Dr. Bernard Kouchner was visibly upset as he watched crane operators lower hooks into the Ile de Lumiere, a gleaming white freighter outfitted as a hospital ship for refugees nine months ago. Now the patients were all gone and workers were busy turning the ship back into a freighter.

Below decks they tore out and stacked beds, file cabinets, sterilization machines and other hospital equipment. Discarded syringes and x-ray negatives littered the floor as they readied a new load to be lifted out onto a dock at Bangkok port.

Toward the stern, in a newly cleared hold, other workers loaded bags of powdered milk that would be transported up the Mekong River to Phnom Penh. The politics of the Cambodian conflict had dictated that the ship could call there as a freighter but not as a functioning hospital -- even through the Heng Samrin government in Phnom Penh says it has only 50 Cambodian doctors for 4 million people.

Several weeks earlier Dr. Kouchner, a stomach specialist from Paris who was the ship's senior doctor, had asked the heng Samrin government for permission to proceed to Kompong Som port and begin receiving patients.

Ile de Lumiere (in French it means Island of Light) offered a hospital probably more advanced than any in Cambodia: 115 beds, seven doctors, and operating theater, air conditioning, a medical laboratory, an x-ray room, a well-stocked pharmacy.

Permission was denied and no explanation was given, Dr. Kouchner, said in an interview aboard the ship. The ship's parent organization, a French charity called A Boat for Cambodians, decided to remove the hospital gear to a refugee camp in Thailand.

Ile de Lumiere would instead transport food into Cambodia. On Nov. 10 it left Bangkok for Phnom Penh. It was among the first Western ships cleared since 1975 to sail up the Mekong. It carried 1,000 tons of rice, milk powder, cooking oil and sugar.

Indochina watchers here see the ship's story as another example of politics overriding humanitarian concerns in Cambodia. Nationalistic pride, analysts believe, prevented the Vietnamese-supported leaders in Phnm Penh from accepting help from white Western doctors whose governments do not recognize them.

Moreover, with war continuing against guerrillas loyal to the ousted Khmer Rouge regime, it is believed that Phnom Penh wants to limit the number of Westerners in Cambodia who might provide embarrassing information to the outside world.

Some aid specialists here say Kouchner showed poor understanding of these sensitivities and helped assure his proposal's rejection. "He has a sort of colonialist approach -- we are here and you have to accept us," said one source.

Heng Samrin's regime has accepted huge quantities of drugs and medical equipment from UNICEF and the International Red Cross but no doctors. Effort to place doctors in the Khmer Rouge zones have failed, too, apparently because of the same nationalistic and military considerations.

The Heng Samrin government refused the other even though its official radio had quoted Health Minister Nu Beng as saying "the former regime destroyed hospitals, medical equipment and public health centers."

Since January, the Heng Samrin government had repaired three hospitals in the capital and eight in the provinces, he was quoted as saying. However, they still lacked basic items like blankets, mosquito nets, mats and medical instruments.

Phnom Penh appears to have no objects to medical aid from countries that recognize it. A health delegation from Cuba visited the capital recently and promised to send 19 doctors, a radio broadcast said.

Relief sources believe an unknown number of Eastern European doctors are in Cambodia. The Vietnamese Army is also helping.

Ile de Lumiere was chartered away from its cargo run in the South Pacific earlier this year and converted into a hospital ship in eight days, Dr. Kouchner said. The hold was air-conditioned, metal beds installed, and a container normally used for cargo was fixed to the deck to make quarters for the medical staff.

In April, the ship arrived in Malaysia to treat Vietnamese boat people reaching its shores. Later it moved to an island in Insonesia where refugees are concentrated. A total of 2,500 people were hospitalized aboard the ship, Kouchner said.