When, as a new mother in 2001, Kim Bunnath walked into her home after visiting her sick mother in Kampot province, she saw no sign of her baby boy.

Without her knowledge, she says, her then-husband had abandoned their 9-month-old son, who had a chronic medical condition, leaving him at an orphanage. Once he was there, Bunnath was convinced the centre would facilitate crucial medical treatment for him abroad. She separated from her husband and visited her son every Sunday – her only day off from factory work.

Not long after, he was adopted by a family in the United States. She hasn’t seen him since.

“I did not get to say goodbye,” she says, dabbing her eyes with a tissue. “I am worried that he is thinking that I gave up on him.”

As her son’s 18th birthday approaches, Bunnath clings to a small cluster of mottled photographs that show her son in a montage of a typical American childhood – blowing out candles on a birthday cake, grinning widely in a picture from summer camp, dressed in the bright colours of his soccer team.

Bunnath is one of a trio of women highlighted in a new report from rights group Licadho investigating Cambodia’s “stolen children”. The women were victims of deceptive practices from orphanage rackets that exploited their poverty and, in many cases, fabricated documents to have children adopted without the consent of parents.

The harrowing circumstances that saw children sent from their mothers has prompted calls for an official apology from the Cambodian government and more robust steps to ensure fraudulent international adoptions do not take place in the future.

Children pose for a picture at a Phnom Penh orphanage in the mid-2000s from which at least four children were sent to Italy for adoption. The adoptions went ahead despite the birth parents changing their mind about sending them abroad. Licadho

By the government’s estimates, 3,696 Cambodian children were adopted overseas between 1987 and 2009 – when Cambodia banned the fraught practice in the wake of human trafficking and allegations of selling children.

However, the report highlights the number in reality is likely much higher, as not all adoptions were processed by the Ministry of Social Affairs and records are incomplete.

The three cases highlighted in Licadho’s report could be emblematic of hundreds, if not thousands, of others.

In Bunnath’s case, her son was initially sent to Thailand for treatment and returned within a week. When the orphanage said they would send him to the US for further medical care, she always expected him to return.

From Licadho’s investigation, it appears her son was fostered during his care in the US and later adopted, contravening an American ban on adoptions from Cambodia put in place in 2001.

Years later, she was asked to sign documents by an orphanage staff member and was issued a birth certificate, which appears to be “a post-hoc attempt to create documentation to legitimise the trip to the US and to certify that the child had been abandoned by his parents and was therefore adoptable,” Licadho’s report said.

The cadence in Bunnath’s voice warps with emotion as she recounts caring for her small and ailing son, watching him fluctuate from feverish to nearly frozen, almost two decades ago.

“I don’t want anything from my son. I just want to see him,” she says. “At least let him know that I am his mother, too.”

Two sisters, Neang Phal, 31, and Neang Yorn, 37, echoed Bunnath’s sentiments. Between them, seven of their children were sent to Italy, without their informed consent.

Struggling to make ends meet at a rubber plantation, Yorn placed her four children – the youngest just seven months old – into an orphanage in 2007 on the advice of a neighbour, who turned out to be a broker. “We are very poor and I hope my child could get a better education if they were living there,” she says.

Phal, who has three children adopted in Italy, said she knew her children would be sent abroad, but was misled about the circumstances. The sisters were told they would receive photos and updates every six months and their children could return home for visits. That was not the case. “I feel very regretful. I just keep missing them, and I don’t know if I can ever meet them again,” she says. “I have very little hope.”

“I think about my children so often, I sometimes faint.”

Nursing her youngest child, a starry-eyed 8-month-old and one of three children she had after the elder four were shipped off to Italy, Yorn says she has contemplated suicide. But she knew she had to be there for her younger children.

“If I raised them in Cambodia, I would not have to worry that I am going to lose them. Even though we did not have enough food, we could have shared,” she says. “We would have been happy together, but now I am not sure if I can see their faces again.”

Kim Bunnath sifts through snapshots of her son’s life in the United States. She allowed her nine-month-old son, who had a chronic medical condition, to stay in an orphanage in 2001 so he could receive critical treatment overseas. He was later adopted by an American family without her knowledge or consent, and she hasn’t seen him since. Hong Menea

Licadho’s report highlighted another case where a mother’s four children were also sent to Italy. The parents were convinced by the orphanage director it would benefit their children, although they did not understand the extent of what foreign adoption entails.

Although they initially agreed, they later chose to keep the children with them after they visited for a Pchum Ben holiday prior to going overseas. When the director came for them, the mother hid with her youngest child in a rubber plantation. Seeing the child playing a short distance from the mother, the director picked up the youngest and told the mother it was too late to renege – all the paperwork was complete.

While some countries began to put their own bans on adopting Cambodian children in the early 2000s due to widespread corruption, many countries continued the problematic practice over the next decade. Italy accepted the most children, by far, in that time.

Italy’s Foreign Ministry and the embassy in Bangkok did not respond to requests for comment by deadline.

Licadho Director Naly Pilorge described the cases as “tragic”.

“The birth families were cheated, adoptive parents were tricked and the children have been robbed of their true identities,” she said. “They all deserve to know the truth of what happened, and those responsible for these hideous crimes should be held to account.”

There have been no international adoptions since Cambodia imposed its own ban in 2009, although there are conflicting reports suggesting that ban has been lifted.

In Maly breaks down as she recounts how her daughter and son were abruptly sent to Austria to live with a foreign family. Maly keeps two dolls in her room as small tokens of the children who were stolen from her in Cambodia’s orphanage rackets of the 2000s. “As a mother, I feel very hurt,” she says. “I did not get to see my children one last time.” Hong Menea

Sou Key, the chief of data management at the Intercountry Adoption Administration, claimed international adoptions became legal again in 2014, but a 2015 document shows the Ministry of Social Affairs was planning to re-open the practice at a later date.

Key suggested international adoptions would now be “safe” and that no cases had yet come up because of new and stringent processes. “With the new procedure, it takes more than 200 days, and one child is $5,000, with 70 percent going to child welfare,” he said.

Yet Licadho was adamant that no new international adoptions should take place until a system of redress is established to investigate fraudulent cases preventing a repeat of past abuses.

Academics agree, and echo the call for “a public acknowledgment of the wrongdoings of the past in relation to intercountry adoptions, an apology to all those affected, and an invitation to all affected families to come forward, tell their stories and seek redress”.

David Smolin, director of the Center for Children, Law and Ethics at Samford University, said receiving states must also share the burden of investigation and redress, giving children, parents and adoptive families “the opportunity to find out the truth and to reconnect family ties that were wrongfully broken”.

“These abuses tear children unnecessarily away from their parents and families, while undermining and poisoning adoptive family relationships,” he said in an email. “These abuses also destroy intercountry adoption systems and are largely responsible for the sharp drop worldwide in intercountry adoption.”

Dr Patricia Fronek of Griffith University, who specialises in surrogacy and adoption, said that “the cases of fraudulent intercountry adoptions and trafficking that are known about are only the tip of the iceberg”.

“Intercountry adoption has life-long consequences,” she said in an email. “Mothers, fathers and families suffer life-long grief and other mental health consequences particularly when they don’t know what has happened to their children.”

She said tracing and reunion services are needed, as are social workers and counsellors. Even when children are raised in good adoptive families, she said, they still “suffer issues of identity and separation from their families, communities and culture”.

Indeed, Unicef spokesman Iman Morooka said that proper case management was of “critical importance” if international adoptions were to resume, and that they should only occur after domestic options have been exhausted. “There’s currently a severe lack of social workers in Cambodia and this is an area that requires urgent investment by the Government,” she said.

Fronek further warned Cambodia against caving to influential countries pressing for adoptions to meet the demands of its citizens. “There is a market in babies. Cambodia is not equipped to run an intercountry adoption program,” she said.

Even without an international adoption market, exploitation of both children and parents still occurs. The vast majority, roughly 80 percent, of children living in Cambodian orphanages have at least one living parent. Sometimes parents are given false promises that their children will receive a better education away from home, in some cases in orphanages that thrive off tourist revenue.

“Not all children’s homes in Cambodia have been inspected or are regulated by the government,” she said. “Orphanage tourism still exists and there are children and families at risk and vulnerable to the many people who will take advantage of them.”

In a statement, the US Embassy said its government “continues to support Cambodia’s efforts as it works to promote child welfare in Cambodia and establish an intercountry adoption process under the Hague Adoption Convention”, which establishes ethical practices.

“It is critical that Cambodia build these safeguards before the United States can resume intercountry adoptions there.”

Two people connected to orphanages identified by the mothers interviewed as having sent children abroad against the will of their biological parents distanced themselves from past cases.

Ouk Narom, executive director of Sacrifice Families and Orphans Development Association, said she had been at the centre, where 40 children are housed, for the past four years and stressed no adoptions had taken place in that time. “I only take care of the children. The decision for matching with the families, it is the ministry who decides. I have no right to do it,” she said.

She said there were “very few cases” where adoptive parents enquired about the relatives of their children.

When presented with allegations of fraudulent international adoptions to Italy, Meas Yuth, former head of the 7 Makara Solidarity Association stressed he retired from the orphanage five years ago. “When the children were adopted by foreign parents and live abroad, it’s all through the Ministry of Social Affairs. We never do it directly,” he said. “Adoptive parents give us some money, it is all from their heart,” he added, denying children came with a price.

Two sisters, Neang Phal, 31, and Neang Yorn, 37, said they regretted sending their children to an orphanage and have lost all hope of their return. Between them, seven of their children were sent to Italy, without their informed consent. “We are very poor and I hope my child could get a better education if they were living there,” Yorn says.Hong Menea

But the price is all too high for the women left behind. One of them, In Maly, sits with her hair swept back and fastened with a clasp at the nape of her neck. In 2005, two of her children were sent to Austria without her consent.

Like so many others, she felt compelled to put her children in the care of an orphanage due to her poverty and a seriously ill husband.

When she discovered her daughter had been sent away, she confronted the orphanage director, who had previously reprimanded Maly for visiting too often.

“Why would you want to know?” the director asked her. “You were going to faint if you ever saw your child walking away from you.”

Maly was devastated. Unable to concentrate on her work, she made mistakes in the garments she sewed. When she got word that her young son was being prepared for adoption abroad, she began to rush to the centre, but he was already gone.

The children gave her dolls they received from foreigners at the centre, which Maly keeps in her room to this day – small tokens of the son and daughter who were stolen from her.

“As a mother, I feel very hurt,” she says. “I did not get to see my children one last time.”