WARNING: This article contains graphic images and descriptions of genocide and human suffering.
In 1992, the United Nations deployed what was at the time the largest and most multinational peacekeeping force in its history to war-ravaged Cambodia. More than 21,000 UN personnel from 46 countries around the world arrived in the Southeast Asian nation.
The outcome of the UN intervention was stabilising what had been decades of war in the country, the implementation of a democratically elected government, and the repatriation of more than 350,000 refugees.
However, in the years following the mission, influential individuals involved in the running of Cambodia placed criticism on the United Nations for wider consequences faced by Cambodians following the UN's withdrawal in 1993.
One such prominent accusation came from the King of Cambodia, King Norodom Sihanouk. He accused the UN Peacekeepers of introducing HIV to the country and its people.
His criticism joined that of US Government-funded think tank The East-West Centre, who in a report about the UN mission was frank on the subject of HIV. Their report, titled UN Peacekeeping Missions: The Lessons From Cambodia, stated:
"[UN] personnel helped introduce the disease into Cambodia and are also taking the HIV virus back to their home nations."
By 1995, two years after the end of the UN operation, Cambodia was one of the most impacted counties in the region of HIV / AIDS, which was minimally present before the UN's mission.
Here, BFBS explores the historical backdrop to the UN's 1992 intervention in Cambodia and investigates whether the criticism faced by the UN on the topic of the AIDS pandemic is fair.
Cambodia's Difficult Past
In 1970, Lon Nol led a military coup ousting the Cambodian Chief of State, Prince Norodom Sihanouk.
Nol's power grab led to the proclamation of the Khmer Republic and placed him as the head of state. It was a textbook coup d’état, one of the dozens worldwide in the second half of the twentieth century.
Historians and commentators alike have suggested the CIA secretly supported Nol in planning his coup d'etat. This, however, remains unproven. Nevertheless, shortly after he seized power, Nol ordered North Vietnamese forces out of Cambodia, which placed the country substantially involved in the ongoing Vietnam War.
In the weeks following his overthrow, the removed former Chief of State, Prince Norodom Sihanouk, began talks with hitherto enemy, the Khmer Rouge – a communist dissident force built-up over the latter years of the 1960s in the jungles of Cambodia. In making this personal peace, he formed a partnership with the Khmer Rouge. They jointly called on North Vietnam to invade Cambodia, which they duly did.
This resulted in the loss of thousands of Vietnamese soldiers whose bodies were dumped by Nol's forces in the Mekong River.
Nol ordered the forcible removal of 200,000 Vietnamese people from Cambodia, joining the 100,000 who had already fled. This action significantly reduced the Vietnamese population in Cambodia to a little over 100,000 within five months of Nol's coup d’état.
On one side, the US-supported Khmer Republic led by Lon Nol. On the other, the Soviet-backed North Vietnamese and Khmer Rouge. The Cold War playing out via proxies.
HIV And AIDS In 1991
1991 is an important year in recent Cambodian history discussions and the global AIDS pandemic. But, before we explore why this 12-month period within the early nineties is so significant, it is worth briefly explaining matters that were going on more globally.
On TV screens, the rolling news of the Gulf War commanded the world's attention. Alongside this, the worldwide fight against AIDS, although not new in terms of its featuring in everyday discourse, continued to disproportionately impact fringe communities in the Western World and significant populations in Africa and Asia.
According to the Centers For Disease Control And Prevention (CDC), by the end of 1991, AIDS was the number one cause of death in the United States for men aged 25 to 44.
HIV and AIDS significantly impacted gay men. In LGBT hub locations, notably New York, San Francisco and London, an entire generation of gay men were at risk of being lost to this terrible pandemic. Its awful impact was brought home in November 1991 by the death of Freddie Mercury, who had fought a prolonged but secret battle with HIV.
As of November 2020, 35 million people have lost their lives to AIDS. Today, 70% of the world's population infected with HIV live in sub-Saharan Africa (source: WHO).
In the wake of the fall of the Soviet Union and its involvement in proxy conflicts worldwide, the politics of Cambodia culminated in the Paris Conference in November and the signing of the Paris Peace Agreements. This would, however, place the country on a trajectory with the global AIDS pandemic.
Why Was Cambodia So Fractious?
The Cambodian Civil War began in 1968. It was initially between the Kingdon of Cambodia and the Communist Party of Kampuchea (more popularly known as the Khmer Rouge). However, as discussed earlier, upon Nol's coup d’état in 1970, the deposed former Chief of State, Norodom Sihanouk, crossed sides and allied with his former enemy, the Khmer Rouge. Nol then changed the country's name to the Khmer Republic. The civil war then became a conflict between the soviet supported Khmer Rouge (which included Sihanouk) and the US-backed Khmer Republic (led by Nol). There followed five years of intense fighting, including an incredible effort by the US Air Force to defeat the Khmer Rouge with ferocious bombing missions.
Historians say that the USAF dropped more tonnage of bombs on Cambodia during this period than it had done in the entirety of World War Two.
In 1975 the Khmer Rouge captured the Cambodian capital and emerged as the victors in the long civil war. Nol fled the country in the final days before defeat. It was the end of the Cambodian Civil War.
Upon victory, the Khmer Rouge, which had been led by a man called Pol Pot, alongside others including Nuon Chea, overthrew the Khmer Republic and seized power. A year later, in 1976, they renamed the country Democratic Kampuchea.
Genocidal Cambodia And The Establishing Of The PRK
Pol Pot ruled Democratic Kampuchea with an iron fist of autocratic totalitarianism. Life under the regime was appalling and resulted in significant losses of civilian life, deaths that ran into the millions.
In agriculture, a policy of collectivism resulted in mass famine. In medicine, Pot's determination to be fully self-contained and sufficient caused the needless deaths of thousands to curable illnesses such as Malaria. Pot orchestrated mass murders of perceived political opponents as well as overseeing purges wherever disdain within the Khmer Rouge was suspected. There were summary executions, and torture was commonplace. The mass killing of minority groups living within the country's borders added to the brutal nature of life under the Khmer Rouge.
The Cambodia Genocide resulted in the deaths of up to two million people, or 25% of the population. (source: The Demography of Genocide in Southeast Asia: The Death Tolls in Cambodia, 1975-79, and East Timor, 1975-80).
In December 1978, Vietnam invaded Cambodia, which almost completely wiped out most of the Khmer Rouge's forces. Within a fortnight of this invasion, the Peoples' Republic of Kampuchea (PRK) was established, propped up by neighbouring Vietnam. The creation of this new Republic represented the end of what is commonly known as the Cambodia Genocide. It marked the beginning of the Cambodian-Vietnamese War.
Vietnam's occupation of Cambodia remained in place throughout the 1980s. The defeated Khmer Rouge's Democratic Kampuchea, no longer physically in power, remained recognised by the international community as the official government of Cambodia. This was partly due to the several armed resistance groups who remained in the country fighting the occupying Vietnamese. This meant the Prime Minister of the PRK, Hun Sen, needed to make approaches to the defeated Khmer Rouge to make peace in the borders of Cambodia; otherwise, the Vietnamese would remain indefinitely.
In the interim period since being defeated in 1978, the Khmer Rouge had formed the Coalition Government of Democratic Kampuchea (recognised by the UN as the official government in exile of Cambodia).
Ten years after invading, in 1989, Vietnam withdrew its troops from Cambodia. This was in response to international economic pressures and partly thanks to the peace talks initiated by Prime Minster Sen with the exiled recognised government.
The withdrawal marked the end of the Cambodian-Vietnamese War.
In 1990, under an Australian-led initiative, a power-sharing agreement created a unity government called the Supreme National Council (SNC) to represent Cambodia's sovereignty on the international stage.
It was a temporary measure. At the same time, the United Nations supervised the drafting of the country's domestic policies until the people could freely elect a government. It was called the United Nations Transitional Authority in Cambodia, or UNTAC.
The Global Response To HIV And AIDS In The Run Up To The Early Nineties
Today, treatment for HIV, the precursor of AIDS, is extraordinary compared to what it was in the 1980s and 90s. Nowadays, people living with HIV can get on with their lives following a diagnosis so long as the appropriate medicine is available – which across the western world it generally is. People living with HIV (PLWHIV) can expect to lead somewhat ordinary lives.
However, before 1992 (the year UNTAC began its operation in Cambodia), the corner was still to be turned, and medications in existence to treat HIV (such as AZT) came with frequent consequences.
For many countries around the world, the peak of infections laid yet ahead. In nations with struggling economies or where wars existed, the plight of people diagnosed with HIV (or in many cases not yet diagnosed with HIV) continued or got worse.
It is wrong to say that HIV had not presented itself anywhere in Cambodia before 1992. Research by UNAIDS and The World Health Organisation shows that the rate in which it did feature was starkly minimal.
Cambodia HIV prevalence rate in males aged 15 to 49 (pre-UNTAC)
- 1990 0.1%
- 1991 0.4%
- 1992 0.7%
But the same research by UNAIDS and WHO shows how much HIV prevalence rates increased in the immediate years following the UN mission.
Cambodia HIV prevalence rate in males aged 15 to 49 (post-UNTAC)
- 1994 2.1%
- 1995 2.3%
- 1996 2.4%
- 1997 2.3%
- 1998 2.3%
Source: 2008 Report on the global AIDS epidemic, UNAIDS/WHO, July 2008
The Refugee Crisis
During the Cambodian-Vietnamese War, the Khmer Rouge located itself primarily on the Thailand-Cambodia border. It mounted guerrilla operations against the PRK and Vietnamese from there, crossing the border to do so.
As that guerrilla war commenced, another chapter in what had been years of plight threatened more violence and famine to swathes of the population. As a result, hundreds of thousands of Cambodians fled to refugee camps situated on the border. Over the next several years, almost 250,000 Cambodians were resettled abroad, mainly in the USA. An even more significant number remained at the camps on the Thai border.
Who Made Up UNTAC?
While the Supreme National Council represented Cambodia politically on an interim basis, in 1992, 21,000 UN personnel arrived in the country to oversee the peace process and elections.
The UN frequently found itself under attack by the Khmer Rouge. In defiance of the two main opposed groups (the Coalition Government of Democratic Kampuchea and the PRK), the Rouge broke away, deciding not to play a part in rebuilding the country peacefully.
Personnel from 46 countries made up UNTAC. Nations such as the UK, USA, France and Germany joined others, including Morocco, New Zealand, Japan and the Philippines. It was truly multinational.
By 1992, there were very few – if any – countries worldwide where the AIDS pandemic had not reached. Among the lengthy list of nations participating in UNTAC, some had significant HIV prevalence rates at home.
Of the 46 countries that made up UNTAC, eight had an HIV prevalence rate of above 1%. Three of the countries involved (Ivory Coast, Nigeria and Tanzania) had a prevalence rate of above 5%.
According to a 2008 report by UNAIDS/WHO, Nigeria's domestic HIV prevalence rate was a considerable 10.4% of adults aged 15 to 44.
Increased Sex Work
With the arrival of 21,000 UN personnel into Cambodia in 1992, other patterns within the country's borders started to become evident.
One such difference brought on by the arrival of this predominately male UN force was the substantial increase in the number of women entering the sex worker trade.
According to research published by the Human Rights Task Force on Cambodia, in 1991, there were as few as 6,000 sex workers living in Cambodia. However, during UNTAC, the number increased more than three-fold to over 20,000 women.
In March 1994, the East-West Centre, a US Congress-funded think tank, produced a somewhat damning report titled UN Peacekeeping Missions: The Lessons From Cambodia. The document set out several issues brought to light during UNTAC.
An element of UNTAC that came under heavy criticism was the behaviour and standards of the civilian police contingent, which after infantry soldiers, made up the second biggest group in the UN operation. Their official duty was to train local police officers and guard the delivery of free elections in 1993. But as made clear in the report, this was not a seamless process.
The East-West Centre's report included the following findings:
- [A] lack of adequate training and discipline also plagued the 3,600-member civilian police component that was supposed to train and supervise the local police.
- Not all officers spoke English or French, as was supposed to be the case, so officers at some stations had no common language.
- The police officers were not clearly briefed on the situation or trained in their duties, and at times many seemed to have no idea what their role was. As a result of this sense of uselessness, boredom set in, and many police officers spent their time at play instead of at their duties.
The report showed that police officers were paid an additional rate to their daily earnings because they were easily recognisable and, therefore, on duty 24/7.
In a later section, the report discusses UN police officers and local sex workers:
- The local population was offended at officers getting drunk, causing traffic accidents, and bringing prostitutes to live with them in rural towns.
- When directly challenged on these social issues, UNTAC set up a community relations office to handle such cases as traffic accident reports and allegations of rape.
Additionally, the explicit matter of HIV among UN peacekeepers is addressed. The report stated:
- The [community relations] office was called upon to deal with another deadly problem, HIV and other sexually transmitted diseases.
- While 21 peacekeepers died in Cambodia as a result of hostile action, more than twice that number (47) were diagnosed as being HIV-positive – and UNTAC chief medical officer Dr Peter Fraps believes the true figure is probably as high as 150.
Thailand had felt the impact of Cambodia's long problems, most evidently in the fact that hundreds of thousands of refugees had fled to camps on its border. Alongside the issues of its geographical neighbour, Thailand had problems of its own.
Domestically, one such key issue was the HIV and AIDS pandemic. Whereas HIV had barely touched Cambodia, in Thailand, things were very different.
Thailand HIV prevalence rate in males aged 15 to 49 (pre-UNTAC in Cambodia):
- 1990 1.6%
- 1991 2.2%
- 1992 2.6%
Source: 2008 Report on the global AIDS epidemic, UNAIDS/WHO, July 2008
Thailand's vicinity to Cambodia was referenced in the East-West Centre's report on UNTAC. It said:
- The German field hospital treated more than 5,000 incidents of sexually transmitted diseases. Mission personnel routinely took leave in neighbouring Thailand, where sex tourism is a multibillion-dollar operation and where HIV/AIDS is at epidemic levels.
Outcome Of UNTAC
The UN mission was frequently tricky due to internal matters, such as those made clear in the East-West report, and operational dangers such as the Khmer Rouge. However, UNTAC enjoyed operational successes.
Those wins primarily included organising and executing the election in May 1993, which witnessed over four million Cambodians taking part in the democratic process.
The outcome of the election was a new coalition government. However, the party that secured the most votes was Prince Ranariddh's National Untitled Front For An Independent, Neutral, Peaceful And Cooperative Cambodia (FUNCINPEC).
The new coalition established a framework of liberal democracy with a constitutional monarchy. It elevated the one-time Cambodian Chief of State, Prince Norodom Sihanouk – the original target of the Lon Nol coup d’état of 1970 – as King. Prince Ranariddh (FUNCINPEC leader) became First Prime Minister in recognition of his party securing the majority of votes.
The UN mission also initiated the trial process of senior Khmer Rouge leaders, those responsible for the Cambodia Genocide of the 1970s. Notably, though, the UN failed to disarm the Khmer Rouge, which has attracted criticism.
Does Responsibility For The Cambodia AIDS Pandemic Lie With The United Nations?
When discussing something so wide-reaching and sensitive as a global pandemic, the very notion of blame is an uncomfortable matter, and caution has to be exercised. When determining UNTAC's impact on Cambodia, it is important to consider evidence collected by organisations such as the United Nations themselves and others, including the World Health Organisation and the US Congress-supported East-West Centre.
According to author Milton E Osborne, King Norodom Sihanouk of Cambodia (the former Prince) believed the introduction of HIV to Cambodia was a direct consequence of UNTAC's mission. Yet, the data in the UNAIDS / WHO report of 2008 showed that a minimal HIV prevalence rate was evident before the UN's arrival.
However, the dramatic increase in the national prevalence rate – explicitly during the UNTAC mission – is evidenced in the same report.
The East-West report additionally included a recommendation by UNTAC Chief Medical Officer Dr Peter Fraps that future UN operations must consist of "compulsory HIV testing for all personnel", suggesting that blanket testing was absent from the initiation of the UN mission in 1992.
Of those 21,000 UN peacekeepers, at least several hundred had embarked to Cambodia from nations with high domestic HIV prevalence rates. Perhaps it is fair to ask whether some UN peacekeepers arrived in Cambodia unaware of their positive HIV status. An additional crucial matter is UN personnel travelling across the border to Thailand and engaging in the significant sex tourism industry available there. The East-West Centre report is explicit in this topic, saying outright that:
"UNTAC personnel helped introduce the disease into Cambodia and are also taking the HIV virus back to their home nations."
However, the East-West report and the feelings of King Norodom do not account for the migration of 350,000 refugees from Thailand, where HIV prevalence rates were much higher than Cambodia. In 1992, 2.6% of men aged 15 - 49 were HIV positive, compared to 0.7% of Cambodians.
Khmer Rouge leader Pol Pot died under house arrest in 1998.
In 2018, two of his fellow Khmer Rouge leaders were found guilty of genocide. Pot's deputy, Neon Chea, 92, and Khieu Samphan, 87, were convicted and sentenced to life imprisonment at the Extraordinary Chambers in the Courts of Cambodia. The court has convicted just three people for the atrocities of the Khmer Rouge and the Cambodia Genocide.
Norodom Sihanouk remained the King of Cambodia until his abdication in October 2004. His son, Norodom Sihamoni, then became King after being selected by a special nine-member council. He remains King of Cambodia today. His father, King Norodom Sihanouk, died in October 2012 at the age of 89.
Cambodia faced a difficult period throughout the mid to late 1990s and 2000s regarding HIV and its impact on its people. The country's peak in terms of prevalence came in 1997 when it sat at 2.4% of adults aged 15 to 49. That same year, Cambodia recorded 16,000 new HIV infections. It would take a further ten years to see the prevalence rate fall back below the 1% it had been before UNTAC in 1992.
Today, the rate is 0.5%, which is still evidently substantial. However, the country continues to report declining new infection rates, declining numbers of people living with HIV, and declining HIV/AIDS-related deaths. It is a country very much winning in the ongoing fight against HIV and AIDS.
Globally, the world remembers those lost to AIDS or impacted by it on December 1 each year. The date is known as World AIDS Day.
The United Nations in New York was approached to comment on this story.