality Standards (NDWQS). At the time,each agency applied standards that were appropriate for its operational requirements and notnecessarily directly related to human health. It was intended that the standards should include allforms of drinking water including piped, bottled, and well water, and would require commitmentfrom the relevant agencies, with input and support from technical experts and external agencies.

The Cambodian NDWQS were prepared during 1999-2003 by a task force with guidance fromWHO experts. The standards were based on the latest WHO drinking water quality guidelines(2003) and those of other countries with particular adaptation to the water quality problems inCambodia. The standards are to be reviewed and revised accordingly regularly. The scope of theNDWQS are that it shall apply to all sources of drinking water that are intended for humanconsumption and will apply to water delivered from a water treatment plant through thedistribution network and from small community sources. The microbiological quality of drinkingwater is seen as crucial for health and thus has the highest priority for monitoring, and in theprotection of sources from contaminated with human and animal excreta. Bottled or otherpackaged manufactured waters are subject to separate standards.

A risk-based approach has been taken with consideration of local environmental, social,economic and cultural conditions and the parameters and values were derived based on waterresources and quality, epidemiological data, industrial and agricultural activity, chemical imports,cultural habits in water usage, climate.

The standards aim, together with sanitary surveys and interventions, to ensure the future safety of drinking water, reduce health risks, and provide a benchmark for the assessment of waterresources, treatment and supply processes. It requires that public water supplies are managed andprotected from source to consumer by protecting catchments and watersheds, by operation of


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treatment plants by qualified operators and regular monitoring of chemicals with known health oraesthetic impacts.

Needs analysis

With the development of the National Drinking Water Quality Standards there is an increased

need for a national water quality surveillance and monitoring system that acts on behalf of consumers. The system should be independent of service providers and should have direct linksto the designated authority with responsibility for the protection of public health. To support sucha surveillance and monitoring system requires that policies and legislation are enacted thatstrengthen enforcement of those national standards and encourage co-operation and collaborationbetween relevant agencies.

The system will also require the provision of appropriate and adequate infrastructure to conductmonitoring and surveillance, including independent laboratories operated by trained staff withsufficient capacity to carry out their tasks. The system should have access to and be a leader inthe compilation of all information and data related to the supply and provision of drinking water.

The survey of chemicals in groundwater identified some with potential impacts on health andhighlighted the need to conduct a more extensive nationwide survey for hazardous chemicalssuch as arsenic and fluoride. Certain ground waters were found to contain elevated levels of arsenic and further testing will be needed to more accurately determine the extent of the problemin Cambodia. Much of the testing and analysis during the survey was carried out by overseaslaboratories, and with the potential risks to public health from these naturally occurring chemicalsit will be necessary to develop in-country expertise and capacity to monitor them.

In particular with the discovery of arsenic in groundwater there is a need to develop andimplement a national strategic plan for prevention and mitigation of arsenic in drinking waterwith appropriate interim actions adopted for an immediate response. Such an undertaking willrequire the cooperation of all stakeholders in the water supply sector at the national andprovincial levels with stronger coordination by Government assisted by technical and financialsupport of national and international partner organisations. With the knowledge gained so far theconcerned agencies should take follow-up actions where water supplies exceed recommendedhealth-based limits for chemicals.

Several other chemicals of human health significance have also been detected and in some casesexceed the WHO Guideline Values in several locations. Most are naturally occurring, although afew may result from human activity (such as high nitrate levels). Pesticides have not beendetected in any of the samples tested and it is believed that these chemicals do not currentlypresent a significant health threat to Cambodia's drinking water. However, the improper use ordisposal of pesticides can result in occupational health problems and environmental threats, and anational capacity to monitor these toxic chemicals in both drinking water and in foodstuffs isdesirable.

The population often identifies the important link between water and health, although there isgenerally very little information available at the community level regarding these issues andmisconceptions regarding the connections between water quality and health are frequentlyencountered, such as a perceived link between calcium and hardness and kidney stones. Thesemisconceptions need to be addressed through dissemination of appropriate information andsuitable education programs for both the water sector and for the community. Consumers areoften more concerned with taste, odour and appearance of water rather than its chemical qualities,


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and the acceptability of a safe groundwater supply is vital to the long-term success of watersupply systems particularly in rural areas. However even in remote areas the potential forchemical contamination of water needs to be publicized to the community and their involvementsought, particularly in the area of protection of water sources and delivery systems. Programs arealso need to place a greater emphasis on water safety and quality in the policies and practicesconcerned with water supply development.

Referenced documents

1. Country Report on Drinking Water Quality in Cambodia, World Health Organization,Regional Workshop on Drinking Water Quality, Kuala Lumpur, Malaysia, 12-15November 2001

2. P A Kingston , Chemical Safety of Drinking Water: Identifying priorities using limitedinformation, Reports of workshops held in the Western Pacific Region of the WorldHealth Organization, Phnom Penh, Cambodia, 19-25 August 2001

3. Dr. Prak Piseth Raingsey , Director, Preventive Medicine Department, Ministry Of HealthCambodia Country Report , Meeting on the introduction of the 3rd edition of WHOguidelines for drinking water quality 8 to 11 December 2003, Kuala Lumpur, Malaysia

4. UNICEF/WHO, Country, Regional and Global Estimates on Water & Sanitation, JointMonitoring Programme (JMP) for water supply and sanitation,http://www.wssinfo.org/pdf/JMP_04_tables.pdf

5. UNICEF Cambodia Arsenic and Mitigation presentation 2003

6. Michael Levisay, Chea Sameth , Project Report - Cambodia Rural Water Supply-Coverage Analysis Water and Sanitation Program, Ministry of Rural Development


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Appendix 1 - Map of Cambodia

P Kingston 2006

0 100 km

Capital

Major Town/City National Boundary

Sisophon

Siemreab

Batdambang

Pouthisat

Krong Kaoh Kong

Kampong Saom Kampot

Khampong Cham

Kracheh Kampong Chhnang

Stoeng Treng

PHNOM PENH

CAMBODIA

Documents

Country Background the Kingdom of Cambodia Is