When two North Korean doctors dropped dead in Phnom Penh’s Tuol Kok district in January, the stated cause of death raised eyebrows among many.
Police ruled that the hard-partying duo died of simultaneous heart attacks brought on by alcohol consumption, despite their wives’ admission that they had injected the men with a homemade health serum in the hours before their deaths.
The men’s wives wrote a letter to police requesting that no autopsy be performed, but according to many, they needn’t have bothered.
“In Cambodia, there is no equipment to do autopsies like in other countries,” said Norng Sovannaroth, the Phnom Penh Municipal Court doctor and the only physician qualified to perform autopsies in Cambodia.
Although he believed the suspicious nature of the North Koreans’ deaths warranted further examination, the power to seek an autopsy falls to the police, and it is a request they rarely make—including in this case, when the women’s stories were allowed to stand without question.
In interviews last month, Dr. Sovannaroth, the court doctor, outlined his frustrations with the shoddy state of forensic medicine in the country.
“It’s because the Cambodian government doesn’t care much about autopsies. They just let [the] doctor see what happened and make a report; they never think about it,” he said.
The need to introduce standardized forensic medicine—a discipline that includes autopsies— was first discussed in 2001, when government, medical and legal officials gathered in the capital for the the country’s first-ever conference on the topic. The event ended in formal recommendations for the establishment of a coroner’s office and a university-based forensic medical program.
But 15 years later, neither of these exists, and Cambodian police are still eyeballing most corpses to determine the cause of death, according to Dr. Sovannaroth.
Though police often refer to this external examination as an “autopsy,” a procedure of international standards involves opening a body at the front and removing organs one by one before carefully examining them, as well as methodically scrutinizing the outside of the body.
However, Dr. Sovannaroth— who performs autopsies at the Phnom Penh Referral Hospital— said his repeated requests for the practice to be given more funding had been rebuffed, and there was no autopsy training program at the University of Health Sciences.
“I am an autopsy doctor, but in every of meeting at the Health Ministry when I make requests about the need for technical autopsies, they always ignore me,” he said.
He added that he had requested basics such as better tools, DNA testing facilities and the addition to more hospitals of cool rooms needed for storing corpses, to no avail.
“In other Asian countries, the police take any evidence or bodies to do DNA testing…. When will Cambodia do it too?” he said.
Ly Sovann, a spokesman for the Health Ministry, declined to comment on the issue, saying only that the Ministry of Health “is not responsible for this,” and directing all questions to the Interior Ministry’s technical and scientific department.
Moung Sothea, director of the department, conceded that facilities for forensic medicine were sorely lacking but said there were plans for improvement.
“In the provinces…they don’t have enough equipment for autopsies on bodies,” he said. “But by the end of this year we will have full equipment for autopsies in the whole country,” he said.
He admitted that autopsies were rarely requested without the intervention of NGOs.
“Our police do autopsies sometimes depending on what we see…but almost all are murders or rapes that involve NGOs—they always request for autopsy for more specifics.”
He said that equipment that can identify DNA, an important tool in many investigations into crimes such as rape and sexual assault, would be purchased “soon,” adding that the government currently relied on NGOs to pay to send blood and other samples overseas.
“NGOs that work for protection of children have the budget to take the blood or masks found at the scene [of the crime] to Vietnam or Thailand to do DNA testing,” he said.
James McCabe, chief investigator for the Child Protection Unit, the investigation arm of the Cambodian Children’s Fund NGO, frequently employs the services of court doctor Mr. Sovannaroth.
“We will request an autopsy if we’re not certain [of] the causation of death,” he said, citing an example of an 8-year-old child who was killed by his stepmother in late 2014.
“The stepmother had stomped on him. Obviously there were signs of bruising, but no obvious signs of how that child would have died,” he said.
“Had we not done that autopsy, that stepmother would not have been charged,” he added.
While the CPU regularly requests autopsies and sends DNA samples collected at crime scenes to Vietnam for analysis if necessary, Mr. McCabe said there was room for improvement in how police were trained to collect such evidence.
“The confession is only the start of an investigation…. You then have to corroborate that confession,” he said.
The ability to perform autopsies is crucial to a robust justice system, according to David Ranson, the head of forensic services at the Victorian Institute of Forensic Medicine in Australia.
“In most suspicious deaths the police will request that a full autopsy be performed and this request will usually be supported by similar advice from the forensic pathologist,” Dr. Ranson wrote in an email last month.
Still, determining a cause of death is just the first step, Dr. Ranson said.
“[M]ore commonly the issue is one of analysis of the fatal injury to determine question[s] such as: how much force was used, what type of weapon may have been used, how was that weapon wielded,” he said.
“For example was the knife used in a stabbing pushed in and out of the body several times through the same wound, was the person lying down sitting or standing when they were stabbed or shot, was the person trying to defend themselves when they were fatally injured,” he continued.
The country’s lack of forensic medicine facilities are considered problematic enough that the British Embassy in Phnom Penh highlighted it in an information sheet at the beginning of this year warning families of U.K. citizens who die in Cambodia.
“You should be aware that the cause of death given on the death certificate is often given in very basic terms, and often does not reveal the underlying cause of why the death occurred,” it states, recommending that families use the services of the Phnom Penh-based coroner John Allison Monkhouse Repatriations.
Contacted last month, the head coroner of John Allison Monkhouse, who declined to give his name, said the only thing his company could do for those who desired a more thorough examination was to ship corpses abroad for a proper autopsy.
“There are no forensic pathologists in Cambodia,” he said.
“What we can do is send a body to Bangkok.”