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Up until 2016 Human and Health had only implemented their programs in Ratanakiri province. With growth in the organisation, 2016 has seen their programs extend to Mondulkiri province also.  Ratanakiri is located in Cambodia's far North-East, bordered by Laos to the North, Vietnam to the East, Mondulkiri to the South, and Stung Treng to the West. The province extends from the mountains of the Annamite Range in the North, across a hilly plateau between the Tonle San and Tonle Srepok rivers, to tropical deciduous forests in the South. In recent years, logging and mining have scarred much of the environment of North East Cambodia, long known for its natural beauty and dense forests. The climate is influenced by the monsoon with an annual alternation of rainy season between the months of May to October and a very dry period from November to April. Despite this challenging climate, the majority of the population live in the countryside and base their livelhood on subsistence agriculture. Both Mondulkiri and Ratanakiri are the largest provinces located in Northeast Cambodia in terms of land size, yet they both have the lowest number of inhabitants. The land size of Mondulkiri is 14,682 square kilometers while in Ratanakiri it is 10,782 km².

 
Map 1: Geographic location of Ratanakiri and Mondulkiri Provinces (based on Wikipedia®)

Ratanakiri Province is made up of numerous ethnic groups (refer to map below) forming the majority of the population in the provinces of Ratanakiri, Stung Treng, and Mondulkiri. Elsewhere in Cambodia the indigenous groups are referred to as Phnong and Samrae, both of which have pejorative meanings. The indigenous population is made of numerous ethnic groups (refer to map below). The majority of the indigenous people live in small, remote villages composed of 150 to 400 people. 58% of the populations are subsistence farmers, hunters and gatherers and practice swidden agriculture or rotational shifting cultivation (NIS - General Population Census 2008).     The Indigenous people have their own distinct languages and the majority, especially women and the elderly do not speak Khmer. Culturally, these groups are more related to other ethnic minorities in Laos and Vietnam, than to the Khmer. Their worldview is determined by their animist spiritual beliefs. Their concept of sickness and health is closely interwoven with their religious beliefs, so sacrificial rituals to the spirit world are often the cure of choice. When they seek the help of the government health sector, it is often already too late.



Ratanakiri and Mondulkiri are among the least developed provinces in Cambodia, with both provinces having the worst health indicators in the country. This is attributed to a variety of factors, including poverty, remoteness of villages, poor quality medical services, and language and cultural barriers that prevent the Indigenous communities from obtaining medical care. In recent years Ratanakiri has seen changes in the development of infrastructure and in macro-economic development.  The construction of the new national roads that connect the lowlands to the North-East of the country mean that it now takes 9 hours from Phnom Penh to reach Ban Lung, the Provincial capital of Ratanakiri, appose to three days which was required prior. Ratanakiri’s landscape has been altered from natural forests and farms practicing rotational shifting agriculture into agro-industry plantations of rubber, manioc, soybeans, and cashew nuts. Other economic activities in the province include gem mining and commercial logging. Logging, particularly illegal logging, has been a problem both for environmental reasons and because of land alienation. With these changes, the population has grown from approximately 90,000 during the end of the 1990’s to a current estimate of 204,917 (MoH 2015). This growth is mainly attributed to internal migration of Cambodian people seeking work opportunities. These developments have had little positive impacts for the indigenous Khmer Loeu communities. The developments in the provinces have challenged the traditional ways of life, and introduced land alienation as a major problem. Public social services, such as schools, and health facilities remain overwhelmingly neglected. Most rural communities have only schools that teach up to grade 4. For pupils who want to study higher grades, their family has to organize living arrangements for them in district centers. The costs associated with this are unmanageable for the majority of families. As a result, children, especially girls receive only a low level of education. It is estimated that 75% of the Ratanakiri’s population remain illiterate. To further these challenges, seasonal affects such as flooding block roads, which in turn prevent community members from accessing essential social service facilities.