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“A Small Country with a Big Heart” – Welcoming the Westerdam

The MS Westerdam, with 2257 people aboard, spent almost two weeks at sea unable to successfully negotiate a port at which to dock. Originally bound for Japan, there were fears that the coronavirus may have spread onboard. The ship finally received authorisation from the Royal Government of Cambodia (RGC) to dock at Sihanoukville port on 13 February 2020. The decision placed the international spotlight squarely on how Cambodia would respond to this challenging situation.

Upon reaching Cambodia, the first passengers disembarked from the MS Westerdam on Valentine’s Day and were greeted personally by Cambodia’s Samdech Prime Minister Hun Sen.

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The Westerdam Cruise Ship docked at Sihanoukville Seaport on 13 February 2020.
© Pen Rotha

In stepping up to this challenge, Cambodia exemplified the international solidarity that the World Health Organization (WHO) has consistently been calling for. WHO, the US Centers for Disease Control and Prevention (US CDC) and Institute Pasteur Cambodia (IPC) worked closely with the Ministry of Health to support the public health response operation, a complex one that put Cambodia’s public health preparedness to the test.

As a signatory to the International Health Regulations (IHR) (2005), Cambodia is required to meet core capacity requirements that not only protect the country but also contribute to global health security. Member States are obliged to assess, report and respond to public health hazards, and establish procedures to uphold global public health security. The IHR (2005) also offer guidance regarding the proper practice of international travel and screening for infectious diseases at ports of entry, patient management and surveillance. The decision to allow the MS Westerdam crew and passengers to disembark in Cambodia was made in line with IHR (2005) recommendations, and was initiated after a thorough risk assessment that balanced the public health measures against potential unintended health, social and economic implications.

WHO and other technical partners worked closely with Cambodia’s MoH to ensure appropriate processes were followed in the disembarkation and monitoring of the passengers and crew of the MS Westerdam. The Maritime Declaration of Health provided by the ship indicated that 18 persons on board had been ill at some time during the cruise. All passengers and crew were required to complete a health declaration. Samples were taken from 20 passengers identified as having exhibited minor flu-like and/or other clinical symptoms, but all tested negative for the coronavirus following testing by the IPC. Prior to disembarkation, all passengers and crew had their temperatures taken by the MoH and local health authorities, but no fever was detected. Relieved passengers were welcomed on to Cambodian shores, and shortly thereafter began finding their way home with the assistance of the cruise line, flying via airports across Southeast Asia.

The relief was short-lived however, when an 83-year-old American woman who had been a passenger on the MS Westerdam tested positive for COVID-19 in Malaysia, en route to the United States on 14 February. In light of the positive test in Malaysia, Cambodia’s MoH convened an emergency working group meeting to agree upon follow-on priority actions. These measures included: COVID-19 laboratory testing for the passengers and crew members who remained aboard the ship, and for those passengers who had already travelled onward to Phnom Penh and Sihanoukville; in total 1562 passengers and crew were tested. All who had been on the ship were requested to self-monitor for symptoms and if they developed, to contact their local health authority and advise them of their travel history. The MoH reported on 19 February that all tests conducted on passengers and crew were negative and that they were reported to be healthy and fever-free; remaining passengers were allowed off the ship and to return home.

Whilst the event may have appeared to only run for 10 days from the docking of the ship in Sihanoukville to the last passengers departing Cambodia, the coordination and synchronization required was immense. The operation was managed by Sihanoukville’s provincial governor, galvanized by a multi-sectoral collaborative response. In addition to the MoH’s central role, the Ministries of Foreign Affairs and International Cooperation, Tourism, Public Works and Transport, the Port Authority of Sihanoukville, the Royal Army of Cambodia and others worked alongside WHO and technical partners to ensure the processing of the passengers and crew in accordance with IHR (2005) and technical protocols. All of these actors came together in unity to deploy a highly integrated operation. For example, helicopters from the Royal Army of Cambodia were mobilised and collected the samples from passengers taken by the MoH at the Sihanoukville port and hastened their delivery to the IPC in Phnom Penh for testing.

With the support from WHO and technical partners, the RGC were able to manage the public health risks of receiving the MS Westerdam whilst considering the potential social, cultural, security and economic repercussions. WHO supported the MoH to conduct public health risk assessments to inform risk management based on the information available and the current understanding of the new virus.

One important lesson learned is that leadership and solidarity can be as crucial as the technical elements of public health responses. An effectively coordinated response goes well beyond the scope of the health sector and must include a whole-of-government approach, steered by the country’s leaders.

Cambodia’s response to the MS Westerdam crisis demonstrates that a country with fewer resources can contribute to global health security. It can take a humanitarian approach in a public health crisis and deliver a measured, coordinated response despite the uncertainty and complex challenges. The past and ongoing investment in health security systems enabled Cambodia to do this; it is an investment that has more than paid off during the current COVID-19 crisis and will continue to do so in the event of future health threats. These core public health systems need to be further advanced to address the ongoing COVID-19 pandemic and future health security challenges.