As an unlicensed doctor sits in pre-trial detention on charges of murder and infecting his patients with HIV in Battambang province, the Ministry of Health is drafting a letter to provincial authorities nationwide, urging them to crack down on illegal medical practices immediately, according to a senior official.

The new directive comes on the heels of a similar notice to provincial health departments on December 18, mere days after it emerged that some 70 people in Battambang’s Sangke district had been infected with HIV, the virus that causes AIDS. The infection count has since soared well past 100, with most affected living in Roka commune. New figures were unavailable yesterday.

“It is the same topic, but the second one will be sent directly to the capital-provincial halls to take an urgent action against [unlicensed health services],” said Sok Srun, director of the medical department at the Ministry of Health. “We are drafting it and it needs checking.”

“We will also take immediate measures when we get any information or problems from the provinces,” he added.

In the statement dated December 18, the Ministry of Health advised all municipal and provincial health institutions to move on “illegal health services” throughout the country. Four days later, Yem Chroeum, the local doctor whom residents are blaming for the outbreak, was hit with murder charges and “intentionally” infecting people with HIV. He was also charged with operating a clinic without a licence.

“All directors of the health departments have to take serious measures against illegal health services defying the law and previous directives and send them to court,” reads the December 18 statement, signed by Dr Te Kuyseang, secretary of state at the Ministry of Health.

Though the statement references unlicensed health services, the 2013 annual report from the Ministry of Health states that there have been no illegal or unlicensed health clinics over the past three years in Cambodia. In 2010, however, 7 per cent were unlicensed, down from 25 per cent in 2009.

Srun, from the Ministry of Health, said yesterday that provincial authorities may not be accurate in their reporting of unlicensed clinics. However, he said the existence of the businesses can be hard to trace since they are often mobile.

“Some have permanent locations, but some don’t; some departments have not paid enough attention, so some gaps were left,” he said. “Therefore . . . please help to report or give information since the province is big and it is hard to work on it.”

Voerung Bunreth, director of the Battambang Provincial Health Department, said that while he hasn’t seen any of the directives yet, his officials have been monitoring the problem.

“We did not ignore this and we have done our jobs. Since 2008, we have closed many places, including the monks who treated the diseases at pagodas,” he said.

Asked about Chroeum, Bunreth said he did not register with his health department, and admitted this was a “gap in taking action”.

Dr Masami Fujita, the World Health Organization’s HIV/AIDS team leader in Cambodia, said the outbreak in Battambang could be indicative of the larger problem of illicit medical practices, though he said there were no concrete figures that explained the scope of the problem.

Fujita added that it’s “very important” to pay close attention to “this particular matter of unlicensed practices”.

Dr Mean Chhivun, director of the National Center for HIV/AIDS, Dermatology and STD control, said yesterday he was “in the field” and too busy to answer questions.

Fears of untrained physicians are already spreading outside of Battambang. The Ratanakkiri Provincial Health Department has summonsed an unlicensed doctor in Banlung town’s Laban Siek commune after residents there learned of the HIV outbreak in Battambang and saw disturbing similarities with their local doctor. No one has been found with HIV there, an official said on Wednesday.

In Battambang, provincial police and health officials are still investigating the outbreak and trying to figure out in what ways Chroeum attended to patients. He has already allegedly confessed to reusing needles and instructing his son-in-law to burn evidence.

“We want to know about his treatment, and then we will submit more evidence at the court,” said Chet Vanny, deputy provincial police chief.

Oun Khvay, director of the Battambang provincial crime bureau, said yesterday that Chroeum told investigators he had treated patients with HIV before who later died, though he did not say his treatment led to their deaths. Khvay said it is still too early to offer a comprehensive explanation for what happened.

“We want to offer justice to both sides, people and the doctor. We need precise information. We cannot accuse him at our whim,” he said.