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INTRODUCTION
IRC has been at work in Thailand since 1976, when the first Indochinese refugees began to cross its borders. Over the succeeding ten years, the program has adapted to the many changes in the refugee population and its needs. During 1985, IRC offered assistance to refugees in five different camps on three borders. The refugees included Khmer (Cambodian), Lowland and Highland Lao, and Karen. A total of 145,000 persons were served. IRC employed 35 Thai, 20 expatriate and more than 1,500 refugee workers in its programs.
Once the largest concentration of Khmer outside Phnom Penh, Khao-I-Dang Holding Center (KID) in eastern Thailand has long been a focal point in the Khmer refugee crisis. Over the six years since the camp's construction, the population has decreased from 130,000 to the current figure of 27,000 through resettlement efforts. It continues to be an on-going challenge to provide services for the remaining population -- many of whom are entering their seventh year as refugees -- with little chance for resettlement of repatriation. In its capacity as lead voluntary agency, IRC is involved in almost all aspects of camp life. IRC is responsible for sanitation, formal and non-formal education, public health, medical coordination, two of the camp's three Out-Patient Departments (OPDs), and the laboratory services.
IRC, as lead agency, also has a vital role in monitoring the political and physical well-being of the refugees. This was particularly important throughout 1985, a year which witnessed a series of disturbing events in the camp. As the fighting on the border peaked in mid-March, KID was victimized by a series of raids by armed Khmer bandits which eventually took the lives of 11 residents. Additional security measures were implemented and, finally, the attacks ended. Attention soon turned to the camp's large undocumented population, living in camp without rations and in constant fear of forced removal. The presence of this group led to a heightened tension in the camp and strained existing resources -- especially food. Discussions between Thai officials, UNHCR and the voluntary agencies led to the decision to issue 7,000 Khmers temporary ration cards for one month.
In November these 7,000 were instructed to move to the Annex -- a separate facility constructed adjacent to KID. IRC is currently providing them with limited medical and sanitation services under the auspices of the United Nations High Commissioner for Refugees (UNHCR).
Of particular urgency in 1986 will be the future of the camp's 13,000 K.D. card holders -- refugees who were registered in KID between 1979 and 1982. Rejected for resettlement in the United States, these refugees face a frightening and uncertain future. The need to address the fate of this group was dramatically illustrated in December when, for the first time in KID's six-year history, the camp birthrate exceeded its resettlement rate.
Since late 1982, IRC has had the camp's sanitation mandate. The program includes daily sewage and garbage collection and disposal, vector control, water supply and testing as well as overall road and site maintenance. This is achieved with a labor force of nearly 500 refugee workers. To maintain a hygienic and healthy environment was a particularly challenging objective during 1985 due to several large movements.
In January, a sudden section reassignment within KID involving 5,000 refugees, forced IRC to build more than 200 new latrines within three days. The creation of the Annex in November posed an even greater challenge -- and under similar time constraints. IRC supervised the construction of roads and drainage systems in the Annex as well as made preparations for garbage and sewage collection and disposal. IRC sanitation teams will continue to oversee the program there.
Once responsible for a pediatric hospital, two OPDs and a mobile medical team, IRC's efforts have largely shifted from an emergency effort to a more preventative approach towards health care in the camp. IRC currently operates an extensive public health and Khmer health training program, two OPDs, the laboratory, and the office of medical coordination.
Teams of Community Health Workers (CHWs) are active throughout KID's schools and homes seeking to improve the general health status of the refugee population. The CHWs make regular home visits, administer immunizations and provide health education throughout the camp. Follow-up on chronic patients, referred by the hospitals and OPDs, makes up a significant part of their daily caseload. By the end of 1985, more than 5,000 schoolchildren had been immunized.
This effective teamwork has been instrumental in averting potential communicable disease outbreaks. Early this year, the CHW's quick detection of and response to a measles outbreak in the neighboring evacuation site dramatically limited the disease's impact on KID. This preventative emphasis on health care is evident in the classrooms where School Health Workers offer regular courses on various health issues to all primary, secondary and adult education students. In December, IRC extended its public health program to provide parallel services to refugees in the Annex.
The IRC Laboratory has provided medical lab services in KID and, when needed, to the border camps for over five years. The lab can conduct most of the required tests, such as malaria smears and tests for fecal parasites. Only the most sophisticated tests must be referred to hospitals outside KID.
This office coordinates and evaluates all medical and related services in KID, as well as monitors the general health condition of the Khmers. During 1985, that mandate was particularly challenging due to the fluctuations in the KID population and instability along the border. During the relentless 1984-85 dry season offensives, this office worked quickly to coordinate emergency medical services for the thousands of war-wounded and related victims evacuated to KID for treatment. When the overflow wards finally closed, medical coordination's emphasis shifted to disease investigation and improvement of medical services in the camp. In mid-summer, attention turned to the deteriorating nutritional situation in KID. A medical coordination report linking growing malnutrition rates with the large illegal population was instrumental in winning Thai permission to provide UNHCR rations to the 7,000 undocumented residents.
The regular duties of the Medical Coordinator include: overseeing the treatment of patients referred from the border, reviewing cases for medical transfer to Bangkok and preparation of monthly and annual epidemiology reports.
During 1985, IRC operated one OPD in KID. In November, with only a few days notice, IRC opened a second OPD in the newly established Annex to serve the 7,000 residents there.
In addition to the usual services, both facilities provide chronic out-patient and venereal disease care, while referring complex medical problems to camp hospitals. During 1985, the KID OPD saw an average of 5,000 patients each month. The most common diagnoses were upper respiratory infection, otitis media (ear infections), and skin infections. The Annex-OPD opened to an average of 100 patients daily.
KHTC is a unique "medical school" for refugees in KID. One expatriate health professional trains 15 Khmer instructors, who in turn teach courses in Basic Health, Anatomy and Physiology, Midwifery, Nursing and Pharmacology. The goal of the program is to provide qualified workers for the health care programs -- a particular challenge given the large turnover of refugee staff. During 1985, over 1200 Khmers graduated from these programs. New short courses are continually being developed. Some classes initiated this year to address needs in both KID and the Annex, included: Women's Health Care Training (with the OPD); Basic Sanitation; Post-Surgical Techniques; Physiotherapy; Public Health Training; CPR; and Minor Surgery.
Complementing the KHTC medical instruction, is the center's English language training. Initiated to teach English to Khmers working in the hospitals, the KHTC English program was expanded in late 1984 to offer instruction to refugees working in all camp agencies. One expatriate trains and supervises a team of nine Khmer teachers. Six hundreds and thirty-seven refugee workers graduated from the Program in 1985.
One of IRC's most extensive and successful efforts in KID has been in the area of formal education. In the six years since the education program began, over 30,000 Khmer children have received what for many will be their only Khmer educational experience. During 1985, there were eight primary schools and one secondary school. Libraries, located in each school compound, supplement the texts used in the classrooms. Two hundreds Khmer teachers and over 6,000 students were provided with the necessary training, facilities and supplies. The curricula offer such basic subjects as math, science, grammar, and literature as well as instruction in music, dancing, art and physical education.
Through a series of related programs, IRC attempts to ensure not only the existence, but also the quality of education in KID. The Pedagogy Office offers pre-service and in-service methodology training. One expatriate educator works with a team of Khmer trainers, who in turn instruct the school teachers. IRC has overseen the development of a new curriculum for the secondary school using both traditional texts and new ones needed to fill the gaps. In 1985, 50 books were translated, adapted or up-dated, and printed for the Secondary School and Primary School students.
Significantly, in 1985 IRC began to train teachers whose education was completed in KID and, began to enroll the first primary class in which most of the students were born and raised in a refugee camp.
In an effort to preserve and promote the Khmer cultural heritage -- all but destroyed during the Pol Pot regime -- the culture program offers classes in traditional music, dance and spoken drama to the students in KID as well as weekly performances in the outside theatre. Once a camp-wide program, in 1985 culture classes were incorporated into the primary and secondary curricula and limited to students. New dances were developed and scripts for spoken drama written during 1985 to supplement the traditional ones.
Since 1982 this program has been the primary supplier of texts and story books for Khmer refugees. Some texts are reprints of books brought from Cambodia or shipped from overseas, while others have been written in the camps. Sok Sabay is a monthly magazine which features original stories written by the Khmer in KID and supplements the limited reading material available. When time and finances permit, books are sent to Khmer communities abroad. During 1985, a total of 30,000 books were printed. The IRC Printing Project remains one of the largest sources of Khmer books in the world.
One of the current challenges in KID is to relieve the monotony and inactivity of camp life. The IRC response has been a camp wide recreation program organized by the refugees in each section. The staff coordinates instruction and tournaments in a variety of sports. The necessary equipment is loaned to the teams, and the Khmer supervisors teach game rules and techniques, and referee matches. The program stresses the importance of sports for physical and mental health, and encourages maximum participation from all segments of the camp population.
In addition to the regular primary and secondary school programs, IRC assists children limited by physical disabilities or developmental disorders. Since 1982, the Special Education Program .has provided instruction to over 300 disabled students. In 1985, 100 students were enrolled in this program. Refugee instructors train refugee teachers in Braille and sign language. These two communication programs were developed in KID under the guidance of the IRC coordinator. Parents and family members of the deaf are simultaneously trained in order to communicate with their child or sibling.
The Infant Stimulation Program complements the Special School by serving developmentally delayed and handicapped children five years and younger. Khmer trainers guide the children through physical and mental exercises designed to stimulate development. The trainers also work with the parents, who are encouraged to continue the special exercises at home. In 1985, deaf and mute students of the Special School began to teach classes to those similarly disabled in the Infant Stimulation pre-school.
In order to address the education needs of the adult population, IRC administers two adult education programs. The adult literacy program teaches basic Khmer literacy to more than 800 adults annually. Adult literacy also forms a vital component of the Women's Program. IRC operated two women's centers in the camp during 1985. Each center offered a six-month session combining skills training in such areas as sewing, weaving, knitting and crocheting, with literacy and health education classes. The objective remains to provide useful skills training in a supportive learning environment for women refugees, many of whom have been widowed or abandoned. In 1985, 850 women graduated from this program.
With the dual objectives of offering useful training and production, IRC initiated the Skills Development Training Center in October. Two areas of training, sewing and carpentry, started in 1985. These skills will be useful to the participants in the future and will encourage a greater sense of community in the camp.
The health education program, animated by puppet shows continues to develop projects which target current health problems. During 1985, the scabies clinic treated an average of 250 people a month. Home visitors make regular referrals to the camp's clinic and do frequent surveys on health care and concerns.
"But please tell me what l should do? I can't go forward and I can't go back." This plea reflects the anxiety and hopelessness of the thousands of refugees remaining in Thailand -- and ominously sets the challenge as we 'enter the second decade of the Indochinese refugee problem. The years to come will not be easy. Donor fatigue is already beginning to make its insidious presence felt. However, the need to address the physical and humanitarian requirements of the displaced and dispossessed remains.
As it has done for the past ten years, the International Rescue Committee will continue to provide for those fleeing war and oppression. In 1985, IRC successfully served over 145,000 refugees -- Khmer, Lao and Karen. This was only possible through the generous assistance of our donors to whom we owe a very special thanks. They include: The Federation of Migros Cooperative; United Nations High Commissioner for Refugees; Stichting Vluchteling; Refugees International - Japan; Lutheran World Relief; Joint Distribution Committee; Christoffel Blindenmission; The Packer Collegiate Institute; Church of Christ in Thailand; The Bernard Van Leer Foundation; Tacoma Public Library; Continental Overseas, Corp; Bernard Sandler; Shell Oil Community- Brunei; Liech-tensteinisches Rotes Kreuz; Caltex Oil (Thailand) Ltd.; Cyanamid - Thailand; and Singer Thailand Ltd.
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Last modified: 17/01/14
All photos by Richard Rowat unless otherwise specified