Cambodia

Country background
The Kingdom of Cambodia is situated in Southeast Asia between latitudes 10º and 15º North and
longitudes 102º and 108 º East. (See Appendix 1 - Map of Cambodia). It is bounded on the west
by 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 km2 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% in
rural 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 Tonlé Sap
or Great Lake basin, the Mekong Lowlands and Delta which divides the country from north to
south 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 monsoon
brings 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 varies
considerably 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 Tonlé Sap Lake provides a huge source of fresh water. During the late wet season the
Mekong River backs up northwards into the lake increasing the volume of the lake tenfold at the
height of the flooding. As the flooding abates, the flow reverses and the level of the lake drops
leaving the surrounding area as marshland unsuitable for agriculture and resulting in a gradual
silting up of the lake.

Agriculture, employing 71% of the workforce dominates the Cambodian economy, with a further
21% employed in the service sector and 8% in industry. After 30 years of conflict, the country is
impoverished, many of the government sectors are rebuilding, and the transition from a centrally
planned to a market economy has been an added burden. Some 36% of the population is living
below the poverty line and 20% below the food poverty line (2005 World Bank poverty
assessment) and the country has some of the lowest human development indicators in South East
Asia.

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 Tonlé Sap River supplies the west and
central parts of the country with drinking water and water for cooking. These two systems
provide ample good quality drinking water when compared with WHO guideline values, and
require only basic treatment such as disinfection. The surface water used as a drinking water
supply, 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 and
during the wet season regularly inundate the flood plains surrounding the rivers and their
tributaries.
The Tonlé Sap Lake also represents a huge natural storage covering 2,500 km2 in the dry season
to over 13,000 km2 at the end of the rainy season, but is subject to re-suspension of particulate
matter and contamination with chemical discharges from industry, and from pesticides and
fertilizers from agriculture particularly during the wet season

Of the total urban population of Cambodia of some 2 million, nearly half live in the capital
Phnom Penh while the remainder are distributed across 23 urban centres. These provincial centres
generally have access to surface water from the river systems in unlimited quantities however the
coverage of the piped water supply in these towns is as low as 15%, with service restricted to the
central areas of the town. Rural areas utilise streams, lakes, and ponds, and groundwater resources
from tube, pipe and dug wells.
An analysis of water supply coverage in rural areas has been undertaken and has highlighted the
discrepancies between sources of data due to differing definitions of what constitutes a “safe”
water supply, and what conditions need to be met in order declare a source suitable for
consumption. The study found that the standardisation of definitions and specifications must be
applied across the supply sector and consistent training materials made available to agencies so
that 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 is
commonly high in iron requiring treatment before disinfection, and this has been a major issue
with some of the provincial water supply works. Fine sediment can also be a problem and the use
of groundwater may in certain areas be environmentally sensitive.

More than 81% of the country’s 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 with
hand 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 wet
season and 26% in the dry). In contrast, only 6.7% of Phnom Penh consumes well or bore water
while 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 in
tanks and rainwater collection jars.

The responsibility for the provision and supply of drinking water falls to three main bodies, the
Phnom Penh Water Supply Authority (PPWSA) who are responsible for drinking water in the
capital city Phnom Penh, the Ministry of industry, Mines and Energy (MIME) who are
responsible for drinking water in urban and provincial sectors, and the Ministry of Rural
Development (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 was
on the provision of emergency water supply facilities in areas where security conditions were
favourable. 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 in
number of areas, including the water supply sector.
The WHO/UNICEF Joint Monitoring Programme in its Country, Regional and Global Estimates
on Water & Sanitation gave a 2002 estimate for Cambodia as shown below:

Improved Drinking Water Coverage Improved Sanitation

Population
Total Urban Rural Coverage
Household Household Household
Total Urban Rural Total Total Total Total Urban Rural
Connection Connection Connection
(thousands) % % % % % % % %
% % %
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 or
more parasites, contracted primarily through ingestion but also through contact with water during
bathing or washing.

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

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

Infectious water related diseases are transmitted primarily through human and animal excreta and
the use of such unsafe water, poor sanitation, and low hygiene awareness, acts to increase levels
of sickness and contribute to a rise in the incidence of poverty indicated by high infant mortality
rates.
Toxics algae have been detected in Phnom Penh's raw water and sedimentation tanks and in the
Tonlé Sap River in the late dry season, and can produce toxins and release them into drinking
water 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 is
not yet considered a significant problem.

In 2000, MRD and MIME conducted a nationwide survey on the chemical quality of urban and
rural drinking water sources with technical and financial support from WHO. Over 100 drinking
water sources representing thirteen provinces were sampled and analysed for more than 80
chemicals and pesticide compounds by a certified laboratory in Australia. The survey reported
that the chemical quality of most urban and rural drinking water sources was generally good
although nitrites and nitrates were detected at elevated levels in several locations and
contaminants such as barium, chromium, fluoride, lead, manganese, molybdenum, and selenium
were also found but appeared to be exceptions to the general trend. No pesticides were detected in
any of the samples.

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

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

A field assessment of over 5,000 samples using existing survey data was put into a database
together with geographical information and estimations made that some 19% of tube wells were
considered “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, including
an arsenicosis survey, commence a national testing program, and conduct mitigation trials and an
evaluation of field kits.
In parallel they were also to develop information and educational materials and develop
appropriate policies.

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

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 testing
program. This program was to undertake testing of every well in “at risk areas” to identify those
with the highest priority for mitigation. The reliability of field kits used was tested, with generally
good results particularly in the lower ranges, and all wells tested will also undergo confirmatory
testing at overseas laboratories.

The arsenicosis survey was a cross- sectional study of all household members by trained face-to
face interviewers using pre-tested questionnaires. The chosen study area was Kandal province
with a population of approximately 1 million persons. Information was gained on tube wells used
for cooking and drinking including the wells age, depth, ownership, and the arsenic status of the
well 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 have
been relatively short but may show the potential for an increased disease burden in future if not
addressed early.
The key is to prevent exposure to arsenic immediately using alternative sources, water treatment
and other mitigation strategies, including educational material for distribution to villages and
schools
The emerging problem of arsenic however remains less of an immediate threat than
bacteriological contamination, and switching to less safe surface water supplies would have a
negative impact on the levels of water-borne disease. Consumers themselves are also concerned
about insufficient supplies of water, (particularly during the dry season) and turbid water in the
rainy season. There are concerns also that the aesthetic qualities of some supplies that may direct
consumers to less safe alternatives.

Water quality surveillance and monitoring

As described in the previous section the main agencies responsible for water supply are the
Phnom 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 another
depending on their purpose. The PPWSA and the Ministry of Rural Development (MRD) are the
most efficient and conduct regular testing. Some limited testing is carried out by MIME and
Ministry of Health (MOH). The PPWSA has implemented several water quality monitoring
activities including the routine quality control of the treatment process, general water quality
analysis and quality control of the distribution network within Phnom Penh.

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

MRD is responsible for community water supply in rural areas through the Department of Rural
Water Supply (DRWS) and Department of Rural Health Care (MRD) who concentrate mainly on
educating 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 is
limited and only simple parameters such as As, pH, iron and salinity are measured using portable
on-site equipment.

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

The Ministry of Health is responsible for research into waterborne diseases, and the National
Centre for Health Promotion (NCHP) is engaged in health communication and education
activities. The Ministry of Environment (MoE) is responsible for the protection of water
resources and catchments and the monitoring of water pollution, at least in part for human health
protection.

The MRD is mandated to improve access to safe water supply and sanitation services in rural
areas and in 1995 MRD issued the "Water and Sanitation guidelines" and in 2001 the "Policy
Framework for Rural Water Supply and Sanitation Sector" and this RWSS Policy was approved
by the government in February 2003. Other ministries have also contributed to a "Draft Law on
Water Resource Management" and water pollution control is subject to a sub-decree issued in
April 1999 by the Ministry of Environment who are committed to developing a national action
plan for prevention of pollution of water sources by establishing national standards for pollution
sources, including wastewater discharges to public areas or sewers.

The responsibilities of the government institutions are mostly separate but there are some areas
that work collaboratively and there is a degree of interaction between the agencies, which hold
seminars, meetings, workshops and training courses. At these joint events provincial experiences
are 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 and
international organizations are involved either by providing wells, simple treatment facilities, or
some 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 support
those national agencies.

Water Quality Standards

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

In 2001 an inter-ministerial committee named the "National Committee on Drinking Water

Quality" 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 not
necessarily directly related to human health. It was intended that the standards should include all
forms of drinking water including piped, bottled, and well water, and would require commitment
from 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 from
WHO 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 in
Cambodia. The standards are to be reviewed and revised accordingly regularly. The scope of the
NDWQS are that it shall apply to all sources of drinking water that are intended for human
consumption and will apply to water delivered from a water treatment plant through the
distribution network and from small community sources. The microbiological quality of drinking
water is seen as crucial for health and thus has the highest priority for monitoring, and in the
protection of sources from contaminated with human and animal excreta. Bottled or other
packaged 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 water
resources 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 water
resources, treatment and supply processes. It requires that public water supplies are managed and
protected from source to consumer by protecting catchments and watersheds, by operation of
treatment plants by qualified operators and regular monitoring of chemicals with known health or
aesthetic 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 links
to the designated authority with responsibility for the protection of public health. To support such
a surveillance and monitoring system requires that policies and legislation are enacted that
strengthen enforcement of those national standards and encourage co-operation and collaboration
between relevant agencies.

The system will also require the provision of appropriate and adequate infrastructure to conduct
monitoring and surveillance, including independent laboratories operated by trained staff with
sufficient capacity to carry out their tasks. The system should have access to and be a leader in
the 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 and
highlighted the need to conduct a more extensive nationwide survey for hazardous chemicals
such 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 problem
in Cambodia. Much of the testing and analysis during the survey was carried out by overseas
laboratories, and with the potential risks to public health from these naturally occurring chemicals
it 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 and
implement a national strategic plan for prevention and mitigation of arsenic in drinking water
with appropriate interim actions adopted for an immediate response. Such an undertaking will
require the cooperation of all stakeholders in the water supply sector at the national and
provincial levels with stronger coordination by Government assisted by technical and financial
support of national and international partner organisations. With the knowledge gained so far the
concerned agencies should take follow-up actions where water supplies exceed recommended
health-based limits for chemicals.

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

The population often identifies the important link between water and health, although there is
generally very little information available at the community level regarding these issues and
misconceptions regarding the connections between water quality and health are frequently
encountered, such as a perceived link between calcium and hardness and kidney stones. These
misconceptions need to be addressed through dissemination of appropriate information and
suitable education programs for both the water sector and for the community. Consumers are
often more concerned with taste, odour and appearance of water rather than its chemical qualities,
and the acceptability of a safe groundwater supply is vital to the long-term success of water
supply systems particularly in rural areas. However even in remote areas the potential for
chemical contamination of water needs to be publicized to the community and their involvement
sought, particularly in the area of protection of water sources and delivery systems. Programs are
also need to place a greater emphasis on water safety and quality in the policies and practices
concerned 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, 12-15
November 2001

2. P A Kingston, “Chemical Safety of Drinking Water: Identifying priorities using limited

information”, Reports of workshops held in the Western Pacific Region of the World
Health Organization, Phnom Penh, Cambodia, 19-25 August 2001

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

4. UNICEF/WHO, “Country, Regional and Global Estimates on Water & Sanitation”, Joint
Monitoring 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
Appendix 1 - Map of Cambodia

CAMBODIA

Sisophon Stoeng Treng

Siemreab
Batdambang

Pouthisat Kracheh
Kampong
Chhnang
Khampong
Cham
Krong
Kaoh Kong PHNOM PENH

Kampong
Saom Kampot
Capital

Major Town/City
National Boundary

0 100 km
P Kingston 2006