North Korea 1998

International staff: 13 National staff: 17 Population suffers food shortages North Korea is one of the last bastions of communism. The agricultural sector faces significant structural problems and industrial activity has almost come to a standstill since the collapse of the eastern bloc, yet military expenditure remains disproportionately high. This situation, compounded by the effects of two years of flooding, has severely affected the nutritional status of the population. It was this combination of factors that instigated MSF to start working in July 1997 in three southern provinces, South Pyongang, North Hwanghae and Kangwon, and, in spring 1998, in North Hamgyong, the first time a foreign aid organisation had been allowed to visit this northern province. MSF had previously intervened in North Korea after very severe floods at the end of 1995 and in early 1997. This time, the major needs were recognised as both nutritional and medical. In fact, there is a very high number of hospitals and medical doctors, but they rely on herbal medicine as medical material and Western medicines have been in short supply for years. MSF supplied drugs and medical material to around 300 provincial, county and local health structures in each of the four provinces concerned. Korean doctors were trained in the use of these drugs, some of which were quite unknown to them (e.g. paracetamol, cotrimoxazole, amoxycilline). Part of MSF's guide to essential drugs was translated into Korean (covering 13 basic drugs for clinics and health centres and about 60 drugs for hospitals). They were also given information on simplified clinical diagnostic techniques as there was no functioning laboratory. In the three southern provinces, support was given to 30 district hospitals (each averaging 150 beds) and 150 clinics and health centres. In the northern province, support covered 17 district hospitals and 68 clinics and health centres. MSF teams set up around 40 therapeutic feeding centres in county and paediatric hospitals (for children of less than 80% weight-for-height) and trained many hundreds of health personnel to assess children by the weight-height method. Although MSF has not directly observed people dying of famine, not all of the country is accessible to outside NGOs and thousands of children have required therapeutic feeding. In addition, all visits outside the capital, Pyongang, and all contacts with the population are very strictly controlled by the authorities and the lack of reliable empirical data (anyway treated as state secrets) has made it extremely difficult to measure accurately the extent and severity of the malnutrition problem in order to confirm or deny the claims made. MSF has consistently requested greater access to the population and freedom to carry out nutritional surveys and strongly encourages donors and all other INGOs working in the country to take a common stand in this regard. As this report was being finalised, MSF was reviewing the extent of its intervention and considering a more limited and specific involvement that would concentrate on a medical approach and nutritional support for vulnerable groups (e.g. institutions for orphaned children).