Law Enforcement and Harm Reduction in Cambodia

Why does harm reduction get such a bad name, particularly amongst law enforcement officials? Police attitudes often reflect the views of the broader community. Many people find drug use to be abhorrent, and feel that when clean drug equipment is provided, 'abstinence'-based approaches (such as 'say no to drugs' or the 'war on drugs') are being undermined.

Police are particularly condemning of injecting drug use because they constantly deal with its negative outcomes. Police frequently deal with people they see as having 'lost their lives' to drug abuse. They also respond to the consequences of drug use when they assist affected families, victims of crime, and communities impacted by drug use.

It is not surprising therefore that there are barriers between police and harm reduction services. Service providers see police as inflexible, and see the coercive approaches police use in their treatment of users. Police may see health workers as 'soft' and narrowly-focused. At the same time, many police believe that they are 'caught in the middle' and cannot 'get it right' 100% of the time in 100% of the cases they handle.

Police often say that service providers should see the world more often through the eyes of police -- and I am sure the same words can be heard from those working in the harm reduction field.

So how do we address this impasse?

First, it might surprise both police and harm reduction service providers to discover that there are some things they agree about. From my experience, both groups actually have a lot in common, particularly at the grass roots level -- where the attitude is often that 'a problem shared is a problem halved'.  There is usually a real need for a forum where both sides can discuss collaboration, shared outcomes, resource-sharing and problem solving - but fora like this rarely exist.

Research overwhelmingly supports the notion that collaboration between both sides can effectively reduce the negative consequences of drug use and help create an 'enabling environment' for harm reduction services. In particular, it is vital to engage local police in the decision-making process, to ensure that health services are delivered without hindrance.

But unfortunately, there are many examples worldwide of situations where relationships between harm reduction service providers and police have been problematic. In Cambodia there has recently been publicity about issues with injecting drug use and policing. The Cambodian capital, Phnom Penh, has a high number of injecting drug users, many of whom live impoverished lives with little access to health care.

There, the provision of clean needles and syringes has been authorized by the Cambodian Government through the National Authority for Combating Drugs. The NACD is the same government department responsible for coordinating anti-drug efforts in Cambodia, and is made up of many police. 

The NACD grants licenses to NGOs to allow them to deliver harm reduction services, in particular needle and syringe exchange, to injecting drug users. This service helps reduce some of the risks from drug use and in particular helps prevent the spread of HIV both among and from injecting drug users.

Korsang is one of these NGOs, and it meets the needs of injecting drug users by providing services that are 'user friendly'. There's space for users to come in off the streets, seek medical attention and get much-needed help. Korsang's client numbers are growing steadily as more and more people seek health care services from resident doctors and health professionals.

Korsang's work also involves street-based activities, in which outreach workers walk through areas of high drug use to give out. I have visited Korsang on several occasions and admire the dedication and genuine concern they have for their clients, people on whom many other agencies have turned their backs.

In this way, Korsang meets the health needs of injecting drug users in an environment of trust and acceptance. This often leads to misunderstandings in the local community who may feel that these services are bringing 'unwanted' people into the neighborhood. This in turn can lead to confrontations with police, who are called in to respond to community concerns.There have been several incidents involving Korsang and local police, and the relationship appears to have broken down.  Work is required to determine the nature of this impasse and the underlying causes.

As a researcher and program developer in harm reduction and law enforcement with the Nossal Institute for Global Health, I have a vested interest in this situation. We are undertaking a research project to analyze harm reduction programs and their impact on law enforcement policy and practice in Cambodia (and in two other SE Asian countries, Vietnam and Laos). The project aims to help bridge the gap between agencies. 

This research project, known as Law Enforcement and Harm Reduction at Nossal (LEHRN) - which is partnered with the National Institute for Public Health in Phnom Penh - will seek to identify how and why harm reduction services influence police policy-making and how this in turn affects police operational practice -- or in other words, 'what happens on the streets'.

In order to highlight this research project, a seminar will be conducted on February 24^th 2010 in Phnom Penh. This seminar, chaired by the Nossal Institute for Global Health's Professor Nick Crofts, will bring together regional expertise from the law enforcement and health sectors to explore issues of HIV and injecting drug use in Vietnam, Cambodia, Laos and beyond.

Speakers will also include representatives of the Institute for Social Development Studies (Vietnam), the National Institute of Public Health (Cambodia), the University of Health Sciences (Laos), and Victoria Police (Australia).

I would encourage anyone who is interested in understanding more about the complex relationship between law enforcement agencies and harm reduction services to attend the seminar. Please email me directly to get more information.

Greg Denham is Law Enforcement and Harm Reduction Adviser at the Nossal Institute for Global Health.