“I am Huo, aged thirteen,” the boy said. “I saw the Khmer Rouge take two children and another child who was as young as me but was a little smaller than me to kill, cutting off their flesh for eating. One day, Khmer Rouge took me, sprinkling hot water on my head and sawing my neck, intending to kill me and to eat my flesh. At the time, I was screaming out, prompting the neighbors to be panic-stricken. After that, they set me free, so I ran away. My neck wound has left a scar there until now.”

This is a translation of a little boy’s testimony in 1979, when the People’s Revolutionary Tribunal tried Pol Pot and Ieng Sery for the war crimes of the Khmer Rouge, the radical communist group that wiped out nearly a quarter of Cambodia’s population. Huo was one of thirty-nine survivors who gave testimony during the five-day trial. The witnesses, along with many of the five hundred courtroom spectators, broke down and cried again and again during the proceedings.

“Cambodia suffered one of the worst genocides of the twentieth century from 1975 to 1979,” says Jeffrey Sonis, a professor of social medicine and family medicine. The Khmer Rouge’s attempt to exterminate educated Cambodians and create an agricultural utopia led to the deaths of some 1.7 million people in the countryside from starvation, disease, overwork, and murder.

And for the past twenty-five years, most of the Khmer Rouge’s leaders have enjoyed complete freedom. Most legal authorities consider the 1979 trials to be a sham — the defendants weren’t even present. Even though Ieng Sery and Pol Pot were sentenced to death, their sentences were never carried out. Ieng Sery, now eighty-three, was granted a pardon. Pol Pot died of natural causes in 1998. But now the United Nations and Cambodia have begun a joint trial of the still-living senior leaders of the Khmer Rouge (including Ieng Sery), and Cambodians are once again standing up to testify about the executions, forced labor, torture, and rapes they and their families suffered.

Sonis, who’s leading a study of the trial’s effects on Cambodians, says that many countries struggle with how to move forward after periods of cataclysmic violence or war. Most societies seek out some form of justice for the survivors, and they use one of two methods to get it: truth commissions, which reveal crimes but don’t mete out punishment, or trials.

“But the big question is, ‘What is the effect of these tribunals or truth commissions?’” Sonis says. “And can attempts to provide justice help people and countries move forward?”

Photo by Katie O’Brien. ©2010 Endeavors magazine.

Photos of victims cover the walls at the Tuol Sleng museum. “If you can make people feel that justice has been done, what impact does that have upon mental health?” Sonis asks. “Does that make people less likely to be prisoners of the past?”

Click to read photo caption. Photo by Katie O’Brien. ©2010 Endeavors magazine.

In the early 1990s, during a trip to former Yugoslavia, Sonis began trying to answer those questions. He and several other doctors from Physicians for Human Rights were on a fact-finding mission, sent to interview victims of the Bosnian War at a refugee camp.

“The people in one room in this camp were all from one small town, Ljubija,” Sonis says. “They had just come out of the very worst of the concentration camps in northern Bosnia, the places that people described as the Twilight Zone.”

When the doctors arrived, the refugees were gathered together, smoking cigarettes in silence. The doctors introduced themselves, and an elderly woman stood up and spoke for the group. “We don’t want to talk to you,” she said. “We have fear into our bones.”

The doctors were disappointed. As they prepared to leave, though, the refugees slowly began to talk. And for the next four hours, they wept and told about the executions, the torture, the mass graves, and, Sonis says, “the kind of atrocities that are just otherworldly.”

The next day, another woman told them, “At first, we didn’t want to talk to you. But it felt good to have someone listen to us. We’re so glad that you came.”

“Those words have stuck with me ever since then,” Sonis says. Talking about what had happened to them had been therapeutic for the refugees, and possibly a step toward the beginning of recovery, he says. “And I wanted to know — after such trauma, what can be done to help people and societies move forward?”

For the next several years, Sonis conducted studies of the Truth and Reconciliation Commission in postapartheid South Africa and the Greensboro Truth and Reconciliation Commission in North Carolina (see inset, this page) to find out what effects they had on those communities. Now he and his colleagues are well into their work on the Cambodia study; they’ll collect data from the participants before, during, and after the tribunals.

Right now, only the first of five Khmer Rouge trials has begun. (Kaing Guek Eav was the first; his charges include the torture and murder of thousands of people, including by medical experimentation and “live autopsies.” The court is scheduled to announce its judgment in early 2010.) But Sonis’s initial findings have revealed some interesting things about mental health in Cambodia.

Surveyors fanned out across the country — on foot, by motorcycle taxi, by boat — to collect data from randomly chosen participants. So far they have found that Cambodians who believe that the trials will bring justice for the victims of the Khmer Rouge are less likely to suffer post-traumatic stress disorder, or PTSD. And those who don’t believe the trials will bring justice, as well as Cambodians who have a great desire for revenge, are more likely to have PTSD.

In Cambodia, PTSD is five times more common than in the United States, Sonis says, and the rate is particularly high in those who lived through the Khmer Rouge era. PTSD is a mental disorder, but it’s also a precursor to some physical disabilities; it’s associated with stress-related chronic illnesses and with autonomic system arousal, or increased heart rate, which can be a sign of heart disease. There are only thirty-two psychiatrists for Cambodia’s population of eleven million, Sonis says, and there’s no way to treat everyone who suffers from the disorder.

They also found that many older Cambodians felt the trials were a good step for the country, but worried that the matter would bring up bad memories for the survivors. Those memories, Sonis says, could make things worse for those with PTSD. Then again, if the trials help those same participants feel that justice has been done, it could reduce their symptoms. Sonis and his research team won’t know until the trials are complete.

Sonis talks about this study

UNC Medicine

“It’s really remarkable, the transformation that’s taken place since the Khmer Rouge era,” he says. Cambodia now has a soaring economic-growth rate and a population famous for friendliness; the whole country is eager to move into the future.

“But there’ll never be closure,” Sonis says. “With something that painful, there will never be closure. But will there be moving on? We hope so.”