On Feb 13, the Westerdam cruise ship received authorisation from the Royal Government of Cambodia to dock at the Sihanoukville Port. It had on-board 2,257 people in total, including 802 crew members and 1,455 passengers.
The World Health Organization (WHO), the US Centers for Disease Control and Prevention (US CDC) and the Pasteur Institute in Cambodia lent their support to the Royal Government of Cambodia in the rescue operation of the Holland-America MS Westerdam cruise ship, which was denied entry into Japan, the Philippines, Taiwan, Thailand and Guam, because the fear of the Coronavirus infection, despite the fact that no one on board was sick.
After almost two weeks of roaming the high seas, the ship finally docked at the Sihanoukville Port. The good health of almost all passengers and crew members was confirmed by the ship’s medical team and later validated by the Cambodian medical team.
The triage through the Maritime Declaration of Health identified 20 passengers that exhibited flu-like clinical symptoms but tested negative for the novel Coronavirus by the Pasteur Institute of Phnom Penh. Tracking for fever among all people before disembarkation was negative.
All passengers found their way home by flying through various airports across Southeast Asia. Incidentally, one passenger, not among the 20 passengers identified earlier, was tested positive in Malaysia, but turned out to be negative two days later. Later, all passengers and crew members returned home, all in good health and with no signs of viral respiratory infections.
Dr Tedros Adhanom Ghebreyesus, WHO Secretary-General, praised Cambodia for allowing the Westerdam to dock. “This is an example of international solidarity we have been consistently calling for. Outbreaks can bring out the best and the worst in people.” During such an adversity and fear of contagion, Prime Minister Hun Sen showed leadership and compassion, while calling for an international solidarity to offer humanitarian assistance to those stranded on the ship.
Balancing the efforts to reduce the global spread of the virus and avoiding unnecessary interference with international traffic according to guidelines of the Public Health Emergency of International Concern (PHEIC), was quite delicate.
Yet, Cambodia decided to move to resolve this humanitarian crisis in line with the International Health Regulations (IHR) that offer guidelines regarding the proper practice of international traffic and screening for infectious diseases at ports of entry and exit, patient management and surveillance (Article 43.1).
The rescue of the people from the Westerdam was also conducted with “full respect for the dignity, human rights and fundamental freedoms of persons” (Article 3.1). By refusing the docking of a ship in distress, other countries may not meet the basic human rights requirements, especially when their own citizens were denied the right to return home. Coincidentally, two weeks later, The Lancet underscored this position: “Do not violate the International Health Regulations during Covid-19 outbreak”.
Global health and foreign policy have been intertwined for a long time, but more recently transnational health issues have become one of the top priorities of the global agenda. The current COVID-19 pandemic is a case in point to illustrate the concept of global health diplomacy, which can be divided into three different categories of interaction around international public health issues: (1) bilateral diplomacy, (2) multilateral diplomacy and (3) informal diplomacy; interactions between international public health actors and their counterparts in the field.
Those actors are from various ministries of the host country (in this case Cambodia), the diplomatic corps, the Pasteur Institute, the private sector (The Holland-America Line that operates the Westerdam cruise ship) and the public. Close cooperation between the Cambodian government and the counterparts mentioned above contributed to the complete rescue of more than 2,000 people holding 41 nationalities and their safe repatriation to their respective countries.
This success story casts Cambodia in a positive light as a global player in global health diplomacy. Cambodia has led by example and has shown, in the midst of a severe viral epidemics that one small state, with limited resources, can contribute to the resolution of a complex international travel restriction in line with guidelines from the IHR. Protecting the health of all, required an international collaborative effort between those who were victims of disease discrimination and their saviours.
Chhem Rethy, MD, PhD (Edu), PhD (his), honorary senior fellow, Cambodia Development Resource Institute. Chhem Sirika, PharmD, research fellow, Mekong Centre for Strategic Studies, Asian Vision Institute
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