Beyond a Private Matter: Intimate Partner Violence is a Public Health Issue in Cambodia

Author Name: Chansomanita Meung (she/her)

Background: An Australia Awards Scholar pursuing a Master of Public Health at the Queensland University of Technology (QUT).

Intimate Partner Violence as a Public Health Problem

A woman walks into a health centre with bruises on her body. Hours later, she leaves with her physical injuries treated without being asked a single question about her safety, her relationship, or the circumstances that brought her there. No one documents the violence. No referral is made. For many survivors of intimate partner violence (IPV) in Cambodia, the violence is treated, but the cause remains invisible. Every missed opportunity to identify abuse is also a missed opportunity to protect survivors, interrupt the cycle of violence, and prevent further harm.

According to the most recent Cambodian Demographic and Health Survey (2021–2022), at least 21% of ever-partnered women have experienced emotional, physical, or sexual violence from a current or most recent intimate partner. Yet IPV extends beyond these categories. It can also include psychological abuse, coercive or controlling behaviours, and financial abuse that undermine women's autonomy, safety, and wellbeing. The survey also shows clear patterns of structural vulnerability. Women with lower levels of education, lower socioeconomic status, and those living in rural areas are significantly more likely to experience IPV. These patterns indicate that violence is not random but socially patterned along lines of gender inequality and lack of coordinated services and support.

Survivors described their experiences of depression, anxiety, post-traumatic stress disorder, poor reproductive health, and other relevant chronic diseases. Moreover, children exposed to domestic violence are also more likely to experience emotional trauma and repeat the cycles of violence in later life. These consequences demonstrate that IPV is not confined to private couple matters but instead is a population-level health concern. More broadly, the burden associated with IPV is linked to the increased healthcare expenses, low workforce productivity or absenteeism, and long-term social instability, which strengthens its significance as a national public health issue rather than a domestic matter. The health consequences of IPV can also be fatal. A 2024 report by LICADHO documented 146 deaths linked to domestic and sexual violence between 2019 and August 2025, including 46 children. More than half of these killings were reported to have been committed by a current or former intimate partner. These figures challenge the assumptions that domestic violence is merely a private couple issue and underscore its significance as a matter of public safety and public health. These deaths are not isolated tragedies. They reveal the consequences of a system that too often intervenes only after violence has escalated into crisis.

Understanding IPV as a public health issue does not mean neglecting its roots in gender issues. Violence takes place within power imbalances shaped by patriarchal norms that grant men greater control over the household decision-making, mobility, education, and economic resources. These structural inequalities not only influence the risk of violence but also put a strain on the women’s ability to seek support, access the services, or leave abusive relationships safely.

The scale of violence, its health consequences, and the silence surrounding it demand a public health response. At a global level, the economic costs of violence against women are substantial. These costs extend beyond healthcare spending to include lost productivity, reduced workforce participation, social and legal service expenditures, and the long-term impacts of violence on families and communities. UN Women estimates these losses at approximately USD 1.5 trillion per year, equivalent to around 2% of global GDP. Similarly, the World Bank estimates that the economic burden of IPV ranges from 1.2% to 3.7% of GDP in many countries, in some cases exceeding public expenditure on education. These figures underscore a critical point: violence against women is not only a human rights concern but also a significant public health and economic challenge. Failing to respond effectively is far more costly, socially and economically, than investing in systems that protect survivors.

Taken together, these patterns reveal that IPV is not simply a private family or domestic matter. It is a public health issue with consequences that go beyond individual survivors to families, communities, health systems, and the national economy. Yet despite these wide-ranging impacts, Cambodia's response remains fragmented and largely reactive. Recognising IPV as a public health issue is therefore not merely a matter of terminology; it is essential for building more coordinated, survivor-centred responses that can identify violence earlier and reduce its long-term consequences.

Cambodia’s Current Response System Is Fragmented

In Cambodia, when survivors report violence to police authorities, initial responses often rely on mediation or reconciliation, even in severe cases. Such practices leave survivors without meaningful protection and may place them at further risk. Similarly, when survivors seek support at healthcare facilities for visible injuries or chronic health complaints, the underlying link to intimate partner violence frequently goes unidentified. Health workers may be reluctant to inquire about domestic violence due to heavy workloads, limited training, fear of social repercussions, or concerns about involvement in what is often perceived as a private family matter. Even when violence is suspected or disclosed, harmful social norms can still undermine an effective response. Survivors may encounter victim-blaming attitudes, judgement, or pressure to preserve family unity, making them reluctant to disclose further abuse or seek future support.

These gaps are not the result of individual oversight but reflect systemic misalignment. Many health professionals lack specialised training, standardised screening tools, and clear referral pathways. Overburdened facilities, limited privacy, and the cultural normalisation of domestic violence further discourage disclosure and inquiry. Consequently, care remains fragmented, physical injuries are treated, while the structural cause of violence is undocumented and unaddressed. This fragmented institutional response perpetuates silence and reinforces cycles of abuse shaped by economic dependency, gender inequality, social stigma, and weak coordination across sectors.

Why Integrated Services Matter

If IPV is understood as a public health issue, then responses must extend beyond policing and legal remedies alone. Survivors often require medical treatment, psychosocial support, legal assistance, and protection services at the same time. Yet these services frequently operate in isolation. The One-Stop Service Unit (OSSU) model was developed to address this fragmentation by bringing health, legal, psychosocial, and social support services into a coordinated response system. By reducing the need for survivors to move between multiple agencies, OSSUs can improve access to care, strengthen referral pathways, and reduce the risk of re-traumatisation. From a public health perspective, such integration helps ensure that violence is identified earlier and that survivors receive comprehensive support rather than isolated interventions. This integrated model recognises that the consequences of IPV go beyond physical injury and require multiple layers of support.

In 2024, Cambodia’s Ministry of Women’s Affairs and Ministry of Health, with technical assistance from the Australian Government, launched the Standard of Practice (SOP) guidelines for OSSUs supporting survivors of gender-based violence, including IPV. This marked a significant milestone in strengthening institutional capacity and promoting consistent standards across sectors. As of November 2025, OSSUs have been established in seven provinces: Phnom Penh, Kampong Cham, Tbong Khmum, Preah Vihear, Stung Treng, Battambang, and Kampong Chhnang. The development of OSSUs has also been informed by the long-standing work of organisations such as the Cambodian Women's Crisis Centre, Banteay Srei, and the Women's Resource Centre, which have played an important role in service provision and advocacy for survivors of gender-based violence. All these efforts are crucial as integrated services create opportunities for earlier identification of violence, minimising the likelihood that survivors repeatedly cycle through health facilities without receiving appropriate support.

From Policy Commitment to Effective Protection

The establishment of OSSUs represents an important shift towards a more integrated response to IPV. However, the existence of a service model alone does not fully guarantee the timely and effective protection for the survivors.

One challenge is workforce capacity. Many healthcare providers have not received comprehensive training on the national Protocol on Healthcare for Women Victims of Violence, including the WHO-endorsed LIVES approach (Listen, Inquire, Validate, Enhance safety, and Support). Without or with limited skills to identify violence and respond promptly, survivors may continue to pass through health facilities without getting the support they need. In such situations, opportunities for early interventions can be lost. Moreover, there is a concern regarding sustainability. Integrated responses require established mechanisms, including human resources, referral systems, case management, and continuous capacity-building. Yet many services continue to depend on development partners. Without stronger government ownership and financing, expansion of OSSUs may remain uneven and vulnerable to funding shortages.

Accessibility is equally important. Even the most comprehensive services cannot protect survivors who are not aware of the existence of the support services or when they cannot reach the services. Limited awareness, particularly in provinces with high rates of violence, means that many women are not having information about the available support. This challenge may be particularly apparent for women facing additional barriers related to geography, poverty, disability, or social stigma. For some survivors, these barriers are intensified. Women living in remote communities may face long travel distances to reach services. Women with disabilities may encounter physical accessibility challenges or depend on caregivers or family members who may themselves be the perpetrators of the abuse. Survivors experiencing economic insecurity may lack the resources needed to seek help or leave violent relationships. Recognising these intersectional barriers is essential if integrated services are to be genuinely accessible to all survivors rather than only those who can easily navigate existing systems.

Finally, stronger monitoring and evaluation systems are crucial. With no proper and reliable data on service utilisation, referral outcomes, and survivors’ experiences, it becomes difficult to assess whether OSSUs are achieving their intended objectives or not. Hence, effective monitoring is not simply an administrative requirement; it is needed for transparency, accountability, learning, and continuous improvement.

Conclusion

Intimate partner violence in Cambodia is not a private misfortune confined to the household; it is a systemic failure shaped by gender inequality, social norm, economic dependency, and fragmented institutional responses. Recognising IPV as a public health issue is not about changing terminology. It is about building early warning systems of violence, providing coordinated support, and preventing survivors from falling through institutional gaps. Cambodia has already taken an important step through the development of OSSUs. The challenge now is ensuring that integrated survivor-centred services become an accessible reality for all women, regardless of where they live or their ability to access support.

What is needed now is sustained commitment to translate that evidence into action through coordinated, survivor-centred systems of care. Every encounter with the health system is an opportunity to identify violence, provide support, and interrupt the cycle of abuse. Whether those opportunities are realised depends not only on policies or resources, but also on the collective willingness to recognise violence for what it is, and to respond before it is too late. The next time a woman walks into a health centre with injuries, the question should not only be "How do we treat her wounds?" but also "How do we ensure she leaves safer than when she arrived?"

AI Transparency Note: This article was developed with the assistance of generative AI for language polishing and structural refinement. All analysis, arguments, and factchecking were undertaken by the author.

About the author: Chansomanita Meung (she/her) is an Australia Awards Scholar pursuing a Master of Public Health at the Queensland University of Technology (QUT). Her interests include public health, social protection, and inclusive community development in Southeast Asia. She previously worked as a lecturer and junior researcher at the Center for Southeast Asian Studies (CSEAS), Royal University of Phnom Penh, where she contributed to research on social policy and development issues.