The price of isolation
in North Korea
by John Owen Davies
The Democratic People's Republic of Korea is wracked by
crippling economic problems following the break-up of the
Soviet Union and, since 1995, ravaged by a vicious cycle of
floods and drought.
an attempt to warm often freezing wards in winter, and in the
absence of readily available coal and wood, the director of
Huichon City Hospital says his staff heat soot - "coalsmoke
pieces" - gathered from local chimneys. To help retain
any warmth, cracked glass windows are covered with polythene
in spartan wards, fitted out with makeshift beds covered by
threadbare blankets. Windows in the sombre operating area, which
lacks effective anaesthetics for all but minor surgical procedures
and with only a minimum of instruments, receive the same treatment.
But cold is not the only problem facing the director, Chon Tong
Sik, whose 76-doctor hospital is in a northern area of the Democratic
People's Republic of Korea (DPRK). A lack of drugs, food and
transport forces some patients to stay at home.
Once the envy of many developing countries, the country's public
health system is in serious decline. The decay - mirrored in
the pharmaceutical, energy and agriculture sectors - is a manifestation
of DPRK's economic decline, driven by the break-up of the Soviet
Union and a succession of natural disasters.
Floods threaten food security
DPRK, which has never been able to feed itself, suffered
what some commentators referred to as a 'famine' during the
mid-1990s. The widespread floods of 1995-96 ruined many hectares
of farmland, destroyed dams and damaged mines. Since then,
the country has been the recipient of the longest sustained
UN food emergency programme in history.
Many relief workers with experience in DPRK put deaths caused
by the series of floods and malnutrition at between 800,000
and 1.5 million. Some estimates for the period 1995-98 have
been as high as 3 million lives lost.
Figures given by one DPRK official suggested 222,000 had died
since 1995. "We think this is on the low side,"
said David Morton, the UN representative and resident coordinator
And there is more bad news for DPRK's hard-pressed 22 million
people. A senior official with the country's Flood Disaster
Rehabilitation Committee (FDRC), which oversees and coordinates
the work of relief agencies, said the amount of rice - or
its equivalent - for office workers, labourers and officials
was being reduced.
These reductions are despite an improved harvest during October-November
1999 of 4.28 million tonnes of grain and rice - around 700,000
tonnes more than the previous year - which reverses a downward
trend seen since the 1995 floods. But DPRK officials say the
country needs around 6.5 million tonnes a year to be self-
Scant drug supplies and equipment
"We use antibiotics for emergency cases. It is very
difficult for doctors to know who to give treatment to and
who not to treat. Because of malnutrition, people can get
some disease immediately," said Huichon City Hospital's
director Chon, adding that common colds, bronchitis, pneumonia
and cardiovascular complaints were regular problems.
Infectious diseases once under control in DPRK are making
a comeback. The World Health Organization (WHO) says that
while tuberculosis remains one of the most serious public
health problems in DPRK, with an estimated 40,000 new cases
a year, malaria has re-emerged in southern provinces during
the past three years, with a "significant increase"
in the number of cases in 1999.
While DPRK's public health system is stretched alarmingly,
foreign experts with first-hand knowledge do not believe the
situation is yet desperate. WHO's coordinator in Pyongyang,
Eigil Sörensen, said: "I would not say that the public
health system in DPRK is near to collapse."
But, he added, "The problem is that for the past 10 to
15 years they have suffered from a degradation of the health-care
system, with basic problems with water, electricity and heating.
Then there is a lack of reserves and an economic decline."
Humanitarian needs and principles collide?
For international non-governmental organizations (NGOs), there are moral
questions related to working in DPRK based on humanitarian
values. Should agencies maintain unquestioning support for
a country run along tight military lines? Does restricted
access to beneficiaries and to distribution networks threaten
transparency and accountability enough to justify agencies
pulling out? Can an NGO policy of advocacy survive and, if
so, how can it be operated?
Several NGOs have already left DPRK, most notably Médecins
sans Frontières (MSF), the 1999 Nobel Peace Prize laureate,
in a blaze of publicity in 1998. Other NGOs who have left,
mainly over issues focusing on access and monitoring, include
Médecins du Monde, Oxfam and Action contre la Faim.
James Orbinski, MSF's international president, said: "In
large measure, we found it impossible to deliver humanitarian
assistance in an impartial, independent fashion and we found
that it was impossible to target the most vulnerable people
that we knew to exist but were unable to access." Orbinski
alleged that Western foreign policy was using humanitarian
assistance as a form of political leverage.
MSF's departure, more than any other, has raised the issue
of whether humanitarian organizations should stay on and,
quietly, work to continue making valuable inroads - or whether
leaving should be the path. Several agencies appear to have
opted for the former.
The UN's David Morton, in Pyongyang for nearly two years,
believes the situation has improved. "It has been very
difficult," he said. "We think we have a fairly
good idea of what the situation is and what is going on. We
have access to 75 per cent of the area, which is 85 per cent
of the population."
International impressions of what is happening in DPRK depend
largely on what people are shown, almost always under strict
supervision. Forty-eight of DPRK's 212 counties are normally
off-limits to humanitarian workers, making aid monitoring
difficult. An estimated 15.6 percent of the population lives
in these 48 counties, mainly in mountainous land with limited
farming possibilities - and it is in such regions that some
aid workers believe the worst malnutrition may exist.
Another problem area with some aid suppliers has been allegations
that some international aid has been diverted to the army.
This has been denied as "a lie" by DPRK's official
KCNA news agency. "We will never be able to be absolutely
sure where the aid goes. But we know that … at least a very
high proportion of it goes to where we think it has been going,
where it is supposed to go," Morton said.
Staying on pays off
The Federation, which works in concert with the DPRK Red Cross society
and supports 1,678 hospitals and clinics, has reiterated that
it has no intention of leaving the country and will stay there
for as long as necessary.
Maybe the world is looking too much for obvious results from
humanitarian relief going to DPRK. There is another side,
usually noticed only by people who have worked in the country.
"I think the people are suffering so much that some of
them will take the risk to tell you how difficult it is for
them. They know you can tell the world," said the Federation's
Corinne Baas, a health delegate in DPRK. Simply being there
may be the best form of advocacy.
The extent to which DPRK has opened up since 1995, when the
country requested aid for the first time, must not be underestimated.
The Red Cross is providing official links between the two
Koreas, sometimes through contacts between the respective
national Red Cross societies.
But change in the DPRK government's attitude to the way relief
is delivered will not be fast. "I think there will be
little changes slowly but surely," said one long-time
Western resident with a relief organization. "This is
a place where there is no significant overnight change. You
are not going to suddenly wake up one day and find a McDonalds."
John Owen Davies
John Owen Davies, a consultant writer, travelled to DPRK for the Federation.
This article is abstracted from a chapter he contributed to the World
Disasters Report 2000.
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