A tourist visits the Toul Sleng Genocide Museum in Phnom Penh, a former ‘Security Centre’ or torture prison of the Khmer Rouge regime. Post Staff
The Khmer Rouge era, which claimed the lives of an estimated two million Cambodians between 1975 and 1979, left behind more than just physical destruction.
Decades later, the Kingdom still grapples with the hidden scars of that dark period – psychological wounds that continue to affect survivors and their descendants, creating a complex landscape of mental health issues that reverberates across generations.
Youk Chhang, director of the Documentation Center of Cambodia (DC-Cam), highlighted the limitations of the Extraordinary Chambers in the Courts of Cambodia (ECCC), known as the Khmer Rouge Tribunal, in addressing the deep mental health challenges facing Cambodian society.
He expressed his disappointment with the ECCC’s efforts regarding mental health, highlighting that trauma-informed approaches were not integrated sufficiently into the tribunal’s processes.
Chhang noted that the ECCC relied on doctors from Calmette Hospital and an international expert from New Zealand to provide mental health support to the accused and witnesses.
However, he criticised the overall effort, stating that the court should not have been burdened with the responsibility of addressing mental health issues.
“The ECCC is a court meant to deliver justice, not to provide mental health support,” he said, adding that trauma mental health efforts should have been carried out by the public health system, not by the court.
Recognising the trauma
A 298-page book, Cambodia’s Hidden Scars: Healing and Reparations for Trauma Psychology After the Khmer Rouge Tribunal sheds light on this important issue.
Cambodia’s Hidden Scars: Healing and Reparations for Trauma Psychology After the Khmer Rouge Tribunal sheds light on the profound mental health effects of the barbarous regime. DC-Cam
Published by DC-Cam in May, in collaboration with the Human Rights in Trauma Mental Health Program at Stanford University, the third and final edition of the series provides a deep dive into the long-term mental health consequences of the genocide and the attempts made to heal these wounds.
More than 40 years after the fall of the Khmer Rouge regime, a significant portion of the Cambodian population still bears the emotional burden of that era.
According to DC-Cam’s research, 87 per cent of survivors report experiencing disturbing memories of the Khmer Rouge period, while 25 per cent continue to suffer from recurring nightmares.
Many survivors are plagued by post-traumatic stress disorder (PTSD), depression, and other trauma-related conditions.
For survivors like Sokchea, now in her 70s, the memories of what she endured during the regime are vivid and painful.
“I cannot forget the faces of those who were taken to the fields and never returned,” she said.
“Every night, I see them again in my dreams,” she added.
Sokchea’s experience mirrors that of many Cambodians, whose trauma extends far beyond the physical atrocities committed by the regime.
People examine the well-preserved detention centre, where an estimated 20,000 prisoners were tortured. Just 12 people, five of them children, are thought to have survived. Post Staff
DC-Cam’s data, collected from over 31,000 Khmer Rouge survivors, reveals that in addition to psychological trauma, physical ailments such as hypertension, gastrointestinal disorders and heart disease are prevalent among survivors.
These conditions, researchers argue, are often exacerbated by the stress and emotional strain survivors continue to endure.
Intergenerational ripple effects
What makes Cambodia’s case particularly unique is the extent to which this trauma has been passed down to subsequent generations.
The children and grandchildren of survivors – many of whom were born long after the regime’s collapse – are also suffering. Research included in the book shows that these descendants often exhibit signs of anxiety, depression and emotional distress, a phenomenon referred to as intergenerational trauma.
Psychiatrist Dr. Daryn Reicherter, one of the book's editors, explained, “The trauma from the Khmer Rouge era didn’t stop with the end of the regime. It became embedded in the fabric of Cambodian society, affecting parenting styles, family dynamics and even the ways people interact with institutions.”
This transmission of trauma, experts say, is often subtle but profoundly damaging.
In many cases, survivors pass down not just stories of suffering but also emotional behaviours such as hypervigilance, fear of authority and deep-seated mistrust of governmental and social structures.
This inherited trauma has contributed to higher rates of mental illness among younger Cambodians, even those who have never experienced violence firsthand.
Addressing the scars: Progress and challenges
Despite these challenges, Cambodia has made strides in addressing the mental health needs of survivors.
The establishment of the ECCC marked a turning point in the country's approach to trauma.
For the first time, mental health was introduced as a critical factor in war crimes prosecutions.
Local women tour the centre, as part of DC-Cam’s efforts to educate the Cambodian population about the horrors which took place there. Post Staff
The ECCC’s acknowledgment of trauma in its verdicts, particularly in cases 002/1 and 002/2, was groundbreaking.
In these cases, the court noted the psychological harm suffered by survivors and recommended reparations in the form of mental health services.
The court’s decision was based, in part, on research cited from previous editions of Cambodia’s Hidden Scars, which played a pivotal role in demonstrating the depth of the mental health crisis.
However, while these legal milestones have brought some measure of recognition to survivors’ suffering, the country’s mental health system remains under-resourced.
“It’s an injustice to survivors that four decades after the Khmer Rouge era, their minds cannot rest because they lack access to resources for mental health,” Reicherter, noted, in the book’s introduction.
As of 2022, mental health care in Cambodia is still largely inaccessible to the general population, particularly in rural areas.
There are fewer than 50 practicing psychiatrists for a population of over 16 million people.
Many survivors continue to rely on traditional healing methods or informal support networks, which are often inadequate for addressing severe mental health issues like PTSD.
The editors advocate for trauma-informed practices in both the justice and health systems, urging the Cambodian government and international organizations to prioritize mental health as part of the country’s continued recovery.
“Cambodia cannot move forward without addressing the psychological scars of its past,” says Dr. Lisa M. Brown, co-editor of the book.
“The healing process must include access to mental health care, support for survivors and recognition of the multigenerational impact of trauma,” she added.
As Cambodia looks to its future, Cambodia’s Hidden Scars serves as a reminder that the effects of genocide are not confined to the past.
