Has Cambodian Prime Minister Hun Sen contracted the coronavirus? In a de-facto one-party state where almost all media is run by ruling party-aligned outlets, rumors spread as easily as contagions.

On March 9, Hun Sen fuelled that speculation when he said he would get tested after complaining of a “stuffy nose” after travelling to China and shaking hands with several cruise boat passengers who may have been infected.

A week on, the tough-talking leader still hasn’t publicly announced whether he took the test and if so its result, though he has lashed out at rumors that he secretly visited Singapore for treatment.

“I may order authorities to arrest you in your house,” Hun Sen threatened one Facebook user from Prey Veng province who posted the Singapore allegation. “Don’t ever think that we don’t know what you’re doing! This is just a warning!”

Whether or not Hun Sen has contracted the virus, of course, is largely inconsequential to Cambodia’s public health as Covid-19 cases rise in the region.

Although aged 67 and until recently a lifetime smoker, he has access to some of the best healthcare services in the world – indeed, often in Singapore, his preferred destination for medical care.

Behind the rumors of his infection, though, lies a now heated debate about the quality of Cambodia’s healthcare system and the government’s fitness to provide basic services, even if Cambodia hasn’t been as hard hit as others by the global pandemic.

People wear facemasks, amid concerns over a spread of the COVID-19 coronavirus, at a market in Phnom Penh on March 14, 2020. Photo: AFP/ Tang Chhin Sothy

As of March 17, the number of confirmed coronavirus cases in Cambodia was 24, doubling from 12 the day before. Many speculate, however, that figure is likely even higher due to underreporting and incompetence in detecting cases.

In late January, at a televised press conference, Hun Sen responded angrily when a reporter insinuated that Cambodians had scant confidence in public healthcare services.

“Have any of those skeptics contracted the virus yet? If not, how do they know that our government is incapable?” Hun Sen shot back.

“You really don’t want to be infected with Covid-19. And you definitely don’t want to contract it in Cambodia,” Ou Virak, founder of the Future Forum think-tank in Phnom Penh, tweeted last weekend.

Indeed, Cambodia’s healthcare services are among the worst in Southeast Asia, underscored by the fact the counry has the second-lowest life expectancy rate in the region.

State-run medical facilities are chronically underfunded and often in woeful condition. Now, there are concerns that services could be pushed to breaking point if the number of infections spikes from the current dozen into the hundreds, as seen elsewhere in the region.

Class is a dividing line. Cambodians with the financial means generally seek health treatment abroad, often in Singapore and Japan for the wealthy or neighboring Vietnam for the middle-classes.

Indeed, Hun Sen and other government top officials are known to go abroad for their personal treatment. If foreign treatment is out of financial reach, many in Cambodia rely instead on numerous private hospitals or clinics. In other words, few trust state health facilities.

Cambodian patients at a public hospital in Kratie province in a May 6, 2018 file photo. The patients were being treated for ailments other than Covid-19. Photo: AFP

Of 8,587 people surveyed in a comprehensive 2019 study, some 54% used either a private clinic or private pharmacy for outpatient treatment.

For those actually hospitalized, the majority (52%) used a private hospital, according to the study titled “Who benefits from healthcare spending in Cambodia?” Rural Cambodians, the study showed, are more likely to use public hospitals.

The reseach found that roughly half of total health expenditure in Cambodia went towards the private healthcare sector, “which distributes healthcare benefits in favor of the rich.”

The debate over who gets quality and who gets poor healthcare services has intensified as allegations fly that Hun Sen has put the country’s foreign relations above the nation’s health, analysts say.

Hun Sen courted controversy from the outset after China announced its virus outbreak in January.

First, he rebuked Cambodian students as cowardly when they said they wanted to return home from Hubei province, the epicenter of the viral outbreak, despite other countries flying home their nationals.

He also scolded journalists for wearing surgical face masks at press conferences, claiming they should be as confident as him and go unmasked.

Then the leader rushed to Beijing in early February to offer his support to President Xi Jinping, now his closest ally. “A friend in need is a friend indeed,” he wrote on his Facebook page at the time.

Cambodian Prime Minister Hun Sen (L) and Chinese President Xi Jinping (R) during a recent bilateral meeting. Photo: Facebook

Hun Sen said during that meeting that Cambodia would not impose travel restrictions on Chinese visitors, unlike most other countries, a decision that aimed to assuage Beijing at the expense of Cambodians’ safety and health, critics said.

In February, Hun Sen received mixed reviews for allowing hundreds of passengers aboard the Westerdam cruise ship to dock in Cambodia after they had been turned away from several other countries including neighboring Thailand.

Hun Sen portrayed the move as an act of international solidarity at a time of crisis, a line which won congratulatory messages from the World Health Organization, the European Union and even a “thank you” tweet from US President Donald Trump.

In retrospect, it was a reckless move as reports later emerged that passengers who tested negative in Cambodia were found to be positive after being tested in their home countries.

None of this has been helped by Hun Sen’s wild and weird claims.

For instance, Hun Sen suggested that Cambodians use traditional scarves, known as krama, as protective face masks, which he said would create “a bigger market for scarf weavers.”

This week his government finally imposed travel restrictions on several European countries, now arguably the global epicenter of the outbreak, though it has not yet restricted China’s entry.

A woman looks at her son as they wear face masks against the Covid-19 novel coronavirus in a market in Phnom Penh, March 17, 2020. Photo: AFP/Tang Chhin Sothy

The Education Ministry also this week closed all schools and universities, while the government has put aside between US$800 million to $2 billion to help businesses cope with the economic impacts of the coronavirus, especially the tourism and export sectors.

But turning around Cambodia’s failing healthcare system poses a longer-term challenge.

Remarkable progress has been made since the early 1990s, to be sure, though Cambodia’s health statistics are still grim compared to its neighbors.

Thais and Vietnamese live on average 7.3 and 5.7 years longer respectively than Cambodians.

In fact, the current life expectancy in Cambodia today is the same as Vietnam in 1990, according to United Nations Development Program data.

While economic growth has boomed, Cambodia’s state expenditure on healthcare as a percentage of gross domestic product (GDP) has actually fallen over the last decade.

A customer’s temperature is checked before entering a bank in Phnom Penh, March 17, 2020. Photo: AFP/Tang Chhin Sothy

The government has responded to the healthcare debate with its usual heavy-handed tactics. One Facebook user, Kauy Sam Ath, was charged this month with “incitement to cause social unrest” for his critical posts about public hospitals.

It has also deflected suggestions that the actual number of cases in the country is likely higher than the 12 reported.

Yet Cambodia can so far count itself as fortunate that most of its confirmed Covid-19 cases are foreigners who won’t be an additional strain on the country’s failing and flailing state health services.