# **1. Introduction**

<mark>Road connectivity in Cambodia is challenged by its geography, which i</mark> ncludes the low-lying central plains of the Mekong and mountains in the northeast and southwest, <mark>and its exposure to recurrent flooding, particularly in the rainy season, which is between May and September, with regional variability. Cambodia is one of the most vulnerable countries worldwide to disaster risk and climate change</mark> , ranked the 12th most disaster-prone country in the 2018 World Risk Index of 172 countries by the Institute for International Law of Peace and Armed Conflict 2018 <mark>. With</mark> 80 percent of the country within the Mekong River and Tonle Sap basins, Cambodia is especially vulnerable to floods, storms, and droughts. The infrastructure sector has seen significant damages due to disasters. For example, in 2014, the infrastructure sector bore some 86 percent of the total damages, predominantly roads and water and irrigation infrastructure <mark>(Royal</mark> Government of Cambodia 2014) with a cascading effect on local and regional economies due to disruption of infrastructure connectivity and supply chains and loss of market access for key economic goods. Looking ahead, climate change projections indicate temperature increase of 0.7°C–2.7°C by 2060 and increased intensity and frequency of extreme precipitation in the monsoon season and flooding (World Bank undated) which would only exacerbate current vulnerabilities.

The impacts of climate change are more noticeable in the rural parts of Cambodia. Higher levels of poverty compounded by poor infrastructure maintenance and limited access to all-season roads (only 5 percent of rural roads are paved) make the 79 percent of the Cambodian population living in rural areas (2016) highly vulnerable to the frequent disruptions of flooding events. The disrupted connectivity during flooding and other disasters greatly threatens the livelihood of those rural households and their access to basic services. In a context of health emergencies and pandemics, such as COVID-19, it is critical that the population has reliable and resilient <mark>access</mark> to health facilities to ensure rapid medical response and delivery of critical medical supplies.

Rural access to hospitals has been at the center of the discussion amid the COVID-19 health crisis (New York Times,<sup>5</sup> Washington Post,<sup>6</sup> and ABC News<sup>7</sup> ). While most cases and outbreaks have taken place in densely populated areas (such as Northern Italy, New York, or Madrid), those areas tend to have good access to hospitals or have the availability to set up temporary hospitals. Rural areas are much worse equipped to face the impact of a health crisis, in terms of human, operational, and financial resources and capacity. Rural access to health care centers is low; the lengthy travel times to the nearest hospital with necessary emergency

> 5 <u>https://www.nytimes.com/2020/04/16/health/coronavirus-rural-hospitals.html.</u>

> 6 <u>https://www.washingtonpost.com/opinions/2020/04/06/covid-19-crisis-is-going-get-much-worse-when-it-hits-rural-areas/.</u>

> 7 <u>https://abcnews.go.com/Health/surprising-covid-19-hot-spots-coronavirus-threatens-rural/story?id=69940146.</u>

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